As the definitive, trusted voice representing the best of the chiropractic profession, it is imperative that our Board of Directors and members adhere to the highest ethical standards of practice.
Our first responsibility is to promote the dignity, health and well-being of our patients. To do this, we meet the requirements of the laws, regulations and standards to which all self-regulating health care professionals, and those to which chiropractors specifically, must adhere.
Beyond this, we always act honestly and with integrity, to foster trust and respect through a commitment to professional, patient-centred practice. Central to all of this is collaboration – with our patients, our colleagues and other stakeholders.
Ethical Guideposts for Practice:
Our Promise of Professionalism
The ‘Promise of Professionalism‘ is a general guide that outlines the conduct the OCA and its Board of Directors expects of its members.
The following guideposts to ethical practice help us to meet our collective responsibility toward our patients, colleagues and our profession. This promise of professionalism is framed in two parts – patient-centered care and professionalism. The expectation of collaboration is embedded throughout.
It is not intended to be an exhaustive list of all behaviours. The key goals of this promise are: patient-centred care, professionalism and collaborative practice.
In our constant pursuit of patient-centred care, we:
- Consider our patients to be our principal collaborators; we make sure they are as informed and involved in decisions as they wish to be; we always ensure we have obtained informed consent before beginning any treatment.
- Respect the individuality of our patients and other stakeholders; we always practice cultural sensitivity – check with patients about all their needs, anxieties, fears and hopes; we avoid making assumptions about these things.
- Openly and transparently communicate our own scope of competent practice, our qualifications and our expectations of our recommended treatment plan.
- Collaborate with others to ensure efficient and effective care for patients.
- Aim to provide unbiased explanations for treatment options, including risks and costs involved.
- Always respect the legal limits of patient confidentiality.
- Arrange discharge of patients from our care with appropriate notice and communication.
To attain the highest level of professionalism in our practice, we:
- Improve our knowledge, skills and judgement through lifelong learning, self-reflection and ongoing awareness of emerging best and most promising practices.
- Ensure our fees are reasonable.
- Collaborate with patients, health care provider colleagues and other stakeholders to maintain a safe and healthy work and treatment environment for all.
- Communicate as needed to ensure efficient and effective collaboration for high quality care.
- Collaborate with our own self-regulatory framework by seeking help for any personal problems that may affect our own practice and encourage each other to do the same; if ever we become aware of misconduct that should be reported to a regulatory authority, we do so in a timely and appropriate manner.
- Promote our own practice and our profession with integrity and in a manner informed by education, experience and evidence.
As members of the OCA, we make these promises to our patients, colleagues and all other collaborators, as well as to the general public.
With these promises of professionalism guiding our daily practice, we can best ensure our ability to act with integrity and honesty when unexpected ethical issues arise at any time. In keeping these promises at the core of our practice, we keep our patients’ well-being front and centre.
Where we stand on various topics:
In this context, “Block Billing” means billing and payment for a group or series of services rather than for each service individually. A “block” should not extend beyond one assessment-treatment-reassessment.
There are two circumstances where discounting fees is both appropriate and professional:
- For compassionate reasons, where a patient’s ability to pay is taken into consideration.
- For administrative savings and patient convenience, when billing a block fee.
Discounting of fees should not be an inducement to purchase a volume of services and the scope of any such discount should not exceed a single assessment-treatment-reassessment cycle.
Evidence-based practice is defined as the process health care providers follow to apply the best available evidence into their clinical practice, along with clinical expertise and within the patient’s values and preferences.
Research demonstrates that evidence-based practice:
- Enhances health care’s effectiveness, efficiency and accountability
- Leads to better outcomes for patients
- Promotes transparency
- Supports collaboration and knowledge-sharing between health care professionals and patients
In cases where applicable evidence is not available, health care professionals base their decisions on clinical expertise within their appropriate area of practice and their patient’s preferences.
We have began the process of developing a comprehensive understanding of evidence-based chiropractic care within the universally accepted three pillars of the evidence-based framework: best available evidence, clinical expertise and patient preference, ensuring exceptional care for patients.
The Ontario Chiropractic Association supports vaccination and immunization as established public health practices in the prevention of infectious diseases. Vaccination is not within the scope of chiropractic practice. The appropriate sources for patient consultation and education regarding vaccination and immunization are public health authorities and health professionals with a scope of practice that includes vaccination.
Patients consult chiropractors for a variety of reasons. These include spinal and other complaints resulting from acute conditions, complaints related to long-standing or recurrent spinal and other biomechanical dysfunction, performance enhancement and health related self-management strategies.
In all cases, chiropractors should apply the principles of patient-centred care. Each patient is an individual. Each patient’s individual goals are the basis for recommendations and care. Patients are partners in their care.
Chiropractors use a variety of practice approaches. Specific interventions, frequency and duration of care should be based primarily on the individual patient’s clinical status, goals and needs.
Patient-centred care involves a process of continuous re-evaluation of the patient’s goals, the treatment approach, progress and outcomes. There is an element of assessment during each patient visit, as well as scheduled re-assessments that are generally based on a milestone, such as the number of patient encounters and/or a time period.
What we say about various topics:
In Ontario, chiropractors care for pets and large animals, including horses, dogs and cats. In the same way a person seeks a diagnosis and treatment for musculoskeletal issues (or issues with the spine, muscles, joints and nervous system), animals can have similar issues and injuries.
Those chiropractors treating animals complete a post-graduate training program, which is open to chiropractors and veterinarians. Animal chiropractic does not replace traditional veterinary medicine or surgery but provides an integrative method of care. Often, veterinarians and animal chiropractors work together to best serve the needs of an animal. A referral from a veterinarian is not required to seek the expertise of a chiropractor certified to assess and treat animals with chiropractic care.
Chiropractors provide a safe and effective hands-on approach to many neuromusculoskeletal issues and injuries in animals. Initial consultation and examination include thorough health history review, gait analysis, static and motion palpation of the joints, muscles and extremities, range of motion testing, and neurological evaluation.
Pediatric care is within the regulated chiropractic scope of practice that is granted through legislation in Ontario. Children can experience low back and neck pain and dysfunction, as well as various conditions affecting their peripheral joints, which can be successfully treated by chiropractic care.
Infants should be under the care of a pediatrician, family doctor or nurse practitioner; and the OCA supports collaboration and communication with an infant’s health care provider team.