A patient presented to your office with a complaint of heel pain. The patient reports walking 10,000 steps daily and noticed that their heel started to hurt a few months ago and has gotten worse. After your history and assessment, you recommend a care plan including soft tissue mobilization and spinal manipulation. During treatment, based on the patient’s subjective reporting, you adapt your treatment plan to include shockwave therapy. The patient sees significant improvement and concludes the initial treatment plan.
After a month or so the patient checks in regarding their heel, which is doing well. During that visit, the patient indicates that they still have morning heel pain and asks about using a Strassburg sock. During the conversation, you quip that “the problem with a Strassburg sock is that they don’t match pajamas and get in the way of bedroom activities.”
After the visit, you pause and wonder, “what did I just say that to the patient? What does that patient think about my comment? It was meant as a joke.” You laugh in your head at the comment.
The conversation keeps playing in your head. While you don’t think you violated the profession’s standards or ethics, it isn’t sitting well with you and you decide to discuss the situation with a colleague. You reach out to the CCOA Practice Advisor to discuss. The Practice Advisor recommends that you make a note of the comment to the patient’s health record and provide an apology to the patient.
Time passes, and the patient checks in with you regarding their heel again. Aware of your comment during the last visit, you raise your previous conversation and the Strassburg sock comment and provide a specific apology for your quip. You note the conversation in the record.
The Conduct in Question
Is the chiropractor’s comment considered unprofessional conduct? In this scenario, the conduct in question is the chiropractor’s quip, not the impact on the patient. The conduct does not overtly violate the Standards of Practice or Code of Ethics; however, if there was a pattern of repeated, or escalating behaviour with one or more patients, it could be considered a boundary violation and could potentially violate Standard of Practice 6.1 Professional Boundaries with Patients. The CCOA did not receive a complaint regarding the chiropractor’s comment. The chiropractor did not continue to make these types of comments to any patients.
What if the patient did file a complaint regarding the comment? The complaints process, described in Part IV of the Health Professions Act, is founded on the principles of administrative fairness. The patient and the chiropractor both have a right to be heard and present the facts that support their version of the story. The Complaints Director can investigate to gather information on unanswered questions in the stories and facts provided. The Complaints Director decides whether the evidence supports that the actions of the chiropractor represent unprofessional conduct.
In this scenario, the chiropractor identified their error, made amends and consciously decided not to repeat the error. The pause for self-awareness provides the opportunity for the chiropractor to not only improve their behaviour, but to also avoid a pattern of behaviour.
Advice to the Profession – Ethical Decision Making
Self-awareness is the ability to see ourselves clearly, understand who we are and how others see us and how we fit into the world. Self-awareness can be further considered in two primary categories:
- Internal self-awareness is our own clarity in how we see ourselves. It is an inward understanding of our values, passions, aspirations, patterns, reactions and impact on others.
- External self-awareness is our own clarity on how others see us.
Tessa Eurich, in her book Insight shares her Self-Awareness research findings that 95 per cent of the population believes they are self-aware, while evidence demonstrates that, at most, 15 per cent are self-aware. The author also indicates that her research shows that the skills to establish self-awareness can be acquired and developed.
Self-awareness is an essential competency skill for chiropractors to develop and demonstrate.
Competency is the combination of knowledge, skills, attitudes and decisions that chiropractors perform in the delivery of health care. Professionalism is founded in competency and implies not only standards of technical competency, but also expectations regarding values and beliefs. Self-awareness and reflection have been identified as a core element of professionalism.
Chiropractors hold diverse beliefs and values. Society also has diverse beliefs and values. Self-awareness in the context of professionalism offers a way to recognize, understand and reconcile difficulties and conflicts in practice that arise from diverse beliefs and values.
A lack of self-awareness may lead to a failure to notice when standards and ethics become compromised. It may also lead to failure to understand distress caused by our actions and communications within our practice, our profession and community-at-large.
Barriers to Self-awareness
Self-awareness can be impeded by our own insecurities. It is important to understand that no one is perfect and different levels of energy are required to behave in certain ways. There is no expectation that you must be or that you will be “perfect” in practice.
Practicing Professional Self-Awareness
An approach to professional self-awareness can be accelerated through consideration of four questions:
What are my goals as a professional?
What are my goals as a professional? Are they in alignment to those of society, the government, the health care service, my profession or my practice? What impact do my goals have on attitudes and decisions in my conduct?
What are my beliefs?
What impact do my beliefs have on attitudes and decisions in my conduct?
Beliefs have both a tangible and relevant impact on chiropractors whether those beliefs are scientific beliefs, health beliefs, political beliefs or moral beliefs. Chiropractors have a professional obligation to not allow their own beliefs to prejudice their work.
What are my values?
What impact do my values have on my attitudes and decisions in my conduct?
Values are basic and fundamental beliefs that guide or motivate attitudes or actions. Values identify beliefs that help us differentiate between “good” and “bad.” Values demonstrate the degree of importance some thing or action has with determining the best way to practice. Chiropractors have a professional obligation to not allow their own values to prejudice their work.
What is my condition?
What is my condition? What is my physical condition? What is my emotional condition? What is my intellectual condition? What is my moral condition? What impact do my conditions have on my attitudes and decisions in my conduct?
Chiropractors have a professional obligation to ensure that they maintain their capacity to provide safe, competent and ethical chiropractic care.
Self-Awareness – A Call to Action
What chiropractors do and how they behave matter. These behaviours constitute a social contract of professionalism that is assessed by our patients, by our colleagues, by other health professionals and by the public. Ask yourself these questions:
- What can I do to take responsibility for my actions?
- What can I do to represent my profession well on social media?
- What can I do to build and maintain trust with my patients?
- What can I do to build and maintain trust with my colleagues?
- What can I do to build and maintain trust with other health care providers?
Resources and Documents
The following resources are available for chiropractors who want to study, practice and expand the skill of self-awareness.