Don't let good intentions--or a bad day--lead you astray

Pinocchio tried hard to be good. But his inner wishes—to have fun and experience life—often won out. And in the choices you and your team make, what's right and what's wrong aren't always as clear cut as the dilemmas fairy-tale characters face.

Complicating the issue is the fact that your wishes and values exert constant influence on the decisions you make. And when they rub with ethical or legal mandates and that friction goes either unseen or unaddressed, an ethical violation may occur.

Of course, you're likely making good ethical decisions every day—and your clients know it. Veterinarians are ranked the second-most ethical professionals, according to a CNN/USA Today/Gallup Poll conducted in 2003. And the word is out to the general public, too. John Stossel, co-anchor of ABC's 20/20 reports in his book, Give Me A Break: How I Exposed Hucksters, Cheats and Scam Artists and Became the Scourge of the Liberal Media, "... I had my assistant take my cat to 17 different vets for a checkup. Not one vet ripped me off." Stossel later reported that segment on national television, recounting how veterinarians clearly aren't out to just make a buck. That said, the damage done from a little white lie could be devastating to your practice.

Why are people unethical?

Whether or not you're conscious of it, your behavior is governed by your wishes and values. In other words, you make every choice in response to the question, "What's the most important thing for me to do right now?" The scary fact: Most people rarely take the time to consciously and carefully examine their guiding values.

Staking out the straight and narrow

Take a cold, hard look at your key motivators. Do you value honesty over all else? conflict rank higher? Does your retirement account top your list of priorities governing your business plan? Or maybe you really want more time to pursue a personal interest. There are no right answers here. (Although it's tough to argue with "honesty over all else.") The point is that knowing what you want and value helps you identify areas where your judgment might more easily be compromised by efforts to accommodate those wants and values.

Of course, you and your colleagues know it's important to understand and apply the AVMA code of ethics. And more veterinary students these days review instructive ethics case studies to help them manage ethically challenging situations. This knowledge is critically important to maintaining the highest possible standards for clinical excellence, business acumen, and overall ethics.

Creating a code of professional conduct

So if ethics violations may occur when what you believe and want differs from what you know is right, then what exactly are the causes of this disharmony? The underpinnings of most ethics violations correspond to a pretty short list of benign or even positive-sounding wishes:

• "I just want to get ahead in life."

• "I just want more time for my family/myself/continuing education."

• "I just want to be liked/respected/left alone by my partner/my clients/my peers/my family/my boss."

• "I just want to be a good partner/ breadwinner/employee/associate."

You'll notice that these statements sound pretty upstanding. In and of themselves, thankfully, each has the ability to move us in many more positive ways than negative ones. The fact remains, though, that each can be the underpinning of unethical decisions.

Code of Professional Conduct

Does this mean you need to worry about anyone who has these aspirations? No. Actually, you would need to worry if you or your staff members didn't pursue some or all of these goals!

The key is to quickly spot any negative pressures resulting from the above wishes and values. Some examples include the urge to overcharge or undercharge, practice outside of one's competence, ignore others' inappropriate actions, misrepresent oneself, and be less than honest. If you know what to look for, then you can clearly and conscious-ly direct questionable behavior to the proper side of the ethics line.

Spotting a problem

The easiest way to spot conflict early: Pay attention! You and your staff members must make clear, conscious evaluations of your reasons for making the choices you make all day, every day. To do otherwise begs for problems.

What would you do?

Listen to your internal conversations about why you're doing what you do. Pay attention anytime you find yourself (or someone else) thinking or saying:

• "It's such a small thing, who'll notice anyhow?"

• "It really won't hurt anybody, so it must be OK."

• "I don't feel comfortable doing this, but if this is what it takes to get ahead (i.e. garnering more money or more work, a promotion, or prestige), I guess I'd better do it."

• "Everybody else does it, so why shouldn't I?"

• "Geez, I hope my boss/my partner/my spouse/my client/my staff doesn't find out about this!"

• "Well, I'm not in charge here, and I was told to do it, so I guess I better do it."

• "I better do this, so I don't let my boss/my partner/my staff/ my spouse/my client down."

• "If I do this, at least I can get my boss/my partner/my spouse/my client/my staff off my back."

Each statement is a signal you have started down that slippery slope of questionable ethical conduct. Of course, not one of these statements automatically establishes you've actually slipped—or that you will.

Quick facts

The moment you become aware of these rationalizations, however, you should immediately examine your behavior. Make sure you haven't set yourself up to act unethically or to let someone else's ethics lapse without attempting to intervene.

Remember, ethics violations come in all shapes and sizes. You don't want to be fooled into thinking a little violation is any less harmful than a big one. What's small to you may have extremely large consequences for someone else. And it could have extremely large consequences for you, too, if your action violates the AVMA ethics code or any state or federal laws.

What's more, once you begin, for example, under-working, practicing outside your area of competence, or allowing even small inaccuracies in bookkeeping, you've set the stage for progressively more inappropriate practices. Why? Because when you cross the line, such consequences as increased income or reduced confrontation feel good in the short run. If these reinforcers are present, and guilt or external intervention fail to catch up and spin you around, then you'll have an easier time finding your way across the line again and again. It's simply human nature to do more of what's been reinforced in some way.

What to do when you stray

You're only human, after all, as fallible as all other humans, so what should you do if you or a staff member crosses the line? Consult, consult, consult! Of course, if you think your behavior was questionable or even unquestionably inappropriate, you'll likely feel too confused, embarrassed, or frightened to share your problem with someone else. And if you've spotted a possible lapse in a staff member, you might be too angry or confused to address it effectively, so it's easy to push the incident aside. Yet these are the times you and your staff members most need insight, input, and support.

Developing a well-defined list of available consultants can be extremely helpful when the going gets tough or even when it looks like things might head in that direction. Make a list ahead of time of who can help you when a dilemma occurs, and update it regularly.

Who are the best consultants? Anyone who can give you informed, clear, direct feedback and who can help you think through the situation qualifies. Remember, you don't want to limit your list of advisors to veterinarians.

Ethical conflicts can arise not only from professional matters but from physical or mental health issues, substance abuse, financial difficulties, religious or spiritual conflicts, relationship difficulties, and more. So put legal advisors, business associates, financial advisors, religious or spiritual advisors, mental health and substance-abuse counselors, and medical providers on your list, too.

Did I just see what I think I saw?

No one likes to feel like the neighborhood watchdog, but a critical part of ethical practice is to be alert to the inappropriate actions of others. Remember the saying, "If you're not a part of the solution, you're part of the problem." In other words, if you knowingly let another practitioner or staff member violate the ethics code, you're also contributing to the problem. Period. So what can you do?

Start by approaching the individual. If you're like most people, you'll become queasy at the prospect of approaching someone about his or her judgment or behavior. It feels intrusive or judgmental or potentially insulting or any of a long list of other potential distresses. Yet some type of discussion is exactly what's required. Follow these guidelines when you face this tricky situation:

• Do begin with an informal discussion unless the violation is egregious or has persisted despite informal attempts at intervention.

• Do be as diplomatic as possible, but remember, diplomacy isn't a substitute for honesty!

• If you aren't sure whether a certain behavior is a violation, do discuss your concerns with someone on your ethics advisory committee. Don't identify the individual involved unless the advisory committee concurs that an investigation is appropriate. Whenever possible, this discussion should be with an advisor or consultant who has no relationship to the individual. This approach will help increase the likelihood of anonymity and will reduce the risk of hurting the individual's business or reputation if your concerns turn out to be unwarranted.

• Don't go to any of your consultants without first considering the potential impact of discussing the issue with that person. Is the potential infractor someone the consultant might recognize when you're discussing the situation? If so, do you accept that bringing this matter to him or her risks either inadvertent defamation or anti-trust issues? Or is the matter grave enough—and this consultant so clearly the person to discuss it with—that his or her expertise outweighs the risks? There are no clear rights or wrongs here. Just be thoughtful.

• Do report the problem to the identified staff member's supervisor (or the supervisor's supervisor), practice owner, ethics committee, state board, or a combination of the above if the problem persists or is egregious. Of course, you need to find out who should receive these reports and under what circumstances in your practice and state. Key here: Stay on top of any changes in these policies and procedures. Otherwise, you risk unwittingly adding your own ethics violations to the mix.

• Don't make a formal report capriciously! Ethics reports should be taken extremely seriously. It's easy to ruin someone's reputation through allegations or innuendo. Be sure that you aren't risking that through premature or unfounded formal reporting.

This in no way means that you should hesitate to make a report when something is clearly awry. You must make a report if you have credible information that a violation occurred. And you have federal protection against retaliation if you make an ethics report in good faith. But you need to be as sure as possible of a violation before you act. If you have doubts or concerns, get legal advice.

• Do document your observations and the actions you take to rectify the problem. Maintain that documentation for your protection, so you can verify any part of your involvement if it comes under question later.

What if it's too late?

It's never too late. Yes, it's sometimes more difficult or even legally riskier to stop something that has continued for a long while, but that's no reason to avoid acting. If you aren't sure what to do, remember to be thoughtful, consult, consult some more, think some more, and then take action.

Are all the ideas in this article as easily done as said? Often not. But they're possible. And given that you hold the comfort, health, and safety of your patients and clients in your hands, you can't afford to underestimate the value of putting these ideas into practice. After all, it's your professional reputation and practice harmony on the line—be sure you keep them on the right side of the line and don't let good intentions lead you astray.

Editor's note: How do you prevent ethical pitfalls in your practice? Share your ideas with other doctors and team members at www.VetMedTeam.com.

The bottom line

Ethics violations rarely occur because someone is truly a bad person. Everyone has the potential to be swayed by the stresses of the day. Paying attention to red flags and acting immediately to correct any problems keep you on the right side of the gray area.

Christopher Bauer, Ph.D., owns Bauer Coaching and Bauer Ethics Seminars in Nashville, Tenn. Please send your questions or comments to ve@advanstar.com.

Christopher Bauer, Ph.D.