Your fiduciary responsibility
By Angelica Redleaf, DC, and Christine Bond, EdD

According to Black’s Law Dictionary, a fiduciary duty is the responsibility to act in someone else’s benefit while subordinating one’s personal interests to those of the other person.

All of us who are professionals and have people come to us for help have a fiduciary responsibility to those individuals. We have power over those individuals, whether they are patients, employees, or students.

Here are two examples that illustrate this power and the care we must take:

UNWELCOME BELIEFS

Several weeks ago, a patient of another chiropractor confided that the chiropractor did not listen to her physical complaints. Worse, however, was how the chiropractor pressured the patient about his guru. The doctor made the patient feel that if she did not go to the guru’s lectures and follow his teachings, she would never get better, nor would she ever progress in her spiritual evolution.

The patient felt she had been betrayed by this chiropractor, who had been her doctor for 17 years.

Comment: Healthcare professionals are in a position of power over patients. When a healthcare professional makes a suggestion to a patient, the professional is potentially taking away the patient’s free will to come to his own conclusions and make his own decisions.

In this example, the doctor pushed his beliefs onto the patient, and in his zeal to help her, not only lost her, but made her feel bad about herself.

The doctor crossed a line separating helping the patient and getting into the patient’s psyche. The doctor’s action made the patient uncomfortable and also risked turning the patient against chiropractic, something the patient needed.

Though the chiropractor’s behavior was not bad enough to result in a rebuke from the licensing board, he did not exert proper fiduciary responsibility.

Healthcare providers are in a position of power. When power is unbalanced, a dangerous situation can arise.

INFORMATION EXPLOITATION

Here is an example of a situation in which a counselor took advantage of his role:

Like any counselor or therapist and many doctors (including chiropractors), Dr. X is on the receiving end of private and intimate information. And many of his patients are female.

He also carries a secret he barely acknowledges to himself: He is a sexual predator. Although he limits his pursuits to women who are no longer his clients — and therefore does nothing wrong legally — ethically, it is a different story. The information he has about these former clients makes them vulnerable in his amorous pursuits. This is an irresponsible use of his power.

Comment: In a counseling relationship, it is important to understand that adult relationships of unequal power can often be viewed symbolically as parent-child relationships. The potential for exploitation exists and can often be masked as caring behaviors.

GUIDELINES TO BEHAVIOR

The media carries stories about those in power that overstep their boundaries or use their power to get what they want, without regard for others. It is important for professionals to be aware of their behavior and clear about their motivations. By doing so, they will watch their fiduciary responsibilities and not harm those they are trying to help.

These guidelines can help you monitor your boundaries:

1. Know your motives. Be very clear about why you make recommendations and how you behave with those who come to you for help. Make sure your recommendations and actions are done on behalf of the individual with whom you have a fiduciary relationship — not for you.

2. Always be respectful. When you make recommendations, phrase them in the following manner: “Please be aware I am going to make a suggestion to you about what I think might be of help to you. This is something I [do, have done, have found beneficial, or have heard is beneficial]. There is no obligation for you to do this. I respect you know what’s best for you and I want, most of all, for our professional relationship to continue to be on good terms.”

The key is to always be respectful and treat others as we would want to be treated.

3. Ask for feedback. If in doubt about any of your behavior, check with a colleague or therapist who specializes in the supervision of professionals to determine whether you have done something that puts your fiduciary responsibility at risk.

Angelica Redleaf, DC, has been in practice in Providence, R.I., since 1978. She is the author of Behind Closed Doors: Gender, Sexuality & Touch in the Doctor/Patient Relationship (1998) and an instructor on boundary training for ChiroEcoCE.com. She can be contacted at angelchiro@aol.com.

Christine Bond, EdD, is an assistant professor of education at Salve Regina University in Newport, R.I. Her research interests include educational reform issues and social emotional learning theory.