D. Professionalism

1. A lack of integrity in your practice can adversely affect patient care. Some examples are:
   1. putting your own interest above your duty to your patient
   2. subjecting a patient to an investigation or treatment that is unnecessary or not in their best interests
   3. deliberately withholding a necessary investigation, treatment or referral
   4. prolonging treatment unnecessarily
   5. putting pressure on a patient to obtain other professional advice or to purchase a product
   6. recommending a professional service or product solely for financial gain
   7. borrowing money from patients or accepting any other benefit that brings you financial gain.
2. You should not allow misleading advertising or information about you and your practice. You should make sure that:
   1. Your advertising and promotional material, including website content, is legal, decent, honest and truthful as defined by the advertising standards authority (ASA) and conforms to current guidance, such as the UK Code of Non-broadcast Advertising and Direct and Promotional Marketing (the CAP code).
   2. The information you provide about your professional qualifications, practice arrangements and the services you provide is of a high standard and factually accurate.
   3. You do not use any title that implies you are a licensed medical practitioner if you are not; if you use the title ‘doctor’ because you have a PhD, other doctorate or you qualified as a medical doctor but you do not have a licence to practise, you should make this clear to patients and others.
   4. You do not generate publicity so frequently or in such a manner that it becomes a nuisance or puts those to whom it is directed under pressure to respond.
3. You must have a professional indemnity insurance arrangement which provides appropriate cover in accordance with the requirements of the Osteopaths Act 1993 and the current Professional Indemnity Insurance Rules.

1. Abuse of your professional standing can take many forms. The most serious abuse of your professional standing is likely to be the failure to establish and maintain appropriate boundaries, whether sexual or otherwise.
2. Appropriate professional boundaries are essential for trust and an effective therapeutic relationship between osteopath and patient. Professional boundaries may include physical boundaries, emotional boundaries and sexual boundaries. Failure to establish and maintain sexual boundaries may, in particular, have a profoundly damaging effect on the patient, is likely to bring the profession into disrepute and could lead to your removal from the GOsC Register.
3. Not all crossing of professional boundaries will necessarily be an abuse of your professional standing. For example, sometimes it may support empathy and trust with a patient to disclose personal information or to treat a patient as an emergency outside your usual hours. However, there is a spectrum, and osteopaths must ensure that patients who may be vulnerable are protected at the time and throughout the duration of the professional relationship.
4. You should be aware of the risks to patients and to yourself of engaging in or developing social or commercial relationships with patients, and the challenges which this might present for the therapeutic relationship and to the expectations of both patient and professional. You should also be aware of the risk of patients developing an inappropriate dependency upon you, and be able to manage these situations appropriately, seeking advice from a colleague or professional body as necessary.
5. When establishing and maintaining sexual boundaries, you should bear in mind the following:
   1. words and behaviour, as well as more overt acts, may be sexualised, or regarded as such by the patient. Examples might include:
      1. sharing inappropriate intimate details about yourself
      2. visiting a patient’s home without an appointment
      3. making inappropriate sexual remarks to or about patients
      4. unnecessary physical contact.
   2. You should avoid any behaviour which may be construed by a patient as inviting a sexual relationship or response.
   3. Physical contact for which valid consent has not been given can amount to an assault, leading to criminal liability.
   4. It is your responsibility not to act on feelings of sexual attraction to or from patients.
   5. If you are sexually attracted to a patient or if a patient displays sexualised behaviour towards you, you should seek advice from, for example, a colleague or professional body on the most appropriate course of action. If you believe that you cannot remain objective and professional or that it is not possible to re-establish a professional relationship, you should refer your patient to another healthcare practitioner. If referring a patient because of your own sexual feelings towards them, you should endeavour to do so in a way that does not make the patient feel that they have done anything wrong.
   6. You must not take advantage of your professional standing to initiate a personal relationship with a patient. This applies even when the patient is no longer in your care, as any personal relationship may be influenced by the previous professional relationship and an imbalance of power between the parties.
   7. You must not end a professional relationship with a patient solely to pursue a personal relationship with them.
   8. If you think that a personal relationship with a former patient might develop, you must consider whether this is appropriate. Factors that might impact on this include:
      1. the nature of the previous professional relationship
      2. the length of time the professional relationship lasted, and when it ended
      3. whether the former patient was particularly vulnerable at the time of the professional relationship, and whether they might still be vulnerable.
   9. Osteopaths who practise in small communities may find themselves treating friends or family. In such cases, establishing and maintaining clear professional boundaries will help you ensure that your clinical judgement is objective and that you can provide the treatment your patients need. The same level of care should be given to all patients, whether you know them in a social or other capacity, or not.

1. If something goes wrong with a patient’s care which causes, or has the potential to cause, harm or distress, you must tell the patient, offer an explanation as to what has happened and the effects of this, together with an apology, if appropriate, and a suitable remedy or support.
2. You must also be open and honest with your colleagues and/or employers, where applicable, and take part in reviews and investigations when requested.

1. A complaint is an opportunity to reflect on the communication and standard of care that was given, and it may highlight areas of your practice that could be improved. A complaint which is handled well can also result in a stronger bond of trust between you and your patient, leading to improved patient care.
2. In the event of a concern being raised, if you act constructively, allow patients the opportunity to express their dissatisfaction, and provide sensitive explanations of what has happened and why, you may resolve this at an early stage.
3. You should provide information to patients about how they can make comments, complaints and compliments about the service they have received.
4. You should make sure that your staff are familiar with your complaints policy and know to whom they should direct any patient complaint.
5. You should inform your professional indemnity insurers immediately if you receive a complaint.
6. You should ensure that anyone making a complaint knows that they can refer it to the GOsC, and provide them with appropriate details explaining the procedure.

Confidentiality

1. Maintaining patient confidentiality includes:
   1. keeping confidential your patients’ identities and other personal information, and any opinions you form about them in the course of your work
   2. ensuring that your staff or anyone else attending your clinic in a professional capacity (for example, students of osteopathy, potential students or peers) keep such information confidential
   3. ensuring that the information is kept confidential even after the death of a patient
   4. not releasing medical details or information about the care of a patient to anyone – or discussing such information with anyone – including their spouse, partner or other family members, unless you have the patient’s consent to do so (see standard D5(7) and standard D5(8) below)
   5. taking appropriate measures to ensure that that such information is securely protected against loss, theft and improper disclosure.
2. Patients are entitled to obtain copies of their notes and, if such a request is made, you must comply with this in accordance with relevant legislation and good practice.

Management of patient information

3. You should have adequate and secure methods for storing patient information and records. Patient records should be kept:
   1. for a minimum of eight years after their last consultation
   2. if the patient is a child, until their 25th birthday.
4. You should have a written policy regarding retention, transfer and disposal of patient information and records, which should include whether it is your practice to retain them beyond eight years, or, in the case of a child, beyond their 25th birthday. Your patients should be made aware of this.
5. You should make arrangements for records to continue to be kept safely after you finish practising, or in the event of your death or incapacity. Patients should know how they can access their records in such circumstances.
6. You must comply with the law on data protection and associated legislation. For further information on data protection, please refer to the website of the UK Information Commissioner’s Office.

Disclosure of confidential information

7. There may be times when you want to ask your patient if they (or someone on their behalf) will give consent for you to disclose confidential information about them; for example, if you need to share information with another healthcare professional. In that case, you should:
   1. explain to the patient the circumstances in which you wish to disclose the information, and make sure they understand what you will be disclosing, the person you will be disclosing it to, the reasons for its disclosure, and the likely consequences
   2. allow them to withhold permission if they wish
   3. if they agree, ask them to provide their consent in writing or to sign a consent form
   4. advise anyone to whom you disclose information that they must respect the patient’s confidentiality
   5. disclose only the information you need to (for example, does the recipient need to see the patient’s entire medical history?).

Disclosure of confidential information without consent

8. In general, you should not disclose confidential information about a patient without their consent; however, there may be circumstances in which you are obliged to do so. Such circumstances might include:
   1. if you are compelled to do so by order of a court or other legal authority. You should only disclose the information you are required to under that order.
   2. if it is necessary in the public interest. In this case, your duty to society overrides your duty to your patient. This might happen when a patient puts themselves or others at serious risk; for example, by the possibility of infection, or a violent or serious criminal act.
   3. if it is necessary, in the interests of the patient’s health, to share the information with their medical adviser, legal guardian or close relatives, and the patient is incapable of giving consent.
9. In any such circumstances, you are strongly advised to seek appropriate legal advice.
10. If you need to disclose information without your patient’s consent, you should inform the patient, unless you are specifically prohibited from doing so (for example, in a criminal investigation), or there is another good reason not to (for example, where a patient may become violent).
11. Any disclosures of information should be proportionate and limited to the relevant details.
12. If a patient is not informed before disclosure of confidential information takes place, you should record the reasons why it was not possible to do so and maintain this with the patient’s records.

1. You should be familiar with the requirements that apply to you under equality law.
2. It is illegal to refuse a service to someone on the grounds of their age, disability, gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sex or sexual orientation.

1. The public’s trust and confidence in the profession (and the reputation of the profession generally) can be undermined by an osteopath’s professional or personal conduct. You should have regard to your professional standing, even when you are not acting as an osteopath.
2. Upholding the reputation of the profession may include:
   1. acting within the law at all times (criminal convictions could be evidence that an osteopath is unfit to practise)
   2. showing compassion to patients
   3. showing professional courtesy to those with whom you work
   4. behaving honestly in your personal and professional dealings
   5. maintaining the same standard of professional conduct in an online environment as would be expected elsewhere
   6. not abusing alcohol or drugs
   7. not behaving in an aggressive or violent way in your personal or professional life
   8. not allowing professional disputes to cause you to fall below the standards expected of you
   9. not falsifying records, data or other documents.

1. You should charge fees responsibly and in a way which avoids bringing the profession into disrepute.
2. It will help you avoid disputes about fees if you have clear and visible information available on patient fees and charging policies.
3. You should not place pressure on a patient to commit to unjustified treatment.
4. You may recommend products or services to patients only if, in your professional judgement, they will benefit the patient.
5. You should declare to your patients any financial or other benefit you receive for introducing them to other professionals or commercial organisations. You should not allow such an organisation to use your name for promotional purposes.
6. You should maintain sound financial records for your practice.

1. Where the care of patients is shared between professionals, you should consider the effectiveness of your handover procedures. Effective handovers can be done verbally, but it is good practice to make a note of the handover in the patient’s osteopathic records.
2. You are responsible for all the staff you employ in your clinic (including administrative staff) and for their conduct, and any guidance or advice they give to patients. You should make sure that staff understand the importance of:
   1. patient confidentiality
   2. secure storage and retention of medical records
   3. appropriate relationships with patients, colleagues and other healthcare professionals
   4. complaints and associated procedures for handling them
   5. maintaining a safe work environment
   6. health and safety
   7. equality duties and good practice.
3. If you are responsible for an associate or assistant, you should provide professional support and adequate resources for them so that they are able to offer appropriate care to their patients. You should not put them under undue pressure, or expect them to work excessive hours. You should not expect them to provide treatment beyond their competence.
4. If your practice employs support staff, you should ensure that they are managed effectively and are aware of any legal obligations necessary to fulfil their role.

1. To achieve this, you should:
   1. treat other health and care professionals with respect, acknowledging the role that they may have in the care of your patients; any comments that you make about other healthcare professionals should be honest, valid and accurate
   2. understand the contribution of osteopathy within the context of healthcare as a whole
   3. follow appropriate referral procedures when referring a patient, or when one has been referred to you
   4. work collaboratively with other healthcare providers to optimise patient care, where such approaches are appropriate and available.

1. If you know or suspect that your physical or mental health is impaired in a way that might affect the care you give to patients, you must:
   1. seek and follow appropriate medical advice on whether you should modify your practice and in what way
   2. if necessary, stop practising until your medical adviser considers you fit to practise again
   3. inform the GOsC.
2. If you are exposed to a serious communicable disease, and you believe that you may be a carrier, you should not practise until you have received appropriate medical advice, and you should follow any advice you are given about suspending or modifying your practice. You should take all necessary precautions to prevent transmission of the condition to patients.

1. Such information regarding your conduct and competence would include:
   1. being subject to regulatory proceedings by a professional body anywhere in the world
   2. being charged with a criminal offence anywhere in the world
   3. accepting a police caution
   4. being suspended or placed under a practice restriction by your employer or a similar organisation because of concerns about your conduct or competence.