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2018 Student Ethics Essay Award—First Place Essay

Overstatement of Qualifications: Misrepresentation in Clinical Practice

2018 SEEA Kaley Ervinby Kaley Ervin, Texas State University

Lies, even seemingly insignificant lies of omission, can lead to misrepresentations and ethical dilemmas. They may come easily to the tongue and seem harmless in the moment; however, these misrepresentations can ultimately end up causing harm to all involved. The American Speech-Language-Hearing Association (ASHA) developed a Code of Ethics (2016) with a goal to ultimately "ensure the welfare of the consumer and to protect the reputation and integrity of the professions." This framework offers guidelines and expectations for the ethical conduct of practicing speech-language pathologists (SLPs) and audiologists. It spans responsibility to the consumer, the public, and the profession. Still, despite clear ethical guidelines and intentions to maintain ethical behavior, at times a desire for ease of explanation and provision of services will lead a well-intentioned SLP or graduate student to misrepresent themselves to a client.

According to the ASHA Code of Ethics (2016), a misrepresentation is "any statement by words or other conduct that, under the circumstances, amounts to an assertion that is false or erroneous (i.e., not in accordance of the facts)" or "any statement made with conscious ignorance or a reckless disregard for the truth." The Code of Ethics delineates a variety of ways in which an individual may misrepresent himself or herself in the course of clinical practice. As SLPs are in constant communication with clients, colleagues, and the public in their daily work, it is likely that there will be situations that lead to SLPs misrepresenting themselves in ways in which they may think are harmless but remain unethical in nature. 

Considering ethical decision-making around errors of omission and misrepresentation may best be viewed through the lens of a real-life situation. Imagine the following scenario: Connie is a second-year graduate student who just began a placement in a transitional high school working with individuals who span a range of diagnoses and intellectual abilities. As a 22-year-old young woman, Connie finds herself to be close to the same age as many of her clients. Despite the experience she gained as an undergraduate student majoring in Communication Sciences and Disorders and her experience in the first year of her graduate program, she feels insecure about her ability to successfully portray herself as a competent and professional graduate student clinician. She worries that her age and title may undermine her authority with her students. When asked about her role by one of the clients she is assigned to work with, Connie insinuates that she is a fully certified SLP rather than explaining that she is a student who is training to become an SLP. She hopes that this will gain her the respect and recognition that she believes come with experience and offset any lack of confidence in her abilities that might be inspired by her youth. She justifies this misrepresentation to herself and believes that she is best serving her clients by putting herself in a position of authority and expertise, even though she does not yet hold the Certificate of Clinical Competence. She proceeds to work with these clients for the semester under the false guise that she is a fully certified SLP, a misrepresentation that she believes is justified given her situation. 

As outlined in Principle III, Rule A of ASHA's Code of Ethics (2016), "individuals shall not misrepresent their credentials, competence, education, training, experience, and scholarly contributions." Further, according to Principle I, Rule D of the Code of Ethics (ASHA, 2016), individuals "shall inform those they serve professionally of the name, role, and professional credentials of persons providing services." Connie is willfully misrepresenting her credentials, competence, education, training, and experience. By not beginning her professional relationship with her clients with a description of her background and qualifications, she is acting against ASHA's (2017) position that "it is always good practice for a clinician to fully introduce himself or herself, including professional status, when beginning service."

In a 2008 edition of The ASHA Leader, Chabon, Hale, and Wark (2008) emphasized that "patients always have the right to know that they are being treated by a student." Connie's actions overtly ignore this guidance from seasoned professionals. By presenting herself as an experienced professional rather than a student, Connie is shirking her duty to her clients by not offering them the information that they or their parents would need to make an informed decision about their care. Further, as described in ASHA's statement on Ethical Disclosure, Misrepresentation, and Conflict of Interest (2018), "many clinical, research, and teaching scenarios can potentially foster a natural tension between professional obligation and personal preference/gain." Connie's insecurity fostered tension between what was true and what might be beneficial to her professional practice and led her to act for personal gain under the pretense of better serving her students. While she may have felt compelled to misrepresent herself for what she believed was the good of her clients, by misleading her clients she compromised their trust, their therapy, and their "right to be fully informed of the professional qualifications of the service provider" (ASHA, 2017).

Connie's misrepresentation of herself and her professional credentials could easily have been avoided by comporting herself with authority and starting her semester with an explanation of her role as a graduate student clinician. These steps would have allowed her to gain the trust and respect necessary to have a successful semester with her clients despite any similarities in age. Explaining the training she had received to that point and the training and supervision that she would continue to receive throughout her placement would have provided clarity to her client regarding her role and qualifications. By simply presenting herself professionally rather than exaggerating her credentials or insinuating that she had credentials that she did not have, Connie could have built trust with her clients while allowing clients to make informed decisions about their care. Alternatively, even if she initially overstated her certification status, Connie should have approached her clinical supervisor about the mistake and worked with her supervisor to communicate the truth to the clients and to help build back trust. As a student, Connie is still learning and one of the most important traits of a promising student is recognizing errors that have been made and seeking advice and support to correct them.

SLPs regularly make quick decisions about how they present themselves to their clients, their colleagues, and the public. Most of these decisions are made with ease and with ethical guidelines in mind.  However, as a field with a specific certification process and timeline that may not be apparent to those outside the profession, it may be easy for a student or clinical fellow to overstate (either explicitly or implicitly) their qualifications in order to garner more professional influence or to avoid an in-depth explanation of the certification process. By being aware of the ways in which an SLP can misrepresent himself or herself and of the supports in place to mentor and guide new SLPs, fledgling SLPs can begin their careers mindful of the ways that they are presenting themselves to their clients, colleagues, and the public and avoid errors of omission and commission that might lead to misrepresentation of their qualifications and certifications.

References

American Speech Language Hearing Association (2016). Code of Ethics [Ethics]. Retrieved from https://www.asha.org/Code-of-Ethics/.

American Speech Language Hearing Association (2017). Issues in ethics: Ethical issues relate to clinical services provided by audiology and speech-language pathology students [Issues in Ethics]. Retrieved from https://www.asha.org/Practice/ethics/Ethical-Issues-Related-to-Clinical-Services-Provided-by-Audiology-and-Speech-Language-Pathology-Students/.

American Speech Language Hearing Association (2018). Ethical disclosure, misrepresentation and conflict of interest. Retrieved from https://www.asha.org/Practice/ethics/Ethical-Disclosure/.

Chabon, S. S., Hale, S. T., & Wark, D. J. (2008). Triangulated Ethics: The Patient-Student-Supervisor Relationship. The ASHA Leader, 13(2), 26-27. doi:10.1044/leader.FTR6.13022008.26

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