Professional Ethics and Standards of Conduct
Domain 4: Professional Ethics and Standards of Conduct
This domain tests fiduciary conduct: putting the patient’s interests first, maintaining boundaries, protecting confidentiality, and keeping billing and advertising honest. The Board may discipline unprofessional conduct, which reaches beyond clinical errors.
Core standards
- Obtain and document informed consent; explain alternatives, risks, and the right to refuse or seek another opinion.
- Keep patient information confidential except as authorized or required by law; safeguard records and communications.
- Avoid sexual or exploitative relationships with current patients; if a boundary issue arises, transfer care and seek guidance.
- Do not abandon patients. If terminating care, give reasonable notice, provide records or transfer information, and document the process.
- Bill only for documented, medically necessary services; do not misrepresent services, diagnoses, or provider identity.
- Recognize and address impairment, conflicts of interest, and misleading advertising.
Worked example
A chiropractor begins a dating relationship with an active patient. The ethical problem is not merely office gossip; the power imbalance and fiduciary duty make the relationship exploitative. The correct action is to stop treating the patient, arrange a transfer, and document the transfer-not to continue adjustments while dating.
Traps that cost marks
- Assuming confidentiality ends when the patient is a coworker or friend.
- Thinking a signed financial waiver cures a boundary violation.
- Upcoding or waiving copays to induce patients; both can be fraud.
- Using patient testimonials in ads without consent or in a misleading way.