Tag Archives: Health care provider

Week 6: Overview & Reflection

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The Physiopedia  PHT402 Professional Ethics Course has been such an exciting CPD activity and eye-opening experience.   It is  a blessing to be able to connect with physiotherapists and students from different walks of life, all around the globe, as each on of us have valuable and diverse perceptions and opinions to share.  It has been an amazing journey, brainstorming, writing and discussing challenging and thought-provoking moral and ethical dilemmas of life and physiotherapy practice.  This will be my final blog post reflecting on the PHT402 course and my learning portfolio.

 

albert einstein

 

The themes I found particularly difficult was equality, torture and assisted dying.  These topics challenged me to objectively look both sides of the coin and argue the point of view or opinion I share.  I tried to look at it, firstly as a human being and secondly as a health care professional.  After receiving some feedback from my peers, I realised that I kept my distance from sharing too much of my professional experience in every post, as I felt that I may become judgmental if I try and use patient experiences and analyse their behaviour or decisions.  In addition to my weekly post, I wrote a reflective post after reading and discussing with other participants the theme of the week on my original blog post and theirs, which made it easier to identify areas I need to develop and summarise opinions and perspectives.  As in life, there were some participants who did not share my opinion on or perception of various topics/themes, but I respect this difference of opinion and accept that it is their prerogative to freedom of speech and expression.  Furthermore, I applaud the brave participants who went against the grain and who took an honest  look at themselves and/or their lives and admitted their fears, shortcomings, challenges and personal experiences.  It is a wonderful opportunity to be “forced” to be open-minded and take a good, hard look at yourself, your life and your practice.  I will definitely incorporate what I have learned in my life and practice.  Mostly to be careful of becoming too involved with my little patients and truly respect the decisions and opinions of all my patients, while still following the rule of the law.

 

It was really hard for me to write my blog post on equality, as I had so much to say and found myself jumping around and not settling on a specific direction.  Growing up and living in South Africa, I had to be sensitive and really search high and low to find diverse and relatable information on equality.  It was so interesting to read the posts by my fellow participants residing in a different country, experiencing equality, as a global issue and struggle.  To sum up my opinion on equality…  Equality is an idealistic notion.  Due to political and social interference, inequality is more common in reality.   You have no right to judge or discriminate against another human being because you don’t approve of their choices or behaviour.   It is with sensitivity and an open mind that we need to approach matters of equality, as seen in the current debate on marriage equalityracismsexual orientation and gender identity.   I believe that focusing on how you act and engage with others, is what is important. It is a personal goal to try and see people without judgement, as your equal, a human being, deserving of equal respect, protection, understanding, kindness and care. This should be carried forward into our practice as health care professionals.

 

Week 4’s theme of torture really touched me deeply.  Just imagining being tortured or someone I loved being tortured gave me such an emotional reaction that it took me some time to gather my thoughts and start researching this topic objectively.  The discussion on my blog post and many other participants’ blogs, revolved around when we condemn torture for one reason but perceive it as acceptable for another.  I am still of the opinion that the concern needs to be on the protection of the human rights of all human beings.   I believe we should respect the rule of law and the principle of upholding fundamental rights and freedoms, for all, even when we personally feel that a person (terrorist or criminal) is not deserving of any rights as a human being.  This is particularly important in clinical practice where student-physiotherapists and physiotherapists in public health sector are faced with treating incarcerated human beings.  As health care professionals we must treat all our patients equally without judgement and not allow or cause them any discomfort or pain as a result of refusing or delaying treatment (as seen in the Steve Biko case).   It is sad that torture is still in practice, globally, behind closed doors in police and military custody.

 

This 5th week’s theme of assisted-dying and end-of-life decision-making, was difficult for me as a physiotherapist (who is trained to improve quality of life) and a Buddhist (who believes in freedom from suffering), trying to objectively see and argue both sides of the coin without judgement. I have no idea what my choice will be when I am in a situation where I am given the choice or when it comes up in a discussion again. That is the beauty of life, we grow, we change, we evolve.   I know that my opinion and perspective on this will change as my life changes in the years to come.  Exploring the relationship and comparison between passive involuntary assisted-dying (legalised abortion) and voluntary assisted-dying (the last human right) helped me put things in perspective.  After reading my fellow participants’ blogs, I conclude that everyone has the right to life and to be treated with dignity and respect, in life and death.

 

I would like to thank all my fellow participants for reading my posts and engaging discussions on these sensitive topics that we face on a daily basis in life and practice.  I will leave this course as a better human being with a new found understanding and goal, to live a balanced life, cherish human compassion and seek further understanding of the complexity of human connection.

 

I will leave you with “The Physics of the Quest”, something to live by:

“If you are brave enough to leave behind everything familiar and comforting;

and set out on a truth-seeking journey;

and if you are truly willing to regard everything that happens to you on that journey as a clue;

and if you accept everyone you meet along the way as a teacher;

and if you are prepared, most of all, to face and forgive some very difficult realities about yourself;

Then truth will not be withheld from you.”

Elizabeth Gilbert: Eat, Pray, Love

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For PHT402 Professional Ethics Course: Week 6: Overview

 

Week 4: Reflection

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“The healthy man does not torture others – generally it is the tortured who turn into torturers”
Carl Jung

Torture

I completely agreed with Emma, Amie and Tamaryn’s  posts on Torture, concluding that torture in an unacceptable practice and in violation of Human Rights.

 

Tony discussed the implications and use of torture by physiotherapists, a side of this topic that I didn’t even think of  when I wrote my original post.  What about when a physiotherapist is causing unintentional pain and discomfort to an uncooprative bedridden patient with Alzheimers and Dementia with contractures and bedsores.  Let’s say this patient is not “compos mentis” and their family (right of attorney and legal guardian) have agreed to therapy as prescribed by her physician.  Now this patient is refusing any touch or movement…. If you stretch or mobilise her and it hurts, or she communicates that are you causing her pain just by touching her skin and she is refusing to do any movements or exercises, is this torture?  If you move her and she screams, and you continue with the stretches, although you know this pain perception is abnormal due to her cognitive state, are you torturing this patient?  This really made me think as most physiotherapists have been in this position.  I don’t believe that this is torture as we are not deliberately trying to cause pain to obtain something from her or to teach her a lesson or just because we are sadistic and want her to suffer.  We are trying to help her as a health care professional with the medical knowledge to know what physical and emotional reactions are appropriate or normal in terms of anatomical and physiological functioning.  As physiotherapists we know that the discomfort felt from stiffness with light stretches or mobilising exercises or supported positional changes (without forcing into end range etc), is more “soreness”, not painful as perceived.  Especially if this patient reacts with abnormal perceived pain with any touch (such as being washed, dressed, hair combed, teeth brushed etc). We are not doing any harm, but improving functional ability and preventing further damage or secondary complications through our treatment. Thus I believe in this instance we are not torturing the patient. This patient might view being washed by the nursing staff as torture, but those sound of mind know what is being done is esssential care and not harmful.  If a “compos mentis” patient refuses your treatment and you go against their will and force treatment on them, or hurt them on purpose by forcing stretches beyond subjective comfort or refusing to help them when they are in pain or discomfort, that is another story.   Marna also discussed this area of potential torture in patient care in her blog post.

 

Torture can also be seen as intentionally delaying essential care or providing minimal or refusing assistance or intervention causing a patient to remain in pain and suffer.  This is also against to Hippocratic oath and the HPCSA National Health Act and Health Professions Act, to do no harm.  This is what happened in the Steve Biko case I discussed in my original post.  Kim also discussed this and I found the words from one of the offending medical practitioners in this case, very central to this topic of allowing or assisting with torture due to the political or social context;  “a medical practitioner’s first responsibility is the well-being of his patient, and that a medical practitioner cannot subordinate his patient’s interest to extraneous considerations.” Tucker 1991

 

Still, torture is being used behind closed doors by police and military forces.
This is a 2013 video of the torture and violence inflicted on innocent human beings in South Africa:

 

What about the saying “an eye for an eye” or that a criminal such as a murderer or child rapist deserves to be violated or tortured and stripped of his Human Rights?  Well, in recent weeks, Carte Blanche ran a story of men that were accused of being child rapists only to be released after 3 months in prison where they were subjected to violence and were told that they “deserve to be tortured, violated in prison and suffer a painful death” by many in the community.  As there were no circumstantial evidence and forensics linking them to this, they were released and the actual guilty child rapist was identified by DNA analysis and charged. Do you even know how many innocent people go to prison for crimes they didn’t commit? This happened with another man who was “framed” by the police for allegedly killing his girlfriend, but only after spending time in prison and going through the process of appeal did the legal system prevail and found that evidence was fabricated and that he could not be linked to this murder. The court also found that the police maliciously pursued this young man and knowing that he was innocent, they tried to ruin his life.  So taking Human Rights away from prisoners or saying that they deserve to be violated or tortured, can never be the right answer.

 

I will end off with the words by Ghandi as quoted by Jackie and Jamie-Lee:

“An eye for an eye makes the whole world blind”

 

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For PHT402 Professional Ethics Course – Week 4: Torture

 

Week 1: Empathy

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“The great gift of human beings is that we have the power of empathy.”
Meryl Streep, actress
empathy

Is it even possible to find a more complex and misunderstood word? A word that bridges the gap between human experience, reactive emotion, compassionate thought and altruistic connection.

The idea of empathy was first described in the 1880’s by a German psychologist Theodore Lipps, who coined the term “einfuhlung” (literally, “in-feeling/touch”).  For me, this definition of empathy best encompasses the full meaning of the word in neutral context: The process of appreciating and understanding a person’s subjective experience while maintaining some degree of professional or personal distance.

As a physiotherapist or health care provider, having empathy is to be concerned with a much higher order of human relationship and understanding of your patients. For me, empathy has been a crucial and required altruistic communication skill as I am faced on a daily basis with overwhelmed and anxious new moms with their newborns, and scared, devastated and at times unrealistic expecting parents of babies and kids with special needs or medical respiratory problems. Our patients expect a lot from us and trust us with their vulnerability. We have to be careful of becoming too emotionally involved or invested in our patients’ lives and human experiences, as you can loose your professional objectivity and blur the patient-therapist boundaries. It can also lead to emotional burn-out by making you feel like you are responsible for your patients’ happiness and solving all their problems. I am of opinion that maintaining a healthy, altruistic but professional relationship with all your patients is key.  By being honest with sensitivity and compassion, listening and observing with all your senses and just taking the extra time to let your patients or their families speak or ask questions, really help to build a trusting patient-therapist relationship and human connection without sacrificing your professional objectivity.  Having mild empathy enhances every facet of holistic management and patient outcomes.

In this fast-paced world driven by quantity rather than quality, it often happens that we forget the importance of human compassion and understanding.  We have all heard or know of health care professionals with “poor bedside manners”. They often speak using medical jargon, talk down to patients or their loved ones, don’t make eye contact, rush through each consult or therapy session, brush off or interrupt patients asking questions, raising their concerns or discussing aspects of their lives.  Many health care professionals consciously choose not to interact with their patients on an emotional level, as they don’t see the point or are unsure of how to deal with it as vulnerability means uncertainty and they only want to focus on objectivity and what they can control. There is a fine line between empathy with professional distance, and sympathy with personal involvement.  I believe as human beings and more important as health care professionals, we have the ability and responsibility to expand our perceptions, lean into the discomfort of vulnerability and spend a little more time focusing on others in need by treating them with common decency and respect.  Remember, you cannot treat others with compassion if you are not kind to yourself first.

Now the controversy… Can empathy be taught? Some may argue that empathetic engagement in patient care or society can be taught… Some believe that it can be enhanced by various emotional intellect and communication skills training programmes and experiences. Others are of the opinion that empathy comes from altruistic human nature, that it is an inherent emotional communication skill that elicits compassion and sensitivity, as all humans long for connection… But it is still a choice, to engage or not to engage….  Where do you stand?

I’ll leave you with Alanis Morissette:

“…Thank you for seeing me, I feel so less lonely.

Thank you for getting me. I’m healed by your empathy…”

Blog Post: Week 1, themed “Empathy”, for PHT402 Online Professional Ethics Course