Jessica McFarland, board eligible orthotist
Currently, there are extensive bioethics research efforts ongoing in most health professions. A literature review revealed there is no research on ethical issues in the profession of Orthotics. The purpose of this study was to determine the frequency of possible ethical issues in the field of Orthotics, identify areas of concern, and identify potential resources for resolving ethical issues. A random sample of 500 American Board for Certification in Orthotics and Prosthetics (ABC) certified orthotists and 90 National Commission on Orthotic and Prosthetic Education (NCOPE) orthotic residents were mailed surveys. The response rate was 39 percent. The primary ethical concern areas, issues with the largest percentage of respondents having experienced the issue at least once, were filling prescriptions of orthotic specifications with which the orthotist disagreed, interpreting chart notes, and time limitations. The issues with the least frequency of occurrence dealt with billing and discussing patient information. The majority of respondents, 97 percent, feel that their respective companies exhibit ethical behavior. Several potential methods for improving ethical communication were identified, with the largest number of respondents indicating an interest in ethical seminars for continuing education credit. Areas for future study would include the discipline of prosthetics. The knowledge gained from this study should contribute to the field of orthotics in an area that hasn't previously been fully explored.
Ethics, moral ideas about right or wrong, is a common term seen in the news today. Mass media showcases many repetitive poor ethical decisions to the public. The influence of the media and general education of the public has led to an increased demand for research attempting to identify ethical dilemmas that affect the public in order to review how they should best be handled. Ethical issues have been examined and researched in many health professions, yet no documented study has been completed on ethical issues in the professions of orthotics or prosthetics.
There are many reasons that ethical issues in the field of orthotics should be explored. First, as the number of certified orthotists continues to increase, the need will increase for practitioner training on evaluating and responding to ethical concerns. According to the ABC, the percent of certified practitioners (orthotics and prosthetics) has increased by 13.4% since 1998. Understanding which ethical issues are present is necessary in order to determine how practitioners can be better prepared to respond to ethical dilemmas. Second, poor ethical decisions lead to financial, professional, and social ramifications. Recently, Hanger Prosthetics & Orthotics Inc. was in the news when a practitioner was alleged to "forge prescriptions and bill Medicare, and other payers for services to non existent patients."(1) The company's stock prices dropped nine percent on the day following the announcement. Although this happened with only one practitioner in one office, it could raise additional questions and speculation regarding other facilities in the industry. Understanding the issues should help prevent recurrences. Third, orthotic residents, as new practitioners, need to be familiar with issues that they may experience so that they can respond accordingly. This information could be used as a tool for educators to help prepare students. Increasing ethical communication, taking preventative measures, and preparing residents are reasons for exploring ethical issues in the field of orthotics.
Although no specific ethics research studies were found pertaining to the Allied Health Profession of Orthotics and/or Prosthetics, studies containing similar objectives to this study were discovered from other health professions. These studies, referenced in the bibliography, were used in the development of the survey. In order to research ethical issues, the following must be determined: What ethical issues are encountered, how often these issues are encountered, and whether practitioners are prepared to handle these situations. The goals of this research project include identifying frequently occurring ethical issues and establishing resource possibilities for managing ethical dilemmas.
A survey was mailed to five hundred randomly selected ABC-certified orthotic practitioners and all 90 NCOPE orthotic residents who were registered by October 29, 2003. The orthotists were randomly selected from ABC's registry containing 2,546 ABC Certified Orthotists (CO) and Certified Prosthetists Orthotists (CPO).
The survey contained five sections: (1) demographics, (2) frequency of ethical situations, (3) general questions, (4) ethics resources, and (5) additional information. The survey was reviewed for clarity and content by Steve Fletcher CPO (ABC board member), Carol Hentges CO (chairperson of ABC professional credentialing committee), and Cathy Carter (executive director of ABC). The results were analyzed by calculating the percentage of total respondents that selected each box with each question. In addition, the percentages of orthotists and residents responding to each possible selection were separated and compared.
The survey responses and comments provided positive feedback as well as insightful suggestions. Many survey recipients expressed interest and were thankful that the issues were being explored. There is little doubt that ethical issues will always be present. The fact that a larger percentage of practitioners are experiencing a specific issue, can serve as a good indicator that the issue should be addressed.
There were five ethical situations that greater than 70 percent of respondents indicated they have experienced. This high response rate indicates these are ethical areas that could raise some concern. The issue that the highest number of practitioners indicated as an issue was not being able to understand what was done during a patient's previous visit from another practitioner's chart notes. The second and third most frequently encountered issues related to prescription specifications. The fourth most frequently encountered issue dealt with time limitations. The fifth most frequently encountered issue was treating patients of the opposite sex without another person.
Approximately 35 percent of all respondents and over 50 percent of residents indicated that they do not know how to report an ethical violation to ABC. Another interesting finding from this survey was that approximately 29 percent of respondents are aware of individuals working as orthotists that are not ABC or BOC certified. Some practitioners feel that people with less training are providing orthoses just as often, or more, than certified orthotists. Billing was perceived as a potential problem when creating the survey, but the results were not as indicative. All four questions related to billing were never experienced by greater than 55 percent of respondents. While this is a positive sign for our profession, there is still some potential concern.
The 39 percent response rate demonstrates that there is a good level of interest in professional ethics in the orthotics profession. The ethical outlook for the profession is positive, even as it is changing. Practitioners are aware of the cannon of ethics established by ABC and 88% have read them. The majority of surveyed orthotists and orthotic residents do not feel limited from "doing the right thing" for patients due to business pressures and feel that they are given enough time to provide adequate care. It is very encouraging that 97% of respondents indicated that their company exhibits ethical practice.
All of the research goals established were achieved. The survey revealed potential areas of concern to be clinical documentation, time limitations, prescription clarification and agreement, and treating patients of the opposite sex. Surprisingly, it revealed billing and limitations from business pressures as areas that do not appear to be ethical concerns for the majority of respondents. Obtaining continuing education credits through ethics courses offered at conferences or individual seminars, FAQ's posted online, and employee reviews were the preferred resources for assisting orthotics practitioners with ethical dilemmas.
At this point in time, the field of orthotics presents itself as an ethical profession to orthotists and orthotics residents. Hopefully the information obtained through this survey and its results will serve to encourage increased communication and consideration of ethical issues in our profession and stimulate interest in future ethical research. Through identifying some ethical issues and resources for practitioners, a step forward has been taken towards enhancing professional ethics.
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The American Board for Certification in Orthotics and Prosthetics. http://www.abcop.com