”You can’t force me, I have rights”.

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The patient rights charter states that all patients have the right to a healthy and safe environment that will ensure their physical and mental health or well-being, take part in deciding on matters affecting one’s health, proper emergency care at any health care facility, treatment and rehabilitation, special needs care, especially newborn infants, children, pregnant women, the aged, disabled persons, patients with chronic pain, people living with HIV/AIDS, counselling without discrimination, intimidation or violence on matters such as reproductive health, cancer or HIV/AIDS, affordable and effective care for people in the final stages of their lives, friendly health care providers, health information in their language of choice, knowledge of health insurance and medical aid schemes, choose their own health care provider or health facility, be treated by a clearly identified health care provider, confidentiality and privacy concerning health care issues and treatment, all information regarding their illnesses, treatment and the costs involved, refuse treatment verbally or in writing. be referred for a second opinion to a healthcare professional of their choice and continuous care,Complain about health services, have their complaints investigated and to receive a full response (Western Cape government, 2019).

“You need to be more stern with your patients” exclaimed my clinician. This is something i’m sure a lot of physiotherapy students have heard before. The clinician might not have said it to you, but you might have heard them saying to one of your classmates. When it comes to patients refusing treatment different clinicians have told me different things. The clinician in the orthopedic ward I was in passively moved a patients limb in order to get the range of motion needed. The patient refused treatment due to the amount of pain he was in. I explained the benefits and importance of physiotherapy treatment, but the patient still refused. My clinician told me that the patient does not have a choice and needs to move his limb in order for it not to become stiff. The patient yelled due the pain and the clinician continued moving his limb while explaining that he needs to move it.

A patient in the ICU I was in refused treatment and the clinician told me to document that I explained the importance of my intervention and the patient still refused treatment. I did this and my clinician explained to me that patients have a right to refuse treatment, we as physiotherapists just have to make sure that the patient understands the risks when refusing treatment. Everything you explain to the patient needs to be documented as well. According to the HPCSA decisions should be clearly documented, details of discussion with patient or other details which may effect further care( HPCSA, 2016).

The clinician in the orthopedic ward said that I was being ineffective due to the fact that I did not force my patient to partake in treatment and I did not get a good mark on my professional conduct report. The professional conduct report is completed by the clinician at a clinical placement. The clinician comments on a student’s punctuality, documentation, time management and effectiveness with regards to treatment of patients.

The patient rights charter says that all patients have the right to refuse treatment verbally or writing.  With regards to clinicians the problem is that we as students are stuck with the questions, Do we force our patients to partake in treatment in order to please our clinician or do we allow patients to refuse treatment which is the ethical thing to do. In order to pass a block well we as students try and do what the clinicians expect us to do. We might not always agree, but we do it regardless. In situations like this we do not think of or consider that what we are doing is ethically correct. We do what are told in order to pass.

In situations where clinicians sends you back to a patient who refused treatment, you find a way to work around it in order to please your clinician and the patient. Telling a patient that we can do less today if they agree to do more the next day. Patients tend to agree to treatment when you do this. Is this considered as manipulation? Is it wrong to manipulate patients into doing treatment? According to the Cambridge Dictionary manipulation is the act of controlling or influencing something or someone to your advantage, often without them knowing (Cambridge Dictionary, 2019). According to Dubov “Manipulative strategies are designed to create an illusion of free choice to lure the victim into a decision that would be probably resisted under normal circumstances”(Dubov A, 2015). Dubov also explains persuasion as a form of influence where the medical practitioner intends to produce a change in the behavior or opinions of the patient by using words to convey reasoning,information or feelings, while leaving enough room for freedom of choice(Dubov A, 2015). The concept of a nudge on the other hand is described as a set of techniques in order to change their behavior by using gentleness rather than coercion or threat of sanctions (Thaler and Sunstein, 2008). Taking all this into consideration it is persuasion provides ethical justification in the patient-medical practitioner relationship(Swindell, McGuire and Halpern, 2010) . Therefor there is no ethical problem when persuading you patient to do some exercise today and continue with the other exercises tomorrow.

References 

Western Cape Government. (2019). Here’s What You Need to Know About the Patients’ Rights Charter. Retrieved from https://www.westerncape.gov.za/general-publication/heres-what-you-need-know-about-patients’-rights-charter

HPCSA. (2016). Guidelines for Withholding and Withdrawing of Treatment. Booklet 7. Pretoria.

Cambridge Dictionary. (2019). Manipulation. Retrieved from https://dictionary.cambridge.org/dictionary/english/manipulation.

Dubov A. (2015). Ethical persuasion: the rhetoric of communication in critical care. J Eval Clin Pract. 21:496–502.

Thaler RH, Sunstein CR. (2008).  Nudge: Improving Decisions about Health, Wealth, and Happiness. New Haven: Yale University Press.

Swindell JS, McGuire AL, Halpern SD. (2010). Beneficent persuasion: techniques and ethical guidelines to improve patients’ decisions. Ann Fam Med. 8:260–264

3 thoughts on “”You can’t force me, I have rights”.

  1. thank you so much for sharing your piece. your writing reflect the topic of the assignment. no picture or video to support your writing. you did not really explain your clinical experience in depth try explaining your clinical experience in detail so it gives the reader the picture of what you are trying to say. please try to explain your argument in more depth and try to find evident to support your claim so that your argument can be strong ( you dont have any reference)
    The sentence in paragraph one is very long consider rephrasing it because is very easy for the reader to get lost while reading it. please go back and read paragraph two somehow i feel like there’s no flow making it difficult to follow while reading also make sure tat your spelling and grammar are correct, i highlighted a few that are incorrect. you submitted on time and the length is not appropriate, consider adding more information.

  2. Dear Robert,
    Thank you for writing your ethics assignment on an this. My comments below are from my viewpoint and I aim to have my comments expressed as respectful, friendly and open-minded in climate, as well as non-judgmental. Should there be a comment which you may disagree on, kindly inform me and we can discuss this.

    Substance/Content:
    Your writing does reflect our module content as covered in our ethics lectures by Prof Rowe as you have discussed the patients rights charter as an introduction.
    Your writing piece is aligned with class discussion and is something which I personally wish should be brought to the attention of other physiotherapy students because I can relate to being in situations like this at different placements.

    Argument:
    “The patient rights charter states that all patients have the right to a healthy and safe environment that will ensure their physical and mental health or well-being, take part in deciding on matters affecting one’s health, proper emergency care at any health care facility, treatment and rehabilitation, special needs care, especially newborn infants, children, pregnant women, the aged, disabled persons, patients with chronic pain, people living with HIV/AIDS, counselling without discrimination, intimidation or violence on matters such as reproductive health, cancer or HIV/AIDS, affordable and effective care for people in the final stages of their lives, friendly health care providers, health information in their language of choice, knowledge of health insurance and medical aid schemes, choose their own health care provider or health facility, be treated by a clearly identified health care provider, confidentiality and privacy concerning health care issues and treatment, all information regarding their illnesses, treatment and the costs involved, refuse treatment verbally or in writing. be referred for a second opinion to a healthcare professional of their choice and continuous care,Complain about health services, have their complaints investigated and to receive a full response”

    – Your first paragraph is a good opening to your writing piece to support your argument strongly as you have presented the patients rights and it is something which all clinicians and patients should be made aware of, and should revise. To my understanding, this claim is evidence based so kindly add an in-text referencing and a reference list (APA style). I’d advise that you add a reason for having this as your introduction to your writing piece.

    ““You need to be more stern with your patients” This is something i’m sure a lot of physiotherapy students have heard before. The clinician might not have said it to you, but you might have heard them saying to one of your classmates. When it comes to patients refusing treatment different clinicians have told me different things. The clinician in the orthopedic ward I was in passively moved a patients limb in order to get the range of motion needed. After the patient said that he is in too much pain to move his limb. The patient yelled due the pain and the clinician continued moving his limb while explaining that he needs to move it. A patient in the ICU I was in refused treatment and the clinician told me to document that I explained the importance of my intervention and the patient still refused treatment”

    – This is the part that had me triggered because it is so common for physiotherapy clinicians to engage in the act of not accepting the refusal of treatment of patients as speaking from personal experience, they wish to have the patients discharged quicker.
    – Are Claims made? Yes. You have made quoted a physiotherapy clinician and you continued with this paragraph by expressing your personal experiences of the matter. Remember to add mention who you are quoting after you’ve said. You could possibly rephrase is as follows: “You need to be more stern with your patients” exclaimed a clinician.
    – Kindly add evidence to your pieces to gain more insight on these situations and how others might have felt or even dealt with a similar or the same situation.
    – Even though I am able to follow your piece, I would advise that you add reasons for your claims being made.

    “The clinician in the orthopedic ward said that I was being ineffective due to the fact that I did not force my patient to partake in treatment and I did not get a good mark on my professional conduct report.”

    – over here you have made the claim that you received a bad professional conduct report due to the lack of forcing your patient to partake in physiotherapy treatment. I would advise that you provide your readers with more insight on what a professional conduct form is, who completes it, whether it contributes to your clinical practice mark and if you could also further elaborate on the comments and/or marks which you received. I’d advise that you don’s assume that your readers know what you are referring to.
    – if you are able to find evidence based on something in the nature of the purpose of professional conduct forms, maybe others viewpoints on it, or you could even reference Mrs. Shamila Gamiet when she explained the purpose of this in class. Or any other means of evidence relating to professional conduct forms for students at placements.

    “The patient rights charter says that all patients have the right to refuse treatment verbally or writing. With regards to clinicians the problem is that we as students are stuck with the questions, Do we force our patients to partake in treatment in order to please our clinician or do we allow patients to refuse treatment which is the ethical thing to do. In order to pass a block well we as students try and do what the clinicians expect us to do. We might not always agree, but we do it regardless. In situations like this we do not think of or consider that what we are doing is ethically correct. We do what are told in order to pass”

    – At this part of your argument, you have made the following claims: Students are being questioned by clinicians, the ethical conflict of not knowing whether to force the patient into consenting and participating in physiotherapy treatment, the desire to pass a clinical rotation with a good professional conduct mark.
    – I would suggest that you search for and add references to your line stating “The patients rights charter says that all patients have the right to refuse treatment verbally or writing”.
    – Add a reference to include a similar incident and how thy might have felt and/or dealt with the situation and then express how you feel about that situation and link it to your experience.
    – regarding the grammar, I’d advise that you rephrase the following:
    *The patient rights charter states that all patient’s have the right to refuse treatment verbally or in writing.
    * Based on personal experience, physiotherapy clinicians have the tendency to question physiotherapy students on their selection of treatment techniques and/or reasoning for patients refusing treatment and what actions we took thereafter. In situations like this, should physiotherapy students have the approach of aiming to satisfy physiotherapy clinicians by forcing treatment onto the patients amidst their refusal thereof, or should we abide by the ethical correct approach of this situation. Which results in a students general dilemma of working towards a goal of receiving a good professional conduct mark by abiding by their clinicians unethical requests.
    – kindly tend to the other grammatical errors in this paragraph.

    “In situations where clinicians sends you back to a patient who refused treatment, you find a way to work around it in order to please your clinician and the patient. Telling a patient that we can do less today if they agree to do more the next day. Patients tend to agree to treatment when you do this. Is this considered as manipulation? Is it wrong to manipulate patients into doing treatment”

    – Here you have made a strong claim about the tending to the same patient in attempt to have them agree to some means of physiotherapy treatment. I would advise that you add literature to support the importance of early physiotherapy intervention to include a clinicians perspective on the matter. furthermore, I’d advise you to conduct further research on the manipulation of patients into agreeing to some form of treatment so that you could answer your own question in the end.
    – Kindly tend to the grammatical errors in this paragraph.

    In general, you writing piece flows logically. I personally think that this can be a really good piece if you just include the necessary literature and rephrase where necessary. I look forward to reading your final piece Robert! All the Best!

    Regards,
    Carla Everton

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