The chiropractor will revisit ethical considerations in daily practice and explore strategies both in the office and online that will assist them in maintaining a professional boundary with their patients.
Chiropractic Boundaries In the Office and Online
I. DC-patient relationship
A. depends on confidence and trust
B. crossing boundaries has many consequences
II. Types of crossings
III. Consequences
IV. Reasons
V. Understanding/Acknowledging Differences
A.Patients have different ideas and expectations about appropriateness
1. Cultural, religion, ethnicity, medical history, assault, abuse, personality
B. Behavior grey area/Warning Signs
VI. DC if you develop feelings for a patient
A. find alternative care for the patient (refer)
B. ensure a proper transfer of care occurs
C. transfer care in a way that the patient does not feel that they have done anything wrong.
VII. Two year minimum in MN between discharge from your care and beginning a personal relationship.
VIII. Things to consider
A. How long was the professional relationship, was there a significant imbalance of power,
was the patient vulnerable (and to what degree) during the professional relationship, would you (DC) be exploiting any imbalance, knowledge, or influence obtained professionally to develop or further the relationship
B. Responsibility
C. If a complaint is ever made the burden is on the DC to show that they acted professionally and appropriately in any situation.
D. No matter who or how the relationship is initiated.
IX. Reporting
A. If you are aware of a colleague having an inappropriate relationship you have an ethical, in some cases legal, and professional duty to report the situation to the Chiropractic Board.
X. Prevention
XI. Communication
XII. Documentation
Ethics
I. Ethical Considerations
A. AMA Journal of Ethics article
1. Example of a doctor that helped a long-time patient get a job.
2. Some doc’s are very strict and would not intervene at all
3. HIPPA to consider
4. Consider other ramifications
II. Guidelines for Social Media Use
A. Social Media= what, when, and where
1) Marketing, Education, Trust
2) Need to be prepared for…
a) Request for your help, opinion
b) Urgent/Emergent situation
c) HIPPA
B. posts can be copied, reshared
1) context may be lost
2) fleeting action, with many permanent possible meanings.
C. Framework
1) start with your usual professional conduct
2) consider confidentiality, privacy, and respecting personal space
3) this goes both ways
D. Consider separate profiles
1) personal, but plan for friend/connection requests from pts
2) professional
a) staff monitor?
b) still need HIPPA and consider the ramifications of staff posts/communications
3) either way, pause before you post
4) consider it the same as a public speaking engagement
5) when posting professionally assume your patients/prospective pts are recipients
E. periodically review socials, website, 3rd party rating sites
1) is the info accurate?
2) how does it portray you?
III. Social Media is everywhere and anytime, both private and public. It is here presently, is a mark of the past, and will continue into the future. Consider how you interact with it.
1. Mazzullo, J. (May 2015). Does helping a patient find a job violate professional boundaries? May 2015.
2. Kind, T. (May 2015). Professional Guidelines for Social Media Use: A Starting Point. May 2015.
3. Goodyear-Smith F, Buetow S. Power issues in the doctor-patient relationship. Health Care Anal. 2001;9(4):449-62.
4. College of Chiropractors of British Columbia, Clear Sexual Boundaries Between Chiropractors and Patients: Responsibilities of Chiropractors, January 2016, available at www.chirobc.com/wp-content/uploads/2014/12/Sexual-boundaries-final.pdf
Kyle Hagel, DC
Dr. Hagel has over 20 years of practice experience with a diverse practice background that includes Evaluation and Management of Auto Injuries, Functional Muscle Evaluation, Sports Medicine, Postural Reeducation, Structural Correction, Disc Injury Management, Spine and Extremity Bracing, Neuropathy Pain Management, Weight Loss, Functional Medicine, and Acupuncture. He also has benefitted greatly from working cooperatively with Physicians, Physician Assistants, and Nurse Practitioners in an integrated clinic for the last 14 years and continues to do so.
Educating patients has always been very important to Dr. Hagel in his practice. Patients that understand their condition make better decisions about their care. He is excited to now be involved in chiropractic continuing education and helping other doctors to do the same for their patients.