"Passion to do the right thing": searching for the 'good' in physiotherapist practice

BACKGROUND

Practitioners' perspectives of what constitutes a 'good' physiotherapist have not been explicitly examined despite their potential implications for the future practice of physiotherapy. Physiotherapists' perceptions may inform professional priorities including education curricula, professional practices, competency profiles, and patient interactions.

PURPOSE

The purpose of this research was to examine physiotherapists' perceptions of what constitutes a 'good' physiotherapist. The context of the study was musculoskeletal practice (MSK).

METHODS

A hermeneutic phenomenological investigation was undertaken. Semi-structured interviews were conducted with twelve experienced MSK physiotherapists to examine their perceptions of what constitutes a 'good' physiotherapist.

FINDINGS

Seven themes were identified. Good physiotherapists were depicted as: 1) oriented to care; 2) integrating knowledge sources; 3) competent; 4) responsive; 5) reflective; 6) communicative; and 7) reasoning. To deepen the understanding of these themes, we discuss the findings in relation to Joan Tronto's ethic of care theory.

CONCLUSIONS

Physiotherapists' perceptions of what constitutes a 'good' physiotherapist highlight practices that may underpin an ethic of care including the pivotal role of person-centered and relational dimensions of practice. The findings call into question the profession's emphasis on a technical rationalist approach to education and clinical practice and invites conversation about future directions that balance technical competence with relational dimensions of practice.

An assessment of public experiences and expectations with physicians: a cross sectional study from Karachi, Pakistan

BACKGROUND

Although physicians are highly regarded members of society, patients are not always satisfied with their care, suggesting a mismatch between the public's expectations and reality. Thus, the aim of this study was to determine the public's expectations regarding roles and responsibilities of a physician, to assess patient experiences, and to evaluate factors associated with the two outcomes.

METHODS

A cross-sectional study was conducted via face-to-face structured interviews from July 14th to August 2nd, 2023, in Karachi, Pakistan. The study sample comprised 424 consenting adults enrolled by visiting public spaces (malls, parks, hospitals, and residential areas). A modified version of 'Exceptionally Good Doctor Likert scale', and 'Patient Picker-15' (PPE-15) questionnaires was used. The Likert and PPE-15 sections were scored through pre-decided criteria for expectations and experience, respectively, and categorized using a median cut-off into high and low expectations and negative and positive experiences, respectively for simple and multivariable logistic regression.

RESULTS

A median score of 30.5/ 34 (IQR = 3.3) was found for expectations and 4/ 14 (IQR = 4) for experiences. Significant factors associated with expectations were older age groups (OR = 4.54 [1.18-17.50]) and higher monthly household incomes (0.40 [0.20-0.79]), while the odds of negative experiences were lower after visits to emergency departments (0.38 [0.18-0.84]) and private health care centers (0.31 [0.13-0.70]).

CONCLUSION

These results suggest that the public has high expectations from physicians, however their experiences are not always positive. Initiatives to develop a patient-centric ethos are needed for which we outline recommendations to both the public and physicians, respectively.

Evaluation of inter-professional seminar involving patient-partners and caregivers

OBJECTIVE

To assess the contribution of interprofessional education (IPE) for pre-graduate students from eight study branches. These seminars had patient-partners and caregivers as co-facilitators for reflexive conversations, with educational goals of learning interprofessional communication and involving patients in decision-making.

METHODS

A pre/post seminar comparison with 2 questionnaires about the students' professional identity, multidisciplinary collaboration and patients' involvement, and the richness of stakeholders' definitions.

RESULTS

1142 students participated in the course (n = 740 after removing missing data). The results indicate that this type of education helps students feel more confident in their ability to communicate and collaborate (z = -10,204; p < 0,001), involves patients in their care plan (z = -7,996; p < 0,001) and fosters the competence and autonomy of the post-graduate students in their own professional field (z = -10,627; p < 0,001). It also enriches the definition of patients' roles (n = 399; z = -17,276; p < 0,001).

CONCLUSION

Including patients-partners and caregivers in IPE enriches the professional identity and increases the self-efficacy of futures caregivers.

PRACTICE IMPLICATIONS

This program exposed students to collaborative care practices, can reduce their resistance to this type of practice after graduation by making them more confident in using a structured team approach and recognising its benefits for both patients and caregivers.

Improved health outcomes in integrative medicine visits may reflect differences in physician and patient behaviors compared to standard medical visits

OBJECTIVE

To identify differences in patient-physician interactions associated with improvements in GERD symptoms in a randomized controlled trial comparing integrative medicine and primary care/standard visits.

METHODS

We analyzed video recordings of 2-minute excerpts (thin slices) from the beginning, middle, and end of 21 study visits (11 standard, 10 integrative medicine).

RESULTS

According to blind coders' analysis of the excerpts, prospective improvement in GERD symptoms was most highly correlated with patients appearing pleased (r = 0.71, p < 0.01) and friendly (r = 0.67, p < 0.01) at the end of the visit, controlling for visit type. The combination of patient and physician smiling at the end of the visit was associated with improvement in GERD symptoms (r² = 0.45, p = 0.004). The physician in the integrative visits was more engaged (p = 0.009), friendly (p = 0.005), relaxed (p = 0.002), smiled longer (p = 0.006), gazed longer (p = 0.02), and gestured more (p = 0.007), compared to standard visits. Patients in integrative visits also smiled longer (p = 0.004).

CONCLUSION

The expanded history-taking questions asked by integrative clinicians may enhance relationship building, modifying patients' responses and improving patient-centered behaviors from clinicians,ultimately facilitating symptom improvement.

PRACTICE IMPLICATIONS

Analysis of nonverbal behaviors may facilitate a better understanding of patient-clinician interactions in integrative medicine visits and yield insights to improve clinical interactions in conventional medicine.

Patient-Provider communication with teach-back, patient-centered diabetes care, and diabetes care education

OBJECTIVE

To examine how the teach-back, interactive communication loop between patient and provider, is utilized and its role in diabetes care delivery.

METHODS

This was a cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) 2011-2016. The study sample included US adults aged 18 or older with diabetes. Survey-design adjusted analyses were used to examine patterns of teach-back utilization across patient socioeconomic/clinical characteristics, patient-provider interactions, and diabetes care education.

RESULTS

Analysis of 2901 US adults with diabetes showed that 25.0 % reported patient teach-back experience during their visit to care. Compared with patients without teach-back, those with teach-back experience had higher scores on interaction quality with their providers (composite score: 90.8 vs. 55.8, P < .001). Those with teach-back were also more to receive additional advice on diet and exercise from providers (67.0 % vs. 60.9 %, P = 0.03) and to report that they were confident in diabetes self-care management (75.7 % vs. 70.3 %, P =0.03).

CONCLUSION

Teach-back communication appears to be effective in patient-provider interaction and diabetes care education, leading to higher confidence in self-care management.

PRACTICE IMPLICATIONS

Despite its potential, the utilization of teach-back communication is suboptimal. More effort is needed to promote effective use of teach-back communication in routine diabetes care.