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Establishing ethical standards in practice starts with owner
Scenes from St. Elsewhere Animal Clinic
Dr. Paul looks at two pills that had escaped and were rolling acrossthe floor. He thinks to himself, "Those pills cost $1.30 apiece. Noone will know if I just put them back into the bottle." So he does.
The entire staff except for Dr. Frank has left. He is an associate atSt. Elsewhere and has now been out of school for three years. He has agreedto stay and wait for Mrs. Galloway in order to see "Franklin."Franklin had just started vomiting late this afternoon, and Mrs. Gallowayis now frantic. After a brief visit she pays in cash. It is the end of Apriland Dr. Frank has recently sent a sizable check to the IRS. He decides topocket the cash.
The Yellow Pages salesman asks one last time if the new ad looks OK.The new ad now contains information that St. Elsewhere Animal Clinic specializesin dermatology and feline medicine and surgery. Dr. Paul hesitates and thenthinks, "I have a special interest in these areas of practice. Whynot?"
Arlene, the receptionist/bookkeeper/office manager waits for everyoneto leave. Today eight clients have paid in cash for over- the-counter medications.Arlene had entered these transactions as cash. She quickly removes the transactionsfrom the computer and pockets the cash. The deposit balances perfectly.Arlene was at first guilty but has rationalized that Dr. Paul doesn't payenough and/or appreciate her efforts. She, therefore, deserves this dailybonus.
It is busy, yet Sally has made three personal calls to her former "live-in"boyfriend's place of employment. Sally and her boyfriend are arguing overa house payment. After the call, Arlene confronts Sally. Sally lies andtells Arlene that her phone has been disconnected. Besides, in her own mind,she had worked late yesterday evening with Dr. Frank on a minor surgerythat had come in right at closing.
The technician is busy in the next room so Dr. Paul decides to hurriedlymix the vaccines for another patient by himself. After drawing the rabiesvaccine into a syringe he accidentally mixes a small amount of the rabiesvaccine into the distemper vaccine instead of using the diluent. He caughthimself and wonders what to do-his new distemper vaccine is expensive. Hethinks about it a minute and decides that there will be no harm done. Hevaccinates his patient with the cocktail.
Darla has worked at the clinic for three months and hasn't received araise. She has six dogs and is glad she finally works for a vet. But evenwith a discount her dogs seem to be eating up her paycheck. Darla comesin to check on one of the patients this Sunday while the clinic is closed.As she leaves she sees the heartworm medication display and realizes sheneeds more. She removes enough for all her dogs (along with her best friend'sGolden Retriever). Darla, at first guilty, finally convinces herself thatshe is justified in that she has been to the clinic many times to checkon patients on "her time" and is underpaid "to boot".
Mrs. Harris' dog "Slobbers" has just died after a brief illness.She returns Slobbers' final medications and states that she would like theclinic to give the medications to some other dog that needs it. After all,Slobbers can't use them anymore. She wants no money back-just the assurancethat some nice dog will benefit.
Later Dr. Paul hesitates a moment then pours the pills back into thebottles where the pills had originated. After all, Dr. Paul was sure thathis associate had undercharged Mrs. Harris for Slobbers' last visits anyway.
The scenes presented above could go on and on. At this point you maybe thinking that this article is about practice economics or criminal activity.
While there may be criminal and other acts described here that affectthe economics of practice, these scenarios have a common root in a lackof business and social ethics.
We would like to think that these scenes are uncommon and mostly fiction,but everyone reading this article knows better. It would be helpful to looknot at the symptoms, but at the underlying motives and rationalizations.
The scenarios above show individuals that feel justified for their activities.Justification is that little man on your left shoulder that out-shouts thelittle angel on your right shoulder. In a lot of cases, justification isthat creeping delusion that life is unfair and you are at liberty to takesteps to rectify the wrongs that others have imposed upon you.
Some individuals rationalize liberty in this way: "Other than actsthat I know are against the law, the constitution provides me with liberty.I therefore can act in any way I see fit according my right to liberty asa free person." These people have overdosed on late night talk radio.
Veterinary medical ethics
Will the real veterinary medical ethics please stand up?
"I will practice my profession conscientiously, with dignity, andin keeping with the principles of veterinary medical ethics." ~~2ndparagraph The Veterinarians Oath.
There seems to be some confusion as to what the term, "veterinarymedical ethics" means. In fact, the term has taken on new meaning consideringthe recent emergence of the animal rights movement.
Younger veterinarians may view ethics simply as it relates to the protectionof animals and a societal responsibility to the animals of this planet.An older veterinarian may think of moral issues related to the interactionof people. In fact, animal rights issues are only a tiny fraction of theethical questions that face veterinarians on a daily basis (see sidebar).
Where to go
Where can we go to improve our ethical behaviors?
Veterinary schools have attempted to provide students with training inethical issues concerning the profession.
Many of these courses now center on applied ethics and take the focusaway from personal responsibility. They instead focus entirely on the socialissues of applied ethics confronting our profession. Animal rights and animalwelfare are obviously legitimate concerns for the profession and veterinariansneed careful and practical instruction in this area. But veterinarians alsoneed to confront the more pervasive and insidious problems rooted in theissues of personal responsibility.
Veterinary ethics was one of those courses at vet school that no onewanted to take and usually didn't. It can be common for veterinary studentsto brush aside the issues of ethics as "corny" or "old fashioned".
On the other hand, some students have found that the controversial issuesof applied ethics to be their own special calling and crusade to hold othersto narrow interpretation of their viewpoint. Indeed, some have obviouslyentered the profession for this very reason.
We also need to keep in mind that many teachers of veterinary ethicsare non-veterinarians and often come from outside the schools of veterinarymedicine. As some of these courses may only include instruction concerningapplied (controversial) ethical concepts, our veterinary schools owe itto the profession to have oversight and input as to the content of thesecourses.
Without question this is a controversial subject.
Before I get a lot of hate mail I would like to point out that I wasthrown out of a Tennessee Walking horse/racking horse competition for whichI was serving as the show veterinarian because I disqualified a horse forobvious soring in violation of federal law. I watched from the grandstandswith disgust as that horse went on to win the event.
Animal welfare issues are important for everyone. Veterinarians, withsome exceptions, have always championed the welfare of their patients. Withoutdiscussing the issue further, we should be ever mindful of the extremesof this issue. Taken to the extreme, some animal rights proponents condemnthe keeping of pets altogether. We should look soberly at the prospect ofa profession with no patients and subsequently no veterinarians.
Into the looking glass
Staff and veterinarians alike need to look no further than their ownmirrors to find ways to improve the ethical framework of veterinary medicine.Everyone in the veterinary workplace today needs to take a fresh look atethical issues and how they affect our lives either in a positive or negativeway.
Steps you can take now:
1. Talk about personal ethics at a veterinary staff meeting andprovide your own scenarios. Talking can be great preventive medicine. Atthese meetings do not accuse others of unethical conduct. Remember thatwhen you point your finger there are three fingers pointing back.
2. Learn to recognize ethical situations that come up and learnto overcome the rationalizations that are obviously coming from that littleman on your left shoulder.
3. Recognize and discuss with staff members the controversialissues of applied ethics, making sure not to bind others to your own opinions.
4. Use a "golden rule" approach when dealing with otherpeople and hold your staff up to an ideal of helping others before helpingthemselves.
5. If you recognize unethical conduct, talk to the person in private.They may not even understand their own conduct.
6. Publish and distribute an employee handbook that includes expectationsregarding ethical conduct.
In the end, we cannot rely only on our schools and religious institutionsto provide our veterinarians and staff members with proper training in ethicalconduct.
It begins with the owner or owners of the veterinary hospital as wellas veterinary school faculty and colleagues.
If our staff sees us treating our clients or patients badly, it willfollow that the staff will feel that they may behave similarly. If our staffsees or suspects that we are cheating the system in some way or treatingother staff members with condescension, they will follow suit. This ultimatelyresults in a dysfunctional working environment. This will be true evenin the presence of otherwise superior veterinary medical care.
As Pogo once said, "We have met the enemy and he is us."