Ethics Wk 8- 10

Clinical competence = ___, ____, and ____

knowledge, skill, judgement

(not in the code of ethics, but in statute)

When is competence in question?

outdated knowledge

burnout

mental health

substance abuse

t/f: competence = perfection

false

mistakes happen, documentation can support competency

reasonable standard = prudent chiropractor

What is the MN agency that monitors impaired chiropractors called?

HPSP (Health Professionals Services Programs)

t/f: A DC complying with HPSP cannot be disciplined by the Board for issues covered in their agreement.

true

t/f: A DC can be ordered to stop working if they miss a required urine test.

true

t/f: HPSP may test a DC to ensure compliance with prescribed mental health medications.

true

What is the difference between intentional and unintentional violations of professional conduct?

Intentional violations: Result from philosophical or deliberate choices (the provider knowingly chooses an inappropriate action).

Unintentional violations: Result from factors such as burnout, impairment, or loss of capacity rather than a deliberate choice.

Both intentional and unintentional violations are still considered violations and may require intervention or disciplinary action.

The __________ standard originated from obscenity law and is an ambiguous, case-by-case standard that is interpreted by local boards.

community

The duty to refer patients includes the referral process and ______ to "close the loop"

follow-up

t/f: It is not permissible to practice below statutory requirements simply because your practice philosophy is in conflict with those requirements.

true

Created in 1994, monitors health professionals with impairments; is confidential and free

Health Professional Services Program (HPSP)

-mental health, physical conditions, substance use

How do you get entered into HPSP?

self-referral

board referral (confidential)

board order (public)

t/f: there is board discipline for issues covered by HPSP

false

this is a legal protection

Participation in HPSP is not available for practitioners who:

Divert controlled substances for non-personal use

• Are accused or found guilty of sexual misconduct

• Pose a serious risk of harm to the public

• Have been discharged from similar programs in

other states

• Are currently subject to disciplinary action or

restrictions (unless referred by the Board)

• Are monitored for certain infectious diseases (e.g.,

HBV, HIB) unless referred by the Board

You may enter HPSP by...select which is correct:

a) Board informal referral: Based on information the Board acquires, the Board asks you to refer yourself without a Board Order. This maintains your anonymity.

b) Via Board Order: Resulting from a disciplinary order which requires participation and is public.

c) Having been found guilty of drug distribution.

d) Self-referral: You contact HPSP voluntarily without Board involvement

A, B, D

t/f: competence is required by law

true

_____ of interest (COI) is when personal interests clash with professional obligations; can be real or perceived

conflict

_____: someone ethically bound to act in another's best interest

fiduciary

What 2 things are the cornerstone of the doctor-patient relationship?

trust and dependency

Common conflicts of interest

-selling products with personal financial stake (supplements)

-referrals to services you benefit from financially (testing, labs)

-dual relationships

-routine financial incentives (waiving copays)

Transparency: always _____ any financial interests to your patients

disclose

Violation of a conflict of interest could lead to disciplinary actions by ____ _____

licensing boards

Who is always the boundary manager?

doctor (you as the clinician)

Zones of Personal Space (Edward T.

Hall's model):

• Intimate (0-18 inches)

• Personal (1.5-4 feet)

• Social (4-12 feet)

• Public (12+ feet)

What are proxemics (personal space and physical proximity in human interaction) influenced by?

culture, context/situation, gender and relationship type

_____ ______: the relationship that exists between the doctor and the patient and the limits of behavior which would be seen by a reasonably prudent person as being appropriate under the circumstances

professional boundary

What are professional boundaries governed by?

ethics (professional codes of conduct)

law (state licensing rules)

public trust

What are professional boundaries based on?

power differential

vulnerability of the patient

fiduciary duty

Professional boundaries protect the space between the doctor's _____ and a patient's _____

power

vulnerability

Type of power in healthcare:

ability to withhold or deny care (even subtly)

coercive power

Type of power in healthcare:

comes from your professional role/title

legitimate power

Type of power in healthcare:

power derived from admiration, trust, or moral character

referernt power

Type of power in healthcare:

perceived or actual knowledge / skills

expert power

Type of power in healthcare:

personal magnetism, charm, influence

charismatic power

Boundaries are ______, meaning they shift based on: individual factors, context (setting)

dynamic

______ boundaries = shaped by personal experience, values, comfort levels

idiosyncratic

____ boundaries = depend on the situation or setting

contextual

Boundary continuum:

distinct --> merged --> indistinct --> violation

Clear, consistent limits between personal and professional roles that maintain therapeutic focus and mutual respect

distinct boundaries

Situations where personal and professional roles overlap slightly, sometimes with therapeutic value, but always requires caution

merging boundaries

Sharing a mild personal story to build rapport is considered to be a _____ boundary

merging

Treating a family or friend is considered to be a ____ boundary

merging

Poorly defined or inconsistently maintained limits between the doctor and patient, often leading to confusion, dependence, exploitation

indistinct boundary

Which statement is most true?

A. Good chiropractors never cross boundaries.

B. Experienced chiropractors don't struggle with boundaries.

C. Boundary violations usually begin with good intentions rather than bad intentions.

D. Patients are responsible for maintaining professional boundaries.

C. Boundary violations usually begin with good intentions rather than bad intentions.

t/f: there are instances where a boundary crossing may be appropriate

true

What is a boundary violation?

clear ethical breach

Who is a "patient"?

anyone who has established or is in the process of establishing a professional therapeutic relationship with the chiropractor, regardless of whether treatment has started or is ongoing

Contributors to boundary problems

stress

burnout

dual relationships

lack of mentorship

With all power comes ______ that the doctor is expected to uphold

responsibility