Clinical Ethics: A Triangular Study

Clinical Ethics: A Triangular Study Level IV John D. Purdy, ATC

Talmud “We see the world, not the way it is, but the way we are”

WELCOME • Sign In • Introductions • Group Set Ups • Purpose, Goals, Structure of Workshop

Survey Results • Few able to identify ethical issues • Lack of clarity of principles in each code • Few responded as to care for burn or preparation of incident report • Lack of familiarity of Patient Bill of Rights • Several not sure of gambling in their code of ethics • Varied and vague definitions of “practicing ethically” • 19 respondents “never faced ethical situation” • Unsure how to act when patient interest is different from facility’s

Survey Results • Confuse legal principles as ethical principles • Unwilling to correct co-worker • More than a few thought it not necessary to report unethical behavior • Many did not think other professions looked at ethical situations the same • Different levels of ethical reasoning • Demonstrated a need to improve ability to identify resources for help • Shows preference to allow management to handle incidents……AND

“Get The Manager !!!” Survey Results

Situations From Life In The Clinic

“YES”… “NO”… “MAYBE” ? • For each scenario, you will make a quick reply using the Yes, No and Maybe cards. • A YES answer indicates you agree with the statement • A NO answer indicates that you disagree with the statement • A MAYBE answer indicates that you are not sure on YES and need more information to decide between YES or NO

SCENARIO BEHIND ON DAILY NOTES; YOU QUICKLY SCAN MEDILINKS TO SEE WHO IS OPEN AND TELL THE FRONT DESK TO MOVE YOUR 9:30 TO MARY

Scenario YOU WANT TO LEAVE EARLY TO PLAY BASKETBALL SO YOU CALL YOUR LATE AFTERNOON PATIENTS AND HAVE THEM OVERBOOK BEFORE 3PM

SCENARIO YOU SEE MUCH TO YOUR DISPLEAURE THAT MARIO, A PATIENT YOU PERSONALLY FIND REPUGNENT IS COMING IN AT 10:30; HE ALWAYS SMELLS OF BODY ODOR AND SMOKE SO YOU TELL SCHEDULING YOU HAVE A HEADACHE AND ASK TO HAVE HIM MOVED TO SOMEONE ELSE

SCENARIO TOOTSIE, A VERY ATTRACTIVE BLONDE WHO HAPPENS TO FIND YOUR HUMOR TERRIFIC REMAINS IN THERAPY FOR MORE THAN 90 MIN. WHEN SHE ASKS “ISNT THIS GOING TO BE PRICEY?”, YOU SAY “ITS OK, I’M ONLY GOING TO CHARGE FOR 30 MIN-ITS NORMAL TO DO SO IN SPECIAL CASES “.

SCENARIO AT LAST YEARS CAP MEETING YOU DID POORLY IN CHART REVIEW. THIS YEAR, YOU SPENT THREE HOURS TO PREPARE TWO SETS OF CHARTS PERFECTLY TO GIVE TO YOUR AUDITOR

SCENARIO IT’S OK TO LET YOUR PATIENT DO HIS OWN ULTRASOUND WHILE YOU DO YOUR NOTE-BESIDES, HE WANTS TO BE A DOCTOR AND THIS IS GREAT PRACTICE

SCENARIO YOUR LAST MORNING PATIENT COMES 27 MI LATE BECAUSE OF BACKED UP VALET PARKING. YOU COULD SEE HIM BUT DECIDE: “LOOK-I HAD A KILLER MORNING AND I’LL JUST DIE IF I DON’T WORK OUT!”

SCENARIO IT’S OK TO TAKE THERABAND FROM THE CLINIC TO USE WITH YOUR PRIVATE PATIENTS ON THE WEEKEND BECAUSE WE DON’T CHARGE FOR IT ANYHOW

SCENARIO MRS JONES IS 88 AND HAS BEEN REFERRED FOR THERAPY TO IMPROVE HER SHOULDER FUNCTION. AT YOUR FIRST METING SHE TELLS YOU SHE IS WAITING TO DIE, GO TO HEAVEN AND TO SEE HER HUSBAND. “I DON’T WANT ANY THERAPY.”YOU SHOW HER THE PT SCRIPT AND HAND HER A DUMBELL WHILE SHE CRIES SOFTLY.

SCENARIO BRIAN IS A WEAK SENIOR CITIZEN AND CAN ONLY TOLERATE A 10 MIN TX SESSION. YOU DO SO PER THE PHYSICIANS ORDERS. TX IN THE CLINIC IS BILLED ONLY IN 15 MIN SESSIONS. YOU LENGTHEN THE SESSION BY ASKING ABOUT HIS STAMP COLLECTION AND WHAT HE DID IN THE WAR SO YOU CAN CHARGE 3 TX AND MAKE YOUR TIME WORTH WHILE.

SCENARIO TWO OF YOU DECIDE TO RETURN TO SCHOOL AT NIGHT TO ADVANCE YOUR PROFESSIONAL TRAINING. YOUR TEXTBOOK COSTS NEARLY $200 WITH 1000 PAGES. YOU DECIDE TO BUY ONE COPY TOGETHER AND USE THE CLINIC COPIER AND PAPER TO MAKE A SECOND”BOOK”

SCENARIO YOU ARE EVALUATING MR BROWN AND DISCOVER THAT HE HAS AIDS. YOUR ATC IS 8 WEEKS PREGNANT. NOBODY ELSE IS AVAILABLE AT THE TIME HE NEEDS TO RETURN SO YOU DECIDE NOT TO TELL HER B/C SHE REALLY HAS NO CHOICE.

SCENARIO GEORGE IS YOUR STUDENT IN HIS LAST ROTATION. HE HAS DONE VERY WELL FOR THE PAST 10 WEEKS. YOU ARE PLANNING TO ASK MANAGEMENT TO CONSIDER AN EXCEPTION TO THE POLICY OF NOT HIRING NEW GRADS. TODAY, WHILE DOING ULTRASOUND, HE BURNED MRS WHITE’S ARM. YOU TELL HER THAT SINCE SHE HAS OLD SKIN SUCH EVENTS ARE NOT UNUSUAL AND SHE’LL BE OK; ANYHOW, YOU PLAN TO DISCHARGE HER AFTER TODAYS SESSION, AND DECIDE NOT TO MENTION THE EVENT IN YOUR NOTES. BESIDES, WHY HURT A FUTURE STAR BECAUSE OF AN OLD LADY WHO PROBABLY WON’T EVER RETURN?

SCENARIO YOU PROVIDE THERAPY TO MANY OF DR DOOLITTLE’S SURGICAL PATIENTS-AND FRANKLY YOU ENJOY HAVING A MORE PERSONAL RELATIONSHIP WITH THE BEST SURGEON THIS SIDE OF JIMMY ANDREWS. DOOLITTLE ASKS YOU TO GIVE A PATIENT A HEP IN ROOM #3 BECAUSE THEY DON’T HAVE ANY INSURANCE- YOU SAY SURE: “WE SHOULD HELP OUR PATIENTS AND NOT MAKE THEM PUT UP WITH THE HASSLE OF AN EVAL FOR A SIMPLE THING LIKE A SORE SHOULDER.”

SCENARIO YOU HAVE BEEN INVITED TO LUNCH BY RAOUL, A NICE BOY WHO YOU ARE CURRENTLY TREATING TWICE A WEEK. HIS GIRLFRIEND LEFT HIM, HE IS FLUNKING AND HIS DOG RECENTLY BIT HIM. HE FEELS YOU ARE THE ONLY PERSON WHO LISTENS TO HIM AND UNDERSTANDS. YOU UNDERSTAND ABOUT SEEING PATIENTS OUTSIDE OF WORK WHILE THEY ARE ACTIVE, BUT THIS IS DIFFERENT. BESIDES, YOU HAVE NEVER BEEN TO FLEMINGS AND PLAN TO WEAR YOUR VANDY JACKET TO ADVERTISE FOR SPORTS MEDICINE.

SCENARIO YOUR PATIENT IS A SINGLE MOM,WORKING 2 JOBS AND TAKING COURSES ON THE WEEKENDS TO GET AHEAD.SHE TELLS YOU THAT SHE MAY NOT BE ABLE TO COME TO THERAPY MUCH LONGER BECAUSE SHE ONLY HAS A RESTRICTED INSURANCE POLICY OF $1000 PER CAL YEAR. YOU REMEMBER TOUGH TIMES IN YOUR LIFE AND ARE CONSIDERING CHARGING HER LESS TO HELP OUT. “IT’S THE RIGHT THING TO DO”.

“Getting To Know You, Getting To Know All About You” • Composite Groups PT, OT, ATC • Compare and contrast Codes of Ethics • Group Discussion

CORE VALUES Best Practice Behaviors as Selected by Peers Method of Determination: • Experienced clinician in each profession reviewed Code of Ethics and selected three key behaviors for peers and patients • Separate clinician in each profession identified single most important behavior for interaction with other professionals

APTA-PT • Respect the rights and dignity of all individuals • Comply with laws and regulations • Maintain and promote high standards for PT practice

AOTA-OT • Provide services in a fair and equitable manner; Recognize and appreciate different cultures • Maintain therapeutic relations that shall not exploit patients; avoid activities that interfere with therapeutic judgment • Conform to AOTA standards of practice

NATA-ATC • Integrity and accountability; must never compromise professional responsibilities; never place financial gain above the patient’s welfare • Never directly or indirectly use information gained through the practice of athletic training to influence the outcome of an athletic event • Participate in continuous learning to enhance skills to provide competent care

What Other Peers Selected • APTA: Demonstrate professional behavior and respect for a patient and every peer; provide the time needed to listen and form a plan as needed • AOTA: Honesty with me and respect for the patients • NATA: Ongoing two way communication; immediate attention on any patient care/ethical situation

Sustaining Relationships That Work Yvette Hachtel, JD, MEd, OTR 6/6/2014

Closure “Patient Care Is, At The End of The Day, Defined By Our Values Of What is Important, Workable and Professional” (Perry)

Clinical Ethics: A Triangular Study