Chapter 12

ETHICAL AND PROFESSIONAL

ISSUES

I. DISCUSSING FEES**

• In some settings (e.g., schools), there is no need to discuss fees

• However, fees are a reality in many settings

• It is tempting to get a secretary to do this, but we must face it head on

It is really important….

• To discuss fees up front—give client a price list on paper

• Make sure cancellation policy is clear—e.g., call within 24 hours or be charged half the fee

Be sure to account for absences:

• Make sure policy is clear Re: # absences tolerated before therapy is terminated

• If therapy is in danger of being terminated because of client inattendance, give them a warning verbally and on paper—no abrupt surprises!

II. DEALING WITH FAILURES**

• There are some people who we cannot help

• We can ask ourselves what we can learn from our failures

• What might be some reasons for a client’s lack of progress?

III. TERMINATING CLINICAL SERVICES

• Ethically-- provide services as quickly and efficiently as possible

• Discuss termination from beginning

• Allude to it along the way

It is very helpful…

• To leave the door open

• To follow up with a phone call or email

• People are terrified that they will permanently fall off your radar—reassure them that this is not the case

• You can even schedule a meeting for a later date—say in 3 months—to check progress

IV. INAPPROPRIATE PERSONAL RELATIONSHIPS**

• Attraction is human nature—nothing to worry about

• Just don’t act on it

• Avoid even platonic relationships

**

• What do you do when a client asks you out or expresses interest?

• I find it wise to prominently display a picture of a significant other

V. CRITICISM OF OTHER PROFESSIONALS

• Sometimes a client will criticize another professional

• DON’T get sucked into gossiping or agreeing with the person!

• It’s not a small world—it’s a tiny one

What you can do:

• Don’t say something like “Oh, I’m sure she didn’t intend to be so grumpy.” (don’t defend the other person or belittle the client’s opinion)

• Point out that this person graduated from a different institution, and say that different universities have different perspectives

You can say that speech pathology

• Is like the medical field

• Different approaches or cures depending on which doctor you go to

Let’s say that…

• Someone tells you that a certain person has been saying negative things about you

• I approach the person in a quiet setting with no one else around

I say something like:**

• “You know, Bonnie, several people have told me that you badmouth me. They said that you say things like ‘Celeste has no idea what she’s talking about when it comes to literacy.’ I know you are a professional and I have a very hard time believing that you would say those kinds of things.”

• (other person denies it)

• “OK, thanks—but I did want you to know what other people are telling me you are saying. I’m glad we cleared the air!”

VI. MAKING REFERRALS

• Never hesitate to make referrals to specialists if necessary (e.g., OTs, ENTs; however, be careful in the schools

• Be familiar with the person you are referring the client to

• Give all contact info

In the schools: **

• Next time you take James to the pediatrician, it would be good to ask her whether she thinks an ENT referral is necessary. An ENT would be able to tell you definitively if James needs PE tubes in his ears.

Another way in the schools: **

• “Next time you take Angela to the dentist, you can ask him if he thinks insurance would cover orthodontia.”

VII. CONFIDENTIALITY AND PATIENT RECORDS

• Keep all confidential

• Make sure clients have signed release forms for exchange of information

• Remember HIPAA (next slide)

HIPAA…

• Health Insurance Portability and Accountability Act

• Set of federal rules followed by health care providers

• First-ever set of privacy standards to protect patients’ medical records and other health information

According to HIPAA…

• Patients should have access to their medical records

• Health care providers must provide requested records within 30 days

• They may charge patients for copying and mailing costs

HIPAA also states that…

• Health care providers must provide a notice to their patients about how they may use personal medical info

• Patients should be informed about their rights under HIPAA on the first visit—they sign a document

VIII. WORKING EFFICIENTLY AND SAVING TIME

• 1. Schedule meetings at odd times (e.g., 3:25, 2:50). This suggests that your time is at a premium.

• 2. Schedule a meeting in the other person’s office. That way, you can say “Thanks so much—I’ve taken up enough of your time.” Then you can leave.

• 3. If possible, arrive really early in the morning. You can get an amazing amount of work done if you arrive 1-2 hours before everyone else. Plus, you beat the traffic!

• 4. Let’s say you always run into a chatty person. Be sure to ask close-ended questions “Did you have a nice weekend?” rather than “How was your weekend?”

• 5. If someone is arguing with you and won’t leave, say “I have another engagement, so I have to go, but let’s schedule another time to finish our conversation.”

• 6. If you run into a perpetually negative person who likes to talk, greet him cheerfully and keep moving.

• Don’t stop and ask how things are going—he will tell you! TMI!

IX. CONTINUING TO GROW PROFESSIONALLY

• ASHA requires 30 hours of continuing education every 3 years

• Our responsibility to keep on learning

• Lots of opportunities!

We can:

• Attend conventions (CSHA, ASHA)

• Read new books and journal articles

• Complete online CEU courses

Sometimes…**

• You find yourself getting bored with the same ol’ same ol’

• The ONLY way to avoid boredom is to accept responsibility for changing things up!

X. WORKING ON TEAMS**

• You will be MUCH happier on the job if you get along with others!

• No SLP functions alone

We can:

• Ask people about themselves and care for them personally, not just as a co-worker

• Remember birthdays with a card and/or small gift—holidays too

• Bring food or coffee to share

• Go out to lunch occasionally

• Tell other professionals how much you appreciate them

• Ask other professionals to teach you new things

If someone is having a hard time in their personal life…

• You can slip them a card and even a small gift

• Sometimes this works better than trying to talk to them—they may not be at a good point for that

• In the card, offer to be there if they need you

Remember…we are all in this together!**