If so, yes it is justified. What about Professionalism in the medical profession though?
And Physiotherapy Professionals?
Jokes apart, let’s dive deep into the topic and understand Professionalism!
WHAT IS IT?
We live in the age of information, right? So answering this question isn’t that much of a task. Alright! Let’s ask ‘OK Google’, Alexa, Siri, Doctor Strange, or Hermoine Granger whichever you prefer- “What is Professionalism?”
This is how Merriam-Webster defines Professionalism as “the conduct, aims, or qualities that characterize or mark a profession or a professional person”
So does that translate to…
I think the only thing Big B did in this is halal the definition of Professionalism.
Professionalism is more about the behavior, our demeanor, and how we conduct ourselves at our workplaces.
What are the attributes of a professional? How should one carry themselves so that one might be perceived as a professional? Indulging in the random meanderings of the mind, ever wondered about the history of Professionalism in Physical Therapy, how things were when Physiotherapy was but a budding plantlet? Can it be taught, and if yes, how?
PS: Our archives in the end are waiting for all the deep readers in the house!
Let us slowly and steadily tread through this article, but first, try answering the following questions-
Are you a-
Neat Dresser
Confident Person
Competent
Responsible
Good Communicator
Adaptable
Knowledgeable
Emotionally Intelligent
If you are these things then my friend, you are a…
Professionalism is not second nature, it can be learned, practiced, habituated day in day out as we step into our workspaces. Let’s elaborate a bit on the attributes that make up for a successful professional-
1] PRESENTATION
Proper appearance has been identified as one of the important components of professionalism which is essential in establishing a successful patient– health care professional relationship. [1]
A Canadian study investigated the perceptions of patients regarding physiotherapists’ attire. Quite surprisingly, the lab coat was ranked by respondents as the most professional attire, jeans as the least professional and least preferred.
However, the perceived appropriateness of lab coats and scrubs decreased, and perceived appropriateness of jeans increased with an increasing number of physiotherapy visits, indicating that the degree of formality of attire is related to their level of familiarity with the health care provider.[2]
It is desirable to mention the impact of cultural differences on the rendering of any dress as appropriate or preferred or professional.
2] ACCOUNTABILITY
Piano lessons, weekly laboratory meetings, and visits to health care providers have in common- accountability that encourages people to follow a specified course of action.[3]
The importance of accountability is illustrated by the example of piano lessons. Students take once-a-week piano lessons and have a recital in 10–12 weeks. In anticipation of each weekly lesson, students practice. If it were not for weekly piano lessons, it is unlikely that students would practice much until just before their recital. The anticipation of the weekly social interactions between the student and the teacher is critically important in holding the student accountable to practice. [3]
A common example of accountability is the Hawthorne effect, that measuring a behavior changes the behavior. [4]
In Physiotherapy, outcome measures such as Performance Index using pressure biofeedback systems, muscle strength in kilograms or pounds using dynamometers could be instrumental in improving adherence to protocol and holding the therapist as well as the patient accountable for the recovery process.
However, as practitioners, we must be aware of the phenomenon of “white coat compliance”, defined as improved patient adherence to treatment around clinic visits. [5]
3] COMMUNICATION
Most interventions in physiotherapy are of long-term nature. Accordingly, communication skill is central to engaging patients in a therapeutic relationship, and particularly putting the patient at the center of the care as an active participant in decision-making.[6,7]
The ability to listen, respond, and convey information clearly, considerately, and sensitively is a prerequisite for a successful practice.[8]
Physiotherapists occupy a privileged social position that permits physical contact with their clients, touch dominates nonverbal communication in physiotherapy.[9,10]
An effective touch can help understand a client’s condition, provide reassurance, and elicit emotional reactions.[9, 11, 12]
Observation is second only to touch in nonverbal communication between physiotherapists and clients. [10]
Observation is extended to “embodied consent”, whereby physiotherapists use the client’s responsiveness to an intervention to be assured of ongoing consent for treatment.[13]
4] CONFIDENCE[14]
Agility, positivity, a “can-do” attitude, eye contact, open body language are the ingredients of a confident person.
Confidence is tricky though, it is often mistaken for competence.
Tomas Chamorro-Premuzic, the author of Why Do So Many Incompetent Men Become Leaders (and How to Fix It), says, “Competence is how good you are at something. Confidence is how good you think you are at something”
In fact, he points out: “While most people look at a confident person and assume that the person is also competent, there is, in fact, no relationship between confidence and competence.”
“It’s not the smart that get ahead, but the bold.” ― Robert Kiyosaki
5] EXCELLENCE
APTA elaborates on Excellence as Physical Therapists having intellectual humility, embracing advancements, challenging mediocrity, and consistently using current knowledge and skills.
Miller-Coulson Academy of Clinical Excellence (MCACE), an initiative at Johns Hopkins University School of Medicine that was established to recognize and promote clinical excellence for the benefit of the patients served.[15]
The following definition for clinical excellence is used for all MCACE-related initiatives:
Achieving a level of mastery in 6 areas as they relate to patient care:[15]
Communication And Interpersonal Skills
Professionalism And Humanism
Diagnostic Acumen
Skillful Negotiation Of The Healthcare System
Knowledge
A Scholarly Approach To Clinical Practice
Excellence is never an accident. It is always the result of high intention, sincere effort, and intelligent execution; it represents the wise choice of many alternatives—choice, not chance, determines your destiny. —Aristotle
6] ALTRUISM
Altruism is the promotion of another’s self-interest at risk or cost to oneself, it is at the core of the medical practice, tracing its roots all the way back to the Hippocratic Oath. [16]
For some clinicians, altruism and a sense of “calling” are at the core of their motivation to their practice; others are motivated by more tangible rewards. [16]
Interestingly, the concept of “pathological altruism”, i.e. altruism or empathy taken to an extreme, has been hypothesized to contribute to burnout and depression among health care providers. [17]
Whatever the motivation, it is important that we take the time to reflect on our professional and personal values and strive to align our work with those values. [16]
7] SOCIAL RESPONSIBILITY
Social responsibility is the promotion of mutual trust between the profession and the larger public that necessitates responding to societal needs for health and wellness. [18]
Over the years health care has become more commercialized as Benjamin Franklin put it “God heals and the doctor takes the fees.” [19]
“In reality, today’s ‘evidence-based medicine may be tomorrow’s malpractice”, since the world is full of researchers who want to prove they are the best.[20]
Why is it important to possess these attributes?
As indicated in the 1964 article by Dr. Jacquelin Perry, the common masses have been ignorant about the Physiotherapy profession owing to the muddled image of a physiotherapist. When people don’t know what we do, is the current predicament of the physiotherapist shocking? There is a dialogue from the movie- ‘Parasite’,
“Money is an iron. All creases get smoothened out by money.”
Professionalism is the iron that will smoothen out all the creases, the hazy perceptions of a physiotherapist, and be a purveyor to claim our worth and establish standing on par with other revered members of the health care team. When we educate ourselves on the values of professionalism and present a poised demeanor, every time we step into our workplaces, on a grassroots level, we modulate the grand perception of our profession, and that is the greatest of contributions.
FROM THE ARCHIVE
This is a 1964 article by Dr. Jacquelin Perry, a pioneer in poliomyelitis and gait analysis. Dr. Perry received her bachelor’s degree in Physical Education at the University of California, Los Angeles in 1940. After World War II, she used the G.I. Bill to study medicine and became the first woman orthopedic surgeon to graduate from the University of California, San Francisco.
For more than 60 years she worked at the Rancho Los Amigos National Rehabilitation Center in Downey, CA.
In the above article, Dr. Perry discusses Professionalism in Physiotherapy, here are some of the key highlights:
Professional value of a Physical Therapist: The image of a physical therapist appears cloudy because the physical therapist is too many things. They must make their image so clear that all will be proud of it and when that status is clear, they will also have better financial compensation in the hospital.
When the physical therapist is appropriately trained, motivated to think, and willing to assume responsibility, they should be in complete charge of the questions related to techniques – here Dr. Perry inadvertently but quite effectively pointed out the values of critical thinking, excellence, and accountability; all essential for a successful PT professional.
When mutual respect exists between the physician and the physical therapist and both accept the responsibilities involved, the patient will have the very best treatment possible.
It would be worth your while to give this article a read and correlate your present professional experience with that described in the piece. Click here
Understanding Professionalism in Classroom
Physiotherapy undergraduate schools are institutions where the minds of aspiring physiotherapists take shape. It is within these walls that the professors and teachers take on the role of sculptors and embark on the journey of carving the minds of these young students. Prospectively, it is an art.
In the context of Professionalism, let’s have a look at the Undergraduate syllabi of a couple of institutions across India and take note of what is taught and how much importance the topic gets on an academic level.
Maharashtra University of Health Sciences (MUHS)
Commendably, professionalism is the first subject to be taught each year.15 hrs allocated per year, and this includes didactic and supervision hours. A college-level exam is conducted in the final year.
Punjabi University
The Punjabi University UG syllabus contains subjects- Basics Computer & Internet Application and Environmental & Road Safety Awareness but sees no mention of the subject of Professionalism. The regional language ‘Punjabi’ is a qualifying exam of the first academic year.
Gujarat University
The subject ‘English’ is part of the first-year syllabus. The subject ‘Ethics’ is included in the final year of undergraduate training and a university-level exam is conducted for the same.
Rajiv Gandhi University of Health Sciences
Regional language Kannada and English are taught throughout the first year; English being allocated twice the amount of time as KannadaOrientation to Physical Therapy is a first-year subject that acclimatizes students to the Physiotherapy profession. Ethics, Administration, Supervision is a fourth-year college-level subject that introduces students to the Professionalism domain in the PT profession.
Final Words
Some institutions have excellent plans to teach Professionalism, covering almost all aspects of it; others have either no such intent or have biases, the most popular one being ‘Verbal Communication’.
This bias might give an upper hand to therapists planning on setting up a practice in their state, but what good is ignorance of the rest of the Professionalism attributes going to bring? If Professionalism was a metaphorical iceberg, then what such institutions try to preach is only limited to the topmost layer of the tip of the iceberg. The core values of Professionalism adopted by APTA (American Physical Therapy Association) provide a list of 7 attributes arranged in alphabetical order, not one value being any more important than the other.
It is also desirable and non-negotiable to mention how incoherent a plan on paper and the ground reality may be.
With so much information at hand, you must surely find yourself saying,
We’ve got your back! We have enlisted below some of the resources on Professionalism for your perusal-
Projecting your best professional image, K C Walsh, Imprint Nov-Dec 1993;40(5):46-9.
Perceptions of Outpatients Regarding the Attire of Physiotherapists, Erin Mercer et al, Physiother Can. 2008 Fall; 60(4): 349–357.
Accountability: a missing construct in models of adherence behavior and in clinical practice, Elias Oussedik et al, Patient Prefer Adherence. 2017; 11: 1285–1294
Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects, McCambridge J et al, J Clin Epidemiol, 2014;67(3):267–277
Compliance declines between clinic visits,Cramer JA et al, Arch Intern Med. 1990 Jul;150:1509–10
Perspectives from physiotherapy supervisors on student-patient communication, Woodward-Kron R et al, Int J Med Educ 2012;3:166–74.
Using clinical outcomes to explore the theory of expert practice in physical therapy, Resnik L, Jensen GM, Phys Ther. 2003 Dec; 83(12):1090-106.
National survey of clinical communication assessment in medical education in the United Kingdom (UK), Laidlaw A, et al, UK Council for Clinical Communication in Undergraduate Medical Education, BMC Med Educ. 2014 Jan 13; 14():10.
Client Education: Communicative Interaction between Physiotherapists and Clients with Subacute Low Back Pain in Private Practice, Katherine Harman et al, Physiother Can. 2011 Spring; 63(2): 212–223
Roberts L, Bucksey S. Communicating with patients: what happens in practice? Phys Ther. 2007;87:586–94. doi: 10.2522/ptj.20060077.
Physiotherapists’ use of touch in inpatient settings, Roger J et al, Physiother Res Int. 2002; 7(3):170-86.
Massage as interaction and a source of information, Ekerholt K, Bergland A, Adv Physiother. 2006;8:137–44.
Informed consent practices of physiotherapists in the treatment of low back pain.
Fenety A et al, Man Ther. 2009 Dec; 14(6):654-60.
Defining Confidence: What Does Professional Confidence Look Like? Author: Lin Grensing-Pophal
Clinical excellence in physical medicine and rehabilitation: Examples from the published literature, Alexis Coslick, MS, DO, J Rehabil Med, 2016 Mar;48(3):253-8.
Altruism and Medical Practice, Mitchell D. Feldman, MD, MPhil, J Gen Intern Med. 2017 Jul; 32(7): 719–720
Pathological Altruism, Oakley B et al, New York: Oxford University Press; 2011.
CORE VALUES FOR THE PHYSICAL THERAPIST AND PHYSICAL THERAPIST ASSISTANT HOD P06‐19‐48‐55
