Professionalism within the clinical context of the patientpodiatrist relationship

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Professionalism within the clinical context of
the patient-podiatrist relationship

• Mairghread Ellis 2007

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Patient-podiatrist relationships

• We all have them, whether good, bad or
  indifferent
• What sort of relationship is it? Friendly?
  Service provider based? Paternally medical?
  Professional?
• How to find out? Why did I want to find out?

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Illustrations of podiatric practice
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Methodological approach

• Phenomenological approach, informed by Gadamers
  hermeneutic philosophy
• The participants own reality is sought
• However, the researcher is accepted as embedded
  in the research process
• Data generation is a co-construction
• Thematic analysis is rigorous, iterative and
  inductive
• Purposive sample of 8 podiatrists (NHS and
  private sector), 2 interviews each

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Gaining meaning and understanding

• 23 subcategories were developed from the data
  into 6 categories -
• Relationship
• Engagement
• Role
• Image
• Reward
• Personal development

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One overarching theme

• Professionalism
• What is professionalism?
• What does it mean?
• What is the utility of this finding?

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Reporting, interpreting, applying

• Firstly, data was presented with description
  and initial interpretation
• Then..
• It was passed through the sieve of theory to
  display its applicability and utility

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Dramaturgy

• Is patient practitioner interaction a
  presentation on the healthcare stage?
• Whos the actor, whos the audience, who writes
  the scripts?
• Who is costume designer?
• And is it costume, or disguise?
• The Presentation of Self in Everyday Life
• (Goffman, 1959)

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Liminality

• Liminality the concept of betwixt and between,
  on the threshold, stepping on the cracks
• Podiatry is liminal within the profession
  (chiropody/podiatry)
• Podiatry is liminal within the wider context of
  healthcare (what do we do?)
• Podiatry is liminal in that it is pushing at
  boundaries not traditionally in its possession (
  surgery)
• The Ritual Process, (Turner, 1969)

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Theories of professionalism

• Macro and Micro 2 faced head of Janus
• (Baldwin 2006)
• Intra, Inter and Public aspects
• (Van der Camp et al (2004)
• Episteme, Techne and Phronesis (Aristotle)
  Hilton and Slotnick (2005)

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Utility and Applicability

• Liminality enables understanding of the
  uncertainty of the present, and confidence to
  step over the threshold into the future
• Theories of Professionalism allow us to
  understand the levels and facets of public and
  individual professionalism. This allows us to
  build our own status, and not merely to expect
  others to award it to us.
• Dramaturgy facilitates reflection and role play
  and may thus be an effective educational tool to
  help develop the phronetic aspects of
  professionalism

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Conclusion

• Liminality lets us understand our development as
  a profession
• Professionalism is as much about the individual
  person as about the podiatrist
• Phronesis is perhaps the most important aspect of
  professionalising the individual

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