Requests for Private Practice Follow Up with Clients

BACKGROUND

Mark works in a local hospital with people recovering from a recent stroke. Sometimes clients or their families will ask Mark if he can continue to provide rehabilitation services in their homes after discharge. Mark does have a private practice but so far, he has not taken on any client seen within his full-time practice at the hospital. With more requests coming from clients, he wonders if he could give his contact information for his private practice services.

CONSIDERATIONS

Mark checks the Standards for Practice online to see which resources can help guide this decision. Some of the considerations from this review are described below:

Conflict of Interest

A conflict of interest arises when the occupational therapist has a relationship or interest, which could be seen by a reasonable person as improperly influencing their professional judgement or ability to act in the best interest of the client (Standards for the Prevention and Management of Conflict of Interest).

  • Mark is required to act in the best interests of the client, and not for his financial or other benefit. It must be clear that his professional judgement is not influenced by any direct or indirect benefit. For example, would Mark be in a position to suggest an earlier discharge knowing he can continue services in the client’s home allowing him to able to gain additional income?
  • Clients are often vulnerable and may feel obliged or inadvertently pressured to comply with health providers. Occupational therapists are in a position of trust and authority and must not take advantage of this relationship. For example, would a client feel obliged to hire Mark for private OT services in fear that saying no may comprise their current care? It may be appropriate for Mark to give the client a list of private OTs in the community who offer rehabilitation services. Consistent with Code of Ethic’s principle of transparency, Mark lets the client know his private practice is on the list but is very clear in his discussion by stating, “there is no obligation for them to use his services, and it will not impact the current OT intervention”.
  • Consider if others could potentially perceive there to be a conflict of interest which would compromise the Mark’s credibility and quality of client care. For example, how would colleagues, managers, clients, or others perceive this arrangement?
  • Mark also has an obligation to his employer, and the organization may have policies that determine if, and how clients can be offered private practice services. For example, the organization’s policies might note that if private practices of their staff are allowed, multiple options must be offered to the client for choice.

Advertising

  • Clients can be especially vulnerable during a health event and it would be unethical to persuade clients to accept OT services. Mark is aware that OTs are not allowed to directly pressure or solicit his business to clients as stipulated in Ontario Regulation 226/96, section 22.

Code of Ethics

Principles described in the Code of Ethics such as transparency, honesty, and respect for client autonomy are important for Mark to reflect on to help guide his next steps. For example, to be transparent about his practice, Mark can discuss this situation with his employer. Mark would also be expected to provide other service options as well, to ensure the client can make an informed choice.

  • Mark considers potential scenarios where this arrangement would not serve the client well e.g., What happens if the private practice relationship becomes strained and in future the client is again admitted to hospital where Mark is the treating OT?

OUTCOME

Mark decides the first step is to talk with his manager to see if the hospital has any policies on providing private practice to clients of the hospital. If this is prohibited, he will decline any requests from clients for private practice services. If this is allowed, Mark will determine how this can be done transparently while managing any conflict of interest.

CONCLUSION

Responding to requests for additional or follow-up service through an OTs private practice can be difficult and the answer is not always straight forward. This may be especially true in remote areas. It is easy to get caught off guard with a direct request and we recommend that OTs weigh the considerations listed above should they be in a similar position. In doing so, they ensure that safeguards are put in place to ensure the client’s best interest are met.

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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