Patient centered care is about treating the patient as their own unique person and showing consideration for their point of view and experiences in the decision-making process (2,3). The basis of patient centered care involves providing the patient with the appropriate health advice and allowing them to make an informed decision (4).  Not only is it a domain within the CSP framework but also belongs to the NHS value of Respect and dignity and the CSP Standard of putting the needs of the service user at the centre of practice. For me, patient centred care is one of the most important aspects of working in healthcare and indeed physiotherapy. We work to help patients and improve lives - therefore everything we do in practice must have the patient's needs, priorities, experiences and worries at the heart of it. A big element of making the patient feel at the centre of practice, is listening to what they have to say and letting them tell their story (5). Listening with empathy and being able to relate to the patient helps hugely in developing this relationship (5). I feel these principles are evident in my 'SOAP notes'.

In order to demonstrate respect for the individual by acknowledging their unique needs, preferences & values, autonomy & independence, over the course of my practice placements I have attempted to build good rapport with my patients. I have done this mainly by showing empathy and addressing concerns and worries they have, while remaining honest with my advice for what I believe is best for them. I have included some extracts from placement feedback around my ability to build relationships with the patient ('placement feedback'). As evidence, I have included a reflection ('complex patient reflection') on a complex patient who was on my caseload over the course of one placement. The particular patient had spent weeks in ICU and when he arrived on the ward had not sat out of his bed in some time. The person was from a background with protected characteristics, and therefore had a very different set of ideals and values to me. However, as everyone counts and deserves respect and dignity, I done my best to understand the patient's position. As I was aware of his heritage, I was able to demonstrate respect by acknowledging their unique needs, preferences, values and autonomy. The patient appreciated this, and therefore I was able to build a good therapeutic relationship with them. The patient was resistant to try to exercise due to pain and fatigue. Through encouragement and emphatising with the patient's situation, a relationship was built and the patient gradually became less resistant. The patient finally understood if he did not try, that his mobility would not improve and therefore, he would not get home to see his kids. I was able to provide information that empowered the patient to make an informed choice to engage with rehabilitation. Providing information to the patient is not something I have found difficult on my placements. However, sometimes I do not present a compelling enough argument to the patient. This may be seen as allowing the patient to exercise their own autonomy, however sometimes patients need the facts presented with openness, honesty and integrity, even if it is difficult for them to hear. I believe the more patient mileage I get, the better I will get at demonstrating this aspect of patient centred care. The more this is encountered, the further my scope of practice will extend to deal with increasingly complex cases. I hope to better my ability to understand when to be firm with patients and when to have a softer stance. I believe this will be achieved through practice, feedback and reflection.

As part of two patient pathways module (SE704 and SE705) during  the MSc course, I was able to demonstrate my attempts at putting the patient at the centre of practice. SE704 followed a patient's journey through frozen shoulder management, and the considerations taken based on the patients personal circumstances. I have presented this here as 'SE704 essay'. This allowed me to get a feel for putting the needs of the service user at the centre of decision making. Although this patient was theoretical, it did give insight into involving patients in the shaping of the design and delivery of the service. This gave me a nice introduction into what would be expected in terms of goal setting while on clinical placements. Initially involving patients in their goal settings was non-existent in my practice. I would not even hold a discussion with patients about goals during encounters, and instead create goals based on what I felt was relevant. After getting more experience I realised that this is not the best way to empower patients or the best way of respecting and supporting individual's autonomy. While on a community stroke placement, I really got a feel for being able to involve patients in the design and delivery of their management as a big emphasis was put on what the patient wanted to achieve. This has led to an improvement in my scope of practice. There is much room for improvement however, and once qualified I will seek to have conversations with every patients about what they wish to achieve, guiding them with my clinical knowledge. 

Following on from SE704, during SE705 I created a resource for a complex patient in order to aid them through recovery from injury and then wrote an essay critiquing the resource. This is presented here as 'SE705 essay' and 'patient pathway patient resource'. The resource I created was an informative poster for a paediatric patient with Attention Deficit Disorder who had injured their Anterior Cruciate Ligament and would be requiring surgery. The poster detailed what had happened to his knee, what to expect before and after surgery and the importance of completing his strengthening exercises pre and post-surgery. I believe this is a relevant example of providing information & support that empowers an individual to make an informed choice & to exercise their autonomy, as the patient would be aware of benefits and risks of avoiding his rehab exercises and it would then be his decision how to proceed. While the quality of the poster could be improved, I had the correct idea of what would be needed for a patient. I have gone on to improve on this skill by successfully supporting and empowering a number of patients to engage with smoking cessation services. I feel this skill requires having the ability to give the patient all the relevant knowledge so they can decide for themselves. This is something I am growing in confidence at doing, however if there was a topic, which I was not confident with - I would seek support from a senior.

I am mentioning COVID-19 again with this domain. I feel that COVID has impacted patient centered care in some ways. One being that some patients are not engaging as they feel perhaps physiotherapy is not essential for them, and by seeing the physiotherapist they are increasing their risk of picking up the virus while on hospital stays. I think the longer the pandemic has gone on and the more information that has been made available that patients are returning to be less wary, particularly when wearing full PPE. It is something to note however that perhaps that little bit extra is needed to get the patient to engage.