Competence

I believe professionalism in chiropractic is required and demonstrated in a vast array of circumstances. Still, a story that springs to mind involves a patient who had become relatively familiar at the clinic and presented for lower back pain treatment that had progressed quickly over the previous week.

This patient was a horse enthusiast and was desperate for some relief from her pain, as she was due to show her horse over the weekend. Previously, this patient had responded exceptionally well to chiropractic care and suffered occasional flair-ups of mild sacroiliac pain for which she had not presented in over nine months.

After a short history of her current presentation, it was apparent that this patient was not experiencing symptoms of the previous diagnosis, and further investigation was required. Despite her desperate and adamant pleading for pain relief, I refused her treatment and referred her for an urgent MRI, which meant she missed her weekend away, but ultimately saved her life.

The results showed a heterogeneous signal coming from her bones.  After a subsequent medical referral, an aggressive subtype of adult Leukaemia was diagnosed, and treatment commenced with a stem cell transplant only one week later.

This case stands out to me because the letter from her consultant explaining her treatment informed me that this treatment was lifesaving and that my actions had very likely saved her life. On reflection, only my professionalism guided me to make the correct and informed decision on her triage and consider the differences in her presentation by referring to her previous notes and medical history.

I also feel that professionalism was shown by taking the necessary steps of referral to get her diagnosis ultimately and to have the ability to justify and communicate appropriately with other healthcare professionals. This example is just one of many cases in that I could identify that sticking to professional conduct and keeping away from familiarity has made an enormous difference to the outcomes of the provision of care.

It’s an affirmation that professionalism within chiropractic can hugely impact outcomes and explains why it is so important.

As part of the MDT approach within the acute psychiatric ward, my colleague was the only person on the team able to establish a rapport with a particular patient.

They demonstrated high degrees of patience, perseverance, empathy, nonjudgment and respect for the patient’s beliefs and values. This was despite the patient displaying assaultive or non-communicative behaviours at times and several other barriers and complexities in the patient’s case.

My colleague upheld the patient’s right to autonomy in the environment and strongly advocated on their behalf. Working as part of the MDT, they offered clinical judgment with evidence-based rationales when this conflicted with other professionals’ judgments or agendas. They maintained their boundaries in the relationship with this patient, facilitated through peer support/supervision with the team.

My colleague and team held a detailed understanding of the patient’s occupational needs and they were considered in regard to long-term care for discharge planning. They adhered to the Occupational Therapy ‘Code of Ethics and Conduct’ for these specific skills and values, my colleague. Similarly, they have met the HCPC’s occupational therapist standards of proficiency. Examples include ‘awareness of the impact of culture, equality and diversity on practice’ and ‘being able to draw on appropriate knowledge and skill to inform practice’. Many of these standards are common sense in daily practice. My colleague was able to remain within the remit of our profession in this service.

My example is an experience as a patient myself when I was anxious about a lumbar puncture for which my neurologist had requested light sedation for me. When I arrived at the department, I felt like I was on a conveyor belt. For example, no eye contact was made throughout booking in as the nurse rattled through the procedure; I was taken downstairs in silence, and the consultant refused the sedation.

I was therefore in a bit of a state. But the professionalism of a young nurse and a radiographer made a massive difference to me and changed the whole experience. Firstly, they took the time to establish rapport, listening carefully to understand my concerns and wishes. They then worked together, multi-tasking throughout, so I felt they knew what they were doing, as they reassured me and made me comfortable. They skillfully completed the procedures and ensured my dignity (they closed doors and were firm but polite with colleagues who wanted to use the room as a shortcut) while reassuring me and advocating on my behalf with the consultant. They were polite with and about their colleagues while letting me know they were on my side and my comfort and dignity were paramount.

It was a traumatic event for me - very painful and terrifying, and I truly felt powerless until the duo transformed everything. What truly stands out as an example of professionalism was the smooth, unruffled, and competent way they carried out their roles with the procedure and dealt with several difficulties while maintaining compassion and keeping me at the centre of everything.

I took away that unpleasant or difficult situations can be transformed for the patient by professionalism: competence, empathy and compassion.