When I was younger, music came on those vinyl disks we called records. The records came in cardboard envelopes and the outsides of those envelopes were called album covers. Many of the album covers in the '50s and '60s had "Hi-Fi" printed on them in large, proud lettering. In fact, many people called the record player a hi-fi.
What is hi-fi? It is short for high fidelity. Fidelity, in the music industry, is the faithful reproduction of the sound that was recorded. In ethics, the duty of fidelity also encompasses the concept of faithfulness. To be faithful to a patient means that one will comply with the patient's reasonable requests or expectations. These reasonable requests or expectations can be spoken or unspoken.
It hardly seems that one need mention the importance of keeping one's promises, as this is something that is not unique to the doctor-patient relationship, but it is critical to the maintenance of that relationship. There are promises we make without actually saying, "I promise." When a doctor's staff makes an appointment for a patient, it is essentially a promise that the doctor will be there and be on time to the best of their ability. Accepting a person as a patient creates other promises as well, one being that the doctor and staff will provide the best care possible.
The health care business is not like other businesses. In almost any other business, one can just decide to close their business. In health care, however, because of the duty of fidelity, we cannot just close our practice doors. Instead, we must give patients the time to find another doctor and facilitate the transfer of the patient's records to that doctor. It is implied that we will not abandon a patient during their care.
The credo credat emptor, "Let the buyer trust," ought to govern a patient's relationship with a doctor. (See "Credat Emptor" Dynamic Chiropractic, Jan. 1, 2003.)1 Patients are supposed to be able to take on faith that a doctor's recommendations are made with the patient's best interests in mind. I think patients anticipate that they will be treated as unique and important human beings worthy of the doctor's respect. Thus, they also expect the truth from their doctors.2 There is a reasonable expectation that they will be given the information they need and that the doctor will respect their right to make decisions about what is done to their body - informed consent.3
A patient may or may not be aware of what the actual components of one's national or state (provincial) association's code of ethics indicates; nevertheless, they expect that health professionals will follow a code of ethics. Even if one isn't a member of the American, Canadian or British Chiropractic Association, etc., the laity often believe these professional organizations have quasi or true governmental authority and expect that membership isn't voluntary. Students in their first semester at the University of Bridgeport College of Chiropractic have often told me they think the American Chiropractic Association sets all the rules for chiropractic practice. The belief in a professional association's quasi-governmental role in the regulation of a profession explains why these associations often find patients filing complaints about the actions of nonmember doctors.
Despite how obvious the differences between the many factions of chiropractic's associations are to members of our profession, they are invisible to the average patient. Thus, if one does not belong to the most visible professional association, the only way to absolve oneself of the duty to comply with the code of ethics might be to let the patient know up-front that this is the case.
Patients expect that their professional is, at a minimum, competent. They also expect that one is up-to-date with the scientific literature. People don't want you to do what was done in the 20th century when they seek your help in the 21st century. I am sure after reading Billy Beane, Newt Gingrich and John Kerry's op-ed piece in the New York Times,4 patients started thinking that they expect their doctor to use evidence-based health care. In the end, they want to be treated with hi-fi to their expectations.
- Perle SM. "Credat Emptor." Dynamic Chiropractic, Jan. 1, 2003. www.dynamicchiropractic.com/mpacms/dc/article.php?id=8962
- Perle SM. "You Can't Handle the Truth!" Dynamic Chiropractic, Dec. 3, 2006. www.dynamicchiropractic.com/mpacms/dc/article.php?id=51471
- Perle SM. "Informed Consent." Dynamic Chiropractic, Mar. 26, 2007. www.dynamicchiropractic.com/mpacms/dc/article.php?id=52115
- Op-Ed Contributors: Beane B, Gingrich N, Kerry J. "How to Take American Health Care From Worst to First." New York Times, Oct. 24, 2008. www.nytimes.com/2008/10/24/opinion/24beane.html.
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