There is also the influence of such outside forces as books and the movies. The popular culture depicts the full panoply of human relationships, from the noble to the ignoble.
Some practitioners may have previously participated in what today is considered a violation of professional boundaries. The key question that must be asked in all relationships is, "Does what I do or am contemplating doing in my relationship violate a personal or professional boundary?"
What we're about to share is not a personal religious, "holier than thou," moralistic or puritanical crusade. Accept it or not, we have to live by the laws of our country and if violated there are terrible prices to be paid. From a legal perspective there is no longer room for sexual affairs with patients or staff members inside or outside of the office.
Character Values
Character values are coming under greater scrutiny and the regulatory agencies by which we are licensed to practice are going to hold all practitioners to high moral standards. Because they serve at the will of state governments they are forced to enter into the conundrum of human behavior, especially as it relates to the moral behavior of practitioners. We are held responsible to control the neurochemical circuitry within our brain that affects our personal sex inclinations, sex drive and sense of attachment.
The following suggestions are based on what prevails today and the sooner a practitioner accepts them and makes sure that she/he adheres to them, the quicker they lower their personal risk management barometer:
Never Initiate the Discussion of Sex, Race, Religion or Politics with Patients
When a doctor and or member of the doctor's staff initiates the discussion of race, sex, religion or politics without the patient instituting the conversation, a professional boundary has been crossed. People come to you for health problems and that's where the relationship should remain. Many patients have other issues that may be related to race, religion, sex or politics, but that's not your realm unless the patient invites your opinion. You may have differences in opinion regarding race, religion, politics or sex, but the feelings of your patients on those subjects is not your business. To varying degrees everyone has racial, sexual, political and religious beliefs, but neither the doctor nor her/his staff members have the right to attempt to change any patient's or staff member's beliefs or influence how they live or conduct their lives as long as they do not violate your rights or those of other patients or staff members. If you have certain beliefs then it behooves you to screen perspective employees to see if their belief systems are similar to yours. If the beliefs of prospective patients are the opposite of yours, then we serve them best by attempting to help them find a caregiver with which they would be more compatible.
You Don't Have to Be a Bus
You do not have to be a bus. You do not have to take care of every body who comes your way. You are not called or given authority to be man's judge or jury. This may cause some practitioners to cringe, especially those who have strong opinions about race, sex, politics or religion, but you have no right to initiate conversations regarding those subjects. The best way to avoid crossing a person's boundaries with regards to race, sex, religion or politics is to refrain from talking with the patient about those subjects. Those we care for are best served if we attempt to view their lives through their eyes. The patient should be the person who initiates any conversation about race, sex, religion or politics, not you. You are there to attend to the health problems of patients, unless the patient opens the door to other areas of their lives. You have no right to enter into any area that is not directly related to the patient's chief physical complaint. If you feel that the patient's physical health problem has possible social, spiritual or psychological entities, refer them to appropriate persons or organizations.
Non-Chiropractic Services
There are many practitioners in our profession who by training are also qualified psychotherapists, pastors, rabbis, and counselors. But it is imperative that if at any time a patient/employee needs and/or requests care (ministry) beyond the normal services you are licensed to perform as a doctor of chiropractic, you refer them out of the clinic to another appropriate practitioner. Sometimes doctors also serve as a rabbi or pastor in their temple or church. That's fine, but chiropractic should not be mixed with psychology or religion. Both offer potential value, but they should be addressed in the appropriate setting. If or when you are asked to take off your "chiropractic hat" and put on a counseling or spiritual one, be careful and specific in doing so.
Perception Is Not Necessarily Reality
May we be ever aware that in the U.S. all people have freedom of choice to think and be who they choose to be as long as what they do does not violate another person's human rights. This is particularly so with regard to beliefs as they pertain to religion, politics, sex or social mores. What one believes may be biblically sound, but the law of the land forbids us to impose our beliefs on patients in our offices. If you feel there is a God and that in your conception of life a patient needs to know your God or is violating God's law(s), you have no legal right to impose your opinions on the patient. If you disagree with a patient's life style or belief system and it will interfere with your treatment of them, refer them to another practitioner. The greatest way to change people is to accept them unconditionally. As health care providers we are called to respect our patients even if we disagree with their lifestyle or beliefs. We have no religious or legal right to attempt to control them. Let us not forget that when we attempt to control others our lives become unmanageable and chaotic.
The personal and professional life of many practitioners is out of control and in various states of chaos because they are focusing on trying to control others rather than doing the things they need to get their own life in order. Attempting to relate to people from a legalistic perspective never produces anything good. Legalism ties people in knots. Unconditional love is what sets people free and the greatest way to influence people is through agape love. True agape love is always redemptive, understanding and forgiving.
Confidentiality
Many doctors of chiropractic have traditionally given testimonials of patients' success with chiropractic care, but doing so can be a violation of confidentiality. Everything a patient says to us or to staff members, or things that are revealed through consultation, examinations, laboratory tests or treatment, has to be kept in the strictest of confidence. We need to keep in mind that something that may seem insignificant to us can be very significant to patients. The same holds true for testimonials. The use of testimonials or patient photographs is prohibited unless the patient gives you a signed authorization to use the testimony or disclose aspects of the case. Even if the patient authorizes you to use the testimony, it may still be considered illegal by your board of examiners. This includes the listing of patient birthdays in newsletters or on displays in your office.
All information regarding your patients must be kept confidential by all staff members. We must see to it that the highest standards are established and maintained in our fiduciary responsibilities regarding patient confidentiality. Just because some practice management organization promotes the idea of sending birthday, Easter or Christmas cards, etc., or displaying patients' birthdays, or thank you for referrals in clinic newsletters or on display boards in the office, doesn't make it legal. Doing so without the written permission of the patient is in violation of human rights and crosses established professional boundaries.
We encourage every practitioner to obtain a copy of NCMIC's Sexual Misconduct by M.J. Stahl, DC, and S.M. Foreman, DC, 1-800-321-7015; fax 1-515-222-2994; e-mail
. John Wolfe can be reached at 651-690-2990. Dr. Wolfe provides an invaluable perspective because he is licensed to practice chiropractic and law.
In the next part of this series, we will explore how this subject applies to the legal requirements of advise and consent, waivers of liability, professional demeanor, prevention of allegations of sexual misconduct, malpractice and improper sexual involvements.
References
- Fellowship of Great Physician, Pastors and Lay Staff -- Risk Management in the Congregation, Rev. Dr. G.T. Lalla, Jan. 1990.
- Sexual Misconduct. MJ Stahl,DC, and SM Foreman,DC, NCMIC 1997.
- Professional Boundaries, NWCC Homecoming, Feb. 1999, J. Wolfe, DC, LLB.
- Professional Boundaries, NWCC Sept. 1997, J. Wolfe,DC, LLB.