Having worked in professional healthcare environments for over 15 years, at the beginning of this year I felt that I had a good understanding of what it means to be a professional and the expectations of me as a developing osteopath. I understood that a professional should always act with respect, honesty, and integrity. Safeguard the patient's privacy, dignity, and confidentiality. Whilst maintaining professional boundaries and working within company policy and the relevant laws. Osteopaths are also expected to be able to communicate and efficiently liaise with other health care professionals regarding patient care. Maintaining professional conduct is essential for the development of trust and an effective therapeutic relationship. Achieving this will lead to more effective patient care and management (General Osteopathic Council, 2019).
I am confident in my understanding of this due to my experience working as a senior care assistant, where part of my responsibilities was to develop and oversee support plans with the individuals and their families, and to liaise with GPs, Community Nurses, Occupational therapists, Physiotherapists, and Psychiatrists regularly regarding the care and support of the individuals.
I have also gained confidence in professional conduct from working in a multi-disciplined Physiotherapy clinic and from setting up and managing my own successful sports massage clinic. Feedback throughout my working life has always been positive with regards to my professional conduct and has often said things like ‘performs well under pressure’ and ‘is able to communicate and professionally manage challenging situations’.
Conversely, I have had several years of experience of being patient when I was a professional athlete, working with the Team managers, coaches, physiotherapists, strength and conditioning coaches, and logistics staff. Which provided me with the opportunity to experience examples of good and bad professionalism from a patient's perspective. This I feel has left a resounding effect on how I wish to be interpreted as a therapist and my professional behavior towards patients.
What I did not expect from Professionalism this year was to be challenged to identify my values and beliefs and understand how they can affect the way I might treat individuals who may challenge them.
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Barrett (2020), founder of the Barrett Values Centre describes values as deeply held principles, ideas, or beliefs that individuals hold or adhere to when decision making. When an individual's work culture aligns with their values, they feel liberated and can apply their energy, enthusiasm, and commitment to their work which increases overall customer satisfaction, personal fulfillment, and success. Values can be positive or potentially limiting. For example, 'Trust' is a positive value and fundamental for building a positive professional patient-practitioner relationship, but on the other hand, if a practitioner held a potentially limiting value such as 'being liked', it could influence them to compromise their integrity to satisfy their need in ‘being liked’, which could be extremely detrimental to the outcome of the consultation and compromise patient care and the clinical decisions being made regarding it.
Most patient-practitioner consultations intend to improve health outcomes. Often, they are successful, resulting in patient satisfaction. However, some can fail to improve health outcomes causing patient dissatisfaction. When this occurs, the cause is not usually a collapse of evidence-based practice/medicine (EBM), but a failure in values-based practice (VBP). Consisting of the failure of the practitioner to ascertain the patient's relevant values perspectives and act on them purposefully and coherently to develop patient-centered decisions informed by values as well as evidence (Fulford et al, 2012).
Clinical decisions are increasingly made amongst a background of complex and often conflicting values. VBP offers a new and primarily skills-based approach to working with complex and conflicting values in medicine. (Fulford, 2008). Using VBP to support clinical decision-making where complex and sometimes conflicting values are involved, provides a clinical skills-based approach to connecting the scientific knowledge of EBM to relevant patient values, needs, wishes, and expectations (Petrova, et al 2006), enabling the practitioner and patient to work congruently to achieve good health care outcomes and promote patient autonomy. Resulting in patient satisfaction and the deliverance of a more biopsychosocial model of care.
After our VBP lecture in November 2019 to achieve a greater understanding of my values, I completed the Barrett Values Centre Personal Values Assessment (PVA) (Appendix A). The report identified that I had chosen positive values in each of the seven levels of the Barrett Model (Appendix B), that this was rare and the types of values I had selected showed that my individual capabilities were most important to me.
On reading the brief for this essay, I was curious to see if my values had changed over the academic year so I repeated the PVA in April 2020 (appendix C) and was surprised to find that although I had still chosen positive values there were quite a few differences in the values I had chosen and areas in which I had chosen them. I now had all of my values in levels two to six of the Barrett Model, this indicates that I am ‘’someone whose meaning is important and that I have a strong set of moral standards in how I treat others and wish to be treated’’. The report states that the type of values I selected indicates that now not only my individual capabilities but also the connections I build with others are important to me. I feel this shows how my values have changed and that I am growing and gaining more understanding and confidence in how I can develop positive practitioner-patient relationships and achieve successful patient outcomes as a developing osteopath.
I think additionally I need to consider that the second time I completed the PVA was during the ‘‘Covid 19’’ lockdown. This may have influenced the values I chose due to emotional and psychological apprehensions during this time. Our values have a propensity for stability. Yet they are missing strict limits or boundaries, this allows them to change and adapt in response to our fluctuating life conditions (MindTools, 2020). Moving forwards, it is important as a developing osteopath to reflect on and re-evaluate my values regularly to be able to maintain the deliverance of good patient care and successful treatment outcomes.
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