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An Issue of Ethics: Summer 2004

Randy Smith is an RMT employed by the Good Health First multi-disciplinary clinic, which also employs a chiropractor, naturopath and personal fitness trainer. Abigail White is a middle-aged client of the clinic who has received therapeutic services from both Randy and the clinic’s chiropractor, Dr. Peter Allen.

September 25, 2009  By Cidalia Paiva

Randy Smith is an RMT employed by the Good Health First multi-disciplinary clinic, which also employs a chiropractor, naturopath and personal fitness trainer. Abigail White is a middle-aged client of the clinic who has received therapeutic services from both Randy and the clinic’s chiropractor, Dr. Peter Allen. 

Most recently, Abby, as she is referred to in the office, suffered a whiplash injury in a motor vehicle accident and has been seeing Dr. Allen for chiropractic treatment of her injury. After her third treatment, Abby approaches Randy while he is on break in the staff kitchenette, and asks if she can speak to him privately, stating that it’s very important. 

eoa.jpgShe begins by telling Randy what a wonderful therapist he is and how pleased his patients, whom she has chatted up in the waiting room, are with his services, and then adds that she needs to see him as soon as possible to treat her whiplash injury.  Randy is surprised by her approach and asks her if she isn’t seeing Dr. Allen.

“Dr. Allen,” she responds, “is a quack, just like the rest of them, adding that “he’s the third chiropractor I’ve seen for this problem, and they are all useless. What I need is a massage therapist. Massage therapists are way better at treating whiplash, and anything else for that matter.” She explains: “my daughter is studying to be an RMT and she tells me what massage therapists can do with all that advanced orthopedic work you are taught.” “Of course,” she adds, “you know all this and you know you are way more qualified and I shouldn’t be wasting my time with him.”


Randy responds: “Well, you may be right that massage therapy is more effective than chiropractic, and there really is very little that they do that we cannot do. Yes, I am pretty sure I can provide a better treatment with better results. After all, massage therapists are soft tissue experts.”

Before Randy finishes, Abby adds: “Besides, that Dr. Allen is an arrogant you know what, who doesn’t care about his patients. He’s all ego, that guy.”

To which Randy responds: “Well, I know about Dr. Allen’s ego and it does get in the way and prevents him from being as effective as he could be. Unfortunately, some people’s egos are where they don’t belong and I agree with you that it shouldn’t be in the treatment room with the client. But he is well-meaning.”

“I don’t care how well-meaning he is, I just don’t want to see him any more. Will you treat me, Randy?”

Randy responds: “Yes, but we must not let Dr. Allen know we spoke, and you need to ask him to refer you to me. You know how it is. My life will be hell if he thinks I stole one of his patients.”

“Oh, I get it, office politics! No problem, I’ll go back and talk to him. Thanks, Randy.”

Perhaps the case study above isn’t quite typical, but conversations such as that between Abby and Randy happen all too often and well-meaning therapists cross the proverbial line into unprofessional behaviour far too easily and sometimes without even realizing they are doing so.

The above case study poses a number of ethical concerns that can be clustered under the heading “unprofessional behaviour”.

First of all, the therapist allows the client to breach his personal boundary. Despite the fact that he was on a break in a private area not accessible to clients when Abby approached him, he chooses to engage with her. In doing so, by inference at least, he leads her to believe that he has no boundaries around his time and space. This may very well lead Abby to assume that Randy will always be available to her on her approach and will definitely fuel the resentment that could ensue if at some point in the future he chooses to avoid her, or quite simply of necessity is unavailable to her.

Secondly, he permits Abby to disparage Dr. Allen without intervening and reminding her that he is a colleague and fellow health professional and that it is inappropriate for him to listen to disparaging remarks about a fellow health care professional and perhaps even more importantly, a fellow health care professional who is also a colleague in the clinic.

Thirdly, Randy actually disparages Dr. Allen’s services himself. He fails to acknowledge the value of chiropractic services and does not avail himself of the opportunity to educate Abby on the benefits of both massage therapy and chiropractic services.

Moreover, he fails to explain that massage therapy and chiropractic are different therapeutic services, neither better or worse, more or less effective, simply different and often complementary as adjunct services.

In addition, he does not inform Abby that massage therapists, like chiropractors, must provide services within a designated scope of practice and that referrals are necessary and desirable professional mechanisms for ensuring that practitioners refer clients when a presenting condition falls outside their specific scope of practice.

Fourthly, Randy’s specific comments about Dr. Allen’s ego will likely only serve to support Abby in believing it is an acceptable practice for health care professionals to disparage each other. His comments may very well be interpreted by Abby as deriving from a personal agenda when and if she becomes dissatisfied with Randy’s services at a latter date.

To support labeling a colleague as egotistical and then to rationalize this labeling with the excusing condition of “he is well-meaning” does nothing in the client’s mind to assist her in understanding that her comments are inappropriate and that the therapist’s participation in these comments is even more unbecoming, inappropriate and unprofessional.

Finally, Randy’s request to keep their communication confidential involves Abby in a conspiracy of unprofessional silence, which may initially leave her feeling privileged to enjoy such a special relationship with her therapist, but may also likely lead her to believe that she is entitled to “favours,” perhaps even on threat of revealing what Randy said about Dr. Allen to him or their other colleagues if he fails to acquiesce to her requests or demands.

The relationships we participate in create the matrices of our lives. Devaluing, criticizing and disparaging the services of others fails to keep professional boundaries with clients and demonstrates a lack of respect for our colleagues, ourselves and most importantly our clients.

As health care professionals we need to remember that the goal of our therapeutic services is to work in our clients’ best interests to serve their health and well being.

Doing so must invariably include our participation in respectful, ethical and professional relationships that honour and support positive, collegial interactions that respect the contributions of all health care professionals.

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