It has been a daunting long 11 months, with ups and downs, laughter and tears, but surprisingly I made it through it. Being a 4th-year physiotherapy student has been one of the difficult things I had to endure, especially when it came to the clinical setting. Experiencing 5 different rotations, with different personalities from colleagues, clinicians as well as patients. People are different and they do and view things differently, this was proven within the 5 clinical rotations I had throughout the year. There have been numerous challenges and situations when I think to myself now I wonder how on earth did I survive that and manage to come out even stronger? As much as people are different like I mentioned earlier, I guess that’s how we get greater opportunities to learn different things, try and understand why one would see something a certain way maybe even notice how the way you have been seeing and interpreting things could be changed. I came to a realization that with all these situations and different characters that I am being exposed to it is to help me learn. To help me realize that my way is not always the right way, as well as reaching the epiphany that I have a greater purpose and that is helping the people.
I would like to start by highlighting a few different scenarios that stood out for me during my clinical practice as a 4th-year student. At one of my rotations I had a clinician who was very strict and serious on how she went on to do her things, I would say she is a perfectionist but sometimes it reached a point where you would think this lady is actually out to get me. She was the type of clinician where if things were not done her way she would scream at the top of her lungs in front of anyone that was ready to catch a glimpse, be it doctors, nurses or even patients. This lady made my time at the placement very difficult for me to cope. It was literally a drag waking up in the morning to go to work because I knew someone would be in my case the minute I stepped into hospital building. As much as that block was the worst 5 weeks of my life, I channeled myself to try and make the best out of that situation, looking back now, I am grateful that I experienced that cause I came out a better person, I honestly believe that the experience I had with that clinician shaped me into a better future physiotherapist. Though she was wrong to treat me the way she did, and I tried by all means not to confront her and express how she really made me feel, I kept things professional at all times even when she lacked professionalism. According to Langlois & Lymer (2016) study, they highlighted five themes that impacted student learning as well as experiences of professional ethics. One of them highlights students focus on the professional qualities exhibited by health care providers and that they grasped the personal impact of unethical and unprofessional behavior on the individual. Though this clinician thought she was being assertive she was being very unprofessional and unethical. Luckily I’m the type of person that learns from every situation I’m put it, she has shown me that I do not want to be that type of physio in the future , where I use my authority to walk all over people, she has taught me that I actually have a trait of patience and enduring difficult circumstances. Like Langlois & Lymer (2016) study stated, I have learned from her actions and leadership and that has further made me better physio I was 8 months ago.
A hospital is a place for healing, open to everyone, so you can imagine all the different characters that we have to deal with. You find difficult patients that literally want nothing to do with physiotherapy sessions, even after the lengthy reasoning on how this is important to them, they deny treatment, of which they have a right to. This is something I struggled with immensely, I just did not if you know you are in a hospital, it obviously means you are not well, I’m coming here offering you the help you need to make you better but you deny it. I have seen patient’s health deteriorate to an even worse state because of this. This defeats the spirit you have as a physio student had reached a point where I was like what is the point of going to that specific patient knowing very well that it will end with them refusing and probably even cussing me out. So it became a moral and ethical fight within me. As a health profession my job is to make my services available equally to everyone that is in need, but if the patient is not interested what was the point, even my attitude towards that patient would change subconsciously where I felt like I couldn’t even care less about the patient. My patience with the patient got shorter and so did the “this is good for you” speech. This all changed when I actually decided to stop missing the ethics classes and actually listened to the discussions we would have in class. That is when I decided to actually understand what my role as a physiotherapist student is. The health professions council of South Africa, professional guidelines, states general ethical guidelines that we as health profession should abide by. That is when I read through them and had a better understanding of my role as a physiotherapist as well as what is expected of ethically. I now have a better understanding of the situation I had with that patient. It was wrong of me to give up on that patient as ethically they have a right to consent to treatment and me as a physiotherapist I should always give my patients equal and adequate treatment. I should go on my daily duties as a health profession with the patient as vigorous as I would always do with any other patient, rather than having a negative attitude towards the patient.
Now in this clinical scenario, I was working in a polytrauma war where the majority of the patients were involved in gang fights or community assaults. There was one specific room that I dreaded working in cause it was full of males. This bothered me a lot as I even blogged about it earlier this year. I quote from my previous blog: “Sexual harassment in the workplace like a hospital can happen in any forms, and unfortunately, I have experienced one where patients verbally harass me. I worked in a ward where I saw the majority of the patients of that ward. There was a specific room in that ward of which I used to dread. This room had 6 patients of which I used to treat 4 of them. The minute I walked into that room all the comments would start. I first took as a joke till it got to the point where I would actually panic every time I walked into that room. The patients would make comments about my looks, to the way I walked and even my touch to them was more or less like as seen in the video. This made it very difficult for me to conduct an effective treatment for these patients as I did not want to spend a long time in that room. This hindered me achieving my goal as a physio. I made sure that every time I treated these patients I kept the curtain open as I did not trust these patients. They inappropriately look at me while making comments about me being in bed with them. I used to note this down in physio notes. This situation was very difficult to cope with as I did not have a clinician at that time because
she was on sick leave. I had about 5 different clinicians who would check up on me now and then but I never really had the chance to express my concerns with them. I, however, explained this to the sister in charge and she made sure that whenever I was in that room, there was always a nurse or the sister herself around just to reassure me. I don’t know if I handled this situation accordingly but at least I managed to still achieve my duty as a physio” (WordPress.com ‹ Log In, n.d.).
Looking back on this experience I think it is a great example of how I have grown ethically as a student physio. I might have questioned how the situation was handling back then but I believe I did not treat the patients with any bias, knowing they were criminals and even harassed me verbally in a sexual way; I still managed to maintain my professionalism and ethically treat them adequately.
Here is an interesting video to watch
All the above-mentioned scenarios and how they were handled according to me shows how I have grown in ethical decision making. According to Nortjé & Esterhuyse, (2015) Traditionally, ethics has been taught in the form of informative lectures in which much information has been given to students. The author further explains that this kind of method is productive in isolation as a singular teaching technique where only summative assessment is done. They then also state that Socratic classroom discussions small group discussions held over several months can produce changes (understanding issues as having a moral base). I think with the ethic class that we had through the year where different scenarios where outlined for us and discussed as a class, played a huge role in me growing ethically. Applying the information I had grasped in the class to situations I had faced in clinical practice really I believe made me a better physiotherapy student as well as will make me an even better physiotherapist next year in the real world. Though Sheehan, Robbins, Porter, & Manley, (2015) argues that it is almost close to impossible for a medical student to improve ethical reasoning due to the mere fact that our professionalism is not often measured by emotional investment in a patient or participation in their care, but by dress, attendance and meeting set learning goals. They also state that this can provide a significant source of stress in clinical students, who become preoccupied with getting clinical skills or outcomes ‘ticked off a list’, further distracting them from moral and metacognitive development. Though what is also highlighted in the article is that ethical and moral subject matter intellectual engagement is key and so is an exploratory group discussion. It is of paramount importance as it facilitates debate; thus maximizing involvement (Sheehan, Robbins, Porter, & Manley,2015). Literature and film might facilitate moral education (Sheehan, Robbins, Porter, & Manley,2015). This was all achieved through the ethics class we had this year. I believe based on that as well as my experiences in clinical practice I have grown within clinical practice ethically.