COMPO CODE OF ETHICS
This Code of Ethics is based upon the acknowledgement that
the social contract dictates the osteopathic manual practice profession’s
responsibilities to the patient, the public, and the profession; and upholds
the fundamental principle that the paramount purpose of the osteopathic manual
practitioner's professional services shall be to benefit the patient.
This code of ethics applies only to the registered members
of the College of Osteopathic Manual Practitioners of Ontario (COMPO). Failure to adhere to any of the COMPO code of
ethics is cause for a disciplinary action by COMPO against member.
1. Osteopathic manual practitioners (OMP) should adhere to a
commitment to the highest standards of excellence and should attend to their
patients in accordance with established best practices.
2. Osteopathic manual practitioners should maintain the
highest standards of professional and personal conduct, and should comply with
all governmental jurisdictional rules and regulations.
3. OMP-patient relationships should be built on mutual
respect, trust and cooperation. In keeping with these principles, osteopathic
manual practitioners shall demonstrate absolute honesty with regard to the
patient’s condition when communicating with the patient and/or representatives
of the patient. Osteopathic manual practitioners shall not mislead patients
into false or unjustified expectations of favourable results of treatment. In
communications with a patient and/or representatives of a patient, osteopathic
manual practitioners should never misrepresent their education, credentials,
professional qualification or scope of clinical ability.
4. Osteopathic manual practitioners should preserve and
protect the patient's confidential information, except as the patient directs
or consents, or the law requires otherwise.
5. Osteopathic manual practitioners should employ their best
good faith efforts to provide information and facilitate understanding to
enable the patient to make an informed choice in regard to proposed osteopathic
manual practice treatment. The patient should make his or her own determination
on such treatment.
6. The OMP-patient relationship requires the osteopathic
manual practitioners to exercise utmost care that he or she will do nothing to
exploit the trust and dependency of the patient. Sexual misconduct is a form of
behaviour that adversely affects the public welfare and harms patients
individually and collectively. Sexual misconduct exploits the therapist-patient
relationship and is a violation of the public trust.
7. Osteopathic manual practitioners should willingly consult
and seek the talents of other health care professionals when such consultation
would benefit their patients or when their patients express a desire for such
consultation.
8. Osteopathic manual practitioners should never neglect nor
abandon a patient. Due notice should be afforded to the patient and/or
representatives of the patient when care will be withdrawn so that appropriate
alternatives for continuity of care may be arranged.
9. With the exception of emergencies, Osteopathic manual
practitioners are free to choose the patients they will serve, just as patients
are free to choose who will provide healthcare services for them. However,
decisions as to who will be served should not be based on race, religion,
ethnicity, nationality, creed, gender, handicap or sexual preference.
10. Osteopathic manual practitioners should conduct
themselves as members of a learned profession and as members of the greater
healthcare community dedicated to the promotion of health, the prevention of
illness and the alleviation of suffering. As such, Osteopathic manual
practitioners should collaborate and cooperate with other health care
professionals to protect and enhance the health of the public with the goals of
reducing morbidity, increasing functional capacity, increasing the longevity of
the population and reducing health care costs.
11. Osteopathic manual practitioners should exercise utmost
care that advertising is truthful and accurate in representing the OMP's
professional qualifications and degree of competence. Advertising should not
exploit the vulnerability of patients, should not be misleading and should
conform to all governmental jurisdictional rules and regulations in connection
with professional advertising.
12. Osteopathic manual practitioners shall protect the
public and the profession by reporting incidents of unprofessional, illegal,
incompetent and unethical acts to appropriate authorities and organizations and
should stand ready to testify in courts of law and in administrative hearings.
13. Osteopathic manual practitioners have an obligation to
the profession to endeavor to assure that their behavior does not give the
appearance of professional impropriety. Any actions which may benefit the
practitioner to the detriment of the profession must be avoided so as to not
erode the public trust.
14. Osteopathic manual practitioners should recognize their
obligation to help others acquire knowledge and skill in the practice of the
profession. They should maintain the highest standards of scholarship,
education and training in the accurate and full dissemination of information
and ideas.
15. Osteopathic manual practitioners should not call
themselves osteopath in Ontario as this title is reserved for American style
osteopathic physicians who perform surgery and prescribe medications.
16. Osteopathic manual practitioners should not use the term
“osteopathy” when referring to their profession in Ontario as the term “osteopathy”
in Ontario means osteopathic medicine. Osteopathic manual practitioners should
use the term “manual osteopathy” or “osteopathic manual practice” to refer to
their profession.
ADVERTISING
All osteopathic manual practitioners should make sure the
following guidelines are followed:
1. An advertisement must be accurate, factual and contain
information that is verifiable. It should readily be comprehensible by the persons
to whom it is directed.
2. An advertisement may:
(a) name a specific service, technique and/or product but
cannot claim superiority or endorse the exclusive use of such services,
techniques or products;
(b) offer an initial complimentary consultation.
3. Any advertisement with respect to an osteopathic manual
practitioner’s practice must not contain:
(a) anything false or misleading;
(b) a guaranteed success of care;
(c) any comparison to another member’s or other health care
provider’s practice, qualifications or expertise;
(d) any expressed or implied endorsement or recommendation
for the exclusive use of a product or brand of equipment used to provide
services;
(e) any reference to the member being an “osteopath” as this
term in Ontario is reserved for osteopathic physicians who are under the law
equal to a medical doctor. Members should call themselves “Osteopathic Manual
Practitioner”;
(f) any reference to the member practicing “osteopathy” as
this term in Ontario is protected by the College of Physicians and Surgeons of
Ontario and is used only by osteopathic physicians. Members should use the term
“manual osteopathy” or “osteopathic manual practice”;
(g) material that, having regard to all the circumstances,
would reasonably be regarded as disgraceful, dishonourable or unprofessional.
4. An osteopathic manual practitioner may advertise his/her
fee for osteopathic manual practice services provided:
(a) the advertisement contains accurate, complete and clear
disclosure of what is and what is not included in the fee;
(b) there are no hidden fees/costs;
(c) the osteopathic manual practitioner does not bill a
third-party payer for the complimentary portion of the treatment service;
(d) the advertisement expressly states the timeframe to be
honoured for any complimentary or discounted treatment service;
(e) the advertisement does not limit the offer to a certain
number of participants;
(f) no obligation is placed on the patient for follow-up appointments
as a result of the complimentary or discounted treatment service;
(g) the advertisement is presented in a professional manner
that maintains the dignity of the osteopathic manual practice profession.
RECORD KEEPING
An osteopathic manual practitioner shall keep a daily
appointment record, financial record and patient health record. All records
shall be accurate, legible and comprehensive.
1) The daily appointment record shall set out the surname
and initials of each patient the member examines or treats or to whom the
member renders any service.
2) The financial record shall contain; date of service,
services billed, payments received; and balance of account.
3) The patient health record shall contain; patient’s name,
address, birth date and gender, dates of each of the patient’s visits to the
member, a reference identifying the patient, and the name/address of the
primary treating osteopathic manual practitioner, on each separate page, and
name(s) of relevant referring health professionals, if appropriate. The patient
health record shall contain a history of the patient, including; patient’s
chief complaint(s)/concern(s) and supporting data, & relevant past health
history.
4) Every patient health record, including every financial
record shall be retained for at least seven years following the patient’s last
visit, or, if the patient was less than 18 years old at the time of his/her
last visit, the day the patient became or would have become 18 years old.
Destruction of patient health records shall be done in a secure fashion to
ensure that the records cannot be reproduced or identified in any form.
5) As part of the resignation process from active osteopathic
manual practice, the osteopathic manual practitioner shall take reasonable
steps to ensure with regard to each patient health record for which the member
has primary responsibility:
• the record is transferred to another member and reasonable
efforts are made to obtain the patient’s consent;
• the patient is notified that the member intends to resign
and the patient can obtain copies of the patient health record; and
• if the record transferred is not the original patient
health record, the original record is stored in a secure location for seven
years following the patient’s last visit, or, if the patient was less than 18
years old at the time of his/her last visit, the day the patient became or would
have become 18 years old.
6) An osteopathic manual practitioner shall not allow any
person to examine a patient health record or give any information, copy or
thing from a patient health record to any person except as required by law or
as required or allowed by this section.
7) A member with primary responsibility for a patient health
record shall provide, on request, copies of or access to a patient health
record to any of the following persons, or any person authorized by the
following persons:
• the patient;
• a personal representative authorized by the patient to
obtain copies from or access to the record;
• if the patient is deceased, the patient’s legal
representative;
• if the patient lacks capacity to give an authorization, a
committee of the patient appointed under the Mental Incompetency Act.
8) An osteopathic manual practitioner is not required to
provide copies from or access to a patient health record if the member is of
the opinion that disclosure of the health record would likely result in serious
harm to the care of the patient or serious physical or emotional harm to the
patient or another person.
9) A member shall, upon receiving written authorization from
the patient or a duly authorized person, provide a copy of the patient health
record in a timely manner. The member shall maintain the original patient
health record even if he/she is no longer providing osteopathic manual practice
care to that patient.
10) A member may charge a reasonable fee prior to providing
copies of a patient health record to reflect the cost, time and effort required
to provide copies of the patient health record.
11) A member may provide copies of or access to a patient
health record to his/her legal counsel or insurer where the patient health
record is relevant to advice being sought by the member or required by the
policy of insurance.
12) A member may, for the purpose of providing health care
or assisting in the provision of health care to a patient, allow a health professional
to examine the patient health record or give a health professional any
information, copy or thing from the record.
13) A member may maintain an electronic record keeping
system. The member shall take reasonable steps to ensure the electronic record
keeping system is so designed and operated that patient health records are
secure from loss, tampering, interference or unauthorized use or access.
CONSENT
Every member of the College of Osteopathic Manual
Practitioners of Ontario (COMPO) is required to ensure that patient consent to
any treatment and that the consent is fully informed, voluntarily given,
related to the patient’s condition and circumstances, not obtained through
fraud or misrepresentations; and it is evidenced in a written form signed by
the patient or otherwise documented in the patient record.
Osteopathic manual practitioners shall recognize that
consent is an ongoing and evolving process involving ongoing discussions with a
patient and not a single event of a patient’s signature on a consent form. If
the osteopathic manual practitioner recommends a new treatment, there are significant
changes in a patient’s condition, or there are significant changes in the
material risks to a patient, the member shall continue to dialogue with the
patient about the material risks, benefits and side-effects of the recommended
treatment, including potential risks that may be of a special or unusual
nature, and shall document those discussions in the patient's chart.
During discussions, members shall provide patients with an
opportunity to ask questions concerning the proposed treatment and shall answer
questions prior to the commencement of the treatment.
Patients may withdraw their consent to any treatment at any
time.
The Health Care Consent Act does not identify an age at
which minors may exercise independent consent for health care because it is
accepted that the capacity to exercise independent judgment for health care
decisions varies according to the individual and the complexity of the decision
at hand. Members are encouraged to seek consent from the appropriate parent or
guardian to treat children who do not clearly have the capacity to consent to a
treatment.
ABUSE PREVENTION
• It is never appropriate to have a sexual relationship with
a patient who is receiving active treatment. The professional relationship must
be terminated.
• There is a history of complaints against health
professionals of all disciplines who have had sexual relationships with their
patients/former patients. Complaints have been made by patients, significant
others (including spouses of both members and patients) and former significant
others. Therefore, there is a minimum recommended waiting period of one year
following the termination of the professional relationship, before beginning
any sexual relationship.
• Refer the patient to another osteopathic manual
practitioner and document these actions on the patient’s chart (it is
recommended the referral be in writing and a copy of such correspondence be
given to the patient and a second copy placed in the file).
• With the patient’s consent, transfer patient records to
the new attending osteopathic manual practitioner.
• In some cases, it may never be appropriate for a member to
have a sexual relationship with a former patient. For example, if there is a
continued power imbalance between the member and the patient, or the patient is
vulnerable.
• Remarks of a sexual nature are a common form of sexual
abuse of patients. Always speak in words that patients can understand. Pay
attention to the way you convey information and to the words you select when
speaking to patients by employing the correct vocabulary for body parts and
procedures & being particularly sensitive to words that could cause
misunderstandings; and
• Many patients may have language or conceptual
difficulties. Realize that the use of charts and diagrams enhances the
communication process. Because how osteopathic manual practitioners say something
is as important as the choice of vocabulary, they need to use tact and
consideration when explaining procedures to patients to avoid causing anxiety,
and not talk about themselves or their problems to patients, this being
considered unprofessional;
• Osteopathic manual practitioners shall provide patients
with an opportunity to ask questions & provide patients with answers within
the scope of osteopathic manual practice;
• Body language, the non-verbal component of language, will
convey as much or more to patients as words. Patients may distrust the message
if body language contradicts what is being said. Always remember the importance
of maintaining appropriate eye contact, adopting an appropriate facial
expression to convey concern and proficiency, being careful in your use of
physical gestures; and respecting your patient’s personal sense of space.
Careful use of body language can greatly enhance
communication, leading to better understanding and trust between therapist and
patient. Since the main goal of communication is mutual understanding,
listening is just as important as speaking.
You must learn to communicate with your entire being, to
listen and carefully observe patients.
By learning to listen effectively, you can learn to modify
your speech to match the needs of the patient. The benefits of listening and
observing include enriched communication and patients who are dignified
partners in their own care.
TOUCHING
• Obtain the patient’s consent.
• Acknowledge that patients have the right to change their
minds about consenting to procedures.
• Avoid causing unnecessary distress or embarrassment to the
patient by inappropriate touching.
• Show respect by maintaining the patient’s dignity.
• Respect, as much as possible, the patient’s personal sense
of space.
• Use firm and gentle pressure when touching the patient to
give reassurance and produce a relaxed response.
• Avoid hesitant movements by being deliberate and
efficient.
Osteopathic manual practitioners must recognize the patient
controls consent and:
• the patient is entitled to know why, where and when he/she
is to be touched;
• consent may be withdrawn at any time during a procedure;
• agreement, acquired verbally or non-verbally, is required
before a patient may be touched;
• special situations must be identified and possible options
anticipated; and
• patient concerns must be addressed first.
• Make patients, who must necessarily be partially unclothed,
as comfortable as possible.
• Give patients clear instructions about how to wear the
gown.
• Allow patients independence, and enough time and privacy
while disrobing.
• Touch only those areas needed to facilitate removal of
clothing when providing assistance to disrobe, and preferably, if the patient
is female, have a female assistant attend to the matter.
• Request the patient’s permission for staff to observe.
To avoid perceptions of sexual abuse, make touching an
acceptable encounter by:
• providing reassurance and explanations throughout the
procedure;
• involving patients in some aspects of procedures, such as
moving themselves in response to clear instructions;
• encouraging patients to identify affected areas or
landmarks when possible; and
• constantly checking for the level of understanding and
consent by the patient.
Procedures requiring touching of patients are open to
misinterpretation. Ensuring that patients understand at all times what is being
done and why will greatly reduce the risk of offense. Considerate touching will
encourage the patient to relax and cooperate in ways that will save time and
produce better results.
MISCONDUCT
The following are considered acts of professional
misconduct. Any COMPO member who is found to be guilty of misconduct is
referred to the disciplinary committee.
1. Doing anything to a patient for therapeutic,
preventative, palliative or other health-related purposes in a situation in
which consent is required by law, without such consent.
2. Abusing a patient verbally, physically, psychologically
or emotionally.
3. Practicing the osteopathic manual practice profession
while the member's ability to do so is impaired by any substance (such as
alcohol & narcotics).
4. Discontinuing needed professional services unless, the
patient requests the discontinuation; or alternative services are arranged; or
the patient is given a reasonable opportunity to arrange alternative services.
5. Discontinuing professional services contrary to the terms
of an agreement between the member and a health facility or clinic that
provides health services to the public unless; the discontinuation is requested
by the health facility or clinic; or alternative services are arranged; or a
reasonable opportunity to arrange alternative services is provided.
6. Practicing the profession while the member is in conflict
of interest.
7. Giving information about a patient to a person other than
the patient, his/her authorized representative, or the member’s legal counsel
or insurer, except with the consent of the patient or his/her authorized
representative or as required or allowed by law.
8. Breaching an agreement with a patient relating to
professional osteopathic manual practice services for the patient or fees for
such services.
9. Failing to reveal the nature of a remedy or treatment
used by the osteopathic manual practitioner following a patient's request to do
so.
10. Failing to advise a patient to consult with another
health professional when the osteopathic manual practitioner knows or ought to
know that; the patient’s condition is beyond the scope of practice and
competence for the member; or the patient requires the care of another health
professional; or the patient would be most appropriately treated by another
health professional.
11. Providing a therapeutic service that is not necessary.
12. Failing to maintain the member's practice premises in a
safe and sanitary manner.
13. Using a term, title or designation in respect of a member’s
practice that is not true.
14. Using a term, title or designation indicating a
specialization in the profession that is not true.
15. Using a name, other than the member’s name as set out in
the international certificate of registration, in the course of providing or
offering to provide osteopathic manual practice services within the scope of
practice of the osteopathic manual practice profession.
16. Failing to keep records for a period of seven years
after the date of last patient visit.
17. Falsifying a record relating to the member’s osteopathic
manual practice.
18. Failing, without reasonable cause, to provide a report
or certificate relating to a treatment performed by the member within a reasonable
time of 30 days after a patient has requested such a report or certificate.
19. Signing or issuing, in the member's professional
capacity, a document the member knows contains a false or misleading statement.
20. Submitting an account or charge for services the member
knows is false or misleading.
21. Failing to disclose to a patient the fee for a service
before the service is provided, including a fee not payable by the patient.
22. Using the term “osteopath” in the province of Ontario
instead of “Osteopathic Manual Practitioner”.
23. Using the term “osteopathy” in the province of Ontario instead
of “Manual Osteopathy” or “Osteopathic Manual Practice”.
FRAUD PREVENTION
The Financial Services Commission of Ontario (FSCO) has
produced a brochure that addresses reducing abuse and fraud in health care
services for auto insurance. Osteopathic manual practitioner members of the
College of Osteopathic Manual Practitioners of Ontario (COMPO) should consult
this brochure to learn about the role of health professionals in this area.
Reducing Abuse and Fraud in Health Care Services for Auto
Insurance: Everyone has a Role to Play – English (http://cco.on.ca/site_documents/FSCO_Auto_Fraud_Brochure-English.pdf)
Reducing Abuse and Fraud in Health Care Services for Auto
Insurance: Everyone has a Role to Play – French (http://cco.on.ca/site_documents/FSCO_Auto_Fraud_Brochure-French.pdf).
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