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Please read the following case scenarios and summarize the events. After working through the ethical decision-making process, what course of action would you suggest? Scenario 1: Student or PT Bob considers himself very fortunate; his first clinical placement following the conclusion of his first year in PTA school has been an incredible experience. His CI Stephanie, the practice manager, has been welcoming and willing to share not just her PT knowledge but insights into the business of physical therapy. In addition to her position as practice manager, Stephanie was one of the PTs for a dance troupe based in the city, but she accompanied them for 2 weeks at a time twice a year when they went on tour. Stephanie explained to Bob that she would be leaving on tour, but fortunately it was during the final 2 weeks of his clinical placement. Bob wasn’t quite sure why that was fortunate, but he trusted that Stephanie had the whole situation under control. He was determined to get as much as he could out of the next few weeks before Stephanie left; he kidded her that now that he knew she was leaving “he planned to drain her brain.” The Friday before she left she sat down with Bob to review his performance. She was very complimentary of his performance at this point and told him that she was confident that the next 2 weeks would be most beneficial as he gained confidence in his skills. The PTA Gail could help him out if he needed it; they would not be admitting any new patients, and Tim, the agency float PT, would be in for 2-3 days per week depending on the caseload at the other offices. Stephanie had demonstrated through all of her interactions that she was a very knowledgeable practitioner, and Bob was confident that what he would be doing must be OK. Even though he was pretty sure he was supposed to be supervised, he was never completely clear about what exactly supervision is meant-after all since week four, Stephanie was always available but not always right by his side. Bob was actually quite excited that his Cl was confident in his ability to carry on in her absence, allowing him to rely on his skills, and he still had staff to rely on. Gail had been a PTA for a long time and Tim the float PT was used to fitting in to operations that were up and running. Stephanie was careful to make sure that Bob knew all of the patients, and he was clear on the plan of care. She left him Tim’s phone number “just in case.” The first 2 days Bob was quite comfortable-he continued the plan of care that he helped Stephanie create before she left, and he felt pretty confident. He accepted that his documentation would await the arrival of Tim who would countersign his notes. He prepared the billing forms the way Stephanie showed him, giving little thought to whose license number that billing form was utilizing, or the fact that he was billing Medicare Part B, something that he vaguely recollected was “not permitted.” On the third day, Bob had a wake-up call. Dan, a patient he had been treating arrived in considerable pain. Bob immediately went to Gail who suggested that he give Tim a call. Tim responded right away, but not knowing the patient he suggested that Bob tell the patient that he cannot treat him and he should call his doctor. The patient was visibly annoyed, stating he has had this type of a flare-up before, and it always calmed down with some stretching with the machine that makes your skin tingly. Bob knew he could do what the patient was telling him “works,” but he was not sure why there was pain and he recognized that “just because he could, didn’t mean he should.” Bob was conflicted; he wanted to do what was best for the patient, but he just wasn’t sure what was the best thing to do. The incident was a “wake-up call” for Bob. Confronted with a patient in pain, his first instinct was to provide the care that the patient requested; however, he recognized that his limited experience should make him apprehensive. He suddenly saw that perhaps his ego had gotten dangerously in the way of his judgment.
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