When our superiors are in the wrong

How many times have you been told something by a superior and you know it’s wrong but you won’t disagree with them because you feel that your opinion is not valid or you just don’t have enough information to back up your argument? What happens when they are feeding you information you know you should not be getting from them but you listen anyway because it can benefit you? This happens all the time in the clinical context and it really gets on my nerves. 

When preparing for my clinical exam, I know that I may not get any information from my clinician because the exam needs to be a true reflection of what I can do on my own as a physiotherapist and not rely on somebody to help me. Of course I would love information that could assist me because I want to do well but I know in my head that if I did get help I wouldn’t see that as a true reflection of what I can do. So I avoided my clinician the day before my exam and she seemed to appreciate the fact that I was not asking her questions.

But the next day I overheard that some of the other students were asking their clinicians for information and assistance. And it was interesting to see the clinicians’ reaction to the students request.  Some refused, some first refused then started giving hints about the patient’s condition, and one actually helped a student come up with a treatment plan. That’s not fair, is it? How does it help future patients if you are’t willing to put the effort into finding information out yourself? And surely after 6 weeks at a block you should have gained enough learning to make your own sound decisions? Does getting a pass or a good mark outweigh the need for you to be a good physiotherapist? 

And this is where clinical reasoning comes into play. Clinical reasoning is “the sum of the thinking and decision-making processes associated with clinical practice”. What a necessary skill to have. According to Atkinson H & Nixon-Cave K clinical reasoning is becoming a large part of professionalism and is being used to assess students. But do examiners actually pick it up? I would hope that an experienced examiner would pick up that you have a sound understanding of  the patient’s condition and create an effective treatment based on that understanding. If not, I could just get as much information as I want about a patient and memorise it and give a false view of my understanding and do well in my exam. Sure, you get a good mark, but how does that help anybody? In the end, if you just recite things without understanding them then you have actually gained nothing, and neither has your patient. 

The patients that student physiotherapists see in the future are relying on their ability to assess them correctly so that they can treat them effectively. If a student doesn’t put the effort in at university to learn this, then how are they going to behave when they graduate? 

On the other hand, the clinical environment is quite competitive and if a student does badly, does that reflect negatively on their clinician? Is their intention to help you pass in order to make them look good? I think this has a part to play.  I have personally experienced doing well in a clinical exam and my clinician saying that I only did well because she is a good teacher. And I have also experienced a clinician putting unnecessary pressures on students to do well after another student got an A. 

Putting all this information together, I feel that not having competent clinical reasoning would shine through no matter how much external help you get. It is unfair that clinicians assist students because it is not a true reflection of the student’s ability. Next time I see this happening I would like to speak up instead of being quiet about it. 

Is being abused now part of our job description?

Recently a nurse told me a shocking story about her friend, (also a nurse), who was kicked in the face by a patient who she had not provoked in any way, while the patient was fully alert and could comprehend what was happening at the time. She had severe problems with her neck afterwards, and made a formal complaint to the workers compensation fund. At the hearing, the patient reported that he was in ICU at the time and was probably high on medication because he did not remember the event. The nurse was sent home with no compensation what so ever and many years with neck pain to follow.

How is this okay?

We talk about patients being mistreated, but what about medical professionals being mistreated? This is a problem so often ignored. And if nothing is done about it, abuse in the workplace can start to become ‘part of the job’ for some individuals.

How bad is the problem?

There are many studies on this exact problem, mainly focussing on nursing staff, and after reading a few I can understand why. A study was done in Australia and it was found that 92% of nurses had experienced some form of verbal or physical abuse in the workplace. In another study was done in an emergency ward, it was found that there are approximately 5 episodes of violence against staff by patients a week. These episodes include being sworn at, pushed, hit and kicked by patients. Another major problem is that most violated staff feel there is inadequate support for them so they would rather not seek help.

My own personal contact with this issue:

I personally have not experienced any situations where I was verbally or physically abused by a patient but I have frequently found myself in a position where I feel unsafe with a patient. I continue treating the patient because I feel obliged to by the system. “I’m a student, what do I know anyway?” After being subject to abuse in my personal life, I am sensitive to these situations and do not handle them well. My safety becomes my first priority and I avoid physical contact as much as I can, and since physiotherapy is a hands on job, this causes a dilemma.

According to the National Patients’ Rights Charter, every patient has a right to a healthy and safe environment that will ensure their physical and mental health or well-being. I need to ensure that the patient gets treatment that is beneficial to them. But I feel unsafe to touch the patient. What do I do? I have the right to a safe working environment. I do not have to treat the patient if I feel unsafe but I don’t want to get into trouble with my clinician and cause a scene. Can I just settle on treatment that does not involve much physical contact? Or do I make an effort to report how I feel to my clinician?

Conclusion

It is a fact that many health professionals experience abuse in the workplace and it is vital that something is done about it. We should be encouraged to talk about such things and stop believing that its just part of our job. Bullying is never okay.

Introspection

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I’m a third year physio student at UWC doing a course on ethics. For my course I started this blog and posted posts on challenging topics over the period of six weeks. This is my final post for the course, but the beginning to new things. 

I am quite sad to be finishing off this course. I have so enjoyed networking with others from all over the world, and I will miss having something stimulating to think about each week. I feel a need to carry on with something like this. This week I would like to address each question we were given individually.

1. Have my expectations been met? 

To be honest, my expectations were not too high for this course. As for students usually go, they do things because they have to. This course was one the many things ‘I had to do”. But as soon as I started the first week, I enjoyed the challenging topic of Empathy, it caused me to think, and think hard. I expected to not enjoy exposing myself to the world, but for once I really felt like I was being heard and express myself freely, something that boosted my confidence. According to this article, blogging as a communication and learning students between students is quite effective, and I agree. This blog was very effective for my learning, so it exceeded my expectations.

2. What did I learn? 

Where do I start? I’ll start with the simpler things:

  • Firstly I learned how to blog, the fact that I’m writing this is evident enough.
  • I learned the importance of networking with others. Challenging each other’s views and opinions appropriately makes you challenge your own views and options, causing possible personal growth (if you’re open to it).
  • I learned how to have effective conversation. I found this article, “What’s wrong with playing Theology Police?“, and found it so stimulating I had to blog about it. It was about how we shouldn’t talk unless were are prepared to listen, and how we should be faithful to our beliefs but not have a driven egotistical need to be right all the time. You can read this post here.
  • Empathy is essential for life, especially for health professionals. After reading Alexa Pohl’s post on empathy, I found a great series of videos on YouTube which explained empathy in a really simple ways and noted the importance of it and ways to develop empathy. You can find this series  here.
  • Morality shapes the way we act. Our moral values are determined by all kinds of things during our development, but however they are formed it is important they should benefit humankind and not destroy it.
  • All humans are equal but we place different value on different people. Racism, homophobia, xenophobia and other controversial topics should not be an issue in this day and age. Although, we place value on the lives that are most meaningful to us, such as our family and friends and often feel morally loyal to the lives that are most dear to us.
  • Morally ambiguous topics such as euthanasia have no easy or one right answer. It continues to be complex and should be treated appropriately.

3. Will I change? 

Yes. I think this course has stimulated my thinking and thus challenged my outlook on how I should go about seeing and treating a patient. I believe that who we are with our patients should reflect the person we are on the inside and who we in all other contexts.

I have challenged myself to rather be empathetic than to be sympathetic, to respect other people’s points of views even though I may not agree with it and to listen more. But I think most importantly, especially with regards to patient care is I have learned the best way to go about responding to their questions in an appropriate way. Our response should be objective, present both sides of the argument and be able to make the patient feel safe enough to make difficult decisions without feeling judged. I know that I need to work on that, especially to not letting my own personal views take control of conversations.

I know all these things I have just mentioned cannot be developed overnight or even be mastered in a few months, but it is a journey that will continue throughout my life. This course was the start of the journey and I look forward to the new challenges ahead of me.

Thank you to all who read, commented, challenged and replied to this blog, it was necessary for my growth and I appreciate it!

The Power of Life

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I am  third year physio student at the University of the Western Cape. I am doing an ethics course over the period of 6 weeks. This blog is part of it, and this post is basd on the 5th week’s work. 

Euthanasia? 

When I think of euthanasia, I can’t determine if I feel its right or wrong. After looking at both sides of the story, I can now say that I’m probably more confused than when I first started looking at this issue. All I can do is explore each side to the argument, and maybe one day I will be able to decide on a conclusion. 

But firstly, what is euthanasia? 

According to Dictionary.com euthanasia is defined as: “the act of putting to death painlessly or allowing to die”. When a person has reached the stage in their life when suffering has become them, they could potentially think about ending their life in the most painless way possible, simply by falling into a lifeless sleep. This concept sounds peaceful to me, but there are implications and other difficult things to comprehend with. 

Why be pro euthanasia? 

Firstly, I hate suffering and I hate it even more when I have to watch somebody else suffering. Seeing patients who are in constant extreme pain or not able to control their own bodies is horrifying. Life should not be that way. The idea of suffering over many years becomes unbearable to justify. For most people that is enough motivation to agree with euthanasia and I can completely understand why. 

Some people think they have the power over their own life, and I disagree with this (but will not go into that now), but with that mindset, it is easy to agree that if you have that power, you then have power over deciding when and how you should die. And if that means you do not get to suffer and possibly save your loved ones the heartache of caring for you and dealing with your suffering, and you get to die in a painless and peaceful way, then it sounds like a good death. 

Why be against euthanasia? 

I watched a documentary about Terry Pratchett (one of my favourite authors), who was exploring the option of assisted suicide for his progressing Alzheimer’s. You can watch it here. He meets 3 people in the documentary, 2 of which have decided to go to Dignitas and end their life there and 1 person who decided against it. Terry Pratchett was able to actually go with one of the men to Dignitas, and watch him die. He also spoke to the man who decided not to go, who has motor neuron disease and is severely disabled, and experience the joy in suffering. 

Watching that documentary helped me realise the power of life, and the value of it. Another important thing to realise is how suffering changes a person. If a person has hope to carry them through the suffering, their suffering actually becomes a beautiful thing. It becomes inspiring. Not that you would want to suffer like that, but that you would love to be able to handle life like that. The people in my life that are most inspiring to me are the ones that suffered the most. How does that work? Seems like a bit of a contradiction to me. 

Nelson Mandela, Mother Theresa, my grandfather suffering from colon cancer, they all have something in common. They all suffered, in different ways, but they had hope. And hope brought them strength to overcome. In my grandfather’s case, he didn’t physically overcome his disease, but rather it was something far greater than that. 

To better understand what I’m tring to say, reading this man’s blog will help you understand: 

My mother faced this question daily.  She asked as Wendy has – “Is the right to life the same as an obligation to live?”.  It cost a lot of money to keep my mother in relative health and gainful employment in the 30 years between her diagnosis and her death.  Left to herself I think she would have gladly taken the easy route, and her medical aid would have been better pleased with the return on investment.  But then the hundreds of people who turned up at her funeral and memorials would never have known how good it was to have known her.  What I learned from her was how to choose to take the hard path and rejoice.

Suffering produces endurance, endurance produces character, character produces hope, and hope does not disappoint us

 

I think there is power in suffering. 

On concluding notes

There are many different views on this topic and I don’t think humans will ever reach a united conclusion. But we can try to understand each other’s points of view. If euthanasia were to be legal, I think it would have to be very controlled, and there should be a list of conditions that would be considered ‘okay’ to be euthanised. This list should be compiled by a health professionals, along with the government and certain individuals who can give insight into their condition. And the person’s consent for euthanasia must be able to be proved. 

One thing I would like to add is that without hope, a suffering person can so easily lose all will to live, which is why euthanasia is so desirable, but I think hope can make all the difference. 

As a physiotherapist treating patients with a terminal illness is all about making it comfortable for them and improving the quality of life they are able to have. It’s not about trying to force them to get better and improve functionally. Often we struggle to accept that some of our patients are going to die no matter what we do, and accepting this will help us make life more comfortable for our patients and make dying a lot easier. 

 

Torture: Humans resolve to animalistic actions

I am a third year physiotherapy student doing an online course on ethics over the period of 6 weeks. The content for the 4th week was torture, these are my thoughts:

Torture is the act of deliberately inflicting severe physical pain and possibly injury to a person (or animal) who is physically restrained or otherwise under the torturer’s control or custody, unable to defend against what is being done to them.”

The first thing I think of when reading this definition is the abuse of one’s power over another. This is unacceptable. I agree completely with Sarah’s statement: “how fair is it to use your power over another person who is in no place to defend them self? Torture in any form is uncivilized and inhumane. We should not use our own strengths to demean another person.” There is a reason torture was declared unacceptable by the UN in the Universal Declaration of Human Rights, It is a violation of human rights. Humans should never be able to exert their power on other humans. End of story. 

I know what it is like to feel powerless in a situation and I can share with you what it feels like: to be unable to prevent an act of inhumanity against yourself makes you feel useless, weak, defenceless… You feel forced to be vulnerable in an adverse environment, you feel completely violated. Because of this experience, I feel strongly against any form of torture. Human rights should not be violated. Power should never be used as a weapon, but as a tool for the greater good. 

But what about this situation: You have the person who has valuable information about your family who is in danger. What would you do? 

Firstly, the fact that a person is withholding information like that is wrong. That too, is violating human rights. You cannot withhold information that if not shared, could endanger an innocent. As physiotherapists, would we withhold information about a patient that has confided in you about his plan to murder a specific person? I hope not. According to the South African Physiotherapist Code of Conduct we must respect patient confidentiality, privacy, choices and dignity. But at the same time we have a social responsibility. We should use our knowledge and skills to promote and benefit humankind and promote health for all. Something to think about. 

In the above situation, yes, I would like to know the whereabouts of my family but I will not resort to an act I see as animalistic and inhumane. I would try my best to use all the non-inhumane resources I have to get that information. If that doesn’t work, I do not have an answer for you. 

Are some lives more valuable than others?

In my previous post, I argued that we are all humans and therefore all equal. So my answer to this question would be no, no life is more or less valuable than another. Although I completely understand why people disagree with me or have trouble treating all life as valuable. I struggle with this. And I can definitely think of an example: Working in a clinic, having to see many patients in a day and you know you will not be able to see all the patients that are waiting outside for the day. How do you decide who gets treatment? Do you use a first come, first serve approach? Do you chose the patients that have more serious ailments/disabilities? Do you chose the patients that are younger and leave the elderly for last? Each patient has an equal right to health care. I must admit, it is very difficult to decide. 

“Eye for an Eye”

Reading Jackie’s thoughts on this, I find myself completely agreeing with her. She says: “lets say we “did” live by those criterion’s, the consequence would be a spiralling downfall of ignorance and devaluation. Thus, we would never ever learn the value and significance of human life because we would simply kill someone because they killed.” The saying “an eye for an eye” simply does not work. And I think it is because people are too scared to admit guilt, so they attack back. 

In conclusion, I think torture should never be used as it is inhumane as it exerts power over a powerless being. We should stray further away from primitive behaviour and toward civilised behaviour that promote and benefit humankind. 

Challenged to be faithful and eat some humble pie

“We need to move from an ego driven need to be right to a soulful desire to be faithful.” – Michael Hildalgo

While refreshing my Facebook page, I came across this article called “What’s wrong with playing Theology Police?” and decided to read it. I was challenged immediately, especially since so much of this blogging course has revolved around sharing our opinions and sometimes getting offended and trying to always prove we are right. 

A few things really struck me while reading this article. We need to realise no matter how deep the desire is to be right, we are not 100 percent correct about everything. I admit, I am one of those individuals who, like many, struggle with this. We want to be right all the time and refuse to proven wrong. It’s time to eat some humble pie, grow up and admit that there is a ‘right’ and a ‘wrong’ to everything we say, do and believe. 

I also realised how quickly others jump into an intellectual argument to combat other’s beliefs and when this happens it is so often met with hostility, which gets you nowhere. I am often too shy to start these conversations so I often find myself on the other side of the conversation, feeling hostile and closed to other’s opinions. I feel we should shift our mindset. One from seeing theory, theology, intelligence (or whatever we may use to prove a point) as a weapon against other people but rather as a vehicle that moves us toward being more faithful to our beliefs and values. 

In this context to be faithful is to remain with steadfast devotion to someone or something. This someone or something is the thing that shapes you, your moral values and your view on the world. And for me, this means being faithful to our God in my relationship with him. Trusting that God will show me the right way and having enough trust to do that even though it may be the harder thing to do, but knowing God has my back. For others this could be the belief in the common good for all, or any other thing that a person might use to shape who they are. When we focus on being faithful to our beliefs, what is right and wrong becomes readily available. 

Another important thing that I can learn from the article is this: be faithful with love. If you do not love, you give or gain nothing, our actions become quite meaningless if they are not given out of love. Or they mean so much more when done out of love. 

Perhaps a modern paraphrase for us today would be: “If I have my doctrinal statement nailed down flawlessly and am able to prove myself right by quoting verses to support my theology, but do not have love, I am dead wrong.” 

Reading this challenged me in a new way. In the past few weeks I have realised how important it is to have a reason for your beliefs in certain things in order to properly articulate yourself with others so they can understand where you’re coming from. But are my arguments/reasons said or done out of love? Sometimes not. Once again I have to eat some humble pie. 

Some practical things I can do is to not speak if I am not willing to listen. This will need much practise. If my desire is truly to be faithful, then I would be open to accepting criticism, humbly receiving correction and inviting others to offer their insights. This is the journey I am inviting myself on. 

We are greatly limited in how others will receive our comments, but we are not limited in how we share them.

I want to grow my responses to promote more thoughtful, faithful dialogue and not feed argumentative detachment. Afterall, we are called to unity, and not division. 

Equality.. The concept many minunderstand

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We are all one race

 

This week we were posed with the question: “are we really all equal?”. These are my thoughts on this matter and how it affects the way I live. 

Immediately after reading the material for this week, I agreed that we are all equal, I have never had any doubt about that growing up. But I quickly thought about what my religion says about equality, because this is where I get my moral code from and I realized that equality has been a huge struggle in the world, especially in the church. Again, my faith is being challenged, I have been forced to really dig deeper into these issues and have come to these conclusions: 

1. We are all equal. 

After all, we all form part of the same species, the human race. Our similarities outweigh our differences by far. We all have the same basic physiological and anatomical structures and functions, that is part of what defines as as a human. If we can agree that we are all human (which I think is easy for most people to do), then why can’t we agree that there is no such thing as a superior or inferior group of humans? 

I think one of the biggest reasons is this: humans don’t really like differences. We always seem to point out everything that is wrong, or different or strange, but we hardly ever focus on what unites us and what makes us similar. As soon as you start focusing on the differences you start putting people into groups, to try separate the people that might look, feel, orientate themselves differently. We do this to try make some sense of the of the expansive human race. But a problem arises when doing so,  that each group now feels and knows that they are different and will express this, usually outwardly and openly, in order to make themselves come across as superior. “Because that group deserves all the recognition for being great human beings, and all the other groups should feel ashamed that they were not born to look, feel and orientate themselves like that group.” Thus a war begins, white people became racist towards black people, people became homophobic, people started killing others because they didn’t belong to the same religion…. And so the story goes. It’s so sad that this happens. It really breaks my heart to see this happening. 

It’s impossible for me to believe that God would condemn us because of a certain way we were born. I would have to agree with Desmond Tutu who said he would rather go to hell than worship a homophobic, racist, discriminatory God. Our society should be one that allows people to be free to be who God made them to be. And I believe God made every one of us, as different as we are. 

2. Most people misread the bible

This is true, especially for religious people. I think most of us are guilty of this, I know I am. I think this could answer one of Michael Rowe’s comments on my previous posts, which you can read here. He says this: “there’s a lot of evidence for people doing horrific things to each other in God’s name (think about the Middle East, the Crusades, the Spanish Inquisition, 9/11). I could probably make a good argument that belief in a personal God actually predisposes one to acts of inhumanity”. 

I have heard so many Atheists and non-Christians who take a quote from the bible and use it very cleverly to prove a point. This often works out in their favor because they have mastered an art of arguing. And, many people who believe in a God, do exactly the same thing. They take something out of context, or only part of a verse and they use it to prove a point, which can be taken to an extreme (ex: 9/11, the Spanish Inquisition, etc.)  

A simple example of this can be found in the discrimination in gay and lesbian people. If you look in the bible, you will find this verse: “You shall not lie with a male as with a woman; it is an abomination.” Leviticus 18:22. There are a few like it in the bible. Looking at this verse, most people make the conclusion that being gay is evil and should be punished. But, we fail to look at the context in which it was written and the people it was written to and the reasons behind what was said. Once we take the time to understand these things, the meaning of the verse changes quite substantially. Here is a nice explanation on what the bible says about homosexuality. What the video is trying to get across is that the word “abomination” had a different meaning in the time it was written. Many words have different meanings nowadays as compared to a few centuries ago. A male in bed with another male was seen as wrong in that time because they could not produce any children and their population was dying out. People were in dire need to increase the numbers of their population, two people of the same gender being together just did not help the huge problem they faced. 

I think there is a right and a wrong ways to go about reading the bible. There is no one right way and there is no one wrong way. 

So, what I’m trying to get across is that religion has failed at times to “practice what they preach” and at times gotten things wrong. And I’m sad this has happens, but we are humans, and humans are not perfect. 

Lastly, 3. I try my best to treat people equally. 

Because I know that we are all humans, I strive for equality, in all aspects of my life. Once again, you cannot just treat your patients equally because its in our code of conduct and then go ahead and discriminate others when you are not at work. That is hypocritical. Qualities such as empathy, love and compassion as well as our moral code and equality needs to be genuine. They cannot come halfheartedly.  They need to be practiced in your every day life, with all the people you come across. It should not just be switched on when you feel its the right time to. 

I realize what a challenge I’ve given myself, and I challenge you too. It is not easy, its difficult to resist our desire to label people. I need to constantly remove the labels I’ve given people, and open my mind. I want to enjoy our differences. 

BUT, one thing I would like to add, is that equality for all does not diminish corrective actions for immoral actions. In fact, I think it emphasizes it. When a person does an immoral thing, it should be dealt with appropriately in order for justice to be served and to emphasize the importance of treating everybody equally. 

I apologize for such a long post,  but I felt it important to say all of this 🙂