Steven Siegel

HPPA 514 Reflection Essay

12/11/2019

This essay explains a draft moral framework for my initial years of PA practice I foresee being most important to me. I will explain why I chose to become a PA; next I will explain what aspects of clinical practice I anticipate being important, lastly I will identify ethical principles and explain how and why they will support my clinical practices.

The reasons why I chose to become a PA stem from my exposure to health care growing up. I focus on the positive aspects because I want to “pay it forward” and provide the high quality of care that I have experienced and witnessed. My negative experiences influence me as well and serve as a reminder of ways to improve care. From that young age I had an innate desire to help others in the same high quality and respectful way that I was treated. I knew I needed to work in healthcare in order to fulfill my goals. As I gained experience in the field and was exposed to different roles in health care I realized that the way PAs spoke with and treated their patients was consistent with my personal goals.

I anticipate that patient education will be important to my clinical practices. Patient education is important in order to ensure that patients make informed decisions (Heath, 2016). Many patients are not medically literate and the onus is on providers to educate (Hersh et al 2015). Effective education includes teaching how the diagnosis was determined and why I am suggesting that specific treatment. It isn’t enough to tell all of the options, I need to explain why this is the optimal option for their stated goals and back it up. It is critically important to spend time explaining the situation with the patient and their family, if they do not fully comprehend then more time should be scheduled for them. Diagnoses are often confusing and patients often don’t hear or understand their entire condition leading to confusion and anxiety. However, when their condition is effectively explained as treatable with a proven plan then suddenly it is not so scary. Patients deserve to know and understand every aspect of their healthcare. Education can help to remove some of the anxieties patients have regarding their health care.

I anticipate beneficence and autonomy will play the strongest roles in my ethical decision making in clinical practice. Beneficence is the obligation to promote benefit and minimize preventable harm (Yeo et al 2010). Benefits and harms are weighed according to each patient’s individual goals. Autonomy means self-determination and empowering individuals to make decisions regarding their wellbeing (Yeo et al 2010). Autonomy can be broken down into 4 elements: free action, effective deliberation, authenticity, and moral reflection. Free action is similar to liberty; making a voluntary choice and not being forced to do what you do not want to do. Effective deliberation refers to how rational the individual’s thought process is; did they consider the risks and benefits and is the choice consistent with their desired outcome. Authenticity asks is this choice consistent with the patient’s character or is this choice “out of character”? Moral reflection is awareness of one’s personal values and making choices consistent with those values (Yeo et al 2010).

In order to demonstrate how and why beneficence and autonomy will support my clinical practices I want to articulate on my experiences then explain how they apply to each ethical principle. Whenever I had health problems I knew my pediatrician would do what was necessary to help me. Even when he could not help me physically, such as when I had pneumonia, he was able to help me emotionally by educating me about what was going on. No one else explained to an 8 year old me what was happening. He educated about my asthma, how to avoid triggers, and how to help myself when I was unable to breath. Even when he had the story of my illness from my parents he would talk to me and ask what was happening, and as a child made me feel like I was a part of the team. I was shy and would have preferred if he just listened to my parents, but he helped me to step outside of my shell and express what was going on. He went beyond just the physical or biomedical part of care and he helped me to grow as a person.

Beneficence will help me achieve my clinical goals by promoting benefits and preventing harms in order to reach each patient’s ideal outcomes. Beneficence supports my clinical goals because I want to help patients achieve their ideal outcomes and minimize their risk when doing so through education. My provider practiced with beneficence whenever he interacted with me. He understood that my goal was to be able to breath and through the practice of beneficence he helped me to accomplish that long term, as I have not had exacerbation in over a decade. He would support my wellbeing by educating me about my conditions and what lifestyle changes can be made in order to improve my overall health. He educated about my history and promoted healthy habits such as exercise and diet. He also educated me about how sedentary lifestyle and certain allergens can trigger my asthma in order to prevent harm. I can apply beneficence in my clinical practice in a similar way by understanding the patient’s goals I can educate and treat them in ways that best help to achieve those goals and minimize risk of the condition worsening.

Autonomy supports my clinical goals because I aim to respect each patient’s decisions in order to help them to achieve their goals. The patient will make their own decisions, but it is a part of my responsibility to make sure that they are educated and make an informed decision that is consistent with their character and desired outcomes. Autonomy will help me to achieve this by having the patient identify their decisions and making sure that the plan is consistent with that decision. My physician practiced autonomy by allowing me to be a member of my health care team. He respected my autonomy by listening to my stated goals and helping to accomplish said goals. He did not blindly follow my decisions because I was a child, but he took my decisions into consideration along with my parent’s decisions. He empowered me to make my own choices and to voice them and he educated me about the benefits and harms of those decisions. I can apply autonomy following this example, by listening to and respecting the decision of an individual I can educate on how those decisions will impact them and whether or not it will help them to achieve their stated goals.

By expanding on my experiences and influences my goal was to use a proven clinical example that shows how and why the elements of autonomy and beneficence will best support my clinical practices. I want to provide the same high quality and respectful care that I was treated with by using autonomy and beneficence as similar tent poles in my clinical practices.  This essay allowed me to draft a moral framework for my first years of practice as a PA by explaining my motivations to become a PA, discussing the importance of education in my clinical practice, and reflecting on the principles of autonomy and beneficence.  

References:

Heath, Sara (2016) Why Patient Education is Vital for Engagement, Better Outcomes. https://patientengagementhit.com/news/why-patient-education-is-vital-for-engagement-better-outcomes

Lauren Hersh, MD; Brooke Salzman, MD; and Danielle Snyderman, MD. July 15, 2015, Health Literacy in Primary Care Practice. American Family Physician Volume 92, Number 2.

Yeo, Michael et al. (2010). Beneficence . In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116.

Yeo, M et al. (2010). Autonomy  [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.