2016 – The Professional Rollercoaster

“To develop professionally: adopt a beginner’s mindset, stay teachable, seek feedback, teach others and embrace teamwork” – Dan McCabe

This year has been a wild rollercoaster to say the least. It’s been one year, but I hopped on and hopped off of several rollercoasters this year – emotional, physical, psychological, etc. In the physical aspect I am referring to the physical work that has gone into making this year a success and adapting to the working hours and physical requirements of a physiotherapist. There were several scenarios and situations in which professional ethics came into play.

Looking back to the beginning of the year, it’s scary to compare the two girls standing next to each other. The scared one walking into Surgical ICU for the 1st time on her first clinical block for fourth year and the confident and strong girl walking out of the ICU after her final unseen examination at the end of the year.

But in order to get to that confident and strong 4th year physiotherapy student, I had to climb over, crawl under and roll through several obstacles.  These obstacles also aided in and contributed to developing professionalism and to keep building on what I had already learnt. When I first started writing blog posts and started to explore the different topics of ethics, professionalism, etc, I thought I knew what professionalism was but in fact, my idea of professionalism was a list of characteristics I thought I should have to be considered professional.

“Professional is not a label you give to yourself. Its a description you hope others will apply to you” – David Maister

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Wear and Castellani (2000) wrote that the development of professionalism is not fostered by lists of abstract qualities, end-of-term checklists, or virtue checkpoints, but rather it is fostered by students’ engagement with significant, integrated experiences with certain kinds of content. Like clinical reasoning, which cannot occur in a vacuum but must be built on particular knowledge, methods and the development of skills, professionalism cannot flourish without its necessary basis of knowledge, methods and skills. In addition to that, they state that professionalism and professional development are priorities in medical education at all levels.

I agree with this statement as I believe professionalism isn’t something that just appears overnight. It is also not something that one can study and then possess. It is an aspect of one’s professional personality that develops through interactions in the workplace and with integrated experiences with patients as well as with co-workers and other members of the multidisciplinary team.  This goes to show how much I have learnt over this past year just with regards to the topic and term “professionalism” itself. Here is a video that explores the term “professionalism”:

 

This year has definitely had its challenges and struggles with regards to ethical principles and dilemmas. My first struggle was with regards to morality vs ethics. I had inner challenges and several questions about why other students found it difficult to treat prisoners, but I actually seemed to enjoy it in some way. I was concerned that maybe my morals weren’t what I thought they were and weren’t what they were supposed to be according to how I was brought up. I struggled with this particular dilemma throughout the year as I found that I felt differently toward a variety of patients in which I previously thought I would feel otherwise.

In my last clinical rotation I came in contact with a patient that I would see for the very first time. As it was out of habit and purely to gain more information about the patient and their condition, I read and paged through her folder. She was referred for shoulder pain, but she had quite a thick booklet with the cover page containing the heading “Psychology”. I was uncertain of whether or not reading this part of the patient’s folder would be wrong with regards to the patient’s right to privacy or whether or not it would help me to understand the patient better. This was another challenge I encountered numerous times that will be discussed later – when is it considered violating human rights and when it is ‘acceptable’ or considered necessary.

With that said, I quickly paged through the Psychology booklet and it came to my attention that the patient has two children, one of which, her son, has Huntington’s disease. Both the children had been seeing a psychologist to deal with the diagnosis, but in one of the sessions her daughter disclosed to the psychologist that her mother gets frustrated with her brother’s illness and she gets very irritated and impatient. When this happens she would act violently towards both children and hit them.

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I was shocked as I read this and could feel the rage building up inside of me. I didn’t know what to do. I knew I was supposed to assess and treat this patient now, but I found it very difficult to remain objective. I then spoke to my block partner, without even thinking about the patient’s right to privacy, and decided to put whatever I saw in the folder to the back of my thoughts and go in with a clean mind and treat the patient as I would any other. I struggled. While I was speaking to the patient and asking about her symptoms all I could think about was those poor children. I was drowning in a pool of prejudice and I thought the absolute worst of this woman. I managed to get through the session without behaving unprofessionally, but afterward I asked myself, “Why can I treat a prisoner convicted for murder with ease and no inner challenges, but I struggle to treat a woman that probably has a very tough life and as a result of that acts violently towards her children?” It made no sense to me.

Honestly, this was probably my biggest struggle this year. To try and understand how it was possible to feel so different toward different patients that have all reasons for me to possibly judge them, however, I don’t.

According to Mitton (2010), a big portion (more than 50%) of healthcare professionals feel morally distressed in ethical situations that do not align with their morals or beliefs. They feel as if they are placed under pressure and experience a big amount of guilt when faced with certain ethical challenges requiring them to behave in a certain manner, but their moral values say otherwise. In certain occasions they feel prevented from carrying out proper ethical action due to their moral values.

I had to make various moral decisions in these particular situations, some of which I’m not very proud of and some of which I wish I spent a little bit more time thinking about. In this particular situation I had to decide whether or not I was going to treat the patient and forget about what I read and how I felt about it, or if I was going to let my block partner rather treat the patient. I decided to treat the patient myself as this would be a good test and good way to develop my own professionalism and to learn how to cope with such situations. Besides, if I just passed every patient on that I was uncomfortable with treating due to personal reasons, what kind of healthcare professional would I be? Here is a video that helped me to understand moral distress:

 

Another situation where I had to make ethical decisions was when both the doctor and myself was aware the patient that was coding had a DNR, but still the doctor decided to resuscitate and asked for my assistance with the resuscitation process. I had to decide whether or not I am going to help save someone’s life, or am I going to respect the patient’s wishes and do my ethical and professional duty and stand back? I thought to myself, would this be referred to as professional misconduct or is it more related to my integrity?

Professional misconduct or unprofessional behaviour can be defined as behaviour outside the bound of what is considered acceptable or worthy of its membership by the governing body of a profession (Neale, 1996). Dr. Lawrence Wilson (2014) states that the concept of integrity refers to being “whole”, “complete”, balanced in one’s life and lifestyle, honesty, truth-seeking, reliability, authenticity and consistency in all areas of your life. Furthermore, these must be your principles of living and truth is the most essential component of integrity.

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Looking back now, as I have developed with regards to professionalism, I am now able to understand that a good balance between sympathy, empathy and professional duty is required. We do work in the medical and health provision department and therefore sympathy and empathy is needed, otherwise the job would get extremely tedious and no personal satisfaction will be gained from the service given to others. However, we need to understand our professional duties and responsibilities and need to know when to act on our sympathy/empathy and when to stand back behind the boundary set by HPCSA as professional guidelines as well as in the case of a DNR, the law. If I were to encounter a similar situation now, I would be able to empathize with the family as well as the patient, but I would also be able to stand back and not assist in the resuscitation as I am prohibited by law to do so. I now also understand that in such a situation, my training has not only lead me to help patients in a medical manner, but I am now able to use my training and expertise to comfort the family to a certain extent and explain and answer questions to the best of my abilities.

I believe I have developed greatly with regards to my approach to managing moral compromise. Throughout the year, the situations and experiences encountered in various medical and ethical environments I have learnt and realised that there is a relationship between moral compromise and integrity. Central to this relationship is a view of the self that is responsive to multiple commitments and grounded in an ethic of responsibility.  This was difficult for me to learn and realise, as explained above with regards to my internal challenges, as I believed myself to be someone of good morals and good integrity. However, how can a person of moral integrity, “compromise”? Over the course of this year, writing the blog posts, and reading the experiences of others has led to and aided in my professional development as it made me analyse situations in my mind and speak more openly to colleagues about their experiences. It lead to many sessions of personal reflection which has opened a door in my development.

This open door led me to a place where I could now understand that at times we confront situations in our personal and professional lives where some degree of compromise on important values may be necessary. Goodstein (2000) writes that the possibility of moral compromise occurs whenever one confronts a situation in which a contemplated choice puts at risk values and ethical principles with which an individual closely identifies.

I am still not 100% the professional I would like to be, however I strive to be that professional physiotherapist every day. In the beginning I thought it was simply to just abide by the rules and guidelines and that I was required to have a list of certain traits and characteristics. Over the course of this year, actively engaging in many ethical issues, being encountered with situations of others where I was asked for an opinion as well as reading and writing many blog posts, has taught me that professionalism is a daily struggle in all professionals lives as we are only human and as humans we always want to be the best we can possibly be. My mind-set and behaviour has changed as I have engaged in more situations requiring me to think about more than just what I would include in the patient’s treatment plan.

In conclusion, even though I still have a lot to learn and a lot of professional maturing to do, I now feel more confident to deal with ethical and professional situations as this year has forced me to deal with things I would usually just avoid. I now aim to not only treat a patient in order to relieve their symptoms, but also to act as a professional in all ways and to always stay true to who I am. Personal maturing also plays a great role in these changes that have taken place as I was forced to be mature in many situations as we are now entering the adult world.

REFERENCES

Goodstein, J. D. (2000). Moral Compromise and Personal Integrity: Exploring the Ethical Issues of Deciding Together in Organizations. Business Ethics Quarterly10(4), 805.

Mitton, C., Peacock, S., Storch, J., Smith, N., & Cornelissen, E. (2010). Moral Distress among Healthcare Managers: Conditions, Consequences and Potential Responses. Healthcare Policy | Politiques de Santé6(3), 99-112.

Neale, A. (1996). Professional conduct and professional misconduct: A framework and its application to the accounting profession. Journal of Business Ethics15(2), 219-226.

Wear, D., & Castellani, B. (2000). The Development of Professionalism. Academic Medicine75(6), 602-611.

Wilson, L. (2014). Integrity – What it is and what it means. Retrieved on November 3rd, 2016 from http://drlwilson.com/Articles/INTEGRITY.htm

 

 

 

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