Tag Archives: Physiotherapy

What is religious freedom anyway?

I was struggling to get inspiration for a post then I remembered how I enjoy talking about religion and maybe I could think of something relating to that. I love watching Grey’s Anatomy and I remembered watching an episode about an ethical dilemma (of which there is no shortage of in the programme) which involved a strong religious view. I found it, and re-watched it, now finally I have my inspiration for this post 🙂 

The dilemma

In episode 13 of season 9, a teenage boy is rushed into the ER after sustaining serious injuries after getting hit by a car while skateboarding. The boy has some serious heart problems and is losing a lot of blood, he desperately needs a blood transfusion. The doctor orders a few units of blood and at that moment a tag falls out from the boy’s pocket, which says that he is a Johovah’s Witness, which changes everything. Johovah’s Witnesses cannot accept any form of blood transfusion, even in life-or-death situations. 

The doctor is forced to stop the blood from being administered, perform heart surgery without any extra blood and watch as she does everything she possibly can to save her patient before he passes away. An intern doctor felt horrified at this situation and tried acting against her orders by giving him blood, she was caught out just before it was connected to him. She could not understand how you could abide by a religious rule that she thought was not at the best interest of the patient. 

The patient soon passed away.

The problem was that the patient was a minor and his parents had to make the decision to not give him blood. The child could of had a different religious belief and if able to might of made a different decision. But the doctors had to trust that the parents included this into their decision-making process.  

Is religion really that important? 

We as medical professionals need to respect each and every view of our patient, including their religious beliefs, because that is what’s important to the patient. Even if it differs from our own beliefs. Religion is often a huge part of a patient’s identity and it is just as important as every other aspect of the patient’s life. It would be wrong not to respect it.

But should a religious rule control medical decisions, especially ones that are in conflict with ‘the best medical treatment for the patient’? Who even determines that? 

On the other hand

Being a doctor and having to make that decision must be so hard. It is (for some) going against your own morals, going against your innate tendency to do good for your patient. On the one hand you would be going against the patient’s right to the best medical treatment, but giving the patient treatment that is contrary to the their belief would not be giving the patient their right to autonomy. To go against something you believe in for the sake of remaining ethically correct is hard. Incredibly hard, impossible for some.

What is the solution?

There is no easy answer. In the end, you cannot break ethical code just to satisfy your own needs. Finding a solution should be personalised because we are all have different beliefs. Somewhere in the process we need to change our mindset that spirituality is important and needs to be taken into account. And sometimes we need to accept that we may not always know what is ‘best’ for our patients. 

I personally would find this really hard if I were in that ‘Grey’s’ situation, I would feel very conflicted. But it doesn’t come down to what I feel, it comes down to what is right for the patient and I must learn to accept that. 

Pain Management

Would you ever under-treat a patient’s pain because you were concerned about repercussions or because you believe that a patient – even a terminal patient- might become addicted? 

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This was a question asked to doctors in a survey. 84% said no, they would give their patients the pain medication, and one of the most striking reply to the question was this: “Pain should not be undertreated, and what’s the problem with a terminal patient being addicted and comfortable?”

A patient’s perspective

Struggling with immense pain, especially pain that severely impairs quality of life is a problem. A huge problem.  I found 3 quotes very useful in getting an idea about how detrimental pain can be:

“The most frightening, the most humiliating, and the most difficult ordeal of my life . I became withdrawn, completely disabled by my terrible, relentless pain. I was unable to function professionally. I was unable to be much of a wife or a mother, a daughter or a friend.”

“Pain is my biggest fear, it puts me in a darkness, you can’t find peace in that darkness of pain. Pain blinds you to all that’s positive.”

“They wanted to know why the medication was not working? Why are you still in pain? If you are crying, why are you crying; if you are not crying, how can you be in pain? You are not only experiencing your pain, you are experiencing other peoples’ opinions and feelings; that makes it worse.”

Pain now seems much more than a ‘highly unpleasant physical sensation caused by illness or injury’. True pain is much deeper than that, it’s more like a torment of one’s entire being, physically, emotionally and spiritually. Most people would do almost anything to relieve their pain in some way, even if it was just a small amount.

A doctor’s perspective

Most medical professionals would do as much as they could for patients to be comfortable, but some won’t because they are scared of the possible legal implications. We were taught to always have the patient’s best interests at heart, and thus  the relief of pain is a core ethical duty in medicine.

But why then is pain not always correctly dealt with? Some medical professionals do not treat pain sufficiently, patients lie about pain and most people do not know what to do with chronic pain.

I was told a story once of a patient who was diagnosed with chronic pain after a car accident. A physiotherapist had convinced her that she needed physiotherapy everyday to help her with her pain, she was told if she did not get her knots worked out everyday it would snowball and the pain would become unbearable. This is a perfect way to ensure your patient will believe they have pain and to make sure you get money every day. But completely unethical.

Another example is a patient who was previously a drug addict and lost everything. He then decided to make up a story about an accident he had a few months ago and he has been is such pain ever since, hoping the doctor would prescribe narcotics to give him his fix.

How do we deal with this problem?

I think with experience you can pick up on small signs that the pain is real or not, but there is a fine line there. I also believe that chronic pain is more psychological than just physical and needs to be handled properly. It is easy to jut handle the chronic pain patient by prescribing them the medication they need every month and sending them on their way, but it needs to be addressed at a deeper level and that is why a multidisciplinary approach is a good idea. Sometimes all a patient needs is somebody to explain what chronic pain is and how it works and the pain already decreases.

Real pain should not be pushed aside, underestimated or undertreated. Treatment for pain can be quite complex, but it is possible. Personal and professional accountability for failing to treat patients competently and compassionately is critical, but so is creating environments that make effective care for patients in pain the norm.

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.

The art of empathy

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What a challenging first week of the course! After reading and watching the content for the first week, I just could not get all my thoughts together, it is difficult to sift through all the different opinions and find your own at times. But I guess this is one of the main objectives, to actually get to engage with the content, think about it and find something meaningful to take out of it. This is what I intend to do. 

Empathy? What is it anyway? 

To my knowledge, empathy is very often confused with sympathy, but there is a big difference between them. This is where it can get complicated… Empathy can be defined as “the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner.” It’s something of a personal connection you experience with another, however slight. You can relate to a person because you can put yourself in their shoes and try understand what they really need. This to me, is about emotionally investing yourself with a patient (and I’ll get to that later). 

Now, sympathy is a different concept, and it’s defined as “Acknowledging a person’s emotional and/or physical hardships and providing comfort or reassurance.” This to me, is less helpful and impersonal. You cannot tell a patient that its all going to be okay, when you know that it might not be or much struggle lies ahead for them. But rather empathise with them by being honest about their situation and walking along side them in their struggle. 

I think empathy is essential, not only in my professional life, but in all aspects. I also believe it is an art. You cannot simply learn empathy. You need a desire for it, a desire to let another person just “be” in your presence. It involves work, being uncomfortable and possibly vulnerable (oh no! how dare I say such a scary word). Doing this, developing empathy is one of the greatest and most rewarding things you could ever do, no matter how scary or alien it may seem. That being said, we cannot run away from emotion, especially emotion connected with the patients we see. After all, they are trusting us with the intimacy of touching them, and getting into their personal space. This is often the only intimacy they let into their lives. 

BUT, being empathetic is draining, emotionally and physically and if you’re intending to invest emotionally with every patient you see without any help, you’re bound for self-destruction. It can kill your spirit and even take away your original passion. You see it in young women who go “all out” when it comes to caring for people and they eventually end up hating what they set out to do. You need to find a balance. Somehow. For me, my God sustains me and refreshes me. Without that I cannot have empathy for everybody I come across or I end up with some kind of mediocre empathy mixed with sympathy and a bit of annoyance.

What are your ways of dealing with or developing the art of empathy?

This is me!

Climbing up Table Mountain
Climbing up Table Mountain

Hi!

My name is Kristin, a third year physiotherapy student from the University of the Western Cape. I’ve been enjoying my time away from a classroom this year as I get to practice what it’s like to be a Physio in the real world. I must say it is exciting, challenging, difficult but above all, it is fulfilling knowing that I’m doing something I’m passionate about.

I am a Christian. I love being outdoors doing hiking, climbing, spelunking, and just general outdorsy things. I love to read, especially thrillers and I have a passion for music and frequently play the piano when I get the opportunity. I also think of myself as an arty person, although I do not get many opportunities to explore this side of me. In terms of Physio, I’m interested in Neuro, Paeds and NMS, I look forward  in exploring these areas of interest in the next few years.

I stared this blog for a module I am doing, called Professional Ethics, and I hope to engage with the material I am given and use it as an opportunity to grow both in a personal and professional manner. Reading this blog will allow you to journey with me through the many challenges ethics brings with it. It is a daunting task, I will be challenged, but if I am not being challenged, I am not learning.

Lastly, I use my religion as my main guide in grappling with life, so I finish off with this quote: “You might have heard of the old saying “Give someone a fish, and you feed him for the day. Teach someone to fish, and you feed him for a lifetime.” The same holds true for life itself. If you give someone an answer, a rule, a principal, you help him solve one problem. But if you teach him to walk with God, well then, you’ve helped him solve the rest of his life.” – John Eldridge