Ethics and professionalism

What is a profession?

“A vocation founded upon specialised educational training, the purpose of which is to supply disinterested counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain”

The question of what constitutes a true profession is a complex one because it is not only a descriptive term to denote a group of people who share a common occupation. It also conveys a value judgement; do the members of that group display behaviour that makes them worthy of their professional position?

Historically, the word professional was most likely linked to someone – almost certainly a man – practising law, medicine, religion or education but in more modern definitions, a profession has to meet at least four criteria:

  • There should be a commitment to the public good
  • It requires advanced expertise and education
  • It involves having independent judgement
  • There is some form of social organisation and recognition

Commitment to the public good presumes a shared devotion to some aspect of the good of society – for example, in the case of any health professional it might mean to promote health in the community. In physiotherapy it ascribes certain aspects of health care and distinctive social roles, etc. functional movement, prevention of injury, reducing or relieving pain, etc., which are obvious, and it directs professional ethics to a code of ethics and guidelines for professional conduct, distinguishing professionals from technicians and drafters. This governs professional activities as a distinctive attitude to professional work is expected. Professional life spills over into leisure time and private life and the boundaries between these may be fluid, meaning that a modern professional is never “off duty”. Thus the physiotherapist will be judged by the standards of the profession, regardless of the context or circumstances or even whether advise or treatment are given.

A profession and its functions are subject to society’s approval and confidence. Society will require evidence that the profession is mindful of its broad social responsibilities. Professionals are accorded considerable trust, allowed to deal in fiduciary (trust/confidential/reliance) matters, handle confidential information and are often officially consulted about professional matters. Social standing, status and prestige are knowledge if society is convinced that the members of the profession pursue their vocation honestly and disinterestedly, and not purely for financial gain.

Advanced expertise: Sophisticated practical skills with a strong grounding in sophisticated theory, i.e. “know-how” (practice) and “knowing-that” (theory) are expected. Traditionally physiotherapy has been a “hands-on” profession with emphasis on practical skills, but the theory research- based knowledge, although having increased exponentially in recent years, still needs refinement to lead to credible evidence-based practice.

Physiotherapy started as increased practical skill in nurses and /or gymnasts/ physical educationalists, was certified by in- service training, usually by/with doctors involved with or specialising in rehabilitation. Education and training later moved into universities or institutions of higher/tertiary education, first at two or three year diploma level and later at four year bachelor degree level. In the USA it has now reached master’s level for entry into the profession and the long term plan is a doctorate in physical therapy (DPT). In some countries it is still only a two or three year diploma. Thus professional practice should be based upon a substantial body of applicable theoretical knowledge and skill. There is a professional and legal obligation to update this knowledge and to keep abreast of new developments, which should be substantiated by research.

Independent judgement: This ensures professional discretion to make a diagnosis and present alternative solutions, based on sound verdicts, to proceed. Thus professionals act independently on their own judgement without supervision, giving them first line practitioner status. This enables physiotherapists to examine, evaluate and treat or refer patients/clients in their own right.

Where a referral system exists, e.g. COID (WCA), it is usually open-ended i.e. the physiotherapist decides on treatment and discharge (via the referral agent). However, today professionals often share responsibility in multi professional/interdisciplinary practice or managed health care and autonomy has become blurred, but professional freedom and accountability still exist i.e. a profession controls, and is responsible for, its own practice. Autonomy of action is based on professional authority. The professional is the final judge whether intervention is appropriate and, if so, the form it should take. An individual’s autonomy is usually determined by the practitioner’s own predisposition and attitudes of colleagues. There is differentiation between first line and first contact practitioner status- first line implies being autonomous in professional decision making, whilst first contact implies just that- the first practitioner to make contact with the patient/ client. A further concept is primary care practitioner- in medicine this usual implies the general practitioner or family doctor.

Social organisation: Most professions have a national professional organisation to which membership is voluntary e.g. SASP, CSP, APTA, APA, etc., leading to social recognition and support from government to educate, discipline and regulate membership. Control of education, legal discipline, registration/license to practice is usually by a statutory body, e.g., HPCSA, State Registration Board etc., but these bodies are informed by, and work in consultation with, the relevant professional organisation. These statutory bodies usually define the scope of practice of each profession and even monopoly of service, but again the boundaries are becoming more and more blurred.

However, the requirements for entry, such as minimum academic qualification, personality compatible with the professional role to be fulfilled, sharing the norms and values of the profession, are usually laid down by the statutory body. The training process is very specific, usually lengthy and prepares the candidate for the role s/he is to play. This entails the student physiotherapist not merely learning about physiotherapy, but becoming a physiotherapist.

Professions are therefore guided by a body that will protect the public from professional misconduct and malpractice. This body controls standards of entry into the profession, as well as maintaining or ensuring high ethical standards of conduct and practice of the registered professionals. This role is fulfilled by the Board for Physiotherapy, Podiatry and Biokinetics (board). The professional association (SASP) on the other hand, should act as the authoritative voice in technical matters, reflecting it’s members’ unrivalled expertise. It affords considerable protection for it’s members, guarding their interest (politically, social and legally) and promotes levels of appropriate remuneration. The professional association usually provides updating workshops/courses and publishes a journal dedicated to disseminating knowledge and research findings.

Professional motives

The decision to enter into the profession may be facilitated by different motives. Craft motives are to meet high standards of technical excellence and to seek creative solutions to technical problems. Compensation motives could be to earn a good living, to have a job stability, to gain professional recognition and to exercise power and authority. Moral motives could involve aspects of integrity i.e. a desire to meet professional responsibility and to maintain moral integrity. Finally, caring motives may promote the wellbeing of others for its own sake. All of these different motives are interwoven in the life of a professional.

Professional responsibilities

Professionals – in general – have a responsibility to:

  • Patients / clients
  • Colleagues
  • The public
  • Research
  • Laws and governmental regulations

Questions

Here are some questions that you can use to guide your reflections on this topic:

  1. What is a professional? What does it mean to be a professional?
  2. How do you become a professional? What personal qualities do you need to be professional?
  3. What does a professional physiotherapist “look” like? Is that what you look like? How do you think you could get to be that way?
  4. What are the norms and values of the profession? Where do they come from? Why do we have them?
  5. What are the criteria you could use to determine if you are a “professional”?

Additional reading

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