E7 - Ethics in Interprofessional Practice
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[00:01:04] Narrator: Okay, welcome Dr. McFarland and Dr. Williams. 
[00:01:14] Dr. McFarland: Welcome to Ethics is Essential and our discussion of ethics in interprofessional practice. Interprofessional collaboration requires a team effort and communication to facilitate decision making about care and intervention for a client, patient, or student who requires the knowledge and expertise of several professionals.
[00:01:41] Whether it is the person with a complex health issue or a child with a phonological disorder who requires an IEP, a well functioning interprofessional team can make a difference. When an interprofessional model is used in educating students in speech language pathology programs, there must be opportunities for the speech language pathology students and students from other disciplines to learn about, from, and with each other.
[00:02:16] This ensures that students from each discipline learn about the principles, the vocabulary, and practices of each of the other disciplines. In an interprofessional team, the team members recognize each member's role, and they value the knowledge and expertise that each brings to the decision. And the discussions that they have ashes certification standards for 2020 include a recommendation that interprofessional practice and interprofessional education be included in students and clinical fellows.
[00:02:57] Supervised clinical experiences ASHA's code of ethics also speaks directly to the ethics of interprofessional relationships and practice. So let me introduce you to our guest for this podcast on ethics in interprofessional collaboration and practice. Dr. Lynn Williams is Associate Dean of Academic Affairs in the College of Clinical and Rehabilitative Health Sciences and Professor in the Department of Audiology and Speech Language Pathology at East Tennessee State University.
[00:03:41] She provides oversight and curriculum development for several allied health professions within her college and is the Interprofessional Education Coordinator. For her college, which is a part of an academic health sciences center that includes 5 health colleges. Dr. Williams participated in the 2017 inaugural interprofessional education collaborative Dean's leadership program.
[00:04:12] She is an ASHA fellow. And from 2016 to 2018, she served as the Vice President for Academic Affairs in Speech Language Pathology for ASHA. She is also a member of the West Virginia University College of Human Resources and Education Hall of Fame, and a Distinguished Fellow of the National Academies Practice.
[00:04:40] She was also an Erskine Fellow at the University of Canterbury in Christchurch, New Zealand in 2011. Lynne, welcome to Ethics is Essential. Thank you so much, Elise. I'm really happy to be part of this podcast. Okay, let's get started. Let me begin by asking you how do speech language pathologists and other healthcare professionals ensure ethical interprofessional collaborative practice as a routine part of practice and care?
[00:05:16] Dr. Williams: That's a really great question, Elise. And it's important to know, first of all, that there is no code of ethics for interprofessional collaborative practice. So each healthcare professional must be familiar with their own disciplines, code of ethics, and then practice within their professional code of ethics.
[00:05:40] Now that said, interprofessional care is essentially ethical because the whole purpose, the whole foundation of interprofessional collaborative practice is to foster better patient outcomes and reduce. costs. And so that's, that's the basis of it, which is essentially ethical. So the motivation of interprofessional collaborative practice is that it promotes the wellbeing of the patient or beneficence, which is to do well by the, by the patient.
[00:06:19] So at least if it's, Okay with you, I'd like to share with you and your listeners in activity that we do here at East Tennessee State University related to ethics and interprofessional education. I think that would be great. Please do. Great. Thank you. So here at East Tennessee State University, we have a well established IPE program that that we've been doing since 1991.
[00:06:49] So we've been doing this for a long time and and our program is both nationally and internationally recognized. So, as an IPE faculty facilitator within our IPE program, we work with teams of about seven to eight Graduate and professional students that include medicine, pharmacy, nursing, public health, and then my college, clinical and rehabilitative health sciences, which includes speech language pathology, audiology, physical therapy, nutrition, and social work.
[00:07:28] So, one of the things that we do as part of this IPE program is we we really teach to the four core competencies that were put forth in 2011 by the Interprofessional Education Collaborative or IPEC. And one of those four core competencies is values and ethics. So in working with our interprofessional student teams, this is one of the first core competencies that we teach.
[00:08:01] And we have an activity that is designed to reflect on ethical codes. And we, we give the students a pre assignment to review their professional code of ethics prior to our team meeting. And then we ask them in the team to discuss similarities and differences among the different members professional codes of ethics.
[00:08:27] And that's a really interesting activity because they get to say, wow, there's a lot of similarities here and then, you know, find some differences, but overwhelmingly find a lot of similarities. Okay. And after they engage in that discussion of similarities and, and differences, we have them do what we call a silent consensus activity to determine what the team members would include in a code of ethics for interprofessional practice in healthcare.
[00:09:01] So we begin this activity by asking each team member to write three to five codes of ethics from their own professional code of ethics on individual post notes. Post it notes. And then we ask them to sort the post it notes silently into common themes on their work table or on the whiteboard. So the team members can move, remove, or point out moves for post it notes, but no one's talking.
[00:09:35] And this continues until consensus is reached and no one's moving any more post it notes. Then the team members discuss what the themes were that they identified in grouping these post it notes. And they consider whether to add outliers to, to what their themes are. And then the final part of this activity is they work together to write an interprofessional ethics statement for each theme on an index card.
[00:10:09] And then these will make up the code of ethics for the interprofessional health care team. So it's really a wonderful activity. Activity for getting them, first of all, to be familiar with their own professional code of ethics, then seeing how there's a lot of similarities across different professions in our codes of ethics, and then work together and say, well, how could we put this together and, and writing an interprofessional code of ethics?
[00:10:41] Dr. McFarland: That is very that's quite an interesting exercise and one It seems to me has an awful lot of benefit for one thing, obviously it is important to know other professions codes of ethics. If you're working with people essentially from other professions, I think it probably enhances the practice. It enhances the the interaction and the communication.
[00:11:11] So that is that's quite an interesting exercise and one that I'm sure helps to, to really prepare the students for interprofessional practice. Very interesting.
[00:11:25] Dr. Williams: Yeah, I was going to say that it was interesting for me as a faculty member to participate in this.
[00:11:31] I mean, how often do we actually get in and read our codes of ethics? And, and then to see how it was similar or different from other professions. So it was interesting for me as a, as a professional and as a faculty member. as well. 
[00:11:50] Dr. McFarland: Very beneficial. All right, let me ask you I have another question for you.
[00:11:57] As speech language pathologists, we may not think about conflict in our workplace or in relation to the, the work that we do, but what could potentially set up an environment in which conflict can occur or be intensified? between speech language pathologists or other, and other professionals in an interprofessional collaboration?
[00:12:25] Another good question, 
[00:12:26] Dr. Williams: Elise. Well, first of all, it's rare that speech language pathologists will work in isolation unless they are in a very remote area. So typically, speech language pathologists will find themselves sitting alongside colleagues from different professions. Transcribed So there are different perspectives about patient outcomes.
[00:12:51] There can be power struggles among team members. A lack of role clarity is something that you had mentioned in your introduction. Lack of understanding about the roles and the scopes of practice. of other providers, and then also stereotyping to other professions are all professional influences that can diminish the contributions of the different members of a health care team.
[00:13:19] And, and then this can lead to limited participation by some of the members in planning care for and with the clients. So, what's what's interesting is that as healthcare professionals, we bring not only our skills and knowledge to patient centered care, but we also work to the fullest extent of the skills and knowledge that are that That are legally allowed to each of our professions.
[00:13:52] So this potentially sets up an environment in which conflict can occur or be intensified between SLPs and other professionals. And, and at least I'll add another thing that I think contributes to conflict, and that's differences in reimbursement policies that can make power sharing between two professions difficult.
[00:14:17] And therefore interprofessional collaboration More challenging to achieve 
[00:14:23] Dr. McFarland: now that I think you've, you've raised some really interesting points. I hadn't really thought about the differences in reimbursement policies. Yeah. Although at you know, without your and my interaction with Asha, we know that that is.
[00:14:40] Reimbursement for services is certainly something that that our ASHA staff is continually working on and concerned about. That's interesting. Can you say a little bit more about this particular point, the differences in reimbursement policies? How, how does that, how can that play out in an interprofessional collaboration?
[00:15:08] Such that it could be problematic for, for the professionals involved in the team. Well, you know, I think that it can 
[00:15:15] Dr. Williams: have a couple of different impacts or consequences. One is, I think there's that power differential, you know, like one profession is valued over another because they get reimbursed more or at a higher percentage than another.
[00:15:31] And, and so particularly in health care, there's a hierarchy, whether, you know, we want to acknowledge it or not. In, in an ideal setting, we're all equal and we all have particular roles to play and, and contributions to make in, in the health care and service provision to our, our patients. But in reality, there is this hierarchy and and.
[00:16:00] The physician is generally at the top of that. And, and I think that that reimbursement issue plays into that hierarchy into that power struggle. The other thing is, is, you know, then if this is value, if this service is valued more than another, then it could impact scheduling. It can impact communication with the patient, their family.
[00:16:26] So I think that it's a very focused aspect, but it can have very broad ripples across the team. And then, you know, there are a couple other things that I wanted to say about conflict here. So ethical differences is an area that will often contribute to tensions between the professions. So this concept of, of professions from different disciplines working together, needing to find common ground.
[00:17:04] And this is an important, and you mentioned this, Elise, in your introduction, and it's going to be a theme that we'll probably talk about throughout this podcast, needing to find common ground in the interest of continuity of care and the consistency of standards. And this is not a new concept.
[00:17:26] So these are the reasons why it's important to have a good understanding of roles and responsibilities, not just within our own discipline, but also of our colleagues in from other professions whom we're working with on a team. So, and, and, and this is another one of those four core competencies.
[00:17:49] So we've already mentioned values and ethics, but rules and response, I mean, roles and responsibilities is a second core concept. And then the the third one is interprofessional communication. And we'll, we'll talk about these again, but I wanted to share with you. And a study that I read recently that did a, an analysis of why professions are different.
[00:18:22] And how, how they're different and identify the most salient differences between the professions. And they found three major reasons. And this, I found really interesting. One is that differences in the concepts, the theories, and the practices that are peculiar to a particular profession can create differences.
[00:18:46] differences between professions. Like, well, why do you think that? Or, you know, why is that important in, in your profession? So that can create differences. A second major reason for differences between professions was the extent to which the professionals use technology as part of their work. And I thought that was interesting because it's like, is that valued more because You're using technology and I'm not, and, and, and that kind of relates to the third major reason that I found really interesting, the degree of the visibility of the interventions.
[00:19:32] For example, medication or testing versus talk therapies or counseling or the kind of work that we do as speech language pathologists. And, you know, I think that this plays into so much about What we hear speech language pathologists talking about, people don't understand what we do, or you know, they think that all we're doing is talking, or how is that helping them to eat?
[00:20:04] You know, how's a speech language pathologist going to help this person be able to eat better? So, You know, communication disabilities have been referred to as the invisible disability because you can't see it like a physical disability where, you know, a person's on a walker or in a wheelchair. You can see that disability, but you can't see a communication disability.
[00:20:32] So I believe that that contributes to. The lack of awareness and lack of understanding of what we do, which then can lead to value differences, can lead to ethical differences and, and ultimately add to conflict. So, I, I thought that these were all interesting components when we think about conflicts that can occur within interprofessional teams.
[00:21:04] Dr. McFarland: And you know, they are, they are all very. Very interesting. All of the, all of the things that you've cited and all of the points that you've made really make me make me very aware of the challenges of preparing our students for interprofessional practice because there are so many things that have to be considered and, and so much information that they need.
[00:21:33] This idea of differences in reimbursement policies, I'm not sure that students coming out of some of our programs are, are aware of that until they get in to the Into the working world and are confronted with it, or things like the difference in the use of technology between professions is something else that you may not have any previous experience with because as a speech language pathologist, you're being educated with other speech language pathologists and in some instances the at least hardware technology that we use at times is at a minimum.
[00:22:18] And so, you're in an interprofessional situation in which there are people who are valued because they do use technology. My goodness, that's, that's certainly something that that a person, especially a new practitioner may not be particularly comfortable with. Prepared for but certainly all good points and gives us a lot of food for thought not only in terms of the practice But also in terms of preparing our students 
[00:22:48] Dr. Williams: Well, you know Elise that goes back to what you were saying in the introduction about interprofessional education is learning from with and about each other So when you're talking about Our students are in classes and all the other students are SLPs, then we're not getting that, that level of understanding and awareness.
[00:23:10] Of course. And you know, I have, I have an exercise if we have time for this. We do. Let's go. Okay, so, I ran across this in some of my reading, too, and, and this is helping to understand maybe some of the, the roles and responsibilities of different professionals as well as what we think about them and, and, in terms of respect and value that can lead to conflict or help us steer away from that.
[00:23:44] So, this one exercise. They gave a list of several different professions, and, and I'm going to limit it to, to three different professional disciplines. OT, physician, and social worker. And so, the first thing is to think about the first three words that come to your mind when you think about each of those professions.
[00:24:10] O. T. physician and social worker and I did this so I can share with you what, what I wrote and not the right answers, but for O. T. I wrote they're, they're caring they're functional. They're resourceful for a physician, I actually had more difficulty writing this one. So the first three words that were coming to my mind, one was focused, they're very focused, busy, and then I wrote, And put in parentheses, authoritarian, and social work social worker, I wrote caring, broad based community.
[00:24:57] So one of the things that this exercise asks you to do after you do this is to think about was one discipline harder to describe than another, was one easier? And why do you think that is? And I shared with you, I found the physician harder, which was kind of surprising because it's like. You know, that's the one that we probably know the most about.
[00:25:22] But I guess I had difficulty in dealing with some of the values that I was associating with them. And then another part of this activity was to look at your, your professions again. So, the three that I have here, OT, physician, social worker, and ask, can you describe in fewer than 10 words, what each practitioner of these professions do.
[00:25:51] And, and that was an interesting exercise too. So, for OT, I wrote functional assessment and treatment of daily living skills. That fell within fewer than 10 words. That was eight words. For the physician, I wrote provide medical assessment and treatment and caring for patients. And that was nine words.
[00:26:17] The social worker, I went 14 words and had to pare it down. I my pare down is support patients. to function well in their home. So what I think that this exercise points out is that first of all, we need to understand the roles and responsibilities of these other professionals. And, and this might be an interesting exercise to, to do with your team to see You know, are we able to describe each other and then check and see, you know, well, let me clarify that or You know, can you explain why you said that like, you know for me saying authoritarian for a physician It's probably reflecting some of my own experience Maybe as a as a patient but also as a team member So interprofessional education helps us in acknowledging, but also setting aside difference and, and power and status of different professions and presenting each profession positively and distinctly, and importantly, agreeing on ground rules.
[00:27:39] So here's that theme that I said will probably be coming up again. So there's a lot in terms of conflict, but knowing and understanding roles and responsibilities is a really good place to start in understanding that. 
[00:27:58] Dr. McFarland: That is, is very, very important. I really like that exercise because it's very doable, but it's also a great opportunity to stimulate thought.
[00:28:11] About the different professions. And even I think sometimes we in, in doing an exercise like this, we're certainly influenced by the people that we know in those professions. But you're right. Understand really understanding what it is that these professionals do and what they're doing.
[00:28:33] Perspectives and talents and gifts are really can make a difference. I remember some years ago being on a neuro rehab, interprofessional team. There were about 10 people. Well, there were 10 people on this team, but the team was come and, and everyone, you know, highly skilled and very proficient, but this team was totally dominated by a neuro by the neurosurgeon.
[00:29:01] Who was a member of the team. And it was very obvious to me in retrospect, I thought he was just kind of a egotistical bully. But what I came to realize was that they, he really did not understand what it was that everybody could bring to that team and the value that they could that they could give.
[00:29:25] And that really was very debilitating. His lack of information about what it is that others could contribute really was very debilitating to the people who were on the team, as well as it really did influence some of the decisions that were made. So really understanding what it is that people.
[00:29:49] can bring and, and what they can offer becomes really important in terms of the functioning of the team and the morale. That's another thing. And team morale. And when team morale is not high, not good, not positive, it does influence the team. the workings of the team and can influence the outcomes for the patient, actually.
[00:30:16] Dr. Williams: Absolutely. 
[00:30:17] Dr. McFarland: So let's move on. I have another another question for you. Interprofessional collaboration and teamwork allows us as speech language pathologists to work closely with colleagues from other professions. Each profession has its own code of ethics, its own vocabulary, Is it possible for competition to arise between members of an interprofessional team who have viewpoints that are guided by their different professions, their different values and different beliefs?
[00:30:53] Dr. Williams: Yes. So this kind of goes in line with the last question on conflict. And the answer is yes. Yes, competition can arise and it arises because each individual on the interprofessional team comes with different viewpoints that are guided by the values and beliefs of, of each team member. So, so this, you can see would set up potential for tension and conflict within the interprofessional team.
[00:31:27] So, we're going to go back to roles and responsibility. And there's overlap it's not distinct that, you know, this professional always and only addresses these areas and another one these areas and there's no overlap. So the overlap between roles, accountabilities, and even tasks become apparent in the intersection between professions.
[00:31:57] So in, in our own profession, think about dysphagia. So we, This is certainly within our scope of practice, but it's also within the scope of practice of OTs. What about nursing? Why about dieticians? So, you can see where there's going to be competition there. And the difficulty that many of us face is the lack of understanding about the fundamental differences in the roles and responsibilities, as we've already talked about.
[00:32:33] And then the value positions among the different professionals. So if I could go back to the exercise I think that it might help us in, in, in maybe digging a little deeper and understanding the values. So we talked about roles in the last part of the exercise, but let's think about values here.
[00:32:58] So if we go back to the three professions we talked about, OT, physician, and social worker, think about the value positions in each of these professions. So what do doctors value? What do OTs value? And what do social workers value? And again, I'll share my answers. To me, I said doctors value health. OTs, I put value functional activities of daily living.
[00:33:35] And social workers value mental health. So you can see where, when there are differences in values, that's where those professionals are going to be focused on. So the physician's going to be focused on health, but may not be as, as focused on activities of daily learning. And so there might be some competition or conflict there between the OT and the physician where the OT is saying, but we need to be able to do this.
[00:34:10] And the physician's like, well, the patient's healthy, they can return home. So that also helps us in understanding the roles and responsibilities a little more, but it also helps us to, understand the values of each of these professions, maybe to be able to clarify them with each other, because that's going to impact respect.
[00:34:37] So if we don't understand the differences in values, in addition to differences in roles, that can impact respect. So, as part of the process of Interprofessional collaborative practice, we need to be exploring dealing with difference while simultaneously searching for common ground. So. That's, that's where we need to come.
[00:35:08] We need to understand what the differences are and then work towards searching for common ground. 
[00:35:15] Dr. McFarland: You know, you mentioned the term overlap, the fact that there is overlap, can be overlap. In our scopes of practice and duties depending on between professions. So lemme set up a scenario that calls for some problem solving and in a professional, in an interprofessional team situation where we do see some overlap.
[00:35:42] So you can give your guidance on how to respond to a situation such as the one that I'm going to pose. So here we go. You're a new speech language pathologist at a hospital that has a reputation for strong interprofessional teamwork. You've been at the hospital for a month and you've worked with a couple of interprofessional teams.
[00:36:05] Today you're on the rehab unit and a new patient is admitted who's recovering from a stroke. The care team is a physiatrist, a nurse, a physical therapist, Occupational Therapist, and yourself, the Speech Language Pathologist. The physiatrist has written an order for a swallowing evaluation. But when you go to see the patient, you learn from the nurse that the occupational therapist will be doing the evaluation.
[00:36:38] You were recently on a team with the occupational therapist, and it was a very successful experience. You don't want to rock the boat? But you think the swallowing evaluation is your territory. What do you do and what are the ethical issues that could arise in a situation like this? 
[00:36:59] Dr. Williams: Okay. Well, that is a real life scenario that you, you have just given.
[00:37:07] So for this one, I think we need to think about principle one in our code of ethics, which is hold paramount. The welfare of the persons we serve, or in other words, our patients come first. So, if we go back and we look at the four core competencies from IPAC, the Interprofessional Education Collaborative, those are roles and responsibilities.
[00:37:37] Values and ethics teams and teamwork and interprofessional communication, and let's see how those four core competencies might play out. So first of all, as I already mentioned, dysphagia is within the scope of practice for occupational therapists. So we have an overlap in the roles and responsibilities of the speech language pathologist and the occupational therapist.
[00:38:07] So we'll need to clarify the roles and responsibilities. who's going to do what, and who's going to be responsible. And this is going to involve interprofessional communication in order to provide ethical care and work effectively within the team. So there's the teams and teamwork. Now sometimes rehab departments will have a distinct scope of practice that they have already outlined.
[00:38:40] Who's going to do what? So you may want to consult that first to see if that is specified. If, if they have, then you may want to consult with the director of rehab, about dealing with this order from the physiatrist. Now, if there is no distinct scope of practice in the hospital, then you'll want to determine what the OT's qualifications are with regard to their specific training for dysphagia and patients who have this particular diagnosis.
[00:39:14] So you said that You know, this, in this scenario, the SLP had worked with OT in doing a dysphagia evaluation and it had been very successful. So, so you might already have some experience that you have confidence in this OT's ability, but was it a different patient? Do you feel like they would be able to handle this one?
[00:39:38] So you can go to the OT and clarify who does what. And you can also have a conversation with the physiatrist and talk to him or her about what the training, qualifications, and certification are for speech language pathologists to clarify what your role is and what you can bring to this, just so that he or she is aware.
[00:40:06] This is certainly within my scope of practice as well. And talk about how you can work with the OT, and maybe in terms of caseload management, that one takes a lead and one takes a follow up or something. But paramount in all of this is patient safety. And in addition to that, you'll want to maintain a collegial collaborative relationship with the OT, the physiatrist, and the other members of, of the team.
[00:40:40] By the way, I looked up the Association of Occupational Therapists, the American Association of Occupational Therapists their code of ethics, and guess what? They had patient well being as their principle one, just like we do. So, this will provide the common ground to begin a conversation and, and one other thing that I found is that in order to promote an interprofessional approach to ethics, it's necessary to look for the common ground and professional values, which are often enshrined in our professional code of ethics and statements like the Hippocratic Oath.
[00:41:24] So that's, that's kind of the common ground that we want to search for and work towards. 
[00:41:32] Dr. McFarland: So, interesting and, and very instructive because that is certainly something that a speech language pathologist in even in the schools, but in the schools and health and SNFs in hospital practice could certainly run into.
[00:41:48] And so that's great guidance for how it is that you negotiate that type of Of an issue. 
[00:41:55] Dr. Williams: How, go ahead. It's interesting how those four core competencies come into play. The values and ethics, the roles and responsibilities, the teams and teamwork, the interprofessional communication, how those are all interwoven in that one scenario.
[00:42:14] Dr. McFarland: That is interesting. And you know, those, those four core competencies be I think in an, especially in an inter, in an interprofessional. Situation become very important and certainly ones that we can look to in terms of determining. How it is that people should interact, but also how it is that people can negotiate differences and and issues that can occur.
[00:42:41] All right, let's go on to something else. Those of us who have worked with. With interprofessional teams, know that respect for the individual team members and for their contributions to the team and to the client's care are very important. So I want to ask you three questions. The first is, What is the impact of lack of respect within an interprofessional team?
[00:43:11] Dr. Williams: Well, you know, we've already touched on this a little bit and I believe that lack of respect will have the greatest impact on communication and communication within the team and communication with the patient. can be negatively impacted if there's a lack of respect within the interprofessional team.
[00:43:36] And, and this can impact not only the care of the patient, but it can negatively impact workplace morale. And I think you've mentioned that earlier too. And, and it also has the potential to create a toxic culture within that the team is working in and, and that can be very stressful. But ultimately, it's going to impact patient care.
[00:44:04] Dr. McFarland: Now my second question is, what is likely to happen to relationships and communication if there isn't respect? But I think you've, I think you've pretty much covered that. So let me go on to, to my next question. And that is, if in fact There is a respect issue. What is the best course of action? If a team member finds it, it difficult for whatever reason to respect a member of the interprofessional team.
[00:44:36] Dr. Williams: Okay, well, as, as you said, we've already talked about how a lack of respect can have a detrimental impact. Effect on relationships and communication and and the reason is that collaboration is a relational process, right? So, relationship and respect are reflected strongly in interprofessional collaboration.
[00:45:04] And if you have a lack of respect, it's likely that the team member will withdraw or limit or stop contributing to to the team. So, in terms of the best course of action, I think that we have to go back again to roles and responsibilities. So, respect. Fact in interprofessional teams may be impeded by a lack of understanding of the roles of the team members and, and may not necessarily be related to power struggles or to competition, but just lack of understanding what their roles and responsibilities are.
[00:45:46] So this could be address. through education, you know, at least in our IPE program and the, and the IPE team, student teams I've worked with. Just, just recently I had one of our graduate students in SLP say, well, she felt disrespected by one of the team members who was a med student. Who said, why are you even here?
[00:46:13] I thought that you only worked with R and and it was very disrespectful, but, you know, I said, use this as an opportunity to educate to let them know, well, let me tell you what we do. That is one part of what we do, but it's so much broader than that. And then advocate for your profession. So that's one thing. Also respect for others begins. With respect for ourself and what contributions were able to bring to the team. So, if you don't have the self respect, it's, it's, it's, it's going to impact the team and they're not going to have fun. If you don't have it for yourself, it's going to be hard for others to have it for you.
[00:47:08] And then, again, going back to the core competencies of roles and responsibilities, values and ethics, teams and teamwork, and interprofessional education. That's, that's going to be the key to how to address this. And, and partnership will arise out of common goals, and common interests. So I'm going back to that theme of, of common ground.
[00:47:37] We need to work to find common ground. And we can do this by thinking about Aristotle's virtue ethics, that good people do good things. If we can start at that level, it'll help us in finding that common ground. 
[00:47:57] Dr. McFarland: That's that's a great way, I think, to a great kind of closing thought good people do good things, and I think, obviously, if we take that perspective into whatever it is that we do, whether it's interprofessional teams or whatever, that that really can serve us quite well.
[00:48:17] I, I was really impressed with your saying that we have to respect ourselves as professionals. I think that especially in an interprofessional team situation, that is so important. We have to respect ourselves as speech language pathologists. We have to represent What it is that we do, we have to be really clear about what our scope of practice is and what our capabilities are, because in many instances, people really are not as familiar.
[00:48:53] With speech language pathologists roles and abilities and scope of practice as they may be others. So I think that's very important especially when you're new on the team to be really clear about what, what your contribution can be, I think is, is very important. Excellent, excellent point.
[00:49:17] Okay, let's talk for a minute about interprofessional teaming in a school practice. So I have another scenario for you. You're a speech language pathologist who is the only SLP at Bowley Elementary School. You're working on a team with an occupational therapy aide, a nurse, and a physical therapist.
[00:49:41] The team provides treatment for an eight year old who is on the autism spectrum. You have co treated with the occupational therapy aid and the physical therapist, and you've noticed that the occupational therapy aid signs for his supervisor on the Medicaid billing reports. You ask him if he's permitted to do that, and he assures you that he is.
[00:50:05] But you know, that's not allowable. Do you have an ethical responsibility here? And if so, what is it? 
[00:50:15] Dr. Williams: Okay. And you know what, these scenarios that you've come up with, Elise, are really everyday common kinds of occurrences. So I'm, I'm really pleased that you, you have asked this. And I, I kind of have an immediate answer and then kind of a broader answer.
[00:50:34] In terms of the immediate answer to this particular scenario, there's really no gray area here. It is not ethical for the OTA to sign for his supervisor on Medicaid billing reports. And, and it may be that he's just not aware of that requirement. But you can, you would have to at least speak to his supervisor or your own supervisor.
[00:51:02] And then if no one acts, then you're going to need to go to your state licensure board. So this is a tough situation, but it's a very clear one in terms of that's, that's not acceptable. That is unethical. Now, the broader thing, question or answer to this. Barb Jacobson, who is the Vice President for Standards and Ethics on the ASHA Board of Directors, shared this with me.
[00:51:35] It's called the Ethics Calibration Quick Test. It's been around for a number of years. It was it was written by Charlene Seymour in 1992. for in Fred Silverman's Professional Issues in Speech Language Pathology and Audiology book. And so this has six steps of questions that guide you in deciding whether an issue is an ethical or legal violation.
[00:52:06] And then it asks what values are in conflict. Then the third question or step is, well, what's the evidence in this, in this situation. And then the fourth step or question is, what are the courses of action that you can take? And then the fifth step or question is, whose best interest is involved in this situation.
[00:52:36] And and then the, the sixth step and final question is, how will I feel about myself today and tomorrow? So I think that this is a really helpful guide to going through when you're thinking, I'm not sure about this. So in this scenario, if you apply that, what is the problem, the conflict or dilemma?
[00:53:02] Is it a professional or legal violation? You, you know, that, that, that is fraudulent billing. So you can't, that's, that's a legal violation. And then what values are in conflict it's in terms of signing for something that, a service that was not signed off by the appropriately credentialed person, supervisor. What is the evidence? Well, the evidence is this OTA signing the Medicaid billing reports. What are the courses of action I could Take, well, you could talk to the OTA and, and say, are you aware that that is not legal? And, you know, we can speak to your supervisor about it if you would like. So talking to his supervisor, and then you could also talk to your supervisor.
[00:54:05] And then In terms of whose best interest is the decision well, you know, since this is more of a legal issue, it could impact the services being closed down because of billing fraud so, you know, It's, it's impacting that professional service, which would then ultimately impact the patients who would not be able to receive that service in that school.
[00:54:36] And and then how will you feel about yourself? Today and tomorrow and you know, you might be feeling uncomfortable and having to do it. But if you did nothing, how would you feel? So you can deal with some discomfort. That's more short term. Whereas in the long term, you know that you're doing the right thing.
[00:54:58] That's legal and ethical. 
[00:55:01] Dr. McFarland: Excellent. Excellent. Excellent. So, not only is this not legal. What he is doing is not legal, but I think your point about jeopardizing the services for others who can benefit is a very important a very important one. And, you know, I think that if you're confronted with A situation like this it takes a lot probably to make a decision to act especially if you know the person and you've worked with them and you consider them a colleague.
[00:55:36] But I think the idea that what this person is doing could jeopardize the services for others who really do need them can be something that can be a problem. That can help you help you make the right decision. And also, thank you so much. I wasn't aware of the ethics calibration quick test and those sound like 6 really simple, straightforward questions that the answers to which could certainly help you make a decision about the ethics of a particular situation.
[00:56:15] So that's a great a great resource for our listeners to have. Yes. 
[00:56:21] Dr. Williams: I was really happy that Barb shared this with me because, you know, sometimes these ethical dilemmas can kind of be like this big ball of yarn that it's, I'm not sure how to Sort this out, where to start, who to talk to, and this really lays it out for you step by step and and, and determining what you need to do and how you need to do it.
[00:56:49] Dr. McFarland: Very good point. Excellent point. Well, I want to thank you so very much for being with me today. You've provided us with a lot of information and ideas and an awful lot to think about. I know that our listeners will benefit from what you've given us on the topic of ethics and ethical practice in interprofessional practice.
[00:57:17] Thank you so much, Lynn, for being with us today. 
[00:57:20] Dr. Williams: My pleasure. Thank you, Elise. 
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