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REP 20 - On making the call: ethics in practice

Chantal Lauzon, P.T., Senior Practice Manager, CPA

When interviewing regulators and branch leaders about fraud, abuse and waste, we kept hearing the same two messages: 

1. Things go wrong when people put their needs ahead of those of their patients

2. As a self-regulating profession, we have to call each other out for bad behaviour.

Physiotherapy (and health care in general) is an altruistic profession. Most of us go into physiotherapy to help people. 

Of course, we need to be properly compensated for our knowledge, skills, time and education. 

However, when getting remunerated becomes more important than what the patient in front of you needs, you are crossing an ethical line that could land you in hot water. Or worse.

By treating the insurance plan rather than the patient, a line is crossed.

The provider is putting their needs ahead of the patient’s. Treating the insurance plan rather than the patient can look like: 

So how do we make sure that we are behaving ethically? 

Who decides what is right or wrong?

 

One way

The first resource that I think of is “the College” (provincial regulatory body.) There are resources and the standards of practice on their website. Some of the larger colleges have practice advisors available to help work through challenging situations. 

CPA’s Code of Ethics is another resource to help guide your practice. Take the time to review it, especially when you are faced with ethical dilemmas.

There are also rules to follow. If your practice includes publicly funded programs, extended health benefits, motor vehicle accident insurance, or worker’s compensation insurance; they each have their own rules to follow. Make sure that you know the rules and stay up to date on any changes. 

Ignorance is not an excuse.

 

How can we stand by and watch colleagues behave unethically? 

The Alliance announced the results of its investigation and sanctions against a candidate who forged his PCE exam results (May 19, 2016). That candidate will not be eligible to practice physiotherapy in Canada. 

This is an extreme example. But what do we do when our employer, colleague or competitor behaves in unethical ways?

At some point, as self-regulating health professionals, we need to call each other out in order to maintain a positive reputation with Canadians. But that can be scary. 

So how do you decide when to speak up and to whom?

Start with one of these:

 

Remember

Know your rights and responsibilities. 

Follow your standards of practice. 

If you are asked to do something that falls outside the line, listen to your gut. 

Review the rules. 

Speak up. 

Say no. 

Your professional integrity and reputation are too important NOT to protect. 

 

Further reading on whistleblowing

The Canadian Nurses Association has a good resource related to whistleblowing  

 

Over to you

  1. Do you disagree with this stance on “making the call”? Why? Where is the line?
  2. What advice can you share to help others navigate this tricky area?
     

By Chantal Lauzon, P.T., Senior Practice Manager, CPA

 

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Comments

The College will not intervene in financial fraud situations.

Correct. Fraud is a legal term defined in the criminal code and should be reported to the authorities.

@CPA_Chantal

 

It's true the College does not use the term fraud, but we sure do care about inappropriate billing practices, whether they meet the legal test for criminal fraud or not.

At the College of Physiotherapists of Ontario, we spend a lot of time investigating allegations that PTs have inappropriately billed third party payors or patients. We have had 9 discipline hearings related to this very issue in the last handful of years.

We receive complaints and reports from a variety of sources, but the best defense against the few bad apples in the physiotherapy barrel is you - like the sign in the airport says: if you see something, say something.

 

If you wonder what your colleagues are up to, have a look at our Case of the Month series, based on real cases. We often feature cases that involve inappropriate business practices and outline the consequences for these individuals. http://collegept.org/Resources/CaseoftheMonth

You can find a complete list of all Discipline Hearing findings online at http://www.collegept.org/Physiotherapists/Hearings/SummaryDisciplineHearings or www.canlii.org .

 

 
 

I have been in the unfortunate situation where I had to report a colleague for questionable ethical behaviour (inappropriate remarks to patients, breaching confidentiality, allowing the patient to work in the gym completely unsupervised while billing for a physiotherapy appointment, etc). As this person was a relatively new grad, I attempted to discuss these issues with them, and also spoke to the owner of the clinic several times. Nothing changed, so after many sleepless nights, I contacted the College. In the end, it felt like I was the one who was under investigation, and was eventually told that I should have tried to resolve it more on my own, and should work on my communication skills.  This physiotherapist subsequently left that clinic, and has moved on to other pastures. I would think long and hard about ever reporting a colleague again.  I now advise patients to contact the College on their own, which unfortunately, most are unwilling to do.  They just never go to a physiotherapist again.  

 

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