I’m going to make the case that care plans are unethical. Of course, ethics are, to some degree subjective, which is why I welcome you to make the case that they are actually ethical. I hope that we can have a discussion about these ideas without feeling insulted or being insulting.
Imagine a little thought experiment if you will. You are hungry and find there is a new restaurant opened up nearby. You sit down and the waiter brings you water, some bread and olive oil for dipping.
The waiter then takes 20 minutes to explain all the benefits of nutrition, and how their food is the best available. They even take you to a VIP room to watch a video on on the history of nutrition and how you need to eat enough protein to stay healthy, something their restaurant specialises in.
The waiter checks in with you to make sure you understand the importance of nutrition and protein and says that he will be pleased to take your order as soon as you have booked to eat at that restaurant 3 times a week for the next 4 weeks. And to make this investment in your health easier, you can get a 5% reduction on your bill if you pay in advance.
Does that seem reasonable to you?
Would you be keen to pay and stay and refer your friends?
How did Chiropractic get to a place where our best and brightest consider this sort of practice normal and necessary?
Didn’t you train for 5 years to become a professional?
Didn’t you join the profession to help people?
When did it become acceptable to “offer” patients a package of 12, or 18 or 24 or 36 visits and then call that patient-centered? Can I also point out that patient-centered is NOT the same as patient-chosen or patient-consented.
As a professional, we are required and expected to put the patient’s needs and best interests first – before our own financial gain.
Maybe you do have the gift of omniscience. Maybe you can know the future, but what clinical tests or signs did you use to determine whether that patient would need 6 or 12 or 36 visits? How do you know what state they will be in 3 weeks from now? What would I do with my patient last week who was free of signs and symptoms and subluxations on his third visit? If I had sold him 24 visits up front, what am I to do? It seems a bit ridiculous refunding him £1000 because I underestimated my ability.
Perhaps your patient is 75 with severe osteoarthritis of the spine and knees. I can understand a scenario in which you might consider that this patient could benefit from 24 treatments over a couple of years, but do you make it clear to this patient that they may still have the same level of pain, or even be worse after the 24 visits? Do you make it clear that you believe everyone needs treatment for life and you will be encouraging him to come back to you forever? Whether a package of care is ethical or not depends on the degree to which your recommendations vary according to the needs of a particular patient. Are you offering different packages according to the needs or are you recommending a certain package out of principle, convenience, protocol or financial ambition?
How to recognise that your offering is unethical:
If 50% or more of your patients are offered your preferred package, then it’s probably unethical.
If you refuse to treat people who don’t accept your package.
If you talk about or monitor your “conversions.” Conversions are for salespeople and scammers, not for professionals.
My number one objection to care plans is that it compromises our competence and results.
Most people are selling packages of visits on the understanding that there will be re-exam visits at intervals (usually 6 visits) along the way. If you are not examining each visit and checking progress with the patient each visit, then it’s impossible to refine and adjust your techniques with real-time feedback.
If you are looking back over 6 visits, whether you have achieved your objectives or not, you have no idea which part of what you did worked and which part didn’t work. I re-examine my findings before and after each adjustment as well as each visit. Of course I do a full examination of the patient-relevant findings every visit. Why wouldn’t I? Isn’t that what I’m there for?
So that’s it. If you still think that “care packages” are ethical, then make the case and prove me wrong, but when you make the case, you have to make it in ethical terms. I have no doubt you can make a lot of money from care packages, but you can from scamming people as well, but that’s not a reason to use them if they are unethical.