Have you ever been faced with situations that could compromise your ethics and your philosophy of practice? In the flurry of responsibilities that equine practitioners face each day, sometimes it is tempting to take a path of least resistance in keeping your clients served and satisfied. But this is not always in the best interest of your patient, the horse. How do you respond when horse owners ask you to do something that is clearly wrong, both medically and ethically?
Have you ever been tempted to omit sending information about a horse’s condition to an insurance company in order to keep the horse owner happy? Have you ever refused to comply with unethical requests and thereby lost clients? These kinds of questions were examined in a panel discussion entitled “Can Sport Horse or Racehorse Track Practice Be Ethical” at the American Association of Equine Practitioners (AAEP) Convention Dec 4-7, 2016, in Orlando, Florida.
Also at the AAEP Convention, the keynote speaker, Chuck Gallagher, spoke on “Ethics, Integrity and the Power of Choices in Life and Business.” He addressed the concept that every decision has consequences and how that applies to ethical choices. Many people have indicated that this topic was long overdue for discussion by the AAEP membership and that it is important to keep the equine veterinary industry strong and well respected. “Ethics is a powerful driver of clients’ perceptions of trust, honesty and professionalism in the equine industry,” remarked David Ramey, DVM.
The number of unethical choices is as varied as your imagination and your personal experiences. These situations test not only one’s character, but also impact others in your practice, as well as horse owners and their horses.
Gallagher took a wrong turn off the ethical path decades ago, and as a consequence of that decision, he landed in prison. One mistake along an unethical path profoundly changed his life and his outlook. He learned hard lessons from that experience, in particular that “every choice has a consequence.” He stressed that many choices are not necessarily black or white, so making an ethical choice has to be based on all surrounding facts and circumstances. If confronted with an ethical dilemma, it might be prudent to seek professional advice from a dispassionate agent or agency.
Gallagher said that on a daily basis, equine practitioners have many stakeholders who are affected by ethical choices: the practice owner, practice employees, a competing veterinarian, insurance companies, the horse owner, and most importantly, the horse. Each person in this paradigm might have a different perspective about the right thing to do. What is important is that you choose the behavior that fits with your personal ethical philosophy.
When a horse owner or trainer asks you to perform a procedure without an exam, for example, this is a reflection on you. You might ask yourself, “Why is my opinion not valuable?” Instead, view these situations as opportunities to educate clients about the value of veterinary expertise and sound (and ethical) medical decisions.
What Is Socially Acceptable?
“It is easy to make unethical choices when they seem socially acceptable,” said Gallagher. What does “socially acceptable” mean? He brought up the example of speeding on the highway— even though it is illegal, if everyone is doing it, you might be inclined to speed.
This same concept could apply to the propensity for equine veterinarians to administer “prophylactic” joint injections despite the lack of justifiable medical need. Just because many other practitioners are doing it doesn’t necessarily make it the best therapy for the horse. Instead, it is appropriate to perform a proper lameness assessment while educating the client and inquiring about his or her expectations. Sound advice is to always ask yourself whether you are putting the horse first rather than focusing on your bottom-line of profit.
Delving in a little deeper, Gallagher noted, “Our intentions create the behavior that follows.” He pointed out that most people would not voluntarily choose to do something that could derail one’s career. Still, there are situations that create ethical lapses and that might prompt a person to consider a choice that is less than rational, and certainly not ethical. Key triggers include financial problems, relationship problems and health issues.
In addition, he said that ethical lapses often don’t start as a single, big choice. Often these situations go beyond your business and instead apply to your personal life, with many steps leading up to a big mistake. As one example, what would make you choose to disregard an ethical position statement made by your professional organizations, the AAEP and the AVMA?
Gallagher explained that the process that leads to an unethical choice often starts with something unexpected. For instance, you might have made a mistake and are called out for doing something wrong. He noted that when faced with this situation, the human brain goes into fear mode rather than thinking rationally, and this triggers an emotional response, with a likely result of lying.
“When life gets out of balance, human nature seeks a quick solution,” said Gallagher. A common response to being “caught out” is to seek to solve a problem and look for an opportunity to do so, while the behavior that follows rationalizes away the mistake. This line of thinking prompts one to consider that taking money is “borrowing,” not “stealing,” for example—when in fact a person did steal money.
In some cases, when someone makes a wrong and unethical choice and there are no immediate consequences, that person might feel that he or she has gotten off without consequences. But Gallagher emphasized that the truth always comes out, and it might come out when least expected.
Everyone is aware of much of what is going on through social media, even if the State Board or AAEP isn’t. Remember that everything is being recorded all the time by cell phones and social media.
A question to ask oneself: “Am I willing to make a choice that can be viewed that quickly, then suffer the consequences?”
Your Practice Culture
Of importance to consider is the culture of your own practice and what systems you put in place to adhere to ethical guidelines. Such guidelines affect everyone in your practice, including your staff and clients.
Gallagher said it is important to trust your employees, but it is also important to maintain a healthy skepticism. Giving an employee an opportunity to steal could be assuaged by rotating duties, so that no one person controls certain financial issues in your practice. Also, you can have a monitoring system in place that deters a person’s temptation to embezzle if he or she is faced with a difficult choice due to financial, relationship or health problems.
Often there are obvious reasons for ethical lapses. Gallagher reported that 81% of ethical lapses occur because:
- 36% are living beyond their means,
- 27% are having financial difficulties,
- 19% or more have too close an association with vendors and customers, and so offer inappropriate favors in return for favors, and
- 18% or more have excessive control issues. Gallagher said this should be a red flag; for example, consider the employee who said that he or she could not possibly take a vacation because the practice would fall apart if he or she left.
Gallagher also pointed out that 40% of ethical lapses are reported through a snitch or a whistle blower, and not necessarily through surveillance.
The practice of veterinary medicine is laced with ample situations that could cause a person to step over an ethical line. At its Orlando convention, the AAEP sponsored a panel discussion of different situations that could affect ethical choices in equine practice. Members of the panel were Drs. Hope Batchelor, Todd Brokken, Joe Carter, Alan Chastain, David Frisbie, Scott Hay, Melissa McKee, Rick Mitchell, Foster Northrop and Karen Nyrop.
Lengthy discussions focused on the potential for insurance fraud. Panel members agreed that the smart approach is to generate a thorough medical record that is then submitted to the insurance company, keeping a veterinarian within the bounds of ethical practice. Fill out the insurance form carefully with honest answers, while also advising the horse owner of your comments. This way, it is up to the insurance company whether to exclude something about the horse rather than having that burden placed on the veterinarian.
Educating an owner about the “rules” and consequences of omitting information or outright insurance fraud is another instance of remaining ethical. It is the insured’s duty to understand his or her policy’s coverage and to provide documents for the veterinarian to fill out. An equine practitioner’s role is to advise a client to read the policy. It is the owner’s responsibility to report a problem; then the insurance company contacts the veterinarian. All the veterinarian is obligated to do is to fill out the insurance and/or claim forms.
One issue discussed by the panel reflected the conversation initiated by keynote speaker Gallagher. Take the case of a client who forms a large percentage of your practice income. This makes it difficult to be objective about that client’s demands. If that client asks you to do something unethical, it could become a trigger point for unethical behavior because of the need for continued financial revenue. A logical solution to relieve this kind of financial pressure is to find ways to maximize other and varied sources of revenue from a multitude of other clients.
To a person, all on the panel felt that when faced with an ethical dilemma posed by a client, there is nothing wrong with saying, “No, I won’t do or say that,” then “firing” the client. If a client or trainer asks you to perform an unethical task, it is likely that the person will ask for other unethical actions in the future.
Similarly, if an associate is faced with practicing in an unethical environment, the sound advice is to leave that practice. If there is knowledge of some illegal activity, it is the associate’s duty to report it. If veterinarians don’t take a stand, then there is no one to speak up for honest practitioners in the industry, and no one to clean up the potential ethical dilemmas facing the industry. Good mentorship of young practitioners imbues future generations with ethical consistency and integrity.
Without question, equine veterinarians must always consider the welfare of the horse as first and foremost. Those on the panel confirmed that maintaining your veterinary license is far more important than acquiescing to owner demands. The question to ask oneself: Do you want to be popular in the community because you are ethical and look out for the welfare of the horse, or because you are known to bend the rules?
We are reminded that equine practice is a relationship business. Gallagher stressed that true success has to do with the impact one makes on other people’s lives. And beyond the impact on the people with whom you work, you also impact the one who depends on you most for its voice: the horse.
A member of the ethics panel remarked that horses tend to have a way of calling you out when you cut corners. The choice between practicing good medicine versus bad medicine is an overriding concern. Ethically, if the horse is the fundamental client, then what is the best choice for the horse? This tenet can help steer a practitioner’s ethical course.
Gallagher repeated some sage advice given to him at one time: “The choices you make today will define your future and your legacy, so make those choices wisely.”
The open dialogue begun by bringing ethics to the forefront of the conversation at the AAEP Convention will hopefully prompt more ethical behavior. This bolsters not only your practice’s reputation and success, but it adds to the integrity of the equine veterinary industry as a whole.