The past three years of clinical practice have been the most challenging for me and I have experienced quite a number of challenges in the clinics, being shouted at by patients, verbal sexual harassment and patients refusing treatment, just to mention a few. Being able to handle these kinds of situations has always been a challenge for me, but I can say that with the experience I have learnt how to deal with patients in a good manner without appearing to be unprofessional and breaking work ethics in a clinical setting. According to HPCSA (2008) Being registered as a healthcare practitioner with the Health Professions Council of South Africa confers on us the right and privilege to practice our professions. Correspondingly, practitioners have moral or ethical duties to others and society. So I believe it has to be my responsibility to know how to handle some of the challenges I come across in clinical setting.
When I look back to when I was still a second year, which was when we started gaining exposure to clinics and now, there is a huge difference in my interaction with patients. I feel I have grown in being able to address ethical dilemmas in clinics and know what to consider before I make any decision. This isn’t something I developed overnight; it required me to consult more qualified, experienced people and my fellow classmates on how to deal with some patient related issues.
According to HPCSA (2008), Practice as a health care professional is based upon a relationship of mutual trust between patients and health care practitioners. The term “profession” means “a dedication, promise or commitment publicly made”. They then further say to be a good health care practitioner, requires a lifelong commitment to sound professional and ethical practices and an overriding dedication to the interests of one’s fellow human beings and society. As final year physiotherapy student who is hopefully soon to be a qualified physiotherapist, I strongly believe being able to practice professionalism and ethics is vital and throughout my course, I have learnt the most important things on how to be professional.
In my first blog post, I wrote about morals and ethics; I was in a situation with a patient where I felt like the patient was being rude and unfair towards me. A lot was going through my mind and I did not know if I was supposed to continue to treat the patient or not, but eventually I did treat the patient even though at some point I felt like my treatment wasn’t as effective as it could have been if I had not argued with the patient in the beginning before our session, my emotions took over me and I felt undermined and discriminated because I am a student. This scenario got me thinking and I was stuck between patient’s rights, ethics, morals and professionalism. I honestly thought what I did was the right thing at that time, but after posting my blog, reading the comments from my peers about their views on the situation and reading other people’s posts I then concluded that I could have handled the situation differently and better.
My struggles have always been the inability to handle situations, taking everything personal and knowing patient’s rights but still put my rights first as a human being. I have learnt that every situation is handled differently if the scenario puts me at risk as a healthcare provider it is obviously handled differently. For an example, when a patient appears to be physically violent towards me or sexually harasses me, I would put my rights first and I can easily choose not to continue treating the patient. Not being sure how to handle some situations, I always had difficulties to be able to decide on my way forward. But the discussions we had in ethics class also opened my mind and allowed me to look at things on both sides.
There are quite a few posts that were almost similar to mine and going through them opened my eyes and I got to see how other people think and get to deal with different situations in hospitals. For an example, one of the comments to my first post was “remember that the patient’s outburst is not directed to you but to the situation. Sometimes these patients come so far and give up so much to be at the clinic”. This made me view the situation from a different perspective and be able to reason differently. I then realised that sometimes consulting other people before making any final decision is important, if I had looked at it this way I probably would have handled the situation differently.
So I think experiences will always differ from community to community, as well as patient’s expectations will be different. What one of the comments highlighted is then very important and it’s something I should take into consideration next time I encounter challenges related to this. According to Worthington (2015) professionalism is capable of providing a useful framework for modern practice, but it risks being undermined through pressures that increasingly manifest themselves in everyday clinical practice. The concepts themselves should be clear and meaningful, and to this end, it might be useful to treat ethics and professionalism as comprising two distinct but overlapping domains. Because social and cultural difference impacts on how things work in practice, professionalism needs to be sensitive to the environment in which it is applied.
According to care quality commission (2016), there is a Health and Social Care Act 2008 Regulations. The intention of this regulation is to make sure that people using the health care service are treated with respect and dignity at all times while they are receiving care and treatment. To meet this regulation, providers must make sure that they provide care and treatment in a way that ensures people’s dignity and treats them with respect at all times. This includes making sure that people have privacy when they need and want it, treating them as equals and providing any support they might need to be autonomous, independent and involved in their local community.
After I had posted my blog I then experienced another challenge, which was the highlight of the semester for me. Where by the patient spoke to me rudely during a treatment session and he threatened to kick me, this situation made me feel very insecure in treating the patient and I felt very intimidated. According to WomansLaw.org (2016) once the environment makes you feel intimidated or hostile then it is not suitable. So according to this statement, I wasn’t supposed to continue treating the patient but the I was scared my clinician would say I was lazy and did not want to treat the patient, I then continued regardless of the situation.
As a student, growth is one of the objective things one could easily tell, from techniques, interaction with patients and reasoning things out in general. One becomes more confident as they get more exposure to things. I can say that for me, clinical practice has been one of the modules where I got to develop most of the skills that I will need after I graduate. In the workplace, people have a lot of expectations and there won’t always be someone to guide your decision making, but rather one the need to make appropriate and good decisions at the same time. Ethics and professionalism had been identified as one of the major challenges health care workers experience in their daily basis and at any level of experience. This course has taught me very important ways of dealing with different ethical dilemmas and also enables me to be able to hear and see what other people have experienced.
According to Slomka (2008), Public health professionals confront ethical dilemmas routinely in public health practice. This complex and rapidly changing field demand that educators give renewed attention and emphasis to ethical decision- making. Students and practitioners will benefit from the curriculum in schools of public health that present the theory, language, and analytical tools to explore contemporary ethical dilemmas, both hypothetical and real. As the discourse in public health ethics advances, the critical link between education and application in the field will be manifest in professional publications and in professionals better prepared to resolve ethical dilemmas in their professional practice. I will recommend that schools and higher education institutions put a lot of emphasis on this from a very young stage, for students to be led to be more comfortable in dealing with ethical dilemmas in the workplace after varsity.
My only job now is to keep these in my tool box for the future and try to consult even more, because I believe there is no recipe since patients are always going to be different and also one will be working with different people, from different backgrounds in the working environment next year.so it is important for one to stay humble and be willing to learn new things every day because learning is a lifetime journey.
Care quality commission. (2015, March 15). Regulation 10: Dignity and respect | Care Quality Commission. Retrieved on the 02 October 2016 from http://www.cqc.org.uk/content/regulation-10-dignity-and-respect
Health professions council of South Africa.(2008). Professional Conduct & Ethics – HPCSA. Retrieved on the 02 November 2016 from http://www.hpcsa.co.za/conduct/Ethics
Slomka, J. (2008). Professionalism and Ethics in the Public Health Curriculum. Retrieved on the 02 November 2016 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2431097/
WomansLaw.org (2016) sexual harassment Retrieved on the 02 November 2016 from http://www.womenslaw.org/laws_state_type.php?id=14600&state_code=PG
Worthington, R. P. (2015). Ethics and professionalism in a changing world.Investigation en Education Medical, 4(15), 175-178. doi:10.1016/j.riem.2015.05.002