Crossing the Line? Managing Personal and Professional Interests

BACKGROUND

Saul is an occupational therapist (OT) who has started a private practice in home care. His spouse, Neil, owns a health care supply store. They have always believed their two careers complement each other. 

On Saul’s first visit with his client Soji, he determines Soji needs several assistive devices. Soji expresses concern about the cost of the devices as she is on a fixed income. Saul explains how the assistive devices can assist her in her day-to-day activities, but Soji remains apprehensive. Saul is concerned Soji will not buy the assistive devices because of the costs and may place herself at risk of injury. He arranges for Soji to receive a discount at Neil’s store. Soji is appreciative and agrees to buy the devices if the discount will be applied.  After committing to the discount, Saul reflects and wonders if he has put himself in a conflict of interest.

CONSIDERATIONS

  • Saul checks the Practice Standards and Resources on the College website and reviews the Standards for Prevention and Management of Conflict of Interest. 

  • Saul realizes Standard 7 – Stakeholder Relationships pertains to his situation.  Standard 7 states: “The occupational therapist will reflect upon personal, financial and business relationships with stakeholders, and will avoid those that would constitute or be perceived to constitute a conflict of interest.”

  • Saul also refers to the Prescribed Regulatory Education Program (PREP): Conflict of Interest to gain additional knowledge and understanding of conflict of interest issues and how to effectively manage his current situation.  

OUTCOME

After reviewing the Standards for Prevention and Management of Conflict of Interest, Saul realizes the following performance indicators apply:

7.5 If acting as a liaison between the vendor and the client, promote the client’s choice of vendor and/or equipment, or provide clients with options to choose a vendor and then act as a liaison;

7.6 Avoid engaging in self-dealing (i.e., being on both sides of the deal), for instance, providing assessment to a client and recommending a supplier who is the OT’s business partner;

7.7 Disclose to clients the nature of the relationship, if any, with the stakeholder and provide the client with all available options and choices and assure the client that any choice of an independent stakeholder will not affect the occupational therapist’s professional relationship with the client.  

The offering of a discount at his spouse’s store can be viewed as a perceived conflict of interest as Saul can be perceived as favouring his spouse’s business. Although Saul was arranging a discount to assist Soji in obtaining the devices, he has financially connected himself to her potentially creating client expectations that are inappropriate in the OT-client relationship. These expectations may interfere with Saul’s ability to objectively recommend appropriate equipment if Saul is influenced, consciously or unconsciously, by the benefit to his partner.  What should Saul have done?

  1. It would have been prudent for Saul to either include Neil’s services among other options, allowing the client to choose a vendor, or to exclude his services altogether. If Neil’s home care business is listed, Saul must be transparent and disclose the conflict of interest.An OT must refrain from brokering client discounts with individual vendors.

  2. Saul should have explored publicly funded resources to support the client’s needs and address the client’s financial limitations.

DISCUSSION

The College recognizes conflicts of interest can occur in every practice setting. It is important for OTs to be able to anticipate and recognize the types of conflicts of interest that may occur in their practice and proactively take steps to prevent and manage them. OTs are expected to:

  • Review the Practice Standards for the Prevention and Management of Conflict of interest to understand how conflict of interest can occur within therapeutic relationships.

  • Be transparent and discuss any conflicts of interest with clients, managers, or stakeholders and determine the appropriate process to address the situation. 

  • Be aware of any organizational policies and procedures pertaining to conflict of interest. Where no policy exists, develop one. 

  • When recommending services and equipment ensure the primary objective between the OT and vendors are in the best interest of the client rather than the personal interest of either party.

  • Avoid engaging in self-dealing, where the OT will receive monetary benefits or promote business interests by referring clients. 

  • Remain ethical and disclose any conflicts of interest.

In circumstances where a conflict of interest cannot be avoided, or such action may not be in the best interest of the client, occupational therapists are expected to effectively manage the conflict while demonstrating care and professional integrity. 

The onus is on the occupational therapist to: 

  • recognize issues of power and control; 
  • anticipate, be alert to, and manage conflict of interest 
  • practice in a manner that preserves the client’s trust and confidence. 

An occupational therapist must understand client consent is not a defence in a conflict of interest situation. When an OT is uncertain if a situation is a conflict of interest, the OT should seek further clarification from a manager or supervisor, or contact the Practice Resource Service for assistance. 

REFERENCES

  • Standards for Prevention and Management of Conflict of Interest 
  • Code of Ethics
  • PREP module: Conflict of Interest
  • CONTACT

    If you have any questions about this case, or have any ideas or requests for future cases, contact the Practice Resource Service: 1.800.890.6570/416.214.1177x240 or practice@coto.org

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