Introduction
Any kind of organization is expected to keep to certain rules of professional conduct in order to be acknowledged and respected by consumers and other organizations. Ethics, either personal or professional, is widely discussed these days because ethical misconduct may not only tarnish the company’s reputation but ruin even giant firms and organizations. Ethical behavior can be defined as a set of accepted rules and standards which a person should keep to when making a decision. There is no doubt that sometimes ethical behavior demands lawful behavior and to identify the behavior which is ethically acceptable, one needs to possess certain knowledge of applicable law. Though some scholars keep to an idea that “knowing law without an understanding of the underlying public policy may lead to inappropriate application of such rules” (Wolper, 2004, p. 587), it is still better to be aware of the laws before making an important, and desirably ethical, decision. This becomes vital when it comes to medical care. Professional conduct (or ethical behavior) is extremely important for a physical therapist because people of this profession often face ethical dilemmas and are engaged in the process of ethical decision-making. Ethical behavior for a physical therapist consists in possessing certain ethical values and exhibiting behaviors with respect to these values; apart from possessing these values, physical therapists should correspond to a set of professional standards which define the level of their experience. American Physical Therapy Association (APTA) provides physical therapists and students of physical therapy with all the necessary information about this profession and difficulties which it entails; this organization has well-defined purposes and objectives, as well as a perfectly developed plan on the organization growth; each of its members contributes into the implementation of this plan APTA members enjoy a number of benefits.
Definition of Ethical Behavior
Ethical behavior (or professional conduct) may be defined as keeping to a definite set of rules and moral values which the organization and society impose on an employee, regardless the sphere which this person works in. A person who is able to carry out his/her duties according to the ethical standards which the organization keeps to is considered to be a professional. Every company or organization has its own set of ethical principles and values which the employees should follow. A number of organizations compile separate codes of ethics, depending on what exactly the business of the organization consists in. These codes of ethics set standards in accordance with which all the employees are expected to act; at this, the organization management emphasizes the idea that ignorance of these standards cannot serve as defense in case of unethical conduct. The main requirement for any code of ethics is to be as specific as possible, because a great number of corporate ethical standards have failed due to their being too generalized. However, these standards have to be general enough for an employee not to fear to make decisions or act in a certain way. As a rule, vice-president level executives are entitled with setting the standards of ethical behavior; they are also expected to periodically update these standards and make necessary adjustments. Establishing ethical standards usually involves more than a mere written policy. The executives should enforce these standards and, in the first place, start observing them by themselves.
Health care, like any other sphere, also demands definite professional conduct from its workers; ethical behavior is perhaps the most important for this sphere because people working in it are responsible for human health and sometimes even life. A failure to correspond to the professional conduct standards may lead to losing medical license and disgracing the name of the establishment a person works for. Ethical behavior within the field of physical therapy consists in possessing seven values which have been identified by the American Physical Therapy Association as the core ones for a physical therapist. Such values as accountability, altruism, compassion, excellence, integrity, professional duty, and social responsibility incorporate a number of other values and attributes which account for the physical therapist professionalism (Professionalism in Physical Therapy, 2000). Each of these values presupposes certain character features which a person possessing this value should exhibit.
Accountability is essential for the physical therapists who actively accept responsibility not only for all the actions which physical therapists usually undertake, but for working out means to positively affect the patients’ behaviors and outcomes of their treatment, as well as for general health needs of the society. A physical therapist is accountable for his/her actions if he/she responds to the needs of a patient regardless the complexity of these needs, if he/she is ready to bear responsibility for the consequences of his/her actions, communicate accurately to the patients, colleagues, payers about his/her work and professional achievements, continuously improve the quality of the care he/she provides the patients with, and educate students in an accessible manner (Professionalism in Physical Therapy, 2000).
An altruistic physical therapist is devoted to his/her job, patients, and colleagues. Such devotion results in placing the others’ needs above one’s own and sacrificing one’s own interests for the sake of work. A physical therapist who possesses this value is, as a rule, extremely competent, though sometimes too devoted to his/her job. The interests of a patient are always of prior importance to such a physical therapist; he/she offers assistance (often voluntary) to underrepresented populations and provides patients with high-quality service placing completing the patient care above all the personal needs.
Expressing compassion to a reasonable extent is especially important for a physical therapist. The fact whether being sympathetic is necessary for a doctor (any kind of a doctor) is rather controversial and opinions about it are diverse. It is believed that sympathetic doctors are unable to treat their patients well enough because of their emotional state. This is, by the way, one of the reasons why the doctors avoid to (and some of them are not even allowed to) treat their close friends, relatives, or family members. Compassion makes doctors weak and does not let them focus on curing the disease; they often try to find alternative ways of treatment if the real one seems too ruthless for them. This may result in losing precious time and doing even more harm to the patient’s health. Nevertheless, in terms of compassion as a value which a physical therapist is expected to possess, a person should be sympathetic enough to understand a problem from the perspective of a patient, to determine possible cultural, social, and economic problems which the person might face in his/her environment, and to work out a way to solve these problems. A physical therapist who exhibits compassion as one of his/her core values demonstrates respect for other people considering each of them unique; he/she does not discriminate people against their gender, race, and culture though recognizes these differences and tries to provide people with services taking these differences into account. A sympathetic physical therapist is often attentive to the patients; this evokes trust in the latter and leads to improving of doctor-patient relationships.
Excellence is also one of the core values which a professional physical therapist should have. It may be defined as a therapy practice “that consistently uses current knowledge and theory while understanding personal limits, integrates judgment and the patient/client perspective, embraces advancement, challenges mediocrity, and works toward development of new knowledge” (Professionalism in Physical Therapy, 2000). A physical therapist who possesses this value concentrates on constant improving of the quality of his/her services. This consists in permanent carrying out of the research with the purpose of investing into the health care field academically and taking part in collaborative practice in order to improve the quality of health service. Such a person not only aims at acquiring new knowledge throughout his/her entire career, but shares these knowledge with other people and through this contributes into the development of the health care field he/she works in. Excellence has certain similarities with altruism because the doctors who possess these values are completely devoted to their jobs. The main difference lies in excellent physical therapist working for the improvement of his/her skills, while the altruistic one focuses on the patients and their problems.
Professional duty is perhaps one of the most important values of a physical therapist and any other doctor. This value consists in being devoted to one’s job and committed to one’s professional responsibilities and duties the aim of which is to improve the health of the society in the best possible way. Therapists who have this value provide optimal care to their patients and are proud of what they are, as well as of what they do. Physical therapists who are committed to meeting their obligations try to promote their profession and show its significance; they teach other people, but their primary goal here is realizing their potential rather than sharing knowledge or making a contribution into the academic sphere. Such therapists are absolutely competent; they never break the code of ethics and regard confidentiality as a law which their profession bounds them with. They are reliable and trustworthy with their patients and colleagues respecting them and their work. Professional duty may seem to incorporate all the other values which physical therapists should possess, but this is not true. A professional physical therapist, though working according to the code of ethics, may still have bad relationships with his/her patients due to the lack of compassion or devotion to his/her job. Though people who believe that professional duty is their main value rarely make any mistakes or go against ethical principles, they still are not perfect physical therapists for this profession involves much more than observing ethical standards.
Finally, social responsibility is “the promotion of a mutual trust between the profession and the larger public that necessitates responding to societal needs for health and wellness” (Professionalism in Physical Therapy, 2000). This value is typical for people who are socially active and who have high moral values. They often treat as initiators of social policies that meet all the possible needs of the patients and their health needs above all; they promote community volunteerism and are politically active, which often results in their ability to change laws and regulations and affect the state of physical therapist service. Socially responsible physical therapists are preoccupied with nationwide and worldwide issues and try to connect the impact which these issues produce on the society with the sphere of physical therapy. They are born to be leaders and their establishing collaborative relations with their colleagues helps them meet their goals and objectives.
Thus, these are the values which a physical therapist whose behavior can be called ethical should possess. Physical therapists often encounter the necessity to take ethical decisions and “the difficulty of such decisions ranges from situations of simply abiding by professional ethical standards and values to difficult scenarios in which there appear to be two competing obligations” (Swisher, Arslanian, & Davis, 2005, p. 1). These seven values may help a physical therapist find a way out of such situations. Of course, having these values and displaying them to an equal extent is impossible, but a person who works in a health care sphere should be many-sided in order to adapt to the needs of all the patients and provide them with medical services of the quality which they deserve. However, possessing these values, or at least some of them, is not always enough. One has to correspond to numerous professional standards to be a professional physical therapist.
Professional Standards for Physical Therapists
Professional standards exist not only for the medical sphere workers. Any company or organization has a whole list of points which a professional has to correspond to. Nevertheless, health care employees’ professional standards are the most important for the reason that inability to comply with these standards may lead to serious consequences. The standards show how competent a person is in his/her work and reveal the person’s areas of weakness. Since competence is one of the major characteristics for a health care worker, conformity with professional standards is vital for each of them. This is especially true about physicians whose incompetence may result in serious damage to human health and sometimes even life. Physicians’ professional standards are perhaps the strictest ones. Special program was developed by the American Medical Association in 1998 to assess the physicians’ skills and to evaluate them in the following five areas: “(1) credentials; (2) personal qualifications (including ethical behavior and participation in continuing medical education…); (3) environment of care […], (4) clinical processes […]; (5) patient outcomes (including standardized measures of patient outcomes, perceptions of care, and health status” (Kohn, Donaldson, Institute of Medicine, 2000, p. 143). Such a strict accreditation means that, of all the health care employees, physicians undergo the most thorough testing and selection, because only the most skilled and experienced doctors can be ready to bear responsibility for human lives.
Though physical therapists are rarely responsible for human life, at least in a way that physicians are, they are still responsible for the health of their patients this is why their keeping to professional standards is also important. Apart from possessing the values which have been mentioned above, a physical therapist should be aware of the code of ethics which the organization he/she works for imposes over its employees. The principles of the code of ethics may vary depending on the organization a person works for. These principles are universal only to a certain extent and being aware of at least some of them may help a student in physical therapy be prepared to what is expecting him/her at the new working place. Before health care has been split into a number of sectors, all its branches had one common code of ethics that was stated in the Hippocratic Oath. Perhaps, the only part which remained common for all the health care professionals is the one stating that the most important for the doctor is not to do harm to the patient. This, however is more applicable in case with physicians, but physical therapists can sometimes also do harm to the patients, though not as severe harm as the physicians. Therefore, professional standards differ depending on the sector of health care a person is working in.
For instance, the field of physical therapy qualifies its employees (physical therapists) according to separate professional standards. The American Physical Therapy Association has postulated several rules constituting the Code of Ethics for physical therapists. In general, there are 11 principles which should be observed for the ethical practice of physical therapy. According to these principles, a physical therapist should provide compassionate care to all the individuals, as well as demonstrate his/her respect for them; a physical therapist should also be able to evoke trust in his/her patients in any aspect of physical therapy practice; he/she should be aware of laws and regulations that govern the field of physical therapy and exercise professional judgment; a physical therapist should be competent in every sphere of his/her profession and maintain high standards of education, research, and practice. In addition, he/she is expected to take such payment for his services which corresponds to the work done by him/her; the information about physical therapy services should be easily available to the public and presented in an accurate way to the patients; a physical therapist should act in accordance with ethical behavior principles and avoid any illegal or incompetent acts. Finally, a physical therapist is expected to address the health needs of the society and respect skills and knowledge of other professionals working in the health sphere (Kirsch, 2008).
These standards taken into account, it may stated, that a physical therapist who wishes to corresponds to these standards should possess the core values which have been also mentioned above, because the standards and the values are closely related. For instance, to provide care to the individuals, a physical therapist should possess compassion; similarly, in order to evoke trust in the patients, he/she should exhibit professional duty and accountability; lastly, to competent, a physical therapist should display excellence and should be engaged into research striving to improve and even perfect the quality of care he/she is providing to the patients.
Importance of Ethical Behavior for a Physical Therapist
Professional conduct is of vital importance for a physical therapist because this profession always entails ethical decision-making. However, the work of a physical therapist may sometimes involve more than mere individual process of deciding. Some scholars keep to an idea that ethical behavior includes the concept of moral judgment which, along with moral sensitivity, moral motivation, and moral courage constitutes four main components of moral behavior (Swisher et al., p.3). Moral sensitivity requires a physical therapist to frame ethical situations, as well as recognize and interpret them; moral judgment, in its turn, entails utilization of ethical principles when making a decision and choosing between right and wrong actions; moral courage and moral judgment are interconnected for the former centers around bearing responsibility for the chosen action, drawing up a plan on its implementation, and overcoming all the barriers which implementation of the plan entails; finally, moral motivation places ethical values above all the other ones, such as self-interest or financial gain (Swisher et al., p.3).
Another reason why ethical behavior is important for physical therapists is that it helps them during ethical dilemmas. A physical therapist should be aware of ethical principles and professional standards which his/her job involves in order to easily solve dilemmas. Students of physical therapy should bear in mind that ethical dilemma may consist not only in “right” versus “wrong” actions, or moral temptations as they are often called, but in “right” versus “right” where there are two right courses of action (Swisher et al., p.3). However, the cases where a physical therapist has to choose between right and wrong are more frequent and this is where ethical behavior becomes crucial because one needs to possess strong ethical principles for not to resist moral temptations.
Lastly, ethical behavior is of ultimate importance for physical therapists because they perform a role of moral agents and they would fail to perform it if they themselves behaved unethically. Physical therapist students should acquire moral education to be able to perform this role appropriately. Any physical theory curriculum should include discussions of ethical issues and ethical behavior as they applied to the field of health care under consideration. The curriculum should be aimed at developing moral behavior in physical therapist students, as well as at their integrating into main beliefs and values of this profession. Since physical therapists are health care professionals, high ethical standards are expected from them. They should be taught to act in the best interest of their patients and respect the rights of other people, especially their colleagues. Namely the physical therapists’ correspondence to ethical standards which is expected from him/her allows building good relations between them and their patients, which further results in better fulfilling of the physical therapist’s primary function, identifying the patient’s illness and curing the patients.
To become successful physical therapists, the students should have respect for their patient, his/her origin, values, and cultural beliefs. To do this, the students should first identify their own values and beliefs and then “develop a clear understanding of and confidence in their own ethical foundation as well as an understanding that those values and beliefs may differ from other individuals or groups of people” (Triezenberg, 2000, p. 4). This all makes ethical behavior extremely important not only for the students of physical therapy, but for those people who already work as physical therapists and care about corresponding to the standards of ethical behavior.
American Physical Therapy Association Purpose and Benefits
Purpose
The American Physical Therapy Association (APTA) was founded in 1921 as a women’s association and back then consisted of 274 members. These days, this number has increased to more than 72,000 people, both men and women, and the Association itself has become a major organization responsible for accreditation of physical therapist professionals in the United States. Its main task is to supervise the observance of main rules and regulations by not only physical therapist professionals, but by the students who learn to become such. The organization is aimed at moving the field of physical therapy to new advancements, as well as at promoting research and education in physical therapy field in order to change the professional degree of the physical therapist to the doctoral one. To achieve this, all the physical therapists and their assistants will have to “engage in the continual acquisition of knowledge, skills, and abilities to advance the science of physical therapy and its role in the delivery of health care” (Vision 2020, 2007, p.2). This can be regarded as the main purpose of APTA for it is outlined in the organization’s Vision Sentence for Physical Therapy 2020:
By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health (Vision 2020, 2007, p. 1, para. 1).
Apart from this purpose, the organization has a number of other goals to attain. APTA is planning to ensure that the consumers have a direct access to the professionals in the field of physical therapy and that all the physical practitioners have autonomous practice. This kind of practice will give physical therapists an opportunity to “accept the responsibility to practice autonomously and collaboratively in all practice environments to provide best practice to the patient/client” (Vision 2020, 2007, p. 2). By providing proper education to the students in physical therapy, the organization plans to provide the physical therapist professionals with skilled and educated assistants. APTA also aims to ensure that physical therapists and their assistants properly render their services to the patients and improve the quality of the population’s life in general. Apart from fulfilling their primary functions, providing the patients will health care, physical therapists will also carry out basic and clinical research, as well as implement new technologies to facilitate this research. This all, according to APTA, will contribute into “the growth of physical therapy profession and the health of the people it serves” (Vision 2020, 2007, p.1, para. 3).
Taking this into account, it may be stated that APTA cares not only about providing the patients with health care of high quality, but about the development of the organization as such. It works hard to educate students of the physical therapy in order to ensure that the number of personnel is sufficient for addressing the health needs of the population. APTA’s clearly defined purposes and objectives testify to the fact that the organization has serious plans regarding its future work and development, as well as that it will take all the possible measures to reach its purposes and meet its objectives.
Benefits Which APTA Offers to Its Members
The American Physical Therapy Association offers a number of benefits to its members. Those benefits are diverse and range from mere taking pride in working for such an organization to enjoying numerous discounts and an ability to find a new job in the sphere of health care. Thus, the members of APTA enjoy the following benefits:
- APTA protects the future of its every member. The organization does its utmost to ensure that the patients have a direct access to physical therapists and do not need a referral to turn for help. Moreover, APTA prevents “a scheduled 10.6% reduction in payments under the Medicare physician fee schedule for the remainder of 2008 and an additional 5.0% cut for 2009” (You & APTA, 2009, para. 2). At this, the organization also protects its members from restricting of their ability to practice.
- The organization publishes journals and magazines and creates databases, which gives its members additional benefits in consumer awareness, responding to changes in practice, and finding the answers to the questions the members are interested in. Thus, APTA publishes a monthly consumer magazine For Your Health the copies of which the members of the organization are permitted to distribute; in addition, it has created a separate database (Find a PT) where the members’ contact information can be found. This increases the physical therapist’s chances of getting a job in case he/she needs one. Furthermore, the organization also issues PT (Physical Therapy) Magazine where the members can find necessary information on the topics they are interested in. This magazine is quite helpful for physical therapists who are engaged in clinical research for it contains a number of scholarly articles written on a vast variety of subjects. APTA offers another option for physical therapists interested in research. The organization has created a patient record database system, Connect, which contains special documentation for physical therapists and other health care professionals. Connect allows tracing the details of a separate patient’s progress of treatment starting from his registration and up to his/her discharge. This service gives a physical therapist an opportunity to compare his/her performance with that of the previous month or year, as well as with the performance of other clinicians. Several other databases, such as The Guide for Physical Therapist Practice, Hooked on Evidence, and the Catalogue of Tests and Measures are linked to the Connect. They give APTA members access to the research literature on the most different subjects. For instance, Hooked on Evidence is a database which contains research evidence on how effective the physical therapy interventions can be. It gives the members access to scholarly articles relevant to the field of physical therapy and presents links to other websites where other relevant literature can be found. Hooked on Evidence provides APTA members with numerous learning tools which contribute to their professional development and improve the quality of the services they provide.
- Membership in APTA allows strengthening one’s skills and knowledge thus advancing one’s career. Members of APTA can apply for continuing education which they can obtain through online courses. After completion of the courses, the members get a CEU certificate. This gives a member an opportunity to participate in the seminars and conferences, as well as access the documentation in physical therapy, home study courses, and a number of online courses. Conference and seminars enable APTA members to share their knowledge with other participants and to learn something new from their experience. APTA members also get access to online Career Center where they can leave their resumes and view current job positions. The members can also complete Specialist Certification Program which allows its applicants to expand their professional horizons in 7 speciality areas and attain advanced level of skills and knowledge in a definite area. Moreover, APTA members can choose among other distance-learning options which include different interactive online courses and home-study. APTA member can also access Advanced Clinical Practice Series which examine evidence-based approaches to patient management. Since the practice of physical therapy undergoes changes systematically, current perspectives should necessarily be integrated into the physical therapist’s clinical practice. This option enables physical therapists watch live seminars and improve their knowledge and skills in different areas of physical therapy. The series are scheduled according to the date; however, they are available only to the licensed physical therapists (You & APTA, 2009).
- APTA offers extra services to its members. One of such services is Medicare Fee Calculator which ATPA members can use free of charge. Though this service does not give a hundred percent guarantee local contractor’s paying for the service, it still facilitates the process of payment and provides additional information regarding the payment for separate services. APTA membership also guarantees free access to APTA’s Defensible Documentation for Patient/Client Management which provides members with detailed information regarding the organization’s existing documentation. This resource contains a great number of Medicare reports and other issues related to clinical practice; it presents the answers for the frequently asked questions regarding reporting and keeping patients’ records and gives examples of cases which physical therapists may find interesting. APTA members can also use another benefit, namely, MMM or Members Mentoring Members. Owing to this option, any APTA member can serve as a source for other members of this Association and get assistance from them as well. This mentoring is voluntary and free; it allows sharing experiences and getting advice from other physical therapists.
- Being a member of APTA gives access to the organization’s website where all the necessary information regarding this Association may be found. The Website gives information about the Association in general and grants access to annual reports released by it. The rest of the information is presented according to the areas of interest, which makes it convenient to search for necessary data. Each of the areas contains a number of articles on different topics. Some of them are quite educational for they discuss separate medical cases in detail and give advice on how to act in this or that situation (You & APTA, 2009).
Therefore, benefits which membership in APTA offers are indeed incalculable. Joining this Association, any physical therapist or a student of physical therapy field will be able to enlarge his/her knowledge in different areas of studies and improve his/her professional skills.
Impersonality of Electronic Communication
Modern technologies have significantly facilitated the lives of people giving them new possibilities in education, entertainment, and other spheres of human activities. Recent technological innovations made even medicine easily available to all people, irrespective of their geographic location. The only condition is, perhaps, Internet connection. Medical doctors throughout the world offer online consultations to their patients; such assistance is also provided through Telehealth, “a tool that PTs can use to provide care for patients who might not otherwise have access to health care, due to geographic or other barriers” (Gater, 2005, para. 7). There is no doubt that Telehealth significantly improves access to health care. Moreover, it is quite useful for physical therapists because it encourages sharing of information and collaboration between them, as well as increases their professionalism. Telehealth gives a possibility to examine a patient using realtime video. Such a method of examination “decreases travel time and allows home health physical therapists to visit patients with greater needs […] and eliminates the risk of patients developing greater discomfort with long rides to and from the clinic” (Gater, 2005, para. 11). It is of great assistance to the rural health care providers, though it is quite often used in urban locations. This tool has only a few disadvantages because it allows the physical therapists diagnose diseases only visually without doing any tests. Some physical therapists refuse examining a patient without a direct physical contact which is sometimes absolutely necessary to diagnose a patient. Nevertheless, Telehealth may be regarded as an alternative way of treating the patients because for a professional physical therapist only seeing a patient may be enough to diagnose him/her.
However, it is more difficult when the physical therapist can communicate with a patient only through electronic mail. The biggest flaw of electronic communication is that it is impersonal. This is an obstacle even for everyday communication, let alone the interaction between a doctor and a patient. Electronic communication (except for the Voice mail) does not allow conveying emotions. Of course, it is possible to capitalize certain words or phrases thus placing additional emphasis on them or use exclamatory marks and smilies, but this can hardly replace facial expressions, gestures, and eye contacts which are the integral attributes of a live conversation. This impersonality hinders communication between ordinary people and it can become a real problem when it comes to the doctor-patient communication.
Physical therapists should be especially careful when dealing with online consultations through electronic mail. The patient can succeed in describing a disease or its symptoms, to be more exact, but the fact that there can be more than one disease with similar symptoms cannot be denied. A physical therapist who gives online consultations should always bring to the patients’ information that it is impossible to diagnose a disease for sure until necessary tests are done. Any physical therapist, even a professional one, may mistake and, while incorrect diagnosis might not lead to serious consequences, the treatment from such a diagnosis can badly harm the patient’s health.
Conclusion
Therefore, the work of a physical therapist entails possessing certain ethical principles and strictly abiding by the Code of Ethics. Such organizations as APTA are quite helpful for physical therapists for they offer them numerous benefits and allow becoming real professionals. Though using modern technological innovations significantly facilitated the work of a physical therapist, some of them should be used with special attention. When providing online consultation services to the patients, a physical therapist should be aware of the fact that not all of his/her diagnoses may be correct. This is in no way connected with the level of the physical therapist’s professionalism; in most of the cases, the impersonality of electronic communication (especially if it is carried out through electronic mail) is to blame for this.
Reference List
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