Autonomous Physiotherapist?


Throughout my career as a chartered physiotherapist working in the UK I have experienced a huge variety in the levels of professional autonomy in various clinical and managerial roles. Sometime I endured autonomy erosion but often enjoyed situations and opportunities to push the envelope and gain more autonomy. I am sure you are the same.

As a Lecturer in physiotherapy I have discussed the concept and its importance with students and colleagues alike and have always been intrigued as well as impressed with the variety to interpretations.

Under the regular influence of philosophy, leadership-theory and economic theory, my perception of professional autonomy has changed. It is not that important. It probably was important once upon a time. But in the neoliberal political order governing the NHS, it is no longer a relevant issue.

Define Professional Autonomy (PA) as you like, but most definitions are deeply problematic because the three of its key elements are problematic and I will discuss that later.

Different physiotherapists working in or for the NHS are likely to have different experiences. If you experience increasingly that your treatment decisions are being influenced by protocols or service contracts (i.e. a gradual erosion of your autonomy)  you want to ask the question, “So, if PA isn’t relevant according to you, what is”? If on the other hand you have experienced an real expansion of your role and sphere of influence (clinically, managerially) you may still be interested in reflecting on the answer.

My initially short answer to that question would be “Having Authority and Control over necessary resources”. I will explore and explain my answer, fully as we go along.

I accept that letting go of the concept of Professional Autonomy will be a wrench, because we hold it so dearly.  We like to believe that we are autonomous and that we have autonomy. But bear with me and try to keep an open mind. It is not as bad as you think even though it means getting your head around the idea that Professional Autonomy is merely a constructed concept. This is relevant because so far we as a profession we seem to have constructed in relative isolation.

Professional Autonomy for Ostriches

Professional Autonomy (PA) is sometimes defined in various ways by various authors. For example Bebeau, Born and Ozar (1993) as “…the extent to which [a profession] or an individual feels freedom and independence in [their] role…”. As critical physiotherapists you will have spotted the problem with this kind of description as a perceived personal experience. We are likely to experience ‘freedom’ differently in different situations, roles and grades. I don’t intend to compare the various definitions of PA, because (strange as it may seem) that would divert us from our real purpose.

Throughout the literature definitions of PA comprise phrases such as “Freedom to decide and act”, “being responsible” and “self regulation”. It may seem tempting to explore autonomy from a philosophical, ethical and moral perspective.  I believe that makes for a  worthwhile project because it is associated with how we perceive our professional identity and role. However that approach on its own may not yield the analysis we need,  to explore the most relevant aspect of PA (in the real world) and in order to understand how we might  prevent (or manage) perceived and actual erosion of our professional autonomy. While the theories around (professional) autonomy are interesting and relevant due to their associations with personhood, ethics, morality and professionalism, we should take a focused perspective from a high vantage point in order to reflect on it in its appropriate context. This involves viewing our PA from the perspective of other, more powerful agents in the system.


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