You can talk to Merrolee about this blog, it was seeing hers that ‘inspired’ me to get around to starting this blog. An idea that had, I must admit, been kicking around in my brain for quite a wee while…
Finally I got around to it…
This will be a ‘from time to time’ blog, just as my photography one is. Every now and then inspiration hits and away I go!!
But for today – values in health.
Almost all health professionals have a code of ethics in which there is something about ‘respect’ for the client/patient/consumer. All throughout health care we are asked to compromise our values (How much therapy ‘should’ we offer this person? How much time can I afford to spend with that person? Should I tell this person about this therapy – when I know they won’t be offered it here…).
Personal and professional values are challenged directly and indirectly every day we work with people. If it’s about equity in funding (in New Zealand, the difference between funding for accidental injury and health conditions can be vast), about whether a person wants to engage in new behaviour, or how much we compromise our own beliefs about what is and is not important (documenting patient statistics versus spending time with a person?) we make decisions about what is important to us in our practice.
On the NZAOT Values Exchange , participants are asked whether equipment should be offered to an individual with obesity, initially described as developing before the diagnosis of osteoarthritis was made, but later described as being diagnosed at the same time (and presumably as a result of the OA). Ministry of Health determines that equipment needed because of obesity cannot be funded, while equipment needed because of disability from other health problems can be funded. A value-laden judgement suggesting that obesity is a choice, while disability from other causes is not. Perhaps not a value judgement that is explicit, but nonetheless, a judgement about what is and is not important. Is this respectful?
In cognitive behavioural therapy we are often called to ‘challenge’ the beliefs or assumptions of the person we are working with. Some cognitive therapies are very direct, calling the beliefs ‘maladaptive’ or erroneous. To the person hearing someone say ‘your thinking is wrong’, is this respectful?
Can I suggest some things to consider:
- Spend some time with yourself to work out what your values are both personally and professionally
- What are the stated and unstated values of the organisation you work for?
- There will be areas of compromise – have you spent time considering the effect of this compromise on you as an individual and as a professional?
- Think about offering choices to the people you see – what is important to you (their health status) may not be important to them (their kids schooling may be more important than their diabetes!)
- Drawing on motivational interviewing we can be both directive (being clear about our own position on the effects of a course of action), while being respectful of the choices that the person makes (based on what is important to the person).
- We can ensure we provide the person with a range of options so that they can an informed decision on what to do next (and the implications of that decision). Done sensitively the person will feel that you trust them, that they do have the resources to draw on, and that you both respect them and will welcome them back.
I hope this first post provokes thought. Comments are welcome!!