Home' OsteoLife : OsteoLife Winter 2015 Contents 16 Osteopathy Australia
roviding services to people you
know has obvious benefits, but
brings risks and concerns for you
and the patient. For example:
• Parent treating their child
• Employer treating receptionist
• Osteopath treating landlord
• Osteopath and dentist treating
These patients may be reluctant to state
their preference for another practitioner
or decline a recommendation for fear of
offending you. Children may not feel free
to refuse care from their parents, and
staff may feel constrained in expressing
a preference for somebody else. Family
members may withhold relevant
information due to embarrassment, giving
you insufficient information for proper care.
Many health practitioners have a simple
rule never to treat themselves, family,
friends, or staff. That is the most risk-averse
position, and the safest. Other practitioners
see it as a sign of respect for their
competence and experience when staff and
family seek treatment.
If you do treat people you know, here are
things to keep in mind.
The Code of Conduct for Registered Health
Practitioners states that, ‘Good practice
includes recognising the potential conflicts,
risks and complexities of providing care to
those in a close relationship, and that this
can be inappropriate because of the lack
of objectivity, possible discontinuity of care
and risks to the practitioner or patient.’
Some conflicts of interest cannot be
managed. For example, if you have an
injured employee requiring treatment under
a worker’s compensation scheme, you
cannot provide the treatment.
TREAT THEM AS YOU WOULD
ANY OTHER PATIENT
Your responsibilities to the patient are the
same, and do not change because you
know the patient or because you might
waive your fee. Provide the same quality
No Appointment Necessary? Ethical
Challenges in Treating Friends and
Family N Engl J Med 2014; 371:1254-
Is treating family and staff more
problematic than it’s worth? Re-read
the Code of Conduct for Registered
Health Practitioners, the Osteopathy
guidelines informed consent, the
Osteopathy guidelines for clinical
records, and make up your own mind.
Managing the risks of treating
family, friends and staff.
this knowledge for practice-management
purposes until she formally gives you notice.
TRADING SERVICES WITH OTHER
Professional courtesy in waiving fees is
commonplace, but be careful that things
don’t escalate out of control.
Be clear on what you agree. Informal
bartering may be appropriate, but there can
be no fraud or unconscionable conduct,
and treatment should be approximately
equal in value.
WHAT ABOUT BARTERING
OSTEOPATHIC SERVICES FOR
OTHER SERVICES OR GOODS?
• Example: your landlord wants two
appointments a month instead of raising
the rent by one per cent.
Please keep your business and clinical
affairs separate. You’re better off with a less
complicated relationship with your landlord.
BILLING, RECEIPTS, AND REBATES
Many (but not all) health funds prohibit
practitioners treating family members or staff.
If your patient is your child, you cannot
obtain a rebate unless (a) your fund lets you
treat family members, and (b) the full fee
If you waive a fee, your patient cannot
obtain a rebate.
care and the same considerations for
patient modesty and infection control, and
don’t hesitate to refer.
OBTAIN INFORMED CONSENT,
AND KEEP REQUIRED RECORDS.
Do not assume consent just because you
know the patient well. Your obligation
to explain potential benefits and risks of
treatment is unchanged.
Pay special attention to potential conflict
of interests as treating practitioner and
consenting parent. Consider obtaining and
documenting the other parent’s informed
consent or refer to another practitioner. At
a minimum, record the informed consent
and document the details of particular
complexities the situation presents.
CONSIDER YOUR PATIENT’S
PRIVACY WITH EXTRA CARE
• Example: you treat your colleague and
learn of her depression.
Patients must feel able to confide in
practitioners without fear of disclosure.
MANDATORY REPORTING CAN
COMPLICATE THE SITUATION.
• Example: you treat your receptionist and
learn of domestic violence at her home,
where children live.
Mandatory child protection reporting
requirements pertain regardless.
• Example: you treat a colleague and learn
she has engaged in notifiable conduct.
The National Law requires practitioners
to advise AHPRA or a National Board of
notifiable conduct by another practitioner,
even if they are a patient (except in WA).
TREATING STAFF CAN PRESENT
Information you learn in a clinical setting must
not be used for HR purposes.
• Example: when treating your
receptionist, you learn she is eight
As your employee, by law she only has
to give you 10 weeks’ notice before her
parental leave commences. You cannot use
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