Professional codes of ethics

1. Accounting

Professional codes of ethics, of course, encompass many aspects of human behaviour. And doctors are human (though some might think themselves demigods) and prone to all the temptations open to mankind.

The first temptation is a simple five letter word, and I'd suggest that there is no chiropractor who has not had to face it squarely. GREED. The desire to get rich and, if at all possible, get rich quickly .

  • Greed by chiropractor Bernard Preston, a short story.

The temptation comes in various forms, the simplest of which is simply squeezing an extra treatment or two out of patients.

Quite clearly the average Chiropractor (and Medical doctors, too) are highly ethical people there have been enough rumblings in both professions for each and every doctor to again examine him/herself.

  • Pfizer Bextra fraud ...

Are they to be trusted?

Medical practitioners.


A family yarn runs like this: My distant great uncle, Ernest, a surveyor by profession, was contracted to survey the train line between Pietermaritzburg and Howick in South Africa.

In his contract it stated that he would be paid per mile of track.

The family joke: So he make the track as long as possible. It's more than twice the distance between the two towns. The line was eventually disbanded and the track torn up in favour of a new line. And the only memory of Uncle Ernest is as the butt of many a family joke.

It makes a good story, and I've no idea whether it's true that Uncle Ernest deliberately broke his PROFESSIONAL CODES OF ETHICS and cheated the system or not, but I realised as a young graduate that I was on a daily basis faced with the same challenge to my professional codes of ethics.

Our forebears in Chiropractic came from the moral high ground, and in those first weeks I was faced with the question: Can I squeeze a few more treatments out of this patient, run up the bill, or should I be trying to fix this patient for the least possible cost?

What it didn't me too long to figure out, is that my patients, most of them anyway, could see right through me. When I was tempted to use billing systems that verged on fraud, overcharge the insurance, I often lost the patient and my soul at the same time.

When patients realised I was doing my level best to keep the bill DOWN, they started referring me family and friends. And that earned me far more than any fraudulent attempts may have.

"When wealth is lost, nothing is lost;

when health is lost, something is lost;

wnen character is lost, all is lost."

Billy Graham.

2. Behaviour

As Chiropractors we are in intimate physical, emotional and mental contact with many very beautiful, semi-naked, vulnerable people.

It took me some years before I realised that as doctors we are also vulnerable, in one way or another.

Anecdote 1

Some years ago an elderly patient said to me: "My daughter phoned me last night, and amongst other things mentioned that one of your colleagues started fumbling with her breasts and telling her how beautiful she was."

Bad news travels fast. It's shouted from the rooftops. He was suspended for several months, and thereafter was only allowed to continue treating women if a third person was present.

Anecdote 2

I personally was once treating a patient for a frozen shoulder when, whilst stripping the subscapularis muscle in the axilla, I couldn't but help noticing a very large scar that ran the length of her breast. I had no idea that she had had a tumour removed some years previously, and proceeded foolishly in my agitation to do a breast exam, without a secretary present. In the Netherlands it is not enough to tell a patient what you are about to do. They have to verbally give consent. I never waited for a reply.

No objection was made during the procedure. I was concerned, not sure if what I could palpate was scar tissue from the surgery, or a new tumour, and immediately referred the woman to her physician for further examination.

A week later a charge of sexual intimidation was laid against me. It was only then that I realised that the wisdom of the ages, demanding that a third person be present during any intimate procedure is not only for the protection of the patient; it's also for the doctor's sake.

Fortunately a peerless record of thirty years, and the circumstances resulted in nothing more than a slap on the wrist, but I know I was fortunate.

Neither of these stories are isolated incidents, and so our professional codes of conduct demand that always, always, always have a third person present should an intimate procedure be done.

Nothing will ruin a Chiropractor who breaks the PROFESSIONAL CODES OF ETHICS in this domain faster.

3. Dress

A female chiropractor in professional attire.

Dress codes are a controversial part of PROFESSIONAL CODES OF ETHICS. Should a chiropractor always be clad in white in the clinic, a collar and tie, white shoes, and a clinic jacket?

Obviously dress codes vary from country to country, but it still concerns me when I see a Chiropractor, or a medical doctor for that matter, dressed in jeans, T-shirt and running shoes.

Particularly for the young Chiropractor, dressing the part is important. Having established one's identity, it becomes less critical.

4. Telling the truth

Here personally I have a difficulty. Why? It took me many years to realise that hope is an essential part of the healing process. Dash a patient's hope, and all is lost.

Yet we treat very serious conditions on a daily basis, often extremely successfully, but in all honesty the patient responds favourably sometimes against all expectations. Had we spelt out the truth, the whole truth and nothing but the truth at the Report of Findings, the chances of winning would have been drastically reduced.

On the other hand there is no place for lies in any PROFESSIONAL CODES OF ETHICS. The professional treads a fine line.

Should we spell out to every new patient how safe is Chiropractic, and what the dangers are? Do medical doctors do that every time they prescribe dangerous medicines, especially dual antiinflammatory drugs ... a fine line. What is the definition of professionalism as it relates to these matters?

5. Continuing education

"Only the educated are free."

Epictetus, Greek philosopher

Are ALL the educated free?

"Only the truth will set you free."

Jesus of Nazareth.

With the way Chiropractic is expanding in leaps and bounds, only a total commitment to life-long learning can keep the modern professional up to date.

When I graduated I had no idea that a Chiropractor could treat a hip arthritis and I had certainly never heard of Femoro Acetabular Impingement Syndrome.

A pincer deformity.

I thought the main cause of Vertigo was a subluxation in the neck, little knowing that this group of patients are at much higher risk from an upper cervical adjustment. It's all about PROFESSIONAL CODES OF ETHICS.

Benign positional paroxysmal vertigo.

"Each of us today is the same person we will be in five years except for two things, the people we meet, and the books we read. "

Charles Tremendous Jones.

In these tough economic times what has kept my practice bouyant is that fact that continuing education has taught me how to manage the frozen shoulder, a Maigne's syndrome, painful feet, a Patello Femoral Pain syndrome, and many others that I had not a clue about at graduation. It's all about more instruments in our tool bags, and being able to serve our patients in a more complete way.

Not to mention, this aspect of PROFESSIONAL CODES OF ETHICS is what keeps us vital and excited about our profession. Sacral subluxations come in many different challenging forms but once you've adjusted 100 000 pelvis's ... variety is the spice of life.

6. Community service

One last thought from out of PROFESSIONAL CODES OF ETHICS is that the professional is not just a taker. S/he gives back to the community. And surprise, surprise, in so doing becomes the successfuly professional.

"Tis more blessed to give than to receive."

More from Jesus of Nazereth, the humble carpenter who changed and continues to change more lives than all the other people we meet, books we read, and courses we attend.

Community service could be in many different forms. A member of Rotary or Zonta International or one of the many other service clubs. An active member of the local chiropractic chapter it goes without saying. A member of the city council, and even the mayor. It's all about PROFESSIONAL CODES OF ETHICS. Your church council, and in my case the Safety Officer at our Gliding club.

A glider plane in full flight.

Solo chiropractic practice

Many doctors find themselves in solo chiropractic practice; what are the advantages and disadvantages?


Physical Therapists providing a Chiropractic adjustment?

Many insurance companies now only pay for physical therapists to provide a chiropractic adjustment; that's in the face of powerful research proving that inclusion of DCs to perform their own technique would save them a good deal of money. One has to conclude that political medicine has gone off on another tack to contain our profession.

It's being successful with some doctors of chiropractic quitting. Others become involved in some dodgy practices, like demanding that patients sign up for a whole year of treatment in advance, in order to stay in business.

In recessionary times, the going is tough when the insurance won't pay.

Is the day approaching for a new Wilk versus the AMA and the insurance companies?

The chiropractic profession has tried hard to stay on the moral high ground; those who stoop to unscrupulous practices need to be exposed and disciplined if we are not to stoop to the low blows that medicine has often resorted to contain and eliminate us.

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