Searching for the 'Good' in Physiotherapist Practice: Toward an Ethic of Care
Abstract
The qualities and practices of a ‘good’ physiotherapist have not been systematically reviewed nor have practitioners’ perspectives been empirically investigated. Understanding what constitutes a ‘good’ physiotherapist has potentially profound implications that may inform professional priorities including education curricula, professional practices, competency profiles, and patient interactions. The research purpose was to examine perceptions of what constitutes a ‘good’ physiotherapist. This dissertation includes four integrated manuscripts. The first is an integrative review to critically examine how physiotherapists and patients describe the qualities of a ‘good’ MSK physiotherapist as depicted in peer-reviewed literature. Six qualities were identified as: responsive, ethical, communicative, caring, competent, and collaborative. The second and third manuscripts are hermeneutic phenomenological investigations that draw on Joan Tronto’s ethic of care theory as a theoretical perspective. The second manuscript is an examination of twelve physiotherapists’ accounts of what constitutes a ‘good’ physiotherapist garnered from semi-structured phenomenological interviews. Seven themes were identified. Two broad themes highlighted an ethical orientation to care and the integration of person-centered care with evidence-based practice. These were underpinned by more specific themes of ‘being’ competent, responsive, reflective, communicative, and ‘using’ reasoning. The third manuscript was a secondary analysis of data arising in the hermeneutic phenomenological study focused on practitioners’ accounts of ‘responsiveness’ in the practice of a ‘good’ physiotherapist. Six identified themes included: being person-centred, being attentive, being open, being a listener, being validating, and being positive. The fourth manuscript is a reflexive account of my transformed understanding of what counts as professional knowledge in physiotherapy. These studies offer perspectives suggesting the qualities and practices of a ‘good’ physiotherapist are a balance of technical competence intertwined with a relational way of being. An ethics of care is proposed to be central to the practice of a ‘good’ physiotherapist and supported by being responsive as a moral imperative. Practicing with a relational approach within a framework of practical wisdom may facilitate integration of person-centred approaches with evidence-based practices. The findings call into question the profession’s predominant emphasis on a technical rationalist approach to practice, education, and research, and invites conversation about balancing technical competence with relational dimensions of practice.
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