Ethics: Applications to the Clinical, Academic and Corporate Worlds

Editor's note: This is a transcript of the live seminar presented on September 15, 2011. To view the course recording, register here.

What is a Profession?

If we think about our profession over the last several decades, much time has been spent talking about the entire concept of professionalism and what it means to us as audiologists. Let's look at some characteristics of a profession and how they may apply to audiology.

There was an article published on professionalism in ENT Journal by Dr. Loh (2000) that refers to a profession as an organization wherein there is exclusivity in terms of the entrance requirements. In audiology, the doctoral degree is now the unifying degree for our body of practitioners and provides exclusivity. The legal right to practice is defined by the state license and not by certificates or other means. We have recognition by our license now in every state in the U.S.

A profession also has a code of conduct. We are autonomous by virtue of a specialized knowledge. We have a specialized body of knowledge that defines who we are; no other profession has more knowledge in the areas of hearing and balance than audiologists. Of course, a profession also is accountable to its patients and those professionals who refer to us, and as such, we should have high ethical standards. Certainly we have done our best to maintain high ethical standards. These characteristics: exclusivity, code of conduct, autonomous by virtue of specialized knowledge, accountability, and high ethical standards, all define a profession and certainly help to define audiology as a profession. As we live and present ourselves as professionals, others will begin to see us in that way as well.

When the profession began many years ago, no one knew what audiologists were or what we did. Now, the public has a much better understanding of audiology as a profession, and that enhances our view. For example, U.S. News & World Report claim that we are the number one health-care profession for the next decade (Nemko, 2008). Certainly, today we are achieving much better recognition for who we are and what we do.

What is Ethics?

We think of ethics as a body of literature on moral philosophy. It is the literature that addresses who we are in our character. Ethics is also a way for us, as practitioners, to solve problems. When we are confronted with dilemmas, we should be at least asking, "What are the ethical issues that go along with the way that we are managing our staff, managing our patients, running our marketing, doing our billing, developing relationships with third parties, including manufacturers and/or other organizations that we may tend to work with?"

A code of ethics specifies professional standards that protect the integrity of the profession.

We have a code of ethics within the profession of audiology. When the American Academy of Audiology (AAA) was founded, one of the first documents that was published was a code of ethics for the profession, which has been enhanced and re-addressed on an ongoing basis since the inception of the Academy. The AAA updated their Code of Ethics in April 2011. The code of ethics has been a topic of discussion for the past many years.

The purpose of a code of ethics is to define a standard. Once defined, that standard is then developed to protect the integrity of the people within the profession and the persons that we serve. It is based on concepts of nonmaleficence and beneficence. Nonmaleficence is a Latin term meaning to do no harm, whereas beneficence is a state of quality, of being kind to people that we serve, of being charitable or serving and providing beneficial services. If you were to summarize, beneficence is promoting the well-being of others. In a medical context, this means taking actions that serve the best interests of the patients that we serve. It ensures that the public is protected from unscrupulous, incompetent and unethical practitioners.

A code of ethics ensures that persons that are regulated through a means such as state licensure are competent to provide the services within their scope of practice. There are also disciplinary mechanisms within any type of code of ethics.

When confronted with an ethical dilemma, you can ask yourself certain questions to help to come to a solution. The questions I frequently ask follow what I call the "60-Minute Rule." If Mike Wallace from 60 Minutes showed up on the doorstep of your practice and started questioning you about some of the activities you are involved with, would you pass the test? You need to ask questions such as, "Is this in line with my objectives or those of the practice?" and "Will the decision result in the right thing being done for the patient/customer?" You will also want to consider the actions of the people who work for you, and ask the same questions.

Public Perception

Historically, we tended to focus a great deal on patient perception when discussing ethics. One of the best articles on patient perception was authored by T. Newell Decker (1999) from the University of Nebraska who was chair of the AAA Ethical Practice Board in the late 1990s. Decker stated, "The greatest potential harm [for audiologists] is the loss of faith of our entire citizenry in a profession that may be perceived as working primarily not for the patient, but for its own personal gain."

Decker felt that this was a tremendous risk for us, and we needed to be aware of the potential misconception that patients may have. As practitioners, we need to decide what acceptable behavior is. That leads to the question, "How important is patient/public perception? Is public perception a key ethical test?"

We asked this question at Nova Southeastern University when we were reading Decker's article (1999). I worked with Dr. Teri Hamill, who eventually became chair of the Ethical Practice Committee for the Academy, and we did a small study whereby we created typical scenarios that often presented in the audiology clinic. We presented these scenarios to patients as well as practitioners and then asked their opinions. After we completed the study and did a small publication, we expanded it with David Hawkins from the Mayo Clinic and Dennis Van Vliet, who at the time was with HearUSA. The study specifically targeted ethical perceptions of audiology practices, and the complete findings were published a few years later (Hawkins, Hamill, Freeman & Van Vliet, 2002). In 2006, the study was repeated by Hawkins, Hamill and Kukula (2006); at that time Jane Kukula was the chair of the Ethical Practice Committee for AAA.

I want to share with you some of the data that was acquired from those surveys in the form of the scenarios we originally presented.

One scenario was as follows:

A hearing instrument company has what it calls a 'professional development plan'. For each hearing instrument sold, the manufacturer places money into an investment account that is redeemable for the purchase of equipment, books, CE workshops or other business-related expenses. The audiologist joins the plan.

We presented this scenario to consumers and audiologists in 2002 and 2006, and asked them for their perceptions.

The majority of audiologists in 2002 and 2006 responded that nothing was wrong with this model. In contrast, however, the patients felt it was unethical. So we have a disconnect between the beliefs of practitioners and the beliefs of consumers. With that in mind, the Ethical Practice Committee issued a guideline that audiologists should be quite aware of the potential for unethical behavior if they participate in a professional development plan or business development fund sponsored by a manufacturer.

Another scenario presented in the studies (Hawkins, et al., 2002; 2006) was as follows:
 

A hearing instrument company sales representative visits the audiologist's office and brings pens, pencils, and notepads with the name of the new product on it. The audiologist accepts.

When both consumers and audiologists were questioned about this scenario, both groups felt that there was nothing wrong with accepting these small tokens from the manufacturers. This was not viewed as an unethical behavior by either consumers or practitioners. However, we do have some guidelines within the AAA code that address gifting.

The 2011 AAA Code of Ethics, Principle 8 states that "Members shall uphold the dignity of the profession and feely accept the Academy's standards." Furthermore, Rule 8a states that "Individuals shall not violate these Principles and Rules, nor attempt to circumvent them." Rule 8b states, "Individuals shall not engage in dishonesty or illegal conduct that adversely reflects on the profession." This is the premise of a code of ethics.

The AAA guidelines note that published studies have revealed influences of human behavior resulting from the exchange of gifts, or what is known as the "gift effect". The guidelines indicate gifts from manufacturers should not be accepted. The guidelines state that general-use business items like laptops and otoscopes or continuing education would be considered gifts and should not be accepted. Uniquely compatible items provided for patient care, such as software from the manufacturer, demonstration units and cables, are not considered a gift by the manufacturer.

When it comes to attending courses sponsored by manufacturers, meals and travel can be considered rewards or gifts. However, there is an exception for modest meals and travel associated with attending product education and training. These are not considered to fall under gift restrictions. In short, you should not accept anything beyond reasonable travel, meals and lodging associated with product education. The AAA guidelines (2011) then say that acceptance of gifts of any value by a member of the Academy from any company or manufacturer that supplies products that the audiologist dispenses, sells, or recommends may compromise, or give the appearance of compromising, the audiologist's ability to make ethical decisions. It is the perception on behalf of the patient that the Academy is concerned about.

You must determine individually whether or not you are comfortable attending a meeting and accepting a meal and travel expense to attend the meeting, or accepting coffee mugs or pens or pencils, and, furthermore, whether or not you feel this will compromise the patient's perception of your ethical integrity.

Federal and State Anti-Kickback Statutes

It is becoming increasingly important for audiologists to familiarize themselves with anti-kickback statutes. If you accept certain incentives or discounts and are participating in a federal health care program and you do not notify a third party, such as the Federal Employee Health Benefit programs, you need to be careful that you are not violating the anti-kickback statutes.

The anti-kickback statutes prohibit any person to knowingly and willfully solicit or receive any remuneration, either directly or indirectly, in return for purchasing or ordering products. If an audiologist accepts incentives from a hearing aid manufacturer based on a reward system for purchasing the manufacturer's products and then prescribes hearing aids made by that manufacturer that are reimbursable under a federal health care program (e.g., FEHBP, Tri-Care, Medicaid, Medicare), this may violate the AKS. If you find yourself in this situation, it is critical for you to discuss this with an attorney. The logical solution is to avoid participating in certain types of programs that could be construed as a kickback for the services that you are providing. What may be ethical may not be legal, and what may be legal may not be ethical.

We recognize, also, that there is a difference between what may be unethical and what may be good business and marketing practice, such as giving away a desk copy of a book, providing a free package of batteries or cleaning to patients or accepting a meal to attend an educational symposium. You have to decide what you are comfortable with in your practice.

Customer Perception

Remember, we are discussing customer perceptions, and you have to understand what your patients feel about your having a coffee mug, a pen or other type of promotion that is provided to you by one of your suppliers. What is the best way to learn about customer perception? Ask your patients, do surveys, find out what their belief is about what you are doing and the kinds of activities in which you participate.

Here is an example from the two Hawkins et al. studies (2002, 2006). The following scenario was presented:
 

An audiologist is an employee of a clinic. The audiologist receives a salary, plus a commission based upon the dollar amount of hearing instruments sold.

The question is about whether or not it is ethical for an audiologist to receive compensation in the form of commissions from the sale of products. In this case, the majority of audiologists in both 2002 and 2006 did not feel it was unethical ("nothing wrong"). However, consumers were a little less convinced with 10% believing there was "nothing wrong" with this activity, while 64% responded that it would be "better if not done" but they did not believe it to be unethical. About a quarter of the respondents said that it would be "borders on unethical" or "clearly unethical".

What this tells us is that consumers, generally, do not like buying their health care from commissioned salespersons. Instead of thinking about this strictly in terms of commissioned sales, think about total compensation. Compensation based on total productivity is the manner in which most people in private business earn their income. It is very common to generate a certain amount of revenue and to be compensated based on some percentage of that revenue. We refer to that as capitalism.

David Kirkwood published a study in The Hearing Journal in March 2009, where he asked this question about participating in a compensation plan that was based on commission sales. What he found was that, generally, dispensers and audiologists do not have difficulty with this and do not feel that this is unethical. He did not ask consumers in this survey.

Surprisingly, to me, there are some audiologists who still feel that compensation based on productivity may border on some level of unethical behavior, so be aware of that. The AAA Code of Ethics (2011) states that members shall only provide services and products that are in the best interest of those served. This is applicable because we are talking about commission sales versus compensation based on total productivity.

I think the ethical danger is putting yourself in a position where you are compensated based strictly on hearing aid commissions. As an example, say you have a patient that comes to your office who has severe vertigo and needs a vestibular assessment or some other level of diagnostic testing, and you have another patient who is a hearing aid candidate and came specifically to purchase hearing aids. You never want to find yourself in a position where you would decide to only see the patient with the hearing aids because that is where you were generating your revenue. This is where the danger of being compensated based on commission sales from products, as compared to compensation based on total productivity. You want to provide services and products that are in the best interests of the patients that you are serving, and you do not ever want to be put in a conflicted position this way.

It is recommended that an employee be compensated for the total productivity based on a broad-structure compensation package. This is the way other health care professions work. There are many ways to set up a compensation plan. Factors can include patient outcomes, following best practice protocols and many others. That seems, to me, a more reasonable, practical, ethical and legal approach to the way we should be compensated for services that we provide.

University Ethics

One last set of studies to mention concerns ethics from the university perspective. Paul Pessis, Ian Windmill and I were asked to do a presentation on ethics for the Academy of Dispensing Audiologists (ADA) in 2009. We conducted a survey of students and ADA members regarding ethical questions and some of the practices that audiologists use clinically and that students were being asked to participate in. We fielded responses from 165 students from 26 universities as well as 656 practicing audiologists.

One of the questions we asked was how these individuals felt about receiving gifts or giveaways at meetings or from manufacturers they may work with. Over 70% of the students and almost the same number of practitioners feel there is nothing wrong with gifts or giveaways, and they felt it was good business practice.

We also asked about student participation in summer programs that are traditionally hosted by manufacturers. Of course, the vast majority of students felt there was nothing unethical with this and that they should be allowed to attend. Almost three-quarters of the practitioners did not have much difficulty with this, either.

A third question we asked was about social functions. For example, if there was a social function at a conference should practitioners be invited to attend, or is this unethical for them to attend such a function at a meeting? Again, we found that both students and practitioners have no difficulty with this whatsoever from an ethical standpoint.

We asked about price advertising and volume discounts, and I was a little surprised, personally, that students and practitioners did not feel it was unethical to advertise their prices or to receive a discount based on the volume of units ordered. How about the question of exclusive contracts? Should a practitioner only work with a single company and have an exclusive contract with that company? Here both students and practitioners agreed that this could lead to some difficulty. I am sure they are thinking that if you have an exclusive contract, you may not be able to provide all of the quality services and recommendations that patients may need. When we talk about ethics and perceptions, we have to ask the question, "Just how important are perceptions?"

The Reality of Ethics

We know that what some may consider to be unethical is not necessarily illegal and, in fact, may make good marketing and business sense. We know that consumers most often do not perceive our practices as unethical. According to the survey on perceptions (Hawkins et al., 2002, 2006), it was very rare when patients had difficulty with the typical activities in our clinical practices. Do following ethical guidelines make you a better practitioner? Do gifts of any value really persuade a practitioner's decision making? And if so, what kind of gift makes you "sell your soul?"

Answering these questions can help you make some decisions about what is going to compromise your ethical standards. Ultimately, do you decide how to practice based on how others think? I think, to some extent, it should be, because one of the things you have to keep in mind is that what you do is not just about you. It is also about your patients, the people working in your office and the people answering your phone and meeting and greeting your patients.

If you have other practitioners in your office, are they acting in a professional manner? Are they following the ethics and the guidelines you have established for your practice? If perception is a fair marker for identifying ethical violation, then some of this information will be valuable to you. But I would like to ask the question in reverse: "Is perception a fair marker, and, if so, how do you measure it?"

Again, you can obtain subjective information from your patients or colleagues within the field. But often when you ask two people the same ethical questions, especially two audiologists, you get multiple opinions. Or when you read the ethical guidelines from professional organizations you may find yourself saying, "How come my opinion is never reflected in these guidelines?" Here is something to consider, then. Before AAA posts an ethical guideline, almost always it is sent out to the membership for comment. It is critical that you express your opinion to these forums, because these guidelines must reflect what you, as the membership, consider to be appropriate for the profession. Furthermore, if you are not comfortable with a guideline, you need to express that to the Ethical Practice Committee or the Academy's Board of Directors, who finalizes the guidelines.

More important than perception is building a relationship of trust with your patients and your customers or referral sources. Perhaps your referral source is a school district, hospital or physician. Perhaps it is an industry or company in your community. How do you establish a relationship of trust with those individuals? Yes, ethics plays a role, but it should not be just the perception of ethics. There is more to establishing a relationship of trust.

I have used a grid concept when talking about building relationships with customers (Figure 1). On the Y-axis we have the notion of trust, and on the X-axis we have the idea of what I call involvement. How involved are your customers in your decision making?



Figure 1. Continuum of involvement and trust when developing relationships with customers.

Let me give you a simple example here. You are driving through an unfamiliar town, and you are hungry. You decide you have to find somewhere to eat. Maybe you see a McDonald's™, and that is the only restaurant you are familiar with. You unequivocally decide to get a Big Mac, not because it is the best hamburger you have ever eaten, but because you trust what is in it. You know it is going to fill your appetite, and you trust what you are going to get there.

Do you have any involvement in that, other than deciding you are going to stop there and trusting what kind of product you will receive? Do you care who's behind the counter serving you? Do you want to know their life story? Do you want to know the ambiance of the restaurant? Probably not. You are probably going through the drive-through. You know that this McDonald's will be similar to any other you have ever visited, and that you will get the same burger here as you would in a McDonald's located in any other city.

Relating this back to audiology, think how you relate to your patients. Are you considered a McDonald's to your patients, where they think, "I am going to go in there and trust them because I can get the best price," yet they have no involvement in the process. This is what the big-box stores are doing today. They are trying to commoditize our industry, whereby the customer can just order the product online. There is no involvement in the decision-making process on behalf of the patient. That is not necessarily the relationship that we want to establish with our patients.

Suppose you are coming in to an already-established practice which you wish to grow, and you have someone who has been working in that practice for a number of years, but that person has no involvement in the practice. They would prefer, rather, to just show up at 9:00, go home at 5:00, and receive their paycheck. You are new in the practice; they have no trust in you whatsoever. On our grid (Figure 1) this person would be in the bottom and far-left quadrant: very low trust, very low involvement. This is not someone that you are going to be able to build a practice around. And if you cannot work with them, perhaps it is time to terminate them.

How about a patient or a referral source that does not have any trust or involvement in what you are doing? They are seeing you only because their children said to them, "You need to go get a hearing aid." The patient's feeling is that they do not want to be there. They do not want a hearing aid. They do not want to be involved with you. Their intention is to just buy something to get the children off their back. This is not going to be a successful interaction, and that person is probably going to cause more grief for you, as you know, because they will likely tell many people how unhappy they are with the product and services that they received because they never had any involvement or trust in the first place. That is not what we are trying to do. We are trying to build a relationship of trust. We are trying to get these patients to become highly involved in what we are doing. We want them to trust what they are doing.

This is why patients come to us. They have heard good things about us; they heard about our brand; they like our marketing. When they called, the front-line person answered the phone in a professional manner. When they are comfortable and feel like a participating member, the patient becomes involved in the decision-making process, and you are instilling trust in them. That is much more important than any other approach we take in working with our patients.

So then, if you accept a pen or a coffee mug, are you breaking down that trust? Are you interfering with the patient's involvement in the management? Are they going to say, "You know what? I no longer trust this person because they have a coffee mug." Maybe. Maybe not. But this is where you need to think about perceptions, from how you decorate your office to how you work with manufacturers. If that perception undermines this level of trust, then that will interfere with the success of your practice.

Keep these concepts in mind because your goal is to achieve great outcomes with your patients by building good relationships based on trust with that patient involved in the process. Moreover, we do not want to be perceived as a commodity like McDonald's. We want high levels of trust and high levels of involvement by our patients in the process.

Establishing an Environment of Trust

Perhaps our practice is less about ethical perceptions and more about establishing an environment of trust. I am not implying that ethics do not play a role in the environment of trust, but perception is not the only thing. There is a lot more to it. You want the people with whom you work to have a high level of professionalism.

The key issues when establishing an environment of trust are taking sufficient time to earn the patients' trust, understanding the patients' needs and addressing them, and displaying honesty and high levels of integrity in the interactions with your patients.

We must be good communicators of trust. Take genuine time with the patient, and show them that you are interested in them. If you have seen them previously, read the chart notes and re-familiarize yourself with their case. Explain the limitations of your scope of practice. Be honest and transparent with them. If you make a mistake, let them know it and correct it.

Create an environment for a flow of ideas, not just with your patients, but with your referral sources, also, and certainly with your staff. Sit down, talk to your staff about what your goals are and what you want to achieve in the practice or department. Be sure to differentiate your practice and what you are doing from what I call the commodity types of practices. You do not want the patient to leave you and go to a big-box store. You do not want them to purchase a personal sound amplification product online because they do not understand that it is more important for them to have a good relationship with you, as a professional, than it is to just get a cheaper price somewhere else. It should be more about you and about your practice. Discuss this with your staff and make sure they are on board and support what you are trying to accomplish.

Building trust is an attitude. Trust is a culture that is adopted by the practitioners and the office staff. As you begin to build trust, think about the following: What is the perception of your status in the community? How involved are you in community activities? What does our marketing and promotional material look like? Is it something that is consistent with your brand? Is it consistent with your culture?

How about the way the telephone is answered and appointments are made? AAA did a survey several years ago of over 100 clinics in the country, and in every one of those calls the person calling was trying to make an appointment for an audiology evaluation. Forty percent of those calls were lost. Those people did not get appointments because they never got through the frontline person. The frontline person could not answer questions as to who we are and what we do. They did not understand the kinds of services or products that we provided in the practice. They could not answer questions about insurance, and they turned people away. Make sure this is not happening in your office. Establishing an office culture extends beyond your branding and marketing. Once a potential patient responds to the branding and marketing and makes the phone call to your office, that culture must extend to the frontline people that are answering your phone. They are the first impression those potential patients receive.

When a patient finally makes the appointment and arrives in your office, how are you introducing yourself? Are you saying, "I am Johnny, and I am going to test your hearing today," or are you introducing yourself by your title? "I am Dr. Smith, and I am the Audiologist." While this introduction to some may seem formal, it lets people know who we are and what we do.

What is your appearance? Is it a professional appearance and something that patients expect? Furthermore, what about the rest of the staff in your office? Is their appearance in line with your office culture and expectations? Observe how they interact with patients. What about your clinical facilities? Are they clean and neat? Are they conducive to providing professional health care services? What about the follow-up of your services? Do you follow through with your patients in a professional manner?

There was a study done by Carole Rogin (2009), Director of Hearing Industries Association, which identified aspects of hearing aid delight. She surveyed several thousand people who were successfully fit with amplification. Using a psychometric scale of delight, she asked those people that were successfully fit what delighted them about the service and the product that they received. It became a top-ten list, where number ten was that they were pleasantly surprised that the hearing aids worked for them. They were not convinced before they came in that hearing aids were going to work. Number eight was that they were impressed with the professionalism they received in the office, and number six that they were impressed by the personal counseling they received, both of which were extremely important to them.

Number three was delight in the fact that when they were fit with hearing aids, that the function was verified and validated that it was appropriate for them. But when going through the top-ten list, the number one factor that delighted patients who were successfully fit with amplification was the relationship and trust that they had in the audiologist providing the services.

So it is about us. This is fundamentally important, because it is how we separate ourselves from the big-box store and the online sales or products. Patients want to be able to trust and establish a relationship of trust with a person, with the health care provider. That is much more important than getting a better price on a product. If we want to avoid being commoditized, we should take a good look at information like this from patients who are delighted when they have a good strong relationship with the provider of those services.

The Building of Trust is an Ethical Activity

What is the culture of your office, of your practice, of your clinic? Is it a culture of professionalism? Is it a culture that will instill trust in the patients you are working with? The building of trust is an ethical activity. It is an activity that must be presented from the moment that person calls on the phone all the way through the follow-up after hearing aids have been fit and they become a long-standing patient.

Your reputation comes first, then your brand. Reputation is what people think about you. It is word of mouth. I want my patients to refer other people to me by saying, "You need to see my audiologist." If you can have people say that about you, that means they feel they own a part of you, and they trust you. Your reputation will earn you the status of ownership on the part of patients, and that is critically important. It can be the difference between success and lack of success in your practice. Establish your reputation, and then you can brand the good-quality services that you provide in your office.

Reputation and brand are based on four simple questions: What do you want to be known for? Where are you in the process now? What else do you need to learn or do? How will you know when you get there? This is not an exercise to do alone. Sit down with your staff and ask these questions. Talk to your frontline people. If you have other practitioners in your office, discuss your perceptions together with them.

In the book Good to Great (2001) Jim Collins talks about the hedgehog concept. In the hedgehog concept you define what you are best in the world at. What is it that you do better than anyone else in your community? What is it that you do better than your competition? What do you want to be known for in your practice? Define these things and then market the heck out of them. Let people know that you are the best in the world in this particular area. If you are unsure of where you are in the process of developing this reputation, ask your patients, ask your referral sources. Find out from them how they feel about you, and that will help you know where you are at in the process.

Several years ago, there was a disturbing story that came out of Iran. It was at the time of the Iranian presidential elections in 2008. The company, Nokia Siemens, not Siemens Hearing, made international headlines because they were involved with bribery scandals within the election. Nokia Siemens previously had the reputation of being an absolutely outstanding company. This incident made international news and undermined the reputation of the company. All it took was one event. The president of Nokia Siemens released a statement saying that a company's reputation influences customer purchasing decisions. Your reputation is critical. Apply this to your own business or practice. The quality of a company's reputation depends increasingly on whether it is perceived to be responsible.

Are you perceived as being responsible to and for your patients? That should be part of your culture. Do patients trust what you are doing and providing for them? When you talk to your staff about this, understand the challenge. You may have all the information from customer service surveys, and you come up with a culture that you would like to emanate, but is it the behavior that you demonstrate? Make sure there is not a disconnect there and that the values you profess are also the values that you demonstrate. You must have consistency.

There should be a focus on the standard of care. It is what the profession owes our patients. It is consistency in what we do across all of our patients. It is validating what we are doing. We often hear about validating fittings with real ear. To me, it is as much an ethical issue as it is a professional issue. We owe this to our patients to validate what we are doing. It is what the reasonable, prudent professional would deliver. Failure to deliver the standard of care implies some level of negligence or error, and you certainly do not want that to go around your community. When you focus on a high standard of care, you are not inherently going to violate a code of ethics.

Your business should focus on a purpose, mission and values. To define the purpose, ask this questions with your staff, "Why are we here?" To define your mission ask, "What do we do to fulfill our purpose?" To define the values, ask, "How do we work together to fulfill the mission and accomplish our purpose?" Ask your patients and referral sources how you are doing in this area. Then you can move on and enhance the success of your practice.

Summary

In summary, we have discussed some ethical considerations important for defining your focus as an audiologist. First, you need to define the foundation of your ethical decisions. These should be in line with your objectives and those of the practice. The decisions you make should result in the right thing being done for the patient, the customer and the referral source. Ethics are a culture of appropriate behavior that not only apply to you, but extend to everyone else in your office. Do not have that disconnect.

Ethical principles are not concerned with how things do operate, but rather how they should operate. I like to apply the mother or grandmother rule. That is, if your mother or grandmother were your patient, is this the way you would want to behave in front of them? Also, understand that the most difficult decisions to make are those where there is a conflict between two or more principles. Furthermore, realize that sometimes what may be good business practice may be perceived as being unethical, and conversely, something that may be legal may not be perceived as being a good business practice or ethical. Try to separate these aspects out and determine in advance what your priorities are. Document everything that you do, and develop standards for your practice and benchmarks and expectations for your staff.

If you do all of this, you will function in a very ethical and successful practice. It is not just about the perception you create; it is also the culture that you instill. Your standards of care, branding and your behaviors all lead to trust, and trust, in turn, leads to practice success.

References

American Academy of Audiology. (2011). Code of Ethics. Retrieved October 10, 2011, from www.audiology.org/resources/documentlibrary/Pages/codeofethics.aspx

Collins, J. (2001). Good to great: Why some companies make the leap...and others don't. New York: Harper Collins.

Hawkins, D.B., Hamill, T., & Kukula, J. (2006). Ethical issues in hearing. Audiology Today, 18(4), 22-29.

Hawkins, D., Hamill, T.A., VanVleit, D. & Freeman, B.A. (2002). Potential conflicts of interest as viewed by the audiologist and the hearing-impaired consumer. Audiology Today, 14(5), 27-33.

Kirkwood, D. (2009). Study on ethics finds dispensers divided on how to practice on the side of angels. The Hearing Journal, 62(3), 19-26.

Loh, K. (2000). Professionalism, where are you? Ear, Nose & Throat Journal, 79(4), 242-243, 247-248.

Nemko, M. (11 December, 2008). Best careers 2009: Audiologist. US World & News Report. Retrieved October 10, 2011, from money.usnews.com/money/careers/articles/2008/12/11/best-careers-2009-audiologist

Rogin, C. (2009). Top 10 Reasons for hearing aid delight. AudiologyOnline Recorded Course #14615. Retrieved on October 17, 2011 from the eLearning Library on www.audiologyonline.com