Clinical Guidelines for Chiropractic Practice in Canada
Chapter 17 - Practice Advertising
Chapter Outline
I OVERVIEW
Advertising by health professionals is becoming more accepted and more common in Canadian society. Reasons include the presence of the Canadian Charter of Rights and Freedoms and changing social attitudes, including the greater emphasis on patient rights and freedom of choice in health care. The public is entitled to make informed choices and appropriate advertising benefits both patients and health providers.
This chapter presents recommendations or guidelines with respect to advertising by the chiropractic profession.
II DEFINITIONS
Advertising: means any communication with the public with respect to a chiropractor's practice.
III. LIST OF SUB-TOPICS
A. Advertising Professional Services
B. Telephone Advertising
1. White Pages
2. Yellow Pages
C. Signs
C. Radio and Television
E. Addressing the Public
F. Approval Process
G. Free Services
IV LITERATURE REVIEW AND DISCUSSION
Typically Canadian chiropractic provincial divisions or regulatory bodies have advertising regulations that prohibit professional advertising unless it meets certain criteria. The Canadian Chiropractic Association has ethical rulings on advertising in its Code of Ethics.
Many of the existing provincial regulations on advertising by chiropractors and other health professionals are only partly enforceable following the 1990 judgement of the Supreme Court of Canada in the Royal College of Dental Surgeons v Rocket and Price. In this case the Supreme Court struck down the RCDS's regulation governing advertising by dentists in Ontario for violation of the Charter of Rights and Freedoms.
The court held that commercial expression, including advertising by dentists, fell within the scope of Section 2 of the Charter which grants fundamental freedoms, including freedom of expression. The fundamental freedoms are not absolute. They are subject to Section 1 of the Charter which provides:
The Canadian Charter of Rights and Freedoms guarantees the rights and freedoms set out in it subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society.
The court held that the dental regulation in question, which proceeded on the basis of an overall ban on advertising subject to allowable exceptions, did not meet the test of reasonable limits appearing in Section 1.
The court looked in some depth at what prohibitions on advertising by health professionals might meet the reasonable-limits test of Section 1 of the Charter. It held that prohibitions aimed at misleading, deceptive or unprofessional advertising would not infringe the Charter, providing a practitioner's freedom of expression was not unduly restricted and the public was not deprived of relevant information.
It will be apparent from this that the legal position is subtle rather than black and white. For example, a regulation that prohibits unprofessional advertising and is not unduly restrictive will be legal, but what exactly is unprofessional, and what is unduly restrictive? Should regulations prescribe what is unprofessional, or should that be left to the rulings of regulatory bodies pursuant to a regulation that covers but does not seek to define unprofessional conduct? Apart from the legal position, advertising is an area in which there are ethical and professional responsibilities and for which professional guidelines are most appropriate.
For advertising to be both legal and professional the following principle should apply in all media. The message should be:
- truthful, because consumers often lack the knowledge to evaluate potentially misleading advertising claims;
- clear, because consumers often lack the knowledge to evaluate potentially misleading claims;
- complete, because consumers may lack the knowledge to detect omissions necessary to make informed choices;
- professional, as consumers should have confidence in the health providers they choose, and professionalism in all aspects of practice is important in creating and sustaining that confidence. In addition each chiropractor owes it to his/her colleagues to maintain united professional standards; and
- responsible, consistent with provincial division legislation and the Canadian Chiropractic Association's Code of Ethics.
To conform to the above criteria on professionalism and responsibility, advertising claims should not:
- claim professional superiority over other chiropractors, in respect of individuals or generally;
- be offensively critical respecting other health care practitioners' services, or their products;
- guarantee results or in other ways create unjustified expectations;
- refer to products or services that are not subsequently provided as promised;
- violate the confidentiality of the doctor-patient relationship;
- contain self-congratulatory statements;
- state a number of years in practice or in practice in a given community;
- include patient testimonials; and
- offer free examination, diagnostic or treatment services.
V. ASSESSMENT CRITERIA
Rating Systems 2 assessment criteria are used in this chapter. For an explanation of this system see the Introduction and Guide to Use (p. xxiii).
VI. RECOMMENDATIONS (GUIDELINES)
A. Advertising professional services:
17.1 The public interest in professional advertising requires that advertising in all media be truthful, clear, professional and responsible.
Rating: Necessary
Evidence: Class I
Consensus level: 1
17.2 A chiropractor should not claim professional superiority, make invidious remarks respecting other practitioners or their services, make claims of guaranteed success or make inaccurate claims respecting services or products to be provided.
Rating: Necessary
Evidence: Class I
Consensus level: 1
17.3 The following subjects related to the practice of chiropractic are appropriate information to communicate to the public:
| a. | The chiropractor's name and/or group name;
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| b. | University or chiropractic college degrees, diplomate, fellowship status and certification status as recognized by the provincial divisions and/or the Canadian Chiropractic Association;
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| c. | Membership in the provincial division and/or the Canadian Chiropractic Association;
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| d. | Office address;
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| e. | Telephone and fax numbers;
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| f. | Hours and days of practice;
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| g. | Recognized chiropractic emblems;
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| h. | Recognized symbols such as credit cards, handicapped parking;
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| i. | Logos, photos or graphics relative to the chiropractic practice;
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| j. | Language spoken;
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| k. | Parking and accessibility for the disabled; and/or
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| l. | Professional corporations if applicable.
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Rating: Recommended
Evidence: Class III
Consensus level: 1
B. Telephone advertising
1. White pages:
17.4 An alphabetical listing in the white pages of the telephone directory may include:
| (i) | the name of the individual chiropractor, or the office name followed by the name;
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| (ii) | the group name with or without individual members, and/or individual surname listings;
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| (iii) | telephone numbers including business, fax, home, or emergency numbers;
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| (iv) | professional corporation if applicable;
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| (v) | the chiropractor's name or group name may be highlighted in bold print.
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Rating: Recommended
Evidence: Class III
Consensus level: 1
2. Yellow pages:
17.5 An alphabetical listing in the yellow pages under the heading "chiropractors" should be in standard print and may include:
| (i) | the name of the individual chiropractor, or the office name followed by the name;
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| (ii) | the group name with or without members, and/or individual name listings;
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| (iii) | office, fax, home, after hours and emergency telephone numbers, without duplication;
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| (iv) | professional corporation if applicable;
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| (v) | the local society and/or provincial division, but not individual chiropractors, may use display advertising to provide public information relevant to the practice of chiropractic.
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Rating: Recommended
Evidence: Class II
Consensus level: 1
C. Signs
17.6 A chiropractor may advertise with signs that comply with the following requirements:
| a) | The sign may contain a chiropractor's name, degree(s) and profession, the name of the office or clinic with which he/she is associated and office or clinic address, telephone numbers and hours;
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| b) | No sign should, in its character, position, size or wording, be more than is reasonably required to indicate a location to the entrance of the chiropractic office or clinic;
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| c) | Size of the sign should conform to municipal or city regulations and any other legal requirements.
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| d) | A sign should only be used on the premises in which the practice is located;
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| e) | An illuminated neon sign, motionless and non-flashing may be used;
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| f) | All signs must be professionally lettered and adequately maintained.
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Rating: Recommended
Evidence: Class II
Consensus level: 1
D. Radio and television
17.7 Advertisements on radio and television should be sponsored by recognized local societies groups, local groups, provincial bodies, or national organizations.
Rating: Recommended
Evidence: Class III
Consensus level: 1
E. Addressing the public
17.8 a) A chiropractor, in any mode of communication, should strive to make it clear that his/her comments are personal and not necessarily representative of all chiropractors, unless expressly authorized to comment on behalf of an established chiropractic organization.
Rating: Recommended
Evidence: Class I, II
Consensus level: 1
17.9 b) The conduct of interviews with the media concerning chiropractic matters should be carried out so as to conform with the Canadian Chiropractic Association code of ethics and the advertising regulations of the provincial division.
Rating: Recommended
Evidence: Class II
Consensus level: 1
F. Approval Process
17.10 Chiropractors are encouraged to present communications material prior to publication to provincial divisions for review.
Rating: Recommended
Evidence: Class III
Consensus level: 1
G. Free Services
17.11 It is unprofessional and inappropriate to advertise free services such as consultation/examination procedures, diagnostic or treatment.
Rating: Recommended
Evidence: Class III
Consensus level: 1
VII. COMMENTS, SUMMARY OR CONCLUSION
This chapter was prepared following a review of relevant law and the existing provincial chiropractic legislation and current rulings of regulatory colleges or divisions that apply to advertising. The decision of the Supreme Court of Canada in Royal College of Dental Surgeons of Ontario vs. Rocket and Price suggests the need for new model legislation in the area of advertising by health professionals and some provinces, such as Ontario, are currently developing such legislation.
Ultimately, however, advertising is a matter of professional ethics and responsibility, not law. The chiropractic profession should have guidelines that allow professional advertising and indicate with clarity which forms of advertising will be considered by the profession itself as being unprofessional and unacceptable.
VIII. REFERENCES
Royal College of Dental Surgeons v. Rocket and Price [1990] 2 S.C.R., 232.
Canadian Chiropractic Association, Code of Ethics.
Provincial Division Regulations and Rulings (College of Chiropractors of Alberta, British Columbia College of Chiropractors, Manitoba Chiropractors' Association, Newfoundland and Labrador Chiropractic Association).
Professional Advertising in Alberta, Professions and Occupations Bureau Government of Alberta.
IX. MINORITY OPINIONS |