Patients often hesitate to access public health care due to cost of transport, having to leave work, fearing pain, and having to leave their families and travel long distances. When they are in these care settings, they have to learn to trust their doctors and therapists with personal, private information and their health, in order to receive effective and appropriate treatment. While not knowing what is wrong, whether they will recover or how they will return to normal functioning after treatment, they must be willing to take a leap of faith, trusting that their doctors and therapists are competent enough to “catch” them and help them find their feet again. I chose this art piece, as it reflects the complete trust the patient must have in his/her doctors and therapists.

In order for this trust to be formed and management to occur, all members of the multidisciplinary team (MDT) need to respect and communicate effectively with one another and the patient. I draw the comparison to the game Trust Falls, as the MDT must all link hands and feel confident that they are able to contribute towards catching this patient, as they would to treat them, who falls into their hands. However, if the patient loses confidence in the capabilities of one the team members, they are less likely to “fall” or will try to avoid that person as there is a lack of trust. In the same way, if the therapist or patient is not confident regarding management, treatment may be avoided or ineffective. According to Bernhardsson, Larsson, Johansson, & Öberg (2017), patients’ active engagement in physiotherapy management is directly affected by their trust in the physiotherapist’s competence.

This trust can sometimes be fragile. As a student, establishing trust in a patient and assuring them of our competence can sometimes be challenging. This is often made even more difficult by our superiors who, in an attempt to correct or guide us, address students in a degrading or disrespectful manner. According to Totten (2013), “health care workers have the right to considerate and respectful behaviour from their superiors and to be free from harassment, abuse, attack, and verbal and mental abuse”. I have observed, from my own experiences and from speaking with other students, that supervisors often address students in a harsh and disrespectful manner in front of patients, in a way that reduces their skillset, knowledge or competence. These patients may feel that, due to this reaction from our superiors, we lack the ability to treat them effectively and are incompetent. This can negatively impact the patient’s perspective of their therapist and the treatment they receive, making them less likely to participate or adhere to treatment programmes. While we, as students, are still learning and refining our abilities, this does not mean that we are unable to adequately, safely and effectively treat patients with our current knowledge and skillset.

As students treating patients for the first time, we naturally have a lack of confidence and second-guess our decisions and our ability to help the patient effectively. Through guidance from clinicians and supervisors, we are able to gain and refine our knowledge, reasoning and skills in order to treat patients in a competent, efficient and professional manner. However, some of these figures tend to expect perfection from the start and address the lack thereof in a harsh and degrading manner in front of patients. This goes against basic human rights and the rights of healthcare workers, as one is being humiliated and degraded in front of patients and often one’s fellow students and thus one’s right to human dignity is affected (The rights and duties of health care workers, n.d.). Aside from our confidence in our own abilities falling even more, the patient’s confidence and trust in our abilities falters. Once broken, this is difficult to regain and may even be a reason that some patients miss their appointments or allocated treatment times (Bernhardsson, Larsson, Johansson, & Öberg, 2017). In my own experience, patients often missed their appointments without prior notification. While it is unknown whether this was due to a lack of trust in us as student physiotherapists or due to other reasons, it can be assumed that this lack of trust contributed even slightly to the patients ultimate decision to miss the appointment and not reschedule.

From my own experience and from discussions with clinicians and supervisors, I have found that correcting a student in a way that addresses the chosen technique or skill is more effective than addressing the student’s capabilities directly. This gives the student feedback regarding how they can improve, instead of making them feel incompetent and with little hope for improvement. Feedback should also be given fully after seeing patients and when there is opportunity for open discussion and time to identify areas that require improvement. While I have personally spoken to some clinicians and supervisors regarding this and addressed the issue, some often say they do not have time to do this, and that they have also experienced this manner of feedback in their years as a student. This calls into question what “proper and effective” feedback is and how this directly affects patients and the multidisciplinary team as a whole, which should be openly discussed and addressed. This will not only affect students’ confidence in their clinical practice, but also the patients’ trust in their therapist and the treatment programme, allowing them to fall and be caught in competent hands.

References

Bernhardsson, S., Larsson, M. E. H., Johansson, K., & Öberg, B. (2017). “In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy. Physiotherapy Theory and Practice, 33(7), 535–549. https://doi.org/10.1080/09593985.2017.1328720

The rights and duties of health care workers. (n.d.). Retrieved from http://www.rhap.org.za/wp-content/uploads/2014/05/Health-and-Democracy-the-rights-and-duties-of-health-care-workers.pdf

Totten, V. (2013). Viewpoint. Emergency Medicine News, 35(11), 3. https://doi.org/10.1097/01.eem.0000437850.54915.f5