PROFESSIONALISM IN PHYSICAL

THERAPY ????
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• Professional Practice Course content

• Credit Hours 2
Introduction: The Physical
Therapist as Professional
SYED ZAIN UL ABIDIN (PT)
DPT, MSPT, CHR(MSK)
(IPMR, KMU)
• Before deciding on a definition of [physical therapy], physical
therapists must decide whether they really want to be professional or
just make believe they are by paying lip service to professionalism.
 Course Introduction

• The role and responsibilities of physical therapist as an

individual and member of the profession(competencies).
• Ethics & administration issues.
• The change in the profession to the doctoral level and
responsibilities of the professional to the profession, the public
and to the health care team.
• Total theory credit hours 2
 Profession and Professionalism
 Profiteor-“to profess a belief.”
 suggests that professionals have historically been expected to
have a sense of “calling,” or vocation

 A profession is an occupation that is viewed by society as a

profession on the basis of it characteristics, development, or
power.

 A paid occupation especially one that involves prolonged training

and high qualification.
 Professionalism is the internalized conceptualization of expected
professional obligations, attributes, interactions, attitudes, values, and
role behaviors in relation to individual patients and clients and society
as a whole.

 Individual professionalism refers to the internalized beliefs of an

individual member of a profession regarding professional obligations,
attributes, interactions, attitudes, values, and role behaviors. Individual
professionalism might also be called “professional role concept.”
 Sociological Perspective
Sociological literature about the professions takes three approaches

Structural

PROFESSION AND THREE

APPROACHES
Power

Processual (or
process
 CHARACTERISTICS OF PROFESSIONS
CITED IN THE LITERATURE
Knowledge
● Broad, theoretical, generalized, systematic knowledge
● Unique body of knowledge
● “Formal” knowledge—knowledge that is “embodied and applied
in and through the professional”

Autonomy in professional decisions

● Autonomy from client
● Autonomy from organizations or external parties
● Autonomy in selecting colleagues
CHARACTERISTICS OF PROFESSIONS
CITED IN THE LITERATURE
Authority
● Based on internal knowledge
● Granted by society
● Demonstrated by power and status in society
● Demonstrated by monetary and symbolic awards
Education
● Extensive
● Skilled, technical, esoteric
● High standards for admission
 CHARACTERISTICS OF PROFESSIONS
CITED IN THE LITERATURE

Responsibility, Accountability, and Ethics

● Service orientation
● Accountability and responsibility to society
● Formal code of ethics that members enforce
● Self-control of behavior through internalized professional ethic
● Belief in self-regulation
● Community interest more important than self-interest
● Fiduciary relationship and trustworthiness central
CHARACTERISTICS OF PROFESSIONS
CITED IN THE LITERATURE

Nature of work and decisions

● Important or essential to clients
● Complex
● Not routine
● Not programmed
Role and Identity
● Internally based on a sense of calling
● Formed and driven by the professional group
● Extending beyond the specific work situation
Pavalko’s occupation to profession
continuum
The role and responsibilities of Physical
Therapist as an individual
• To provide Quality care
• To be involved in an ethical and legal practice.
• To keep him/her self update about the new
developments in the field.
• To be an evidence based clinician for the quality
care.
• To be a trust worthy professional.
The role and responsibilities of Physical
Therapist as member of the profession

• To educate the other health care team about the scope of

physical therapy.
• To educate the general public how a physical therapist can
help the community to live a healthy life.
• To play an active role for the development of the profession.
• To participate in the research studies.
 Health
• Health is level of functional or metabolic efficiency of a living
being.
• General condition of a person's mind and body, usually
meaning to be free from illness, injury or pain
• (as in "good health" or "healthy").
• The World Health Organization (WHO) defined health in 1946
as "a state of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity.“
Primary Health Care:

• Refers to an approach to health and a spectrum of services

beyond the traditional health care system.
• It includes all services that play a part in health, such as
income, housing, education, and environment.
• Primary care is the element within primary health care that
focuses on health care services, including health promotion,
illness and injury prevention, and the diagnosis and treatment
of illness and injury.
Physiotherapy Services:

• Services provided by a physiotherapist within the

context of health care delivery
• (e.g., client assessment, treatment, related reports,
communication with various parties for the purposes
of delivering patient care).
 Ethics in Physical Therapy

• Ethics is the major branch of philosophy, encompassing proper

conduct and good living.
• What is right for the patients.
• Most patients allow us to touch their backs, necks, or
extremities in ways that would not occur in society in general,
so we must not misuse this position/status.
• Physical Therapists must also consider how stressful it is for
patients when they come to us for care.
• A trusting relationship should develop between the therapist
and patient .
• Confidentiality is a crucial matter in daily practice.
 Principles of Health Care Ethics
 Ethical principles provide general guidance for helping us
make ethical decisions:
a) Respect for autonomy
b) Nonmaleficence
c) Beneficence
d) Justice
Note: Each specific ethical dilemma that you face will be
imbedded in a unique situation that may involve multiple
persons and issues.
The principles will only be helpful in a real case if you gather as
much information about the situation as possible to
individualize the decision-making process.
Respect for autonomy

• Acknowledge a person’s right to make choices, to

hold views, and to take actions based on personal
values and beliefs.
 Nonmaleficence

• The principle of nonmaleficence is an obligation not

to inflict harm intentionally.
• Most persons who choose a health care career only
want to help people, not harm them.
• One way to remember the meaning of this principle
is to think of the phrase in the Hippocratic oath, "To
first do no harm." Usually issues of nonmaleficence
are discussed when patients are at the end of life.
• We often must decide if continuing treatments cause
the patient more harm than benefit.
 Beneficence

• The principle of beneficence is a moral obligation to act to benefit

others.
• There are, however, risks associated with beneficence. Sometimes
we want to help our patients so much, that we begin to believe
that we know what is best for them.
• We sometimes believe that they should do whatever we
recommend since we have the most knowledge about their
condition.
• When we believe that we know what is best for a patient even
when they do not agree, we risk stepping over the boundary from
beneficence to paternalism. When this happens, the patient's
autonomy is not respected.
• If you find that you are trying to convince patients to do things
your way by saying, "It is for your own good," you might be using a
form of paternalism.
Justice
• The principle of justice means that all similarly situated persons
receive their "fair share" of benefits and assume their fair share
of burdens.
• For example, health care is a benefit that should be fairly
distributed and taxes are a burden that we also try to share
fairly.
• There are at least three types of justice that include:
• compensatory (Compensatory justice concerns compensation for
wrongs that have been done)
• Procedural (Procedural justice involves how the laws are
procedurally carried out)
• Distributive. (Distributive justice involves the fair allotment of
benefits or burdens, especially when there is competition for
resources. )
Issues in daily practice
• Confidentiality
• Sexual harassment
• Misleading patients
• Kick backs
• Time management
• Supportive staff behavior
• Quality care
 Privileges of Autonomous Practice in 2020

• 1. Direct and unrestricted access: The physical therapist has

the professional capability and ability to provide to all
individuals the physical therapy services they choose without
legal, regulatory, or payer restrictions.

• 2. Professional ability to refer to other health care providers:

The physical therapist has the professional capability and
ability to refer to others in the health care system for
identified or possible medical needs beyond the scope of
physical therapist practice.
 Privileges of Autonomous Practice in 2020

• 3. Professional ability to refer to other professionals: The

physical therapist has the professional capability and ability to
refer to other professionals for identified patient/client needs
beyond the score of physical therapist practice.

• 4. Professional ability to refer for diagnostic tests: The physical

therapist has the professional capability and ability to refer for
diagnostic tests that would clarify the patient/client situation and
enhance the provision of physical therapy services
Characteristics of professionals
AUTONOMY, SELF-REGULATION OF ETHICAL STANDARDS, AND ACCOUNTABILITY :

• Whether a profession is defined by its characteristics, stage of

evolution, or power, several qualities of professions have
historically been held in high regard: autonomy, ethical standards,
and accountability.
AUTONOMY
• Autonomy can be defined as the “extent to which [a profession] or an
individual feels freedom and independence in his/her role.”
• High autonomy in decision making and high degrees of control over their
work have been considered true professions and vice versa.

• Whether PTs have enough autonomy in their work to be considered

professional has also been a subject of considerable discussion and debate.
Until recently, the tendency has been to view physical therapy as an
occupation in the process of professionalization but not yet fully recognized
as a profession.

• The APTA has established the goal of “autonomous practice” as one of its
priorities, delineated in its Vision 2020 statement: “Physical therapists will
be practitioners of choice in clients’ health networks and will hold all
privileges of autonomous practice.
Self-Regulation of Ethical Standards
• A second important characteristic of professionals is ethical
conduct and self-regulation.
• This includes the possession of a code of ethics and
mechanisms that ensure members abide by the code’s
principles
• The APTA, adopted its first code of ethics in 1935. The first
code identified four major ethics violations: making a
diagnosis, offering a prognosis, advertising for patients, and
criticizing the doctor or other co-workers
• The obligation to enforce a code of ethics is also called self-
regulation and is frequently framed in terms of an implied
social contract.
• Although development of a code of ethics can be one sign of
movement toward professionalization, Purtilo notes that this first
attempt was not necessarily a success in this regard

• A true code of ethics articulates some professional consensus

about the ethical standards that should guide practice and serves
as the collective ethical wisdom of the profession, a map on the
road to high ethical standards
 Accountability of Professionals
• The third important attribute of professionals is responsibility and accountability

• Mean that professionals have obligations and must

“account” to the public for the discharge of these duties

• The process by which a party justifies its actions and policies and delineate three
separate models of accountability: professional, political, and economic.

• Each model of accountability has different domains, components, content areas,

and procedures.

• PTs and other health care providers are actually accountable to many different
parties: the patient, the health care organization, other professionals, the
government, and third-partypayers .
• Ozar developed three different models of professionalism to describe medicine and
dentistry:
• Commercial.
• Guild.
• Interactive.

• In commercial professionalism is a commercial interchange in which

physical therapy is a product or commodity and the therapist must
compete with the patient and other professionals to sell services and
maximize profit.

• In the guild model, PT functions in a paternalistic role, providing

services to a patient who is the uninformed, passive recipient of
professional expertise.
• Ozar believes that a third model, the interactive model, is the ideal model of
the professional relationship. This model avoids the negative aspects of
both the commercial and guild models, with therapists and patients
interacting as moral equals in a relationship in which each person has a
different function.
THANK YOU
