Advanced

Physiotherapy in a Danish private context - a social and ethical practice

Praestegaard, Jeanette LU (2014) In Lund University, Faculty of Medicine Doctoral Dissertaion Series 2014:42.
Abstract (Swedish)
Popular Abstract in Danish

Fysioterapi er en social og etisk praksis som udfolder sig under specifikke historiske, politiske, socialkulturelle og økonomiske forhold. Dansk fysioterapi i en privat kontekst er praktiseret, administreret og håndteret indenfor en neoliberal ideologi, der genererer udfordringer for både fysioterapeuter og borgere: Det forventes implicit at begge parter understøtter den neoliberale ideologi, da fysioterapeuter i privat praksis har viden og færdigheder, som de tilbyder for penge og konverterer til behandling indenfor de givne rammer og forhold, hvilket deres patienter accepterer og støtter op omkring.

Denne disputats har som formål at undersøge, hvordan fysioterapi i en dansk privat... (More)
Popular Abstract in Danish

Fysioterapi er en social og etisk praksis som udfolder sig under specifikke historiske, politiske, socialkulturelle og økonomiske forhold. Dansk fysioterapi i en privat kontekst er praktiseret, administreret og håndteret indenfor en neoliberal ideologi, der genererer udfordringer for både fysioterapeuter og borgere: Det forventes implicit at begge parter understøtter den neoliberale ideologi, da fysioterapeuter i privat praksis har viden og færdigheder, som de tilbyder for penge og konverterer til behandling indenfor de givne rammer og forhold, hvilket deres patienter accepterer og støtter op omkring.

Denne disputats har som formål at undersøge, hvordan fysioterapi i en dansk privat kontekst socialt og etisk er praktiseret, set fra fysioterapeuternes perspektiv.

Denne disputats, som udgøres af fire dele, er baseret på det samme empiriske materiale, der består af interviews med 21 fysioterapeuter og af forskerens observationer af de fysiske omgivelser. De specifikke forskningsspørgsmål er successivt blevet udviklet gennem forskellige espistemologiske tilgange: fænomenologisk hermeneutik, hermeneutik, social konstruktivisme og strukturel tilgang og gennem tre forskellige analyse strategier: Malterud’s ‘systematiske tekst kondensering’, Ricoeur’s ‘textual interpretation of distanciation’ og en social konstruktivistisk analyse foretaget gennem Foucault’s begreber om disciplin, selv-disciplin, modstand og magt er anvendt.

Hovedresultaterne viser, at fysioterapeuter i dansk privat praksis har en overordnet interesse i etik, som primært baserer sig på personlige ’sund fornuft’ argumenter og intuitive følelser om etik. Fysioterapeuternes praksisser er etisk funderet, hvilket viser sig i mange situationer. Fysioterapeuternes bevidsthed om etiske problemer er diskursivt konstrueret i det første møde i privat praksis, da mødet giver anledning til både etiske og økonomiske overvejelser for at fastholde klienten i klinikken. Fysioterapeuternes bevidsthed om etiske problemer vækkes også, når fysioterapeuternes klientel vurderes til at være de såkaldte ’besværlige’ patienter, da den fysioterapeutiske proces ikke bare glider gnidningsløst, men kræver etiske refleksioner og pædagogiske strategier for at fastholde patienterne og derved indtægten i klinikken. Godgørenhed ses som kerneværdien i fysioterapeutisk privat praksis og viser sig vigtig i forskellige sammenhænge: I forhold til patienten, fysioterapeuterne selv og deres forretning. For at sikre godgørenhed viser der sig en paternalistisk tilgang til patienterne. Patienterne disciplineres ind i fysioterapeuternes ’sandhedssystemer’, med det forhold at kunne optimere indtægten på patienten indenfor de politisk definerede rammer, hvilket overordnet understøtter den neoliberale ideologi og relaterer til en nytteetisk forståelse. Fysioterapi i dansk privat praksis viser sig at reproducere vestlige medicinske logikker og praktikker, hvorved fysioterapeuterne ubevidst modsætter sig deres egne politiske intentioner om at være en selvstændig profession. Herved indskriver fysioterapi i privat praksis sig selv som værende en ’wanna-be’ profession. Fysioterapeuternes opfattelse af deres etiske forpligtelser om at respektere patientens autonomi og være godgørende, synes at blive ført af neoliberale ideologiske strukturer, der arbejder bag om ryggen på fysioterapeuterne.

Denne disputats har flere begrænsninger, da den kun bygger på danske fysioterapeuters artikulationer om deres praksisser, forståelser af disse og forskerens observationer. Det betyder, at analyserne kun adresserer, hvordan fysioterapeuter på et givet tidspunkt artikulerer deres praksisser og ikke problemstillinger i forhold til funktionen af kliniske praksis indenfor praktisk realitet. Det at vælge en specifik kontekst betyder endvidere, at resultaterne kun kan overføres til sammenlignelige kontekster og ikke til andre private eller offentlige danske fysioterapeutiske kontekster eller til andre vestlige lande. (Less)
Abstract
Physiotherapy is a social and ethical practice which unfolds under specific historical, political, socio-cultural and economic circumstances. Danish physiotherapy in a private context is practiced, administered and managed within a neoliberal ideology which generates challenges for both physiotherapists and their patients. This thesis aims to explore how physiotherapy in a Danish private context socially and ethically is practiced from the perspective of physiotherapists.

The thesis, which consists of four parts, is based on the same empirical material consisting of interviews with twenty-one physiotherapists and observation notes on the physical environments. The specific research aims in the studies have successively been... (More)
Physiotherapy is a social and ethical practice which unfolds under specific historical, political, socio-cultural and economic circumstances. Danish physiotherapy in a private context is practiced, administered and managed within a neoliberal ideology which generates challenges for both physiotherapists and their patients. This thesis aims to explore how physiotherapy in a Danish private context socially and ethically is practiced from the perspective of physiotherapists.

The thesis, which consists of four parts, is based on the same empirical material consisting of interviews with twenty-one physiotherapists and observation notes on the physical environments. The specific research aims in the studies have successively been developed through different epistemological approaches and analysis strategies.

The main findings show that physiotherapists in Danish private practice have a general interest in ethics which primarily is based on personal common sense arguments and intuitive feelings of ethics. The physiotherapists’ practices are ethically grounded which are shown in many situations. Their consciousness on ethical issues is discursively constructed in the first sessions as these sessions arouse both ethical and economic considerations to keep the client. Further ethical issues arise when the physiotherapists’ clientele are regarded as being at risk: in the meetings with the so-called ‘difficult’ patients as these situations do not just flow, they require ethical reflections and pedagogical strategies in order to keep them in the business. Beneficence is seen as the core value and as having importance in different relationships: towards the patient, the physiotherapists themselves and their businesses. To secure beneficence a paternalistic approach emerges towards the patient, where disciplining the patient into their ‘regimes of truth’ becomes a crucial element of practice in order to exploit the politically defined frames for optimising profit, showing how being beneficent seem to be led by structures of the neoliberal ideology which work behind the backs of the physiotherapists. Physiotherapy private practice in Denmark seems to reproduce the Western medical logic and practices whereby the physiotherapists unconsciously oppose their own political intentions to be an autonomous profession. Thus, physiotherapy in private practice inscribes itself as a ’wanna-be’ profession. The thesis has several limitations as it built solely on Danish physiotherapists’ articulations of their practices, their understandings of these and the researcher’s observation notes. This means that choosing a specific context for the thesis the findings can only be transferred to similar contexts and neither to other private or public physiotherapeutic contexts in Denmark nor to other Western countries. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Engelsrud, Gunn, Seksjon for kroppsøving og pedagogikk, Norges Idrettshøgskole, Oslo
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Foucault, practice, ethical issues, professional ethics, Physiotherapy
categories
Higher Education
in
Lund University, Faculty of Medicine Doctoral Dissertaion Series
volume
2014:42
pages
72 pages
publisher
Division of Physiotherapy
defense location
Health Sciences Centre, Baravägen 3, Lund
defense date
2014-04-24 13:00
ISSN
1652-8220
ISBN
978-91-87651-67-0
language
English
LU publication?
yes
id
f3906a18-cedb-4d9a-adf7-1109ffc25c07 (old id 4864778)
date added to LUP
2014-12-19 13:16:43
date last changed
2016-09-19 08:44:46
@phdthesis{f3906a18-cedb-4d9a-adf7-1109ffc25c07,
  abstract     = {Physiotherapy is a social and ethical practice which unfolds under specific historical, political, socio-cultural and economic circumstances. Danish physiotherapy in a private context is practiced, administered and managed within a neoliberal ideology which generates challenges for both physiotherapists and their patients. This thesis aims to explore how physiotherapy in a Danish private context socially and ethically is practiced from the perspective of physiotherapists. <br/><br>
The thesis, which consists of four parts, is based on the same empirical material consisting of interviews with twenty-one physiotherapists and observation notes on the physical environments. The specific research aims in the studies have successively been developed through different epistemological approaches and analysis strategies. <br/><br>
The main findings show that physiotherapists in Danish private practice have a general interest in ethics which primarily is based on personal common sense arguments and intuitive feelings of ethics. The physiotherapists’ practices are ethically grounded which are shown in many situations. Their consciousness on ethical issues is discursively constructed in the first sessions as these sessions arouse both ethical and economic considerations to keep the client. Further ethical issues arise when the physiotherapists’ clientele are regarded as being at risk: in the meetings with the so-called ‘difficult’ patients as these situations do not just flow, they require ethical reflections and pedagogical strategies in order to keep them in the business. Beneficence is seen as the core value and as having importance in different relationships: towards the patient, the physiotherapists themselves and their businesses. To secure beneficence a paternalistic approach emerges towards the patient, where disciplining the patient into their ‘regimes of truth’ becomes a crucial element of practice in order to exploit the politically defined frames for optimising profit, showing how being beneficent seem to be led by structures of the neoliberal ideology which work behind the backs of the physiotherapists. Physiotherapy private practice in Denmark seems to reproduce the Western medical logic and practices whereby the physiotherapists unconsciously oppose their own political intentions to be an autonomous profession. Thus, physiotherapy in private practice inscribes itself as a ’wanna-be’ profession. The thesis has several limitations as it built solely on Danish physiotherapists’ articulations of their practices, their understandings of these and the researcher’s observation notes. This means that choosing a specific context for the thesis the findings can only be transferred to similar contexts and neither to other private or public physiotherapeutic contexts in Denmark nor to other Western countries.},
  author       = {Praestegaard, Jeanette},
  isbn         = {978-91-87651-67-0},
  issn         = {1652-8220},
  keyword      = {Foucault,practice,ethical issues,professional ethics,Physiotherapy},
  language     = {eng},
  pages        = {72},
  publisher    = {Division of Physiotherapy},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertaion Series},
  title        = {Physiotherapy in a Danish private context - a social and ethical practice},
  volume       = {2014:42},
  year         = {2014},
}