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News in Brief
Major Organizations Announce Joint Conference; Fighting for Section 2706; New Vice President of Chiro. Program at Parker; Two Families, One Chiropractic Dynasty.
Defending With Vitamin D: Helps Prevent Progression to Diabetes
A 2014 clinical trial published in the American Journal of Clinical Nutrition provides additional evidence that optimal vitamin D nutritional status may be important in preventing the progression of prediabetes to diabetes in prediabetic adults.
Image Is Everything: The Power of Branding
Successful businesses use color and design to attract people to their service. They understand how important image is and hire experts to create an attractive package. Starbucks works hard to create an atmosphere that is warm and inviting.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
Are Your Work Orders in Order?
There are times when a patient's occupational duties will delay or prevent them from recovering. These circumstances create the need for the doctor to recommend modified duty or remove the patient from work.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
We Get Letters & E-Mail
Not All Evidence Is Equal; An Abundance of Misinformation; A Well-Researched Decision; Far Too Dangerous.
Overcoming Barriers to Exercise Compliance
One of the most common questions other practitioners ask me is, "How do I get patients to do their exercises?" I am not frustrated by my patient compliance, as many doctors are; in fact, I am actually happy with my patients' involvement and commitment.
Is the EHR Ship Setting Sail Without Us?
The numbers are in: As of July 2014, 10,253 doctors of chiropractic have received $123,059,868 in EHR stimulus funds – and yet that represents less than 15 percent of our profession.
The Art of Day-to-Day Assessment and Treatment: Clinical Pearls
Let's focus on the day-to-day process of assessing and treating the patient. I am proposing a particular attitude; a way of looking at the patient. This often evolves over a few treatments and then changes as you figure out what is significant.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
The Wisdom of the Second Office Location (SOL)
There are some things I never want to do again, like riding a motorcycle 100 mph. I call these things my "negative bucket list." Other things I have on that list include water skiing, riding a roller coaster and eating habanero peppers.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
Love a Nurse – and They'll Love You Back
According to various sources, there are about 3 million registered nurses in the U.S., and according to the American Nurses Association, they are under serious pressure in today's health care reality.
A Dream Come True for Chiropractic: Funding Prevention and Public Health
Back in 2005, Sen. Tom Harkin (D-Iowa) said: "Let's face it, in America today we don't have a health care system, we have a sick care system.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
State by State: Comparing Chiropractic Scope of Practice
"The issue of 'scope of practice' has been a bugaboo ever since our early quests for legal recognition for chiropractic," according to Dr. Claire Johnson, editor in chief of JMPT and National's other two chiropractic journals.
Billing for Same-Visit Extraspinal and Spinal Manipulation
Q: I have always been under the premise that when billing 98943, extraspinal chiropractic manipulation, on the same visit as spinal manipulation, 98940-98942, that the extraspinal manipulation requires modifier 51.
Women's Health: Herbal Formulas to Help Patients With Dysmenorrhea
Chiropractors have long treated women for menstrual pain (dysmenorrhea). Since roughly 60 percent of all chiropractic patients are women and 30-50 percent of women have a history of menstrual cramps, the vast majority of doctors of chiropractic will inevitably see patients with dysmenorrhea.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
May, 2009, Vol. 09, Issue 05
Malpractice Claims: Sexual Misconduct
By Dixie Wall, Contributing Editor
Sexual misconduct is not a new problem among health care practitioners. Hippocrates even added to his oath, "In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction, and especially from the pleasures of love with women or men, be they free or slaves." In order to prevent this damaging conduct from happening to our clients and in our practices, we must maintain appropriate boundaries and develop open communication. It is our responsibility as the therapist to establish these boundaries, and shift them to the needs of the client.
Malpractice and/or liability claims are generally categorized into malpractice, criminal or civil. Malpractice includes acts of commission and acts of omission.1,2 Acts of commission are unintentional or intentional acts, performed by a therapist, that result in some type of harm to the client. Acts of omission is more common among primary health care physicians such as doctors, chiropractors or acupuncturists and involves a failure to refer clients out when indicated, or some type of missed problem in initial treatment of patient. Criminal suits are usually claims that involve some type of illegal implication and ramification for unprofessional illegal conduct. This month, we will further discuss these criminal acts but more specifically unprofessional sexual misconduct.
According to the Medical Council of New Zealand, sexual misconduct can be divided into three categories. The lowest level of misconduct is defined as "sexual impropriety." "This is nonphysical contact of a patient that is inappropriate jokes, crude gestures ... or demeaning comments about a patient's undergarments." The next level is "sexual transgression," which is defined as, "inappropriate touching of a patient stopping just short of an overt sexual act." This can include unnecessary contact with the breasts and inappropriate draping or lack thereof. The last and most severe is "sexual violation." This is defined as, "a sexual act between patient and doctor, there is no distinction between which party initiated the contact and whether the act was consensual." When any type of sexual misconduct takes place, the issue is no longer in the malpractice realm but becomes a criminal issue. These illegal acts are usually excluded in malpractice insurance policies.
Health care professionals are held to higher standards due to the hands-on nature of our field. The one-on-one time spent with clients creates a special personal connection between the client and therapist where the client may share personal information that would not be shared to other types of professionals. With the exception of the health care professionals, people would generally never allow another service provider to touch them. This immediately places us in a unique position of trust as separate and distinctive professionals. Unfortunately, according to the American Massage Council's claims history, sexual misconduct is the number one type of claim against massage therapists.
Sexual misconduct is not limited to sexual interaction with a client. It can be an inappropriate comment, flirtatious behavior, look or gift. This type of misconduct can harm the client in many ways and has major repercussions for us as practitioners. These repercussions may include damaged reputations, lawsuits, and ultimately losing our permits, licenses and practices. How can these issues be prevented? Most experts in practice management recommend setting adequate and appropriate boundaries.
Boundaries separate your personal space from the space of the client. Most boundaries are created by the client and maintained by the practitioner. The maintenance of these boundaries can help us maintain a thriving and professional practice. There are several types of boundaries set by in practice that can help us to prevent any misunderstandings or mistakes that could lead to sexual misconduct.
The first and most important when it comes to sexual impropriety claims are physical boundaries. What kind of touch will we accept from a client when greeting them? What type of draping techniques should we use? According to an administrator at a leading massage school in California, "draping is the number one complaint from clients receiving massage in their clinic." Massage therapists must make sure that the client is properly, consistently and conservatively draped. Always give the client sufficient time in private to change before and after the massage.
The next way to protect yourself is by maintaining verbal boundaries, keeping open all lines of communication with your client. Listen to your clients attentively and comfort them through a routine professional protocol in treatment procedures. When explaining your treatment plans for the client, make clear what you are going to do, explaining again what you are doing while doing it, and then telling the client what you just did. Set the language in conversation on the telephone in a professional level. Always avoid improper slang, language and gossip, and keep client's confidentiality a priority.
Lastly, a first impression is always made with visual boundaries. Our society is based on visual recognition and appearance. Create your own professionalism by consistently practicing routine procedures and retaining a standard dress code. Uniforms can create a comfortable atmosphere by setting a familiar tone. Keep your office clean and neat.
Through establishing, encouraging and enforcing these boundaries, you will promote your profession, as well as the safekeeping of yourself and your clients. Next time, we will discuss three additional boundaries that can help us succeed in practice.
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