Principles of Professional Conduct
Adopted July 2006
Revised February 2013
Introduction
These guidelines for ethical behavior address the demands of contemporary
foot and ankle surgical practice. The American College of Foot and Ankle
Surgeons (College) developed the Principles of Professional Conduct for
the benefit of our patients as well as to serve as a guide to conduct in the
physician-patient relationship. The Principles provides standards of conduct
that define the essentials of expected behavior for the foot and ankle surgeon.
The mission of the College is to advance the competency of foot and ankle
surgeons and the care of their patients by providing continuing education,
publishing research and serving as a source of information to the public. Foot
and ankle surgeons should recognize that they are role models for residents,
surgeons-in-training and other health care professionals and should by their
deeds and actions comply with the College’s Principles of Professional
Conduct.
- The Physician-Patient
Relationship
- Personal Conduct
- Conflicts of Interest
- Maintenance of Competence
- Relationships with Foot and Ankle Surgeons and
Health Professionals
- Relationship to the Public
- Advertising and Solicitation
- Principles of Care
- Research and Academic
Responsibilities
- Community
Responsibility
I. The Physician-Patient
Relationship
- The foot and ankle surgical profession exists for the primary purpose of
caring for the patient. The physician-patient relationship is the central focus
of all ethical concerns.
- The physician-patient relationship has a contractual basis and is based on
confidentiality, trust and honesty. Both the patient and the surgeon are free to
enter or discontinue the relationship within any existing contractual
constraints. A foot and ankle surgeon has an obligation to render care only for
those conditions that he or she is competent to treat. In the absence of a
pre-existing physician-patient relationship, the foot and ankle surgeon is under
no ethical obligation to care for a person unless no other provider is
available. A foot and ankle surgeon is morally bound to provide care in
emergency situations and to arrange proper follow-up. Foot and ankle surgeons
should keep in mind that contracts with health insurance plans might define a
legal obligation to provide care to certain patients.
- Foot and ankle surgeons should not discriminate against classes or
categories of patients in the delivery of needed health care. Such classes and
categories include gender, color, creed, race, religion, age, ethnic or national
origin, political beliefs, and nature of illness, disability, socioeconomic
status or sexual orientation.
- A foot and ankle surgeon should render services to the best of his or her
ability. Having undertaken the care of a patient, the foot and ankle surgeon may
not neglect that person. Unless discharged by the patient, and if further
surgical service is needed, the surgeon may discontinue service only after
giving adequate notice to the patient so that the patient can secure alternative
care. The foot and ankle surgeon should transfer records, if requested. Managed
care agreements may contain provisions which alter the method by which patients
are discharged. If the enrollment of a physician or patient is discontinued in a
managed care plan, the physician will have an ethical responsibility to assist
the patient in obtaining follow-up care.
- Foot and ankle surgeons have a duty to protect and foster an individual
patient’s informed choices. The doctrine of informed consent means that surgeons
provide adequate information that is comprehensible to a competent patient or
patient surrogate. At a minimum, this should include the nature of the medical
condition, the objectives of the proposed treatment, treatment options, possible
outcomes and the risks involved. Foot and ankle surgeons should be committed to
the concept of shared decision making, which involves assisting patients in
making decisions that account for medical, situational and personal
factors.
- Foot and ankle surgeons should maintain confidentiality. Because written,
electronic and verbal information may be intercepted or overheard, surgeons
should always be aware of anyone who might be monitoring communication about a
patient. Foot and ankle surgeons need to abide by all laws pertaining to privacy
and confidentiality and should choose methods of storage and transmission of
patient information that minimize the likelihood of data becoming available to
unauthorized persons or organizations, including social media. Foot and ankle
surgeons have an obligation to keep information in the patient’s medical record
confidential. Information should be released only with the written permission of
the patient or the patient’s legally authorized representative. Specific
exceptions to this general rule may exist (e.g., workers compensation,
communicable disease, HIV, knife/gunshot wounds, abuse, and substance abuse). It
is important that a foot and ankle surgeon be familiar with and understands the
laws and regulations in his or her jurisdiction that relate to the release of
information. Both ethically and legally, a patient has certain rights to know
the information contained in his or her medical record. While the chart is
legally the property of the practice or the institution, the information in the
chart is accessible by the patient.
II.
Personal Conduct
- The foot and ankle surgeon should maintain a reputation for truth and
honesty. In all professional conduct, the foot and ankle surgeon is expected to
provide competent and compassionate patient care, exercise appropriate respect
for other health care professionals and maintain the patient’s best interests as
paramount. Foot and ankle surgeons should not misrepresent directly or
indirectly, their skills, training, professional credentials, board
certification status or identity. Foot and ankle surgeons should uphold the
dignity of the profession and accept its ethical values.
- The foot and ankle surgeon should respect the law, uphold the dignity and
honor of the profession and accept the profession’s self-imposed discipline.
Within legal and other constraints, if the foot and ankle surgeon has a
reasonable basis for believing that a physician or other health care provider
has been involved in any unethical or illegal activity, he or she should attempt
to prevent the continuation of this activity by communicating with that person
and/or identifying that person to a duly-constituted peer review authority or
the appropriate regulatory agency. In addition, the foot and ankle surgeon
should cooperate with peer review and other authorities in their professional
and legal efforts to prevent the continuation of unethical or illegal
conduct.
- Foot and ankle surgeons have an ethical responsibility to protect patients
and the public by identifying and assisting impaired colleagues. “Impaired”
means being unable to practice medicine with reasonable skill and safety because
of physical or mental illness, loss of motor skills or excessive use or abuse of
drugs and alcohol. Foot and ankle surgeons should be able to recognize
impairment in physician partners and other health care providers and should seek
assistance from appropriate resources to encourage these individuals to obtain
treatment. It is ethical for a surgeon to take actions to encourage colleagues
who are chemically dependent to seek rehabilitation.
- When using the Internet for social networking, either personal or
professionally, foot and ankle surgeons should use privacy settings to safeguard
personal content or information, with the understanding that privacy settings
have limited effectiveness and once content is posted it is often times
irretrievable. Foot and ankle surgeons should self-monitor their online presence
to ensure information on their own sites, and to the extent possible, content
posted about them by others, is accurate and appropriate. To maintain
appropriate professional boundaries, foot and ankle surgeons should separate
personal and professional online access and content. Foot and ankle surgeons
(including students, residents, and fellows) should recognize that online
actions and content may negatively affect their reputations, careers, and public
trust in the podiatric profession.
III. Conflicts of Interest
- The practice of medicine inherently presents potential conflicts of
interest. Foot and ankle surgeons should place service to patients before
personal material gain and should avoid undue influence on their clinical
judgment. When a conflict of interest arises, it must be resolved in the best
interest of the patient. The foot and ankle surgeon should explore reasonable
alternatives to ensure that the most appropriate care is provided to the
patient. If the conflict of interest cannot be resolved, the foot and ankle
surgeon should notify the patient of the conflict and offer to withdraw from the
relationship.
- If the foot and ankle surgeon has a financial or ownership interest in a
durable medical goods provider, imaging center, surgery center or other health
care facility where the surgeon’s financial interest is not immediately obvious,
the foot and ankle surgeon must disclose this interest to the patient. The foot
and ankle surgeon has an obligation to know the applicable laws regarding
physician ownership, compensation and control of these services and
facilities.
- When a foot and ankle surgeon receives anything of significant value from
industry, an actual or potential conflict exists which should be disclosed to
the patient. When a foot and ankle surgeon receives inventor royalties from
industry, the surgeon should disclose this fact to the patient if such royalties
relate to the patient’s treatment. It is unethical for a foot and ankle surgeon
to receive monetary compensation from industry for using a particular device or
medication. Reimbursement for reasonable administrative costs in conducting or
participating in a scientifically sound research clinical trial is acceptable.
Acceptance of gifts, trips, hospitality or other items is discouraged.
- A foot and ankle surgeon reporting on clinical research or experience with a
given procedure or device must disclose any financial interest in that procedure
or device if the surgeon or any institution with which that surgeon is connected
has received anything of value from its inventor or manufacturer.
- Except when inconsistent with applicable law, foot and ankle surgeons have a
right to dispense medication, assistive devices, orthopedic appliances and
similar related patient-care items, and to provide facilities and render
services as long as their doing so provides a convenience or an accommodation to
the patient without taking financial advantage of the patient. Ultimately, the
patient must have the choice of accepting the dispensed medication or
patient-care items or obtaining them outside the office.
IV. Maintenance of
Competence
The foot and ankle surgeon should continually strive to maintain and improve
medical knowledge and skill and should make available to patients and colleagues
the benefits of his or her professional attainments. Each foot and ankle surgeon
should participate in continuing medical educational
activities.
V. Relationships with Foot and
Ankle Surgeons and Health Professionals
- Good relationship among physicians, nurses and other health care
professionals are essential for quality patient care. The foot and ankle surgeon
should promote the development of an expert health care team that will work
together harmoniously to provide optimal patient care.
- The professional conduct of the foot and ankle surgeon will be scrutinized
by professional associations, hospital(s), managed care organization(s), peer
review committees and state medical and/or licensing boards. These groups
deserve the participation and cooperation of foot and ankle surgeons.
- When foot and ankle surgeons see Internet content posted by colleagues
that appears unprofessional, they have a responsibility to bring that content to
the attention of the poster, so he or she can remove it or take other
appropriate action. If the behavior significantly violates professional norms
and the poster does not take appropriate action to resolve the situation, the
foot and ankle surgeon should report the matter to appropriate
authorities.
- Foot and ankle surgeons are frequently called upon to provide expert medical
testimony in courts of law. In providing testimony, the foot and ankle surgeon
should ensure that the testimony provided is non-partisan, scientifically
correct and clinically accurate. The foot and ankle surgeon should not testify
concerning matters about which he or she is not knowledgeable. It is unethical
for a foot and ankle surgeon to accept a contingency fee based on the outcome of
a case in which testimony is given or derive personal, financial or professional
favor in addition to compensation. See ACFAS Expert Witness Testimony
Standards.
VI. Relationship to the
Public
- Professional fees should be commensurate with the services provided. Foot
and ankle surgeons should submit billing codes that reflect the levels of
service or complexity that were provided. It is unethical for surgeons to charge
for services not rendered.
- Foot and ankle surgeons are encouraged to devote some time and work to
provide charity care for individuals who have no means of paying.
- The foot and ankle surgeon may enter into a contractual relationship with a
group, a prepaid practice plan or a hospital. The physician has an obligation to
serve as the patient’s advocate and to ensure that the patient’s welfare remains
the paramount concern.
- The focus of managed care organizations on cost containment and resource
allocation can present ethical challenges. Foot and ankle surgeons should
actively resist managed care policies that restrict free exchange of medical
information. A surgeon should not withhold information about treatment options
simply because the option is not covered by a particular managed care
organization. Foot and ankle surgeons should always act in the best interests of
their patients and as an advocate when necessary.
- The foot and ankle surgeon should neither accept nor offer commissions in
any form or manner on fees for professional medical services, referrals,
consultations, pathology services, radiology services, prescriptions or other
services or article supplied to patients. Division of professional fees or
acceptance of rebates from fees paid by patients to radiological, pathological,
laboratory, shoe stores or other establishments is wholly
inappropriate.
VII. Advertising and
Solicitation
- The foot and ankle surgeon should not publicize himself or herself through
any medium or form of public communication in an untruthful, misleading, or
deceptive manner. This includes falsely advertising the status of one’s
membership in the College (i.e. advertising as a Fellow when Associate status is
proper). The foot and ankle surgeon has a responsibility to properly represent
him or herself with regard to training, ability, board certification and scope
of practice.
- The foot and ankle surgeon, in connection with his or her name, must use the
title(s), degree(s), or designation(s) authorized by individual state law. The
title “doctor” or any abbreviation cannot be used in advertising without the
qualification “podiatrist,” “podiatric physician,” or “Doctor of Podiatric
Medicine,” or other appropriate designation. Foot and ankle surgeons are, by
their nature, certified by a specialty board and may use the appropriate term in
connection with his or her specialty.
- A foot and ankle surgeon may advertise through public communications media
such as professional announcements, telephone and medical directories, social
media, Internet web pages and broadcast and electronic media. Types of useful
information that could be included in ethical advertising include a statement as
to specialty board certification; services provided under specified private or
public insurance plans or health care plans; names of schools and postgraduate
clinical training programs from which the surgeon has graduated together with
degrees received; a listing of publications in educational journals;
affiliations with hospitals or clinics; and a statement as to whether the
surgeon regularly accepts installment payments of fees, credit cards and/or
other available financing options. This list is illustrative and should not be
interpreted as excluding other relevant information consistent with ethical
guidelines.
- A foot and ankle surgeon shall not compensate or give anything of value
directly or indirectly to a representative of the press, radio, television or
other communication medium in anticipation of or return for recommending
services or for professional publicity. A foot and ankle surgeon may pay the
reasonable cost of advertising, shall approve all advertisements before
dissemination or transmission and shall retain a copy or record of all such
advertisements in their entirety, including content posted online and via social
media. A foot and ankle surgeon shall be held personally responsible for any
violation incurred by public relations, advertising or similar firm which he or
she retains, or any entity that advertises on his or her behalf.
- A foot and ankle surgeon shall not initiate contact with a prospective
patient knowing that the physical, emotional or mental state or degree of
education of the person solicited is such that the person could not exercise
reasonable judgment in employing a surgeon.
F. A foot and ankle surgeon who
has given unsolicited, in-person advice to a layperson that the individual
should have medical or health care shall not accept employment resulting from
that advice if the advice embodies or implies a statement or claim that is
false, fraudulent, deceptive or misleading; involves the use by the of undue
influence, coercion, duress, harassment, intimidation, unwarranted promises of
benefits, over-persuasion, overreaching, or pressure for immediate response; or
if the surgeon has been given notice that the individual non-patient does not
want to receive said communication.
VIII. Principles of Care
- A foot and ankle surgeon should practice only within the scope of his or her
personal education, training and experience. If a foot and ankle surgeon
contracts to provide comprehensive lower extremity care, then he or she has the
obligation to ensure that appropriate care is provided in areas outside of his
or her personal expertise.
- It is unethical to prescribe, provide, or seek compensation for unnecessary
services. It is unethical to prescribe controlled substances when they are not
medically indicated.
IX. Research and Academic
Responsibilities
- All research and academic activities must be conducted under conditions of
full compliance with ethical, institutional and government guidelines. Patients
participating in research programs must have given full informed consent and
retain the right to withdraw from the research protocol at any time.
- Foot and ankle surgeons should not claim as their own intellectual property
that which is not theirs. Plagiarism or the use of others' work without
attribution is unethical. Violating copyright law may have legal consequences.
When submitting a document for publication, any previous publication of any
portion of the document must be fully disclosed.
- The principal investigator of a scientific research project or clinical
research project is responsible for proposing, designing and reporting the
research. The principal investigator may delegate portions of the work to other
individuals, but this does not relieve the principal investigator of the
responsibility for work conducted by the other individuals. The principal
investigator or senior author of a scientific report is responsible for ensuring
that appropriate credit is given for contributions to the research
described.
X. Community
Responsibility
- The honored ideals of the medical profession state that the responsibility
of the foot and ankle surgeon extends not only to the individual but also to
society as a whole. Activities that have the purpose of improving the health and
well-being of the patient and/or the community in a cost-effective way deserve
the interest, support and participation of the foot and ankle surgeon.
- Foot and ankle surgeons have the dual duty to respect the law and to work
for the health, well-being and the best interest of both the patient and the
community. In general, foot and ankle surgeons should be committed to upholding
and enhancing community values, be aware of the needs of the community and use
the knowledge and experience acquired as professionals to contribute to an
improved community.
Any member charged with a violation of any ethical standard set forth herein
may be subject to disciplinary measures, including censure, suspension or
expulsion, as described in Article 11 of the College’s Bylaws.