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Chiropractic News

September 2004

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Professional Ethics: What would you do to stay in business?

Years ago, I attended a conference for healthcare providers that dealt with the business side of the healthcare practice. The message I took away was this: No matter what the goal of the practitioner in starting a practice, once the practice has opened, the practitioner has a new goal — to stay in business.

But staying in business presents ethical problems. To stay in business, you have to make decisions — and not all of those decisions are based on clear-cut, black-and-white answers.

Although most of us consider ourselves ethical, few people are ethical 100 percent of the time. That’s because ethics serve as an autopilot for our business lives. Just as the autopilot in an airplane constantly makes adjustments to keep the plane on course, so do ethics also help us stay on course. But some of those ethical adjustments are made by trial and error.

When you first start into business, the one basic ethics question you need to ask yourself is this: “What will I do to stay in business? What will I not do?”

A wise practitioner answers those questions early in his or her career to prepare for the day in which a temptation may present itself. Admittedly, these questions are not easy to answer.

Here are two more questions to consider: “If I had the opportunity to do something ‘shady’ and would not get caught, what would I do?” And, looking at the same hypothetical situation in a different light, “If I had the opportunity to do something ‘shady’ and not get caught, what would I not do?”

How you answer these questions can give you insights into your core being.

If you are a solo practitioner, ethics can be even more challenging. For example, when you are presented with a problematic situation, what would your answer be to the questions, “Would I do this if someone

were looking over my shoulder?” and “Is it OK to do this because everyone else is doing it?”

No right or wrong answers
The bothersome thing about ethics is that there is no right or wrong answer. We all need to make decisions for ourselves and then live with the consequences.

As you examine your personal code of ethics, here are some questions to consider in specific areas of practice management

1. Billing. What will I do and not do in this area? Will I:

• Bill for procedures not performed?

• Accept “under the counter” payments?

• Give preferred billing to friends?

2. Communication with patients. What will I say/do and not say/do:

• To have them become patients?

• To “sign on” for more care?

• To have them make referrals?

• To have them pay for care?

3. Record-keeping. How will I handle this area of practice. Will I:

• Do the minimum?

• Do what is expected?

• Leave it to others?

4. Colleagues. How will I speak about/to them?

• To patients?

• To other practitioners?

5. Staff. Will I do the “right” thing when it comes to:

• Hiring?

• Treating staff members fairly?

• Awarding raises?

• Disciplining?

These are a few things to consider regarding ethical practice. The ideal is to consider them all at one time so that you have a picture of who you are and what you will do and not do.

That way, as situations arise, you will be faced with a non-decision about what to do — because you will have already decided your ethical fate.

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 is an instructor on boundary training for She welcomes questions that may be appropriate to answer in this column. She can be contacted at

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