F.R.I.E.N.D.S

Having the fortunate opportunity to be at one of the nicest clinical blocks at a fourth year level, I was able to expand, encounter and experience a different setting to what I was previously exposed to. Being at this specific institution I was able to see the same patients over the entire duration of my clinical block experience, something which I was previously unable to do. As I was able to see these patients over a certain period, it was inevitable I’d develop some sort of functional relationship with them, to which I found myself becoming very fond of the individuals I begun befriending. Being with the individuals for a certain amount of time, I was able to get some insight into what it was like living with sort some of disability, whether it be HIV or a spinal cord injury. This was something I had not experienced before, as I’ve never had the leisure of seeing a patient long enough to establish a “friend foundation”.

As days turned into weeks, what soon changed from my patients to my friends, had me quite chuffed as I couldn’t really establish a boundary as to why I’m not allowed to be someone’s friend. Surely it’s not a crime? No it’s not, though as I went on and ventured into this unknown world of therapist-patient friendship I began noticing a few situations which made me realize that maybe it’s not such a good idea. Patient-therapist relationships is something that every single therapist gets into, though as I’ve written about his before, I‘ve managed to experience a different side of relationships this time round.

One could argue that by not developing a functional friendly relationship with the patient could be in order to focus on the client’s problems exclusively, though how can trust develop in such a one-sided relationship? (Holmes, 2014). As I went about my daily routines, I couldn’t help but to find myself in situations whereby I’m surrounded by patients, fondly laughing, joking with one another and spreading good vibes. Once we got familiar with one another, we shared stories, laughs as we venture through this unorthodox road of duel therapist-patient relationships. As it may seem, one does not coherently realize that this was the situation at the time, as in this specific work environment, there was always a atmosphere of happiness in the air, mainly due to the type of individuals that were being seen to, as majority of them were newly admitted to the rehabilitation center because of a recent injury with the hope of recovering or improving function. What later occurred to me, when with these individuals was how they spoke to one another about their progress, shortfalls and challenges they went through during their stay. As most of them enjoyed and in good-spirit asked me how their friends were doing, was I obliged to tell them that they weren’t as functional as I thought out to be? Or worse, would I lie to these individuals who I recently befriended, laughed with, shared stories and experiences with?

As the article states that most therapists, recognize that they are always revealing aspects of themselves, and that a goal of the therapist is not to hide their personality, but to foster the kind of relationship that allows for the fullest discussion and exploration of all the reactions that take place between the therapist and patient (Holmes, 2014) This I believe, is something that I have done all to often, as I believe that having a relatable experience with someone is a small step in the right direction when establishing ant kind of relationship, it’s what makes us human. However where was I to draw the line? I know it was all meant in good spirit though as a professional, I know I’m not allowed to disclose any kind of patient information without consent, even if it’s in a spur of the moment, good atmosphere environment. As I watched my friends joke about one another about their challenges I know that I stood there with an arsenal of great puns, jokes and one-liners, though sharing any of this means I’d be breaking a boundary that I knew wasn’t to be broken. I suppose this is what would be one of a few cons to being a therapist.

I found another interesting article titled Should I Be “Friends” with My Patients on Social Networking Web Sites?” Though not in the same light, the context remains the same of patient-therapist relationships, especially in our advancing technologically generation:
http://www.aafp.org/afp/2011/0701/p105.html

References

Holmes, L. (2014, May 16). Why Your Therapist is Not Your Friend. Retrieved from http://mentalhealth.about.com: http://mentalhealth.about.com/cs/psychotherapy/a/dualrelshps.htm

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Abled to be disabled

Having been at my clinical block for a number of weeks, I was fortunate enough to bear witness the impact disability has on an individual. As we were designed to walk earth, it wouldn’t take much to realize that acquiring a disability has to be one of the most ill-fated cards one could be dealt. As more than 20% percent of the South Africa population may either have a disability or live in a household with a person who has a disability (SAHRC, 2002).

This has lead me to sit in numerous group discussions, where disabled individuals would banter about their feelings, how it effects them, as well as how they see themselves post-disability. This has proven very interesting and has brought about copious amounts of topic discussions. Topics ranging from all areas, covering every imaginable subject possible, though one has stuck with through this time, as I muse on about it. It was said in one discussion that disabled individuals have more rights than any other “normal” person. I took offense. I did not like this, however, I was not in a position to debate as 1) I was by their definition, the only “normal” person in the room and 2) It’s said that if you’re the smartest person in the room, you’re in the wrong room.

Now, based on a number of sources, disabled individuals obviously have rights, they have to, they’re disabled, though how far and as to which boundaries they’re allowed to push it to, is something that’s primarily overlooked solely because they’re disabled. According to chapter 2 in the South African Bill of Rights, it states that “The state may not unfairly discriminate directly or indirectly against anyone on one or more grounds, including race, gender, sex, pregnancy, marital status, ethnic or social origin, colour, sexual orientation, age, disability, religion, conscience, belief, culture, language and birth” (The Government of South Africa , 1996). As this is the foundation unto which human nature should be built on, especially in South Africa, I found myself sitting and smiting at an underlying sense of disabled inclination towards anyone “normal”, as if I were to owe them something for being disabled.

Based on the SA Commission’s definition of human rights, it states that human rights are the basic rights that everyone has, simply because they are human (South African Commission, 2014), though I could not agree with this more, I found myself sitting in a room filled with individuals whom had been issued an notion that being disabled is part their fault, and the other the governments. I understand the constraints at an environmental level, the inability to access information, malls and recreational activities though I found myself hitting at the fact at how ones perception of the human society has split up, even more, when looking at disabled and “normal”. Have we lost all faith?

Sitting in that room, I discovered that I too, was at that very moment, disabled. Being the only “normal” individual in that room, made me feel disregarded, detached, almost disdained from the human race. For 5 minutes, I felt as if I was the disabled one sitting in a room full of “normal’ individuals. As I’ll never know what it feels like to be disabled (touch wood) I can only merely understand, but never know. As I sat there, feeling as if I was about to be casted off the next episode of survivor, I imagined what it might have felt like being in that position for the rest of my life. I don’t blame anyone for their believe that the government owes them anything, as the government probably owes many people lots of things, but I do know that looking for an escape goat such as blaming another is not the right way to go about it.

Managing instruments such as the medical, social and bio-psychosocial models enable health care professional to understand how disability affects an individual, though is it enough? Especially when you get to discussion group and the general feeling is a sense of an I-O-U. I wouldn’t know where to begin correcting this topic, as it’s probably one of the hardest I’ve ever come across, trying to relate to something that I can merely understand but never actually know.

References
SAHRC. (2002). Towards a barrier-free society: a report on accessibility and built environments. South Africa : SAHRC.

South African Commission. (2014, February). Human Rights Commission. Retrieved from http://www.southafrica.info: http://www.southafrica.info/about/democracy/sahrc.htm#.U_34j_mSx8k

The Government of South Africa . (1996, Janaury 15). Bill of Rights (Chapter 2 of the Constitution of the Republic of South Africa). Retrieved from http://www.westerncape.gov.za: http://www.westerncape.gov.za/legislation/bill-rights-chapter-2-constitution-republic-south-africa#9

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Notable cause

By now, some of us must (living under a rock dependent) have seen some of the ice –bucket challenges that has taken an almost Armageddon-like approach by means of unleashing onto the internet. Water splashes, cold bodies, people of all walks of life, whipping out some video montage of their nomination, followed by some splurge of ice water thrown over them by a significant other. Such a strange world we stay in. This, however, is all for a notable cause, as the ice splash is only but the “guilt free scape goat” that comes with a pool so deep that one would require an stupendous amount of ice-water to really know the true depth of Amyotrophic lateral sclerosis (ALS).

Amyotrophic lateral sclerosis (ALS), often referred to as “Lou Gehrig’s Disease,” is a progressive degenerative disease that affects nerve cells in the brain and the spinal cord (ALS Association , 2014). This, falls within a group of degenerative conditions that in essence, affect motor function of the body, ultimately and inevitably leading to complete dysfunction and loss in muscular control, including speech, swallowing and breathing. I’ve had the experience of managing and befriending a patient whom had been diagnosed with Multiple Sclerosis (MS), though physiologically different to ALS, the eventual outcomes are relatively similar. This, had been one of the most frustrating things I’ve ever had to come to terms with, as every single time I had seen my patient, I knew he was worse off than before.

When dealing with chronic destructive disease such as MS, it’s said that we as physiotherapists should “maintain” an individual’s functional ability. At first, it was something I had thought to work, sitting in class, learning about just how good it is to “maintain’’, though when it came to actually experiencing this first hand, seeing what a condition such as MS is capable of, I felt like a small fish in a very.. Very big pond. Coming in at week one, walking to having to be wheeled in by week five, I had witnessed the progression of something so rapidly, I had couldn’t comprehend what it must have been like for my new friend, who by the way was all but between the age of 32-34. I have heard countless of times, that the worst possible feeling is to stand aside and feel useless, that there’s nothing you can do, irrespective of how hard you try to “maintain”.

Seeing these ice bucket challenges has me stuck between a rock and a hard place. On the one hand, it has raised more than $80million, all for the nobility of people suffering with ALS (Worland, 2014), to which I think is an admiral gesture to something that has been under wraps for far too long. On the contrary, a recent survey revealed that 53 per cent of people who did complete the challenge did not know what cause it was supporting (SAUL, 2014). Though I have admirable respect for the amount of effort and exposure a deadly condition has gotten over the past months, I can’t help but to think how much more conditions there are out there like these, needing exposure, and more importantly how much longer will it take till people begin realizing it.

I’ve not taken part in the challenge, though I can tell you first-hand about my experiences about it. Some may see this as pointless, no money involved, but where were you when these conditions were something kept under covers?
Attached are a few links showing similarities between ALS & MS as well as some ice bucket videos because you know… “Guilt free scape goat”…

http://www.healthline.com/health/multiple-sclerosis/ms-vs-als#Similarities4

References

ALS Association . (2014, October). What is ALS. Retrieved from http://www.alsa.org: http://www.alsa.org/about-als/what-is-als.html

SAUL, H. (2014, August 28). /als-ice-bucket-challenge-over-half-of-brits-polled-did-not-donate-to-charity-afterwards. Retrieved from http://www.independent.co.uk: http://www.independent.co.uk/news/uk/home-news/als-ice-bucket-challenge-over-half-of-brits-polled-did-not-donate-to-charity-afterwards-9696690.html

Worland, J. (2014, August 26). ALS Ice Bucket Challenge . Retrieved from http://time.com: http://time.com/3173833/als-ice-bucket-challenge-fundraising-total/

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What’s next?

Going into community service next year has made me realise how fast time flies, as well as how fast I’m reaching towards that adult phase of my life, of which I’m not too sure about, as I still do enjoy watching cartoons on a Saturday morning. As this year dawns on closing on, I find myself applying for placements next year, which could be a very scary task. As any new recruit student going into the “real world” would feel, do I have what it takes to be on my own for an entire year? Yes I do, I know I can, as I’m one of those people who loathes for autonomy, what I can’t seem to get my head around the fact of me trusting myself being alone for the next few months.

As I venture off into the unknown of becoming a physiotherapist, there are things that linger in my head, making me doubt myself not just as a physio but as an individual as well. I cannot wait to get the community service started, as it’s something every student works towards since being a freshman, though when the time actually comes, just how ready are you in becoming one? I cannot help asking myself “So is this what it feels like being a professional?”” To be honest, as it currently stands, it feels no different, or perhaps I’m jumping the gun a bit but to think that by net year this time (hopefully) people will be relying on me to better their lives, can be a scary thought.

Being independent, with no one looking over you can for some, be a sigh of relieve while for others, a path of misguidance and slackness. I don’t like to speak badly of other nor compare myself, but I’ve seen individuals throughout my experience whom I feel should never be in the field of physiotherapy or any other health profession for that matter. Coming from a clinical block experience where one receives the attention and guidance of supervisors, clinicians etc… I’ve been able to observe and experience first-hand negligence, incompetence and downright laziness. Despite being “watched over “by superiors, the idea of being incompetent does not seem to bother nor affect these people, which makes me think about being alone, what if there aren’t any superiors watching over them? Sure, I’ve had my lazy days, I’m certain many of us have had days where we just feel as if the worlds not playing its part, wanting to just get it over and done with, not really caring about the quality of treatment because of one’s own interest. I admit, I’ve been guilty of it before, attending to patients as to whom I get to see first, based on my biased. Is that okay? No, I know it’s not, but I’m human, and bound to make a couple of errors along the way, though I’ve also learnt that there’s no room for incompetence nor laziness in the health profession.

I suppose that part of being an adult, means making adult decisions. Realizing you’re not the smartest person in the room and your decisions will affect others, whether it be patients or socially. Seeing laziness in health professionals makes me sick, leading me to wonder and fearful for every health professional out there. I say this, as I head off into the “real world”, being fearful of becoming incompetent, not doing my job, or just scraping through the reins due to the fact that there’s no one out there looking over me, whipping me every time I don’t write notes down or give follow up sessions to patients. There are plenty of factors driving inside me, keeping me going, aiding and reminding me why it is I chose to be a health professional, I hope that there’s this same burning passion within every other health professional, reminding them as to why they’re there in the first place.

Attached are a few video’s I’ve sourced through which I feel relates well to the post, despite it not being related to health professionals directly, never less, the message writhing each video echo’s the post and hope that it’ll give you a slight push of motivation.

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Small talk, big words

Being in a profession that enables and requires me to be involved with people, I have seen and learnt many a things concerning not just people, but rather how interlink we may be, irrespective of gender, race or age. Being a future health professional, I’ve been fortunate (if anything) to develop an understanding about people that I’ve not had before, thus said, a sense that we’re closer than we think, each going through our own personal battles, having our own deadlines, going through a walk similar to mine or yours, perhaps just on a different path.

Having dealt with people on the daily, I couldn’t help noticing that when in pain, people tend to be more vulnerable than they’re supposed to. With this excessive vulnerability, comes a great deal of storytelling that almost any health professional can be familiar with, you know, those patients who just won’t shut up, ranging from how bad their days been to how cold it is at night. As the banter and bickering of small talk between a health professional and patient is almost inevitable, I certainly found myself enjoying it a bit more, realizing that I’d probably be doing this kind of thing for a long time coming. Initially, having small talk between myself and patients was something I reserved for the patients whom were female, pretty and had a condition I felt was necessary to see for an disreputable amount of follow-up sessions. Though as one gets older and wiser, I begun realizing that if I listen to what they actually saying, I may have stumbled upon the greatest job on earth.

Listening to what patients had to say, how they perceived the world, how their lives are, what battles they’re facing had me focused on all my patients, irrespective of gender or prettiness. I had captured a part of being a health professional that had made me feel as if seeing these people were a little bit more worthwhile, not for them but rather for me. Sharing stories, laughs and experiences has shown me that developing a relationship with people is not something I should reserve for outside the workplace, but rather inside and continue to pursue it on outside. I have come to the realization that I find myself building character and growing more as an individual through helping people. As cliché as it sounds, I’ve found that by helping people, I help myself in a way that sees me improving on a set of skills thought to be non-existent. This progression has seen me shift from seeing a patient as a just patient, where all human characteristics are detained from. This gives a health professional a sense of godliness over their patients, seeing that they the experts and patients are little diminutive people in need of help.

One of the paramount ability of being a health professional is the ability to connect with people, irrespective of their condition, age, race, it’s the basic ability just to be able to connect with an individual that makes health care that much more poignant. Realizing this as I’ve progressed through the year, I lifted myself towards empathizing with patients, which has shown me just how related we are, irrespective of which side we are of the interview desk. Only when being able to understand what it feels like to be patient, will you know the true value of being a health professional

As I reflect on my past experiences, was I wrong in the first place to take an emotive such as empathy so lightly? Did this have an effect on the individuals I’ve previously managed, what did they think of my nonchalant service? Was it my fault in not being able to see how the effect of my human traits and emotions had on the people I was treating? Though I’ll never be able to correct the misfortunes of the past I can very well prevent them from happening in the future, as I now know how it feels to be on both sides of the coin.

Below are several extracts concerning health care and the human touch


http://www.dailymail.co.uk/health/article-2212538/Treat-patients-people-conditions-Doctors-nurses-ORDERED-carry-bedside-visits.html

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Boundaries

Over the course of this year, I’ve been exposed to a variety of different environments, conditions and people. This has been a great experience and one that I hope will continue over the course of my studies. Meeting new people is something I’ve always enjoyed, sharing stories, getting to know one another, seeing how our lives differ or compare is to some degree a sense of humanity that I believe we all should share. As a health professional, one would be inclined to get to know people (patients) a bit better due to the nature of being a health professional, one would be expected to ask questions, as per norm, in ultimately the aiding and management of a patient. As I’ve seen and managed many patients over the course of the year, I couldn’t help but getting to know some of the patients I’ve seen, however, how much is one allowed to get to know a patient? Where do I draw that line of stepping over my professional and into my personal boundary? Perhaps I’ve taken it a bit too far by developing a certain relationship with a patient, is this wrong? Am I a bad health professional?

Having an interest or a relationship in a patient is something I imagine to be a sort of taboo in the health professional world. As one physician states that the sexual or romantic interactions between physicians and patients detract from the goals of the physician-patient relationship, may exploit the vulnerability of the patient, may obscure the physician’s objective judgment concerning the patient’s health care, and ultimately may be detrimental to the patient’s well-being (Michael S. Victoroff, 2002). This is true, as one’s judgement may become clouded due to an emotional involvement, treatment for the patient may be compromised and for that reason, relationships are not recommended. According to the HPCSA, having a relationship with a patient may result in misconduct and can lead to a disciplinary hearing (HPCSA, 2013). Had I been qualified, I imagine the situation would have turned out differently.

Being a health professional means that I have to set appropriate boundaries between myself and a patient, despite any feelings coming between, as this could only lead to misfortune. With that said, being an amid running follower, many of you know the Boston bombing that took place not too long ago, despite its tragedy, I’d like to draw attention to one of the victims involved, James Costello. As many of you might have not known, James fell in love with the nurse that took care of him Krista D’Agostino, eventually getting married (BROWN, 2013). I do not plan on proposing to the gorgeous patient with whom I’ve had feeling for, though I propose that what if, by my decision and hers, we were to go ahead and foresee a relationship? Will it be wrong? Will I be seen as a manipulative health professional?

Bibliography
BROWN, S. R. (2013, December 20). Boston Marathon victim who fell in love with nurse: ‘I’m glad I got blown up’. Retrieved from http://www.nydailynews.com: http://www.nydailynews.com/news/national/boston-marathon-victim-fell-love-nurse-glad-blown-article-1.1553789
HPCSA. (2013). Professional Conduct & Ethics. Retrieved from http://www.hpcsa.co.za: http://www.hpcsa.co.za/Conduct
Michael S. Victoroff, M. (2002, November 4). When Falling in Love Falls Out of Bounds. Retrieved from http://www.managedcaremag.com: http://www.managedcaremag.com/archives/0211/0211.ethics.html

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Difficult guilt

Having been at my first block for the year, I’ve managed to expand my knowledge in area’s I’ve previously felt I’ve lacked. Being on a clinical block has allowed me to see an array of different patients within week, ranging from cystic fibrosis to amputees. This worked out to be a good thing for me, as I was able to touch on all aspects of a condition as well as to see how physiotherapy plays an important part in each one of them. As this proved to really help me in a way that I was able to work on my shortcomings and as to improve on my strong points, I feel that through a physiotherapy perspective, I’ve gained points. This has seen me improve my techniques, knowledge and thinking on a health professional side, which is great, though there are still slits which I feel need to be filled, on an entirely more human level.

Being able to see patients is one of the things I love and enjoy. It’s what I do. I get that. However, when it comes to certain times, places, situations, I may have slipped up a couple of times. Firstly, I have not nor will have done anything to intentionally hurt or abuse a patient in any way, ever. As many of you may be familiar with a “difficult” patient and how stubborn they may get or how reluctant to treatment they are or even how frustrating it can become, has it ever gotten to a point where you just don’t care?

Having experienced this numerous times, I inevitably came to a point where I realised that, despite my best intentions to help someone, if they not going to put some effort into it, why should I? According to (Jackson JL, 1999) as many as 15 percent of patient-physician encounters are rated as “difficult” by the physicians involved. It’s also noted that not all difficult interactions can be blamed onto the patient’s side, as the physician’s attitudes such as care, fatigue, burnout and stress can impact the situation as well (Sharon K. Hull, 2007). This has leaded me into thinking about my previous situation and how I managed it, by walking away.

By now, I figured that walking away was probably not the noblest thing to do. After pleading, motivating, and explaining myself over a period of one week, I was still not able to provide patient difficult with any source of productivity within this time. Being manipulative, impulsive and pure lazy, I eventually had enough and turned away, due to shear attitude and response. As the week past, I had learned that patient difficult had used a TV cord to hang himself during the course of the night, to which I had an array of mixed responses.

As with death, I believe that it makes you question yourself, was what I did right? Was I to have a part in the blaming process? Was patient difficult’s death on my conscious? I didn’t know what to think, as I hadn’t been in a situation like this before. Physically, I was fie, though cognitively I couldn’t help to think if maybe, just maybe by trying that bit harder or if I had seen in a bit earlier in the day, we would’ve maybe gotten along with one another, better yet, gotten along with what I was actually supposed to do. Though there are plenty of “what if’s” bouncing around my mind, I can only take what’s left of the situation and carry on. Was I sad when patient difficult passed away? No, though I felt a sense of awkward uncomfortableness in me, something that didn’t sit well with me, as I knew that if I hadn’t walked away, maybe he could’ve been hanging with friends and family, and not by himself.

References
Jackson JL, K. K. (1999). Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Arch Intern Med. , 1069–1075.

Sharon K. Hull, M. M. (2007, June). Family Practice medicine . Retrieved March 17, 2014, from http://www.aafp.org: http://www.aafp.org/fpm/2007/0600/p30.html

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