Too much of a good thing?
Mrs. Smith is a retired 62 year old widow with 3 children who live out of the city. You are a physiotherapist working at a private practice. Mrs. Smith and you have a lot in common – your mom and Mrs. Smith were nurses at the same hospital for years. Mrs. Smith hurt her back in an MVA 2 years ago. She was covered by MPIC for the maximum number of treatments and has continued to attend on her own. She made good progress with therapy and has been able to resume all previous activities, however, every time you broach the subject of discharge, she reports that if she doesn’t come in for a regular “tune up” and to “catch up” with you, she “just doesn’t feel as good”. The problem is that your clinical exam is essentially normal. You believe she isn’t doing her exercises because doesn’t demonstrate them well. You’ve explained to her that it is normal to have intermittent low back pain and that these types of episodes usually spontaneously resolve. But Mrs. Smith says she always feels better for weeks after she sees you for treatment. From a biomedical perspective, you don’t think that your physical treatment is changing anything, yet Mrs. Smith insists on booking her regular tune-ups. How do you deal with this?
Too Much of a Good Thing? – Brief analysis of ethics….
In our June 2019 newsletter, we published a story about Mrs. Smith who insisted on continuing to attend private practice physiotherapy for a “tune up” related to her chronic intermittent low back pain. The therapist felt that from a biomedical perspective, their physical treatment wasn’t changing anything. Below are some summarized results when our ethics committee reviewed the case through an ethical lens considering the four main principles of bioethics:
|Ethics Principles||Application to this Case|
|Respect for Autonomy||PT should respect Mrs. Smith’s right to make her own decisions about her health; she has determined that she wants to continue to attend physio because it helps her.|
|Potential for PT to feel conflict if they don’t believe the treatment they are providing is helping Mrs. Smith and it is costing her money. However, Mrs. Smith has reinforced that she believes attending intermittently keeps her feeling good.|
|Nonmaleficence (avoiding harm)||Little risk of harm if Mrs. Smith has resources to afford PT visits, she is the one deciding to attend (not being coerced by the PT) and PT is being truthful about recommended treatment.|
(maximizing benefit to patients – equality, fairness, impartiality)
|Need to ensure that the PT is being reflective, fair and transparent in offering their professional opinion to Mrs. Smith. Decision to continue to treat this patient should not be influenced by prior relationship with this patient (mothers were co-workers).|
This case study was published in CPM’s In-Touch newsletter June 2019