Putting the person at the centre of practice and patient-centred care was a topic that cropped up regularly during the start of our course and featured regularly throughout. Developing patient-centred care appeared to be a focus of the course, and is something the NHS also continuously strives to do (1). This is an area I believe I did prior to this university course, but may not have always considered it in the methods and approaches the university taught me, opening my eyes and mind to this concept.

Demonstrating patient-centred care is something I had an opportunity to do during our Patient Pathways module when we had to write an essay around a case study on a patient we had previously encountered. I had the opportunity to discuss goals with a patient (evidenced – SE704 Assignment: highlighted in yellow under ‘goals’) that allowed me to direct treatment in a method that would allow myself and the patient to achieve this, through this discussing I believe that this demonstrates respect for the individual that I was working with in order to put the person or patient at the centre of practice (2). Additionally, later consultations with the same patient allowed myself to discuss options with the patient due to conservative modalities not helping with the patients osteoarthritic knee pain, therefore we discussed options in detail around a corticosteroid injection and later down the line a total knee replacement (evidenced – SE704 Assignment: highlighted in yellow under ‘pain clinic’), highlighting an ability to provide information and support that enables an individual to make informed choices about their own care planning and respecting and supporting an individuals’ autonomy (2,3) whilst also following NICE guidelines around knee osteoarthritis management demonstrating the use of evidenced-based practice (4,5). This experience taught me the importance of including the patient in their care, goal setting and treatment, I found this to be the most effective patient-centred approach, and through the provision of information to help individuals make informed choices, this is a strategy that I shall look to implement in my future physiotherapy career (2).

During my third placement in a community setting, I had the opportunity to work alongside a falls reaction team where we had to go out on a call to help a gentleman up who had a fall at the bottom of his stairs after returning home. This gentleman had respiratory related co-morbidities, was severely frail and highly reliant on his daughter for care needs. We discussed option with him around a care and treatment plan going forward but the patient refused all care under his rights (6). This left us with no choice other than supply all relevant information to ensure he understands his decisions and options available to him and his daughter (evidenced – Reflection: Refusing Treatment) and supplied information around community care in the Suffolk area (evidenced – Patient Information in Community). This demonstrates respect for the individual in addition to providing information and support that enables an individual to make informed choices (2). Being able to provide information and support that enables an individual to make informed choices was a concept I had the opportunity to do during my second placement in a neuro outpatient setting when treatment a patient with spastic paraplegia, we discussed his spasticity in detail and if he noticed a trend around what makes it better and worse, he couldn’t really put his finger on it, therefore I wrote a list of known  triggers in relation to literature (7) and this this highlighted to him when his spasticity become worse which enabled him to make informed choices around lifestyle through providing information around his condition (2) (evidenced – Neuro Clinical Reasoning Form). 

Putting the need of the service user at the centre of decision making is something I have been taught to do and tried do regularly throughout my career as a physiotherapy student (3). This has come in many ways such as: a patient education and treatment leaflet that I designed during my Patient Pathways 2 module where I considered a range of co-morbidities during the design, e.g. background colour font, use of images etc., and patient concerns, goals and preferences from home or gym based exercises, the end result can be evidenced in the Patient Leaflet tab on the right. This demonstrates the patient being involved in shaping the design and delivery of their service (2). This domain is reinforced in a more practical clinical setting where a discussion I had with a patient involved listening to their problems and discussing a plan going forward on what we can to together to help in relation to what their concerns were evidencing patient involvement  (2) (evidenced – Skills Journal: Discussion Treatment Plan with Patient). A business proposal was a different way of demonstrating this domain through following the clinical governance pillar – patient/carer involvement (8) through family and friend questionnaires to help shape the design and delivery of their service (2), which I shall strive to do throughout my physiotherapy career, to the put the person at the centre of practice.

Reference List

1. NHS England » Developing patient centred care [Internet]. [cited 2020 Jun 3]. Available from: https://www.england.nhs.uk/integrated-care-pioneers/resources/patient-care/
2. Physiotherapy CS of. Chartered Society of Physiotherapy Framework [Internet]. 2013 [cited 2020 Mar 23]. Available from: http://www.csp.org.uk/professional-union/careers-development/cpd/csp-eportfolio/my-eportfolio/cpd-
3. Charted Society of Physiotherapy. Chartered Society of Physiotherapy xx Professional Values of Members’ Code and Behaviour 2 Code of Members’ Professional Values and Behaviours [Internet]. 2019 [cited 2019 Apr 9]. Available from: https://www.csp.org.uk/system/files/csp_code_of_professional_values_behaviour_full.pdf
4. 1 Recommendations | Osteoarthritis: care and management | Guidance | NICE. [cited 2019 Jul 2]; Available from: https://www.nice.org.uk/guidance/cg177/chapter/1-Recommendations#holistic-approach-to-osteoarthritis-assessment-and-management-2
5. De Brún C. The Information Standard Guide Finding the Evidence-7th. 2013.
6. Do I have the right to refuse treatment? - NHS [Internet]. [cited 2020 Jun 2]. Available from: https://www.nhs.uk/common-health-questions/nhs-services-and-treatments/do-i-have-the-right-to-refuse-treatment/
7. Ivanhoe CB, Reistetter TA. Spasticity: The misunderstood part of the upper motor neuron syndrome. In: American Journal of Physical Medicine and Rehabilitation. Am J Phys Med Rehabil; 2004.
8. The main components of clinical governance [Internet]. [cited 2020 Jun 3]. Available from: https://www.uhb.nhs.uk/clinical-governance-components.htm