Frequently Asked Questions

Questions about PBI Education

Where can I find information about confidentiality, refunds, cancelations, and date transfers?

Click here to view our full course policies.

How do I get a course approved by my regulatory agency?

Most PBI Education courses are already approved, but we recommend you send our course agenda to your regulator for pre-approval before you register to confirm that the course meets requirements.

To seek course approval you can download an agenda by pressing the “course agenda” button at the top of the course information page and email it to your regulator for approval.

My disciplinary order states that I need to take a course from a different provider, can I take a PBI course instead?

Yes! PBI courses are competitively priced and considered equivalent to many courses from other providers. Courses are generally approved by submitting an agenda to your regulator. We are always happy to assist with this process, so if you need help call or email us.

Our courses compare to similar courses from providers like: Vanderbilt, Sante, Center for Personalized Education for Professionals (CPEP), Physician Assessment and Clinical Education (PACE), Case Western, Western Institute of Legal Medicine (WILM), Institute for Medical Quality (IMQ), KSTAR Physician Resources, Florida Medical Association (FMA), and others.

I can’t pay in full for a course right now, but I need to take it ASAP, what can I do?

Course fees can be paid by credit or debit card, or with financing through PayPal Credit. PayPal Credit allows participants to confirm their enrollment in a course interest-free with a $99.00 down payment if the course is paid in full within six months. Just select PayPal Credit as your payment option during registration and follow the prompts to verify your credit. You will need to create a PayPal account if you do not already have one to make use of the financing.

Can I attend a course proactively for CE credit even if I don’t have a disciplinary order?

Yes! We welcome and encourage participants to proactively educate themselves by taking our courses, even if they have no disciplinary issues to address.

If I can’t attend a full course, can I attend part of the course for partial credit?

Unfortunately no, full participation is required throughout the entire course in order to receive a certificate of completion.

Questions about professionalism, boundaries, ethics, and more

What are professional boundaries?

Professional boundaries define effective and appropriate interaction between professionals and the public they serve. Boundaries exist to protect both the professional and the client.

What is a boundary violation?

Any behavior or interaction which damages the patient, the professional, and/or the therapy is a violation. It is the victimization and exploitation of a patient by the professional. It is a betrayal of the sacred covenant of trust. This includes sexual and non-sexual misconduct.

What causes a boundary violation?

Boundaries protect the very core of the professional-patient association. The breach of a boundary whether intentional or not can lead to serious harm to all parties. The etiology of a boundary violation is complex. On rare occasion, the professional may be a sociopath, absent of conscience, who knowingly exploits his or her patients. In the majority of cases, the offending professional may suffer from a mental illness or experience crises which impair professional judgment. The professional may not be fully cognizant of the violation and may remain unaware of the damage that has occurred. In either case, the result is exploitation and harm.

Who is harmed by boundary crossings and violations?

Boundary violations harm the patient and the professional. The ramifications are widespread. Damage usually extends to marriages, families, other patients, communities, clinics, institutions, and the profession in general.

Why is professional boundaries training so important?

The legal environment demands and the public expects strict adherence to professional boundaries. No conscientious professional sets out to violate standards of appropriate, professional relationships with clients or patients, yet violations continue to occur. It can happen to those that are dedicated, moral and highly professional in the overall conduct of their practice. Smart Boundaries™ training is essential for professional protection.

Who should consider professional boundaries training?

Anyone in a fiduciary relationship is at risk, especially those in the professions of medicine, psychotherapy, law, education and ministries.

Who benefits and how?

Implementation of Smart Boundaries™ fosters healthy and safe boundaries. This improves interpersonal skills, which in turn, reduces the risks for boundary transgressions. Patients, clients, professionals, clinics, hospitals, institutions and corporations are safeguarded.

Where can I read more about professional boundaries?

You can read stories of professional boundary violations and recovery, advice for maintaining healthy boundaries and more by clicking the “blog” tab in the navigation bar at the top of the page.

How can I help a colleague avoid a boundary violation?

If you suspect that a colleague is in danger of perpetrating a boundary violation or has done so, do not assume that he or she recognizes the situation. In the majority of cases, the professional’s denial and rationalization of their misbehavior is entrenched. When confronted, these professionals tend to distort and minimize the violation. It has been said that these violations occur within a “circumscribed detachment of reality”. This means that a professional may function competently and ethically in all aspects of their practice except in regard to their interaction with the specific patient/victim.

The worse thing you can do is to ignore the problem. Remember that the perception of misconduct can be as damaging as an actual event. This is a professional colleague who is in need of your help. In many aspects, it is not unlike an impaired professional who is suffering from a chemical dependence. An intervention is necessary to safeguard the professional and to protect the public. Your help may prevent further harm and in the long run, preserve the professional’s career.

What is a fiduciary?

Professionals in the fields of medicine, psychotherapy, law, education, and religion are fiduciaries. By definition, they are agents that stand in relation to trust, confidence and responsibility. With this duty comes an obligation to serve others morally, ethically and competently. To successfully uphold this fiduciary duty professionals must posses an increased awareness of personal and professional influences that can place them at risk for a violation.

What continuing education courses do you offer?

We offer a variety of courses that provide CME, CE or CEU credit. Click the “courses” tab in the navigation bar at the top of the page to see a full listing of our courses we offer.

What is professionalism?

Individuals with knowledge of a specialized area or skill that requires advanced training and serves others in a fiduciary capacity are known as professionals. Most areas of specialization typically have a Code of Ethics. Professionals are held to a higher standard of conduct by the society they serve. Demonstration of that standard of conduct is called professionalism.

What is ethics? How does it differ from professionalism?

Ethics is a field of study that helps us answer “should” questions, such as “What should I do in this situation?” or “How should I behave?” The field of ethics provides several different methods of answering questions where there are multiple stakeholders and factors to consider. Those methods include consideration of virtues, ideals, and aspirations, and reasoning that considers consequences, moral principles, context, and norms. Professionalism is related to ethics in that one who demonstrates professionalism conducts him/herself according to the ethical principles, expectations, and norms of his/her profession.

What is the definition of Sexual Impropriety?

Sexual impropriety may comprise behavior, gestures, or expressions that are seductive, sexually suggestive, disrespectful of patient privacy, or sexually demeaning to a patient.

What is the definition of Sexual Violation?

Sexual violation may include physical sexual contact between a physician and patient, whether or not initiated by the patient, and engaging in any conduct with a patient that is sexual or may be reasonably interpreted as sexual.

Do codes of ethics change over time?

Well-conceived codes of ethics generally stand the test of time, although novel situations could not necessarily be anticipated when codes were originally developed. Generally, professions update their codes of ethics as needed to assist their members to handle situations that arise over time, such as with the modernization of health care (e.g., use of electronic communication, electronic medical records, etc.).

Have professional boundaries changed over time?

Generally, no, because the fiduciary relationship between professionals and those they serve remains of paramount importance. However, certain social, cultural, and political forces in the US and other countries have both shaped and been shaped by the expectations of professional behavior among the public. Examples include the ethical principle of respect for patient autonomy that underlies the informed consent process, the widespread accessibility of institutional ethics committees, and laws and documents that set forth patients’ rights. Whereas certain boundary crossings, such as inappropriate language in the operating room or unchaperoned exams, had been tolerated in the past, that is much less true nowadays.

What is remedial education and does ethics remediation work?

Ethics remediation is a process intended as a remedy or corrective intervention for a lapse in ethical behavior. It assumes that the person who erred is of inherent value to his/her profession and has the characterologic potential to learn from past mistakes, hold him/herself accountable, and adhere to future safeguards. Ethics remediation can be accomplished through a formal program or curriculum that provides opportunities for reflection and analysis of the professional’s particular situation. It is most successful when delivered in a classroom or one-on-one setting. In fact, coupled with the development of a plan to safeguard future behavior, it is the only intervention that has demonstrated success in helping professionals avoid recidivism.

What’s the difference between a boundary violation and sexual harassment?

Sexual harassment is a type of boundary violation that usually refers to behavior in the workplace between employers and employees, co-workers, or supervisors and personnel. Sexual harassment can be physical or verbal. In certain workplaces and professions, sexual harassment has a range of specific meanings. Every professional should consult with his/her workplace’s and profession’s definitions to become educated about the kinds of behavior that others might find offensive, threatening, or detrimental to a collegial working environment.

How can a healthcare professional protect him/herself or his/her practice and avoid problems in the future?

  • Be familiar with your professional code of ethics and institutional code of conduct.
  • Behave as if you are on camera.
  • Make sure you are meeting your personal needs appropriately. Don’t look to your profession or practice.
  • Avoid personal and professional isolation.
  • Stay up-to-date with standards of practice through your professional press.
  • If applicable, institute checks and balances to make sure your billing and documentation systems are accurate and complete.
  • Do not cut corners.
  • Create personal policies. They help minimize room for error and create a standard way for you to handle every situation of that type. For example, create a uniform policy about handling requests to treat or write prescriptions for friends or family members.
  • Look at your state’s professional practice act (e.g., Medical Practice Act, Veterinary Practice Act, Dental Practice Act, etc.) for guidance. It should give define scope of authority, supervision, prescribing, and other professional expectations and parameters.
  • When in doubt, seek the advice of your licensing board, professional society, or a trusted colleague. Don’t seek advice from someone who will tell you what you want to hear, but someone who will offer an honest and informed opinion.

What are steps a healthcare professional can take to maintain an ethical practice?

  • Follow your plan to avoid the problem(s) you experienced in the past.
  • Develop the habit of attending continuing education activities that will reinforce your newly-developed good habits. Activities that add to your understanding of the issues that led you to getting into trouble in the first place. These can include activities about documentation, communication practices, leadership styles, billing, appropriate use of social media, etc.
  • Integrate into your practice the protective measures noted in the FAQ above.

What are common pitfalls that can cause a health care professional to cross a boundary? What common pitfalls get clinicians into trouble with their board?

  • Commonplace actions go awry or get misinterpreted. For example: A well-meaning professional may want to be a “nice guy” and may not know how to say no to requests to write prescriptions or treat someone without the usual thoroughness they would employ with a bona fide patient.
  • Professionals are prized for their self-reliance and competence. But some carry that too far. They may avoid asking important questions about policies, procedures, or standards for fear of appearing incompetent or weak to co-workers or supervisors.
  • Clinicians may neglect to familiarize themselves with applicable laws, such as those regarding prescribing, supervision, and ordering.
  • Professionals may not recognize that interacting with patients, families, or co-workers in a casual way may come across as inappropriate.

What trends have been observed over time in the kinds of ethics or professionalism violations that healthcare professionals get into?

It is a bit less common nowadays for healthcare professionals to be reported for paternalistic behaviors. This is largely because of widespread education in and acceptance of the informed consent process and ways of effectively and sensitively delivering bad news. However, lapses in clear and respectful communication still occasion patient and employer complaints to regulatory agencies. In addition, electronic health records and social media platforms have brought about many novel ethical dilemmas that healthcare professionals may not be equipped to handle appropriately.

What do the terms dishonorable, disgraceful, and unprofessional conduct and moral turpitude mean?

These terms are general labels for objectionable and actionable conduct, arising from state statutes that delineate the expectations of ethical conduct for licensed professionals. Admittedly, these are general terms that can apply to a wide range of infractions. The process of remediation can assist the accused to understand with greater specificity and nuance the lapse in professionalism they need to work on, including how they went off track and how they can get back on track and stay there.

How to report a potential or actual ethics or boundary violation

It is our moral and ethical responsibility to help one another when in trouble. If you feel unable to talk to the offending professional, contact a representative from an advocacy program, such as the Physicians Health Program. Contact us if you need further assistance. It may be your legal duty to report the knowledge of a boundary violation. Please call your Advocacy Program for guidance. Failure to do so may expose your license to disciplinary proceedings and potential criminal charges.

Advocate web

AdvocateWeb is a nonprofit organization providing information and resources to promote awareness and understanding of the issues involved in the exploitation of persons by trusted helping professionals. AdvocateWeb offers extensive free resources for victims, survivors, and their families, friends, victim advocates, and professionals. Click here to get a list of resources from their direct help page.

Ethical issues in supervision

Many professionals are in a position to supervise trainees, other professionals, and office staff. Some supervisory relationships, such as that between a physician assistant and a physician, have clear and formal requirements and expectations that must be followed. Other supervisory relationships, such as a student rotating through a faculty member’s clinic, are less formal. The primary ethical issue is one of accountability. As “captain of the ship,” the licensed professional is ultimately responsible for all the activity in his/her domain, and has a duty to ensure the integrity of those activities.

Is it okay to prescribe for myself, friends, family, or co-workers?

Once you write a prescription for anyone, that person becomes your patient. However, sometimes emergencies or extenuating circumstances arise. A general rule of thumb is that, in the case of an emergency or a one-time need (e.g., a refill of your spouse’s anti-hypertensive medication before the pharmacy closes), it is permissible. But such prescribing or refilling with any regularity is inappropriate, as this constitutes medical care and creates a dual relationship. Each patient (including you!) deserves appropriate evaluation and treatment by their own healthcare professional. All states prohibit prescribing controlled substances to oneself or one’s family members except in an emergency.

Is it okay to barter for health care services?

Sometimes bartering occurs in rural areas where patients may be uninsured or lack the ability to pay otherwise. In such cases, the usual sensitivities to relationships in the community and vigilance regarding the potential to develop exploitative or dual relationships should guide the healthcare professional’s decision to barter. Outside such rural settings, however, bartering has the potential to adversely affect the fiduciary relationship between healthcare provider and patient through misunderstandings, feelings of coercion or exploitation, or concerns about self-serving motives. Finally, if one barters on more than just an occasional basis, there may be “income” reporting requirements for the purposes of taxation.

Is it okay to treat co-workers or employees?

Different professions have different norms regarding this practice. Your professional society is a good place to seek advice and learn the professional consensus for your particular type of practice. However, there are some specialties where treating co-workers or employees is prohibited or highly discouraged—such as psychiatry, obstetrics and gynecology, psychology, or counseling—because the intimate nature of those specialties would complicate the existing collegial or supervisory relationship by further shifting the balance of power.

What is the difference between dating a co-worker and sexual harassment?

Sexual harassment defines unwanted overtures by one party towards another. A dating relationship is considered to be mutually desired and consensual. However, if there is a supervisory relationship between the individuals who choose to date, they would be well advised to eliminate that supervisory component. If the supervisory arrangement cannot be changed, then the dating relationship would be inappropriate.

Is it okay to date a current or former patient?

The chief concern about dating a current or former patient has to do with the power gradient in the relationship. The sharing of intimacies can create ambiguities regarding exploitation and self-serving motives. Different professions and different states have their own regulations regarding decisions to date a current or former patient. Your professional society is a good place to learn what the standards are in your profession and in your state. As one example, however, the American Medical Association’s position is that sexual contact with a current patient constitutes sexual misconduct. Further, the field of psychiatry holds to the “once a patient, always a patient” dictum, meaning that it is never ethically permissible to date a current or former patient.

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