Physiotherapy; Private practice; Ethical issues

Physiotherapy is a relational practice where the physiotherapist and the patient meet. Every meeting implies both written laws and guidelines that regulate professional practice, unwritten codes of conduct and power asymmetry, all conditions the physiotherapist has to handle. And even carefully planned meetings are never given how they shall go; some aspects of the meetings are given and some are constructed between physiotherapist and patient . In addition, practicing physiotherapy is characterized by a close and often continued relationship between physiotherapist and patient where both are being touched by one another physically and mentally

The Ethical Frame of Understanding

Since 1970 several studies on ethical issues related to aspects of physiotherapy have been published . These studies revealed a practice with a growing professional consciousness towards its unique ethical issues in the physiotherapist-patient relationship. Normative guidelines for physiotherapy which originate in the belief that physiotherapists place professional fidelity to their patients as their first priority, whatever the context of their employment, have been developed. However, physiotherapists employed in private practice are explicitly asked to balance their professional obligation to fidelity with fiscal accountability.

Relational situations where one needs to weigh alternative actions towards a moral problem [8] are seen as the ethical frame of understanding. Ethical issues are considered to be encased in every relation between physiotherapist and patient  and as such a condition the physiotherapists have to handle.

Given that choosing a carrier within private practice has become more and more desirable amount Danish physiotherapists  and few researchers have focused their work on ethical issues in the context of physiotherapy private practice , why we decided on this context to frame the study.

The Aim of the Study

The aim of this study was to explore whether and how ethical issues arise during the first physiotherapy session discussed from the perspective of the physiotherapists in private practice.

The Design and Methods

The study was designed within a qualitative paradigm, using a phenomenological approach . Semi-structured interviews with 21 physiotherapists in private practices from all regions of Denmark were carried out twice and analysed by using Malterud’s modification of Giorgi’s phenomenological analysis  which resulted in four descriptive themes.

The Ethical Importance of the First Session

The results show that the first session and the clinical context in private practice are essential from an ethical perspective and a great diversity in understandings of what constitutes ethical issues is seen. Physiotherapists in Danish private practice have a general interest in ethics which is primarily based on personal common sense arguments, intuitive feelings of ethics and vague understandings of professional duty, and to a lesser extent based on awareness of ethical theories, principles and ethical guidelines.

On a general level the physiotherapists’ practices seem ethically grounded. The clinical environment, understood as the material décor, seems to influence ethical aspects of the first session as the physiotherapists strive to arrange the clinic in order for the patient to get the impression of friendliness, trustworthiness and professionalism. This means that what is said and done in the first session will influence what happens further on and how the involved parties interpret the situation and attach importance to things and events in physiotherapy private practice and thereby giving it an ethical dimension. The first session of physiotherapy is seen pivotal for establishing a good and trustful physiotherapy-patient relationship for the further process. Beneficence towards the patient is regarded as a fundamental ethical issue to be aware about in order to respect the patients entering the practices.

Awareness about ‘who I am’ as a person and professional is understood as a prerequisite for being beneficent towards the patient. Beneficence towards the patient is stressed as the ideal of physiotherapeutic practice and many examples are given about how physiotherapists strive to have an ethical practice. However, if the physiotherapists have lesser awareness of ethical theories, principles and ethical guidelines it becomes difficult to claim that physiotherapists can avoid unintentionally acting unethically. Further, it can be discussed whether private practicing physiotherapists’ ethical reflections seem wakening when practice situations are not frictionless as these situations require consciousness about respecting the patient and keeping the patient as a paying costumer.

The study shows that further exploration of ethical issues in private practice and conscious focus on the acquisition of knowledge about how to identify, analyse and solve ethical issues are recommendable in order to adhere to society’s expectations and demands of physiotherapists’ professional competence as well as ethical competence. As management policy is deeply embedded within the Danish public sector there are reasons to explore public contexts of physiotherapy as well.