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

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 citizens: both are implicitly expected to support the neoliberal ideology as the physiotherapists in private practice have knowledge and skills which they offer for payment and convert to treatment under certain frameworks and conditions which their patients accept and take part in.
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: phenomenological hermeneutic, hermeneutic, social constructivist and structural, and three different analysis strategies: Malterud’s ‘systematic text condensation’, Ricoeur’s ‘textual interpretation of distanciation’ and a social constructive analysis done through the lens of Foucualt’s concepts of discipline, self-discipline, power and resistance are used.
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 of physiotherapy in private practice 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 of physiotherapeutic private practice 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, which supports the neoliberal ideology and relates to utilitarianism. 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 physiotherapists’ perceptions of ethical obligations about respecting the patients’ autonomy and being beneficent seem to be led by structures of the neoliberal ideology which work behind the backs of the physiotherapists.
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 the analyses only address how the physiotherapists in a moment of time articulate their practices and accordingly the thesis does not address the issues of the functioning of clinical practice within practical reality. Further it 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.