News update

The updated Code of Conduct

You may be aware that the Podiatry Board of Australia put out a new Code of Conduct this year. It contains advice on a range of issues, including professional boundaries and how to end a professional relationship.

Here are some excerpts to bear in mind.

What the Code of Conduct says on…

The Code on…informed consent

According to Section 4.1 in the Code of Conduct, informed consent is “a person’s voluntary decision about healthcare that is made with knowledge and understanding of the benefits and risks involved”.

The Code goes onto say that, Good practice includes that you:

provide information to patients in a way they can understand before asking for their consent (see Section 3.2 Effective communication)
give the patient enough time to ask questions and make informed decisions
act according to the patient’s capacity for decision-making and consent, including when caring for children and young people, based on their maturity and capacity to understand, and the nature of the proposed care. You should consider the need for the consent of a parent, carer, guardian or other substitute decision maker
get informed consent from the patient or where the patient does not have the capacity, from their parent, carer, guardian or other substitute decision-maker before carrying out any examination or investigation, providing treatment (this may not be possible in an emergency), or involving patients in teaching or research. When obtaining informed consent you should include information on material risks and expected outcomes and take into account any advance care directive (or similar)
get financial consent by discussing fees in a manner appropriate to the professional relationship and addressing the costs of all required services and get general agreement about the level of treatment to be provided, preferably before the service is provided
inform your patients of the benefits, as well as associated costs or risks, when referring them for further investigation or treatment, which they may wish to clarify before proceeding, and
document consent appropriately, including considering the need for written consent for procedures which are of higher risk or may result in serious injury or death.

The Code on….ending a professional relationship

Section 4.7 of the Code has the following to say: In some circumstances, the relationship between a practitioner and a patient may become ineffective or compromised and may need to end. Good practice involves ensuring that the patient is informed adequately of your decision to end the relationship and facilitating arrangements for the continuing care of the patient, including passing on relevant clinical information.

The Code on….personal relationships & professional boundaries

Section 4.8 of the Code emphasises the importance of note taking and getting appropriate consent when it comes to providing care to those in a close personal relationship. It says:

Good practice includes recognising the potential conflicts, risks and complexities of providing care to those in a close personal relationship. Providing care to anyone you have a close personal relationship with, for example close friends, work colleagues and family members, can be inappropriate because of the lack of objectivity, possible discontinuity of care and risks to the practitioner or patient.

If circumstances require you to provide care to someone in a close relationship, for example in an emergency, good practice requires that you:

keep adequate records
maintain confidentiality
carry out an adequate assessment
get appropriate consent to the circumstances which is acknowledged by you and the patient
do not allow the personal relationship to impair clinical judgement
maintain the option to discontinue care at all times, and
if care is discontinued, ensure that you refer the patient when necessary and/or appropriate.

Likewise, the Code has the following to say on professional boundaries, in section 4.9:

Professional boundaries allow you and your patient to engage safely and effectively in a therapeutic relationship. Professional boundaries mean the clear separation that should exist between professional conduct aimed at meeting the health needs of patients and your own personal views, feelings and relationships which are not relevant to the therapeutic relationship.

Professional boundaries are integral to a good practitioner–patient relationship. They promote good care for patients and protect both parties.

Good practice includes that you:

recognise the inherent power imbalance in the patient-practitioner relationship and maintain professional boundaries
be clear about the professional boundaries that must exist in professional relationships for objectivity in care, and avoid conflicts of interest, as well as under or over-involvement
never use your position to establish or pursue a sexual, exploitative or otherwise inappropriate relationship with anybody under your care; this includes those close to the patient, such as their carer, guardian, spouse, or the parent/carer/guardian of a child patient
recognise that sexual and other personal relationships with people who have previously been your patients are usually inappropriate, depending on the extent of the professional relationship and the vulnerability of a previous patient, and
do not express personal beliefs to patients in ways that exploit their vulnerability, or that are likely to cause them distress.

You need to be aware of and comply with any guidelines of your National Board in relation to professional boundaries.

Have questions?

To read the Code of Conduct in full head to Ahpra’s Code of conduct web page. To discuss any related issues, speak to a qualified HR team member on 1300 620 641 or email hrhotline@podiatry.org.au.