Published by Martin Sands,
What do you say to yourself when making decisions? What is your justifying framework? How do you get through your day? What is your mantra?
I wondered if I might be excused for wanting to follow William Golding’s lead and ‘hold the conch’ again? I apologise to Dave Nicholls for seemingly piggy-backing off another post he wrote entitled 'If I can’, on the Critical Physiotherapy Network, but so thought provoking was this, that I had to write something too. His post emerged from his reading of an honest reflection ‘Guised as therapy’ at Keith’s Korner: a great example of thinking a little beyond our own perceived successes, and it is to Keith , by chain reaction, I owe this post too.
What if ‘If I can’ were a mantra for care?
Dave Nicholls asks us to consider the words ‘If I can’ as a departure point for discussion about person-centred care. All sorts of thoughts and feelings are conjoured from the three words, ‘If I can':
'If' embraces uncertainty
'I' suggests a sense of personal responsibility
'Can' denotes an awareness of one's competence
In dealing with patients, the whole phrase covers a professional code underpinning a willingness to do one's best. An 'expert’ practice (Resnik and Jensen, 2003). It also conveys a reflectivity. On the contrary, if the mantra were 'if you want me to’, it would represent a sort of professional and reflexive submissiveness: an inflexible willingness to suspend a duty of care regardless of potential benefit or harm to the person. However, 'if I can' suggests one is able to reflect-in-action (Schön, 1991), to think on one’s feet, to make decisions in the best interests of people. Again, an 'expert' practice.
Mantras are interesting things. The Oxford online dictionary’s definition directs us towards a spiritual utterance which aids meditation. Intuitively, mantras are very powerful in assisting mindful practice. To think in the moment. To recognise the conceptual framework on which we base our thinking. To be present in what we do.
When consent has been an issue in care, I wonder whether I have really tried hard enough to persuade people to do the best thing for themselves. For example, if a person on a ward refuses to mobilise out of their bed, have I ever thought of asking someone else to try : working with another profession, a relative or even in certain cases, other patients? Have I really done my best? Have I thought collaboratively?
This has made me wonder whether I should adopt a new mantra for practice. But what should it be? I think, in my early career, I followed the mantra of ‘Firstly do no harm’, which on the whole seemed to make sense. But perhaps this is a little pessimistic and obvious now. Of course, I don’t want to cause harm, but should I live in fear of minor risks. Taken more literally, what if a minor harm averts a major harm? Hope (2000) has written an editorial exploring the importance of this in medico-legal contexts and acts of omission.
My thoughts on mantras. What about: 'We will do our best, if we can’. A mantra for everyone in a rehabilitative team; the ‘patient'; professionals; relatives doing there best for the sake of others. A collective reflectivity and 'People centred care'.
I’d love to hear people’s mantras. For inspiration, historical interest, and an indication of our changing criticality as a profession, I encourage people to go to Google scholar and write in the two keywords ‘physiotherapy’ and ‘mantra’. Look at all the listed hits.
What’s your mantra?
Hope, T. (2000). Acts and omissions revisited. Journal of Medical Ethics, 26(4), 227–228. doi: 10.1136/jme.26.4.227
Resnik, L., & Jensen, G. M. (2003). Using Clinical Outcomes to Explore the Theory of Expert Practice in Physical Therapy. Physical Therapy, 83(12), 1090–1106.
Schön, D. A. (1991). The reflective practitioner: how professionals think in action. Aldershot: Ashgate.