Melbourne Medical School Collected Works - Theses
Permanent URI for this collection
Search Results
1 - 2 of 2
-
ItemWhen General Practitioners (GPs) and patients disagree: impact on the ethics and professional identity of GPs( 2023-04)Patients increasingly present to general practitioners (GPs) with already-formed views of what they feel they need (e.g. antibiotics, X-rays), but which the GPs consider unnecessary. This research explores how GPs experienced and managed these situations in clinical practice. Nineteen semi-structured individual interviews and two focus group interviews were conducted with practising GPs in Victoria, Australia. This study adopted a constructivist and interpretivist methodological approach, and investigated the GPs’ experiences and perspectives of these patient encounters without pre-supposition of what they ought to be doing or thinking. Study methodology privileged the participants’ accounts of their experiences, where they could raise issues that they, rather than the researcher, considered as important. Results showed that GPs found these patient requests for perceived unnecessary care challenging and stressful. They described these patient encounters in two main ways: as interpersonal disagreements with patients that they needed to manage, and also as ethical challenges where they had to work out the right thing to do. Further analysis elucidated that GPs experienced these ethical challenges as a threat that destabilised their professional identity of what it meant to be a good GP. GPs experienced the ethical challenge posed by these patient encounters not as an intellectual conundrum to be worked through dispassionate reasoning, but as a heartfelt threat to their professional identity as good GPs, and how they made sense of themselves and their work. For the GPs, managing these ethical challenges involved working on their sense of professional self, and trying to reshape this identity to mitigate the dissonance between their self-conception of a good GP and what patients expected them to do. My study showed that they struggled to do this work, which was effortful and emotionally stressful for them. This contributed to their sense of stress and distress in these patient encounters and helped explain why GPs found these perceived unnecessary requests so emotionally stressful and difficult. This study provides a fresh perspective on how ethical challenges are experienced and managed in clinical practice. The thesis describes how these patient encounters challenged the GPs’ identity conception of a good GP, the identity work they did in response, and their struggle with this identity work. The research highlights the need to consider the role of professional identity in ethical decision-making when examining ethics in primary care. Importantly, it suggests that effective ethics education and support for GPs require an identity-informed approach, where GPs can be supported to do the difficult and often emotionally stressful identity work. Effective ethics education and support for GPs will benefit not only GPs, but also the patients they care for. This study will also be of interest to medical educators and ethicists involved in the provision of ethics education and support.
-
ItemExploring Contextual Influences on the Ethical Dimensions of Clinical Practice: Perspectives from Physiotherapists in Singapore( 2023-05)Ethics is embedded in all aspects of physiotherapy. The importance of ethics in physiotherapy professional practice is reflected in the growing interest in clinical-based ethical issues and the ethical decision-making strategies used by physiotherapists. With emerging evidence of both contextual and individual influences affecting the ethical dimensions of clinical practice, there is a realisation that one cannot address an ethical issue by simply applying a universal set of principles without consideration of context. Context and culture play prominent roles in how we view, comprehend, and construct our world yet the majority of the ethics norms in healthcare practice are grounded in Western theories of ethics, and most of the physiotherapy research on ethics has been done from the Western viewpoint. There is a paucity of the Asian perspective, specifically the East and Southeast Asian regions. This research sought to contribute to current physiotherapy ethics literature by exploring the contextual influences, specifically the organisational and more broadly societal influences on clinical ethical issues and decision-making, as interpreted by physiotherapists in Singapore. Utilising the interpretive description methodological approach, data regarding the types of ethical situations encountered and physiotherapists’ ethical decision-making were collected through in-depth interviews with 42 physiotherapists practising in four different healthcare settings (acute, community, specialised institutions, and private practice) in Singapore. Inductive content analysis was used to analyse the interview data. The empirical findings reflect current literature indicating that individual, organisational and societal context can influence ethical situations, and illustrate context’s critical influencing role in ethical decision-making, as experienced and perceived by physiotherapists in their unique geographical and clinical settings. This research also highlights variations in the way individual clinicians interpret and prioritise contextual influences in their workplaces and social communities, indicating that ethical decision-making cannot be separated from the values and beliefs held by the physiotherapist. In summary, the findings suggest that physiotherapists’ ethical decisions and actions are ultimately determined by the dynamic interaction between individual characteristics and contextual influences. Finally, physiotherapists practising in the Singaporean context prioritise the maintenance of harmonious relationships and pragmatic considerations as important contextual influences in their ethical practice. By focusing on the organisational and societal influences on the ethical dimensions of physiotherapy practice in the Singaporean context, this research contributes to the body of ethical literature from the Asian perspective. Identifying the contextual factors that influence physiotherapists’ moral agency will allow the local physiotherapy community to understand both the facilitators and barriers to ethical practice. This research provides the impetus to move beyond universal moral theories and code of conduct, and to consider the workplace context as an important inclusion in ethics education and support for clinicians. The empirical data from this research can also inform the development of ethics curricula to ensure that universal ethical principles are situated within the realities of clinical practice. Locally relevant and realistic ethical case studies will better enable students to recognise and address these situations.