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Professionalism: Values in Action
To be a physical therapist professional, you've got to live your
beliefs.
By Maryann DiGiacomo
The words "profession" and "professional" come from the Latin word
"profiteor," which means to publicly declare a belief. When a profession
declares itself to society as a potential benefit, society then grants
that profession certain privileges. In turn, the profession must fulfill
certain responsibilities. Every day, physical therapists (PTs) fulfill
their responsibilities to patients, clients, and society by applying
evidence, advocating for the profession, mentoring coworkers, and
adhering to APTA's Code of Ethics, Standards of Practice, and
policies/procedures.
| Core Values |
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In 2002, 18 PTs were invited to participate in a consensus-based
conference convened by APTA's Education Division. During that
conference, seven core values were identified that furthered define the
critical elements that compromise professionalism. They are listed below
alphabetically and do not represent any order.
Accountability--The active acceptance of the responsibility
for the diverse roles, obligations, and actions of the PT including
self-regulation and other behaviors that positively influence
patient/client outcomes, the profession, and the health needs of
society. Examples: Responding to a patient's client's needs,
acknowledging and accepting consequences of his or her
actions.
Altruism--The primary regard for or devotion to the interest
of patients/clients, thus assuming the fiduciary responsibility of
placing the needs of the patient/clients ahead of the physical
therapist's self interest. Examples: Providing pro-bono service,
providing patient/client services that go beyond expected standards of
practice.
Compassion/Caring--Compassion is the desire to identify with
or sense something of another's experience; a precursor of caring.
Caring is the concern, empathy, and consideration for the needs and
values of others. Examples of compassion: Understanding the
social-cultural, psychological, and economic influences on an
individual's life in their environment. Being an advocate for
patients'/clients' needs. Examples: of caring: Focusing on achieving the
greatest well-being and the highest potential for a patient/client.
Demonstrates respect for others and considers others as unique and of
value.
Excellence--Physical therapy practice that consistently uses
current knowledge and theory while understanding personal limits,
integrates judgment and the patient/client perspective, embraces
advancement, challenges mediocrity, and works toward development of new
knowledge. Examples: Demonstrating investment in the profession of
physical therapy profession. Using evidence consistently to support
professional decisions.
Integrity--Steadfast adherence to high ethical principles or
professional standards, truthfulness, fairness, doing what you say you
will do, and "speaking forth about why you do what you do." Examples:
Abiding by the rules, regulations, and laws applicable to the
profession. Using power (including avoidance of use of unearned
privilege) judiciously.
Professional Duty--The commitment to meeting one's obligations
to provide effective physical therapy services to individual
patient/clients, to serve the profession, and to positively influence
the health of society. Examples: Involvement in professional activities
beyond the practice setting. Mentoring others to realize their
potential.
Social Responsibility--The promotion of a mutual trust between
the profession and the larger public that necessitates responding to
societal needs for health and wellness. Examples: Participating in
political activism. Providing leadership in the community.
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"Our individual and collective notions of professionalism serve as the
rudder we use to navigate the waters of health care," says Laura (Dolly)
Swisher, PT, PhD, a member of APTA's Ethics and Judicial Committee.
"There is a collective concept of professionalism that has to do with
our shared values and how we behave toward patients, clients, and
society as a whole." She continues, "And there's also the individual's
notion of professionalism. Each of us puts on our professional garments
differently."
Swisher, who is assistant professor in the School of Physical Therapy
at the University of South Florida College of Medicine in Tampa,
believes that professionalism in physical therapy can be taught and
learned. "There are a million ways to teach it," she says, "through
APTA's Code of Ethics, A Normative Model for Physical Therapist
Education, the Guide for Professional Conduct, continuing education,
and conference programming."
But, she adds, there's no substitute for role models. "When a PT
takes a job and finds a role model to help him or her understand his or
her responsibilities, it makes a huge impact," says Swisher. Role
models, she says, teach PTs to "go the extra mile."
Realms of Professionalism
Building on the work of Jack Glaser, SVD,MA, senior vice president of
Theology & Ethics and director of the Center for Healthcare Reform
at St Joseph Health System in Orange, California, an expert on ethics
and health care reform, Swisher believes that there are three realms of
professionalism-individual, organizational, and societal. Each realm
presents opportunities and challenges to PT professionals.
"On an individual level, PTs demonstrate professionalism by treating
each person with respect and dignity, putting the patient's needs first,
and listening to the patient," says Swisher. "We also demonstrate it by
recognizing cultural differences and finding out the best way to
motivate each patient." And, it's good to voice your beliefs and
commitments. "Speak out, declare that you are taking a certain course of
action because you are a professional!" she says.
The individual realm also includes personal development and
recognizing one's skills, abilities, and weaknesses. Unfortunately, some
PTs set their personal development bar at the minimum. "If a state
requires 12 hours of continuing education, there are those PTs who will
go to any session that fits into their schedule just to get the
documentation to show that they were there," Swisher says. "But to be a
professional is to engage in a lifelong self-assessment." That can lead
to bettering one's skill set, becoming a certified specialist, or
entering a DPT program. She adds, "Self-assessment also includes
recognizing when you don't have a certain skill and that you're willing
to refer a patient to another PT."
Maintaining professionalism in the organizational realm can prove to
be more difficult than in the individual realm. "Managed care and high
productivity standards may make it hard to deliver quality care,"
Swisher says. "This isn't just a problem for PTs, it's a problem for
physicians and other health care providers." Although PTs have always
put their patients first, she continues, when managed care came along,
providing quality care within the constraints of the system "became a
balancing act." PTs often must weigh one belief or value against
another. (See Core Values at right.) While altruism calls for putting
the patient's needs first, accountability calls for a PT to work within
the organization's policies and procedures. There might not be a "right"
or "wrong" solution. The ability to weigh values to make decisions
demonstrates professionalism.
Swisher notes other challenges in organizations-the giving of
corporate gifts and supervision of personnel. Some organizations feel it
is okay to give gifts to referral sources. Swisher says she knows of PTs
who contend that they were "locked out" from getting referrals because
they weren't giving gifts. PTs also must be diligent about supervising
and directing personnel. It's up to PTs to know the law and speak up
when they see physical therapist assistants or aides "going beyond their
training or practicing outside of the practice act."
Organizations do offer PTs opportunities. Some allow--and
encourage--PT employees to provide pro bono services-something that may
be difficult for a PT in a private practice. Larger organizations, with
their varying levels of management positions, offer PTs the opportunity
to become directors, supervisors, and team builders.
Through larger issues, the third realm, societal, also allows PTs
opportunities to demonstrate their professionalism. "As a health care
profession, we have a role in helping to shape health care policy,"
Swisher says. "We need to be concerned with the number of uninsured
people in the country and open clinics to provide services to
underserved communities. We need to be advocates for our
patients."
Ethics and Professionalism
It's almost impossible to talk about professionalism without talking
about ethics--the two go hand in hand.
| Professionalism and Day-to-Day
Decisions |
| A seemingly innocuous action on the part of a physical therapist
could affect the relationship that he or she has with a patient/client
and the quality of care that patient/client receives. Below are but a
few of these potential actions.
Calling oneself "doctor"--A doctor of physical therapy who
chooses to identify himself or herself as "doctor" must ensure that his
or her patients know that he or she is a PT. Do your patients understand
that you are a physical therapist not a medical doctor?
Dressing for the clinic--Could a facial piercing or a tattoo
influence how a patient feels about his or her PT's values and level of
competence? For PTs who wear street clothes in the clinic, could
patients find your dress offensive?
Accepting gifts from patients--Is it okay to accept a box of
donuts from a grateful patient? How about two tickets to a local sports
event? Does a patient who offers a gift have an expectation about
preferential care?
Dating patients--When, if ever, is it ethically acceptable to
engage in a romantic or sexual relationship with a former patient? (See
"Patient Vulnerability: Ethical Considerations for Physical Therapists"
by Susan W Sisola, PT, PhD, in the July 2003 issue of
PT.)
Understanding other cultures--How should you approach a female
patient from Iran? In which cultures is it customary for a spouse or
other family members to remain in the room for the duration of the
appointment? Should you insist that a patient be seen on a day that is a
religious holiday for him or her?
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Swisher lists several ethical issues that cause PTs to look at their
values, beliefs, and responsibilities to themselves, their patients, the
profession, and society. "Informed consent is a great concern. How much
information should be disclosed about cervical mobilization and adverse
effects? Can a patient with a head injury or CVA give consent?" she
asks.
Another concern is confidentiality. "PTs care about their patients,"
Swisher says, "They talk about them." An unintentional breech in
confidentiality is still a breech. She recalls a recent study that was
conducted in elevators that evaluated the amount of confidential
information discussed among health care providers as they rode from
floor to floor. Confidentiality also comes into play when a patient
discloses other types of information to the PT. "If a patient who
doesn't have the necessary coordination or cognitive skills to drive
admits to his or her PT that he or she is driving, should the PT report
that patient as a danger to society?" Swisher asks.
For PTs who go into patient's homes, there's a unique set of
challenges. There's the issue of truth telling in hospice situations in
which the family doesn't want the patient to know what's going on, she
says. And there's the home health care patient who asks his or her PT to
stop and buy a gallon of milk on his or her way over to the home. As for
PTs involved with discharge planning, Swisher says that they're often
caught in situations in which discharge plans and the family's plan
conflict as to whether the patient should go home or to a rehabilitation
or other type of facility.
More particular to physical therapy than many other professions is
the close physical proximity of provider and patient. "Because of this
physical closeness, PTs must be more vigilant than other professions in
insuring that this closeness is not misinterpreted by the patient," says
Swisher.
And how do ethics and professionalism influence quality of care? "On
an individual level, a PT can provide the best care to a patient, but
under the current structure of the health care system, an organization
or society can thwart a PT's efforts," Swisher says. "Sometimes a PT has
to realize that as an individual he or she can't do everything. But he
or she can work with the organization and society to bring about change
in policies and change in health care legislation." And, she adds, in
promoting physical therapy, "We shouldn't undermine other
professions."
Last, Swisher says, PTs often are faced with the difficult decision
of reporting colleagues who are incompetent or those who are abusing
drugs or alcohol.
"Compared with law and medicine, we are a young profession," notes
Swisher. "We're still learning."
Raising the Bar
While there's always been professionalism in physical therapy, the
degree to which PTs demonstrate it has increased as the profession has
matured. As physical therapy moves toward a doctoring profession, PTs
will continue to increase their responsibilities to patients, clients,
and society.
"We have an implied contract with society," Swisher says. "Society
grants us a lot of freedom and respect based on our education.
Therefore, we have a responsibility to fulfill."
Swisher also believes that professionalism as a part of physical
therapy is a priority for the Association and members. "People are
hungry to discuss issues," she says. She monitors list serves in which
she says "PTs bring out real problems." And, she recalls a "packed
session" on professionalism at a recent meeting of the Health Policy and
Administration Section. "There's lot of conversation going on about what
it means to be a professional," she says.
______________________
Maryann DiGiacomo is news editor. She can be reached at
maryanndigiacomo@apta.org.
PT Magazine - December 2004
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