What can Game of Thrones teach us about acute care physical therapy practice? “When you play the game of thrones, you win or you die”1 seems ill suited to our profession's vision to optimize movement. Maybe “There is only one thing we say to death: Not today”1 is a little more up our collective alley. No matter, people all over social media, the Internet, water coolers, and kitchen tables are filled with all sorts of opinions on the end of the epic HBO series. And don't worry, I'm not wading into that fracas here. No, what I think we can take away from the volume of opinions on all sides about the conclusion of Game of Thrones is that many people encountered unmet expectations. Story arcs, what became of which character, how issues around gender and privilege were covered—lots of people had strong thoughts over the 7 years of the show, and many of those boiled down to dissatisfaction influenced by unmet expectations.
So again, what can we learn from this that can build our acute care physical therapy practice? Attempt to manage expectations, through clear and ongoing dialog, is worth the time. Ensuring practice expectations are clear across the interprofessional team requires ongoing efforts between all parties. Having a shared vision of discharge expectations of patients and their caregivers can take time and patience. Occasionally, playing the role of the “baddie” and having to deliver unwanted, or even feared, information or opinions might be called for. How we, as individual therapists and as colleagues and coworkers, manage these varied roles and responsibilities, often not the type that drew us to physical therapy as a profession or acute care as a practice setting, are monumentally important. Patients, families, caregivers, and even other members of the interprofessional team might want us to serve as an echo chamber for the easy answer or the wished-for outcome. But we have a duty, an obligation, to use all of our expertise and knowledge to speak truthfully and honestly, even when that may be difficult or unwelcome. Finding the moral courage to say the uncomfortable truth, to give the professional opinion at odds with others' thoughts or plans or even dreams is not an easy task.2 But that doesn't negate our professional responsibility to do just that.3
I think we can learn a lot about the potential pitfalls to acting and reacting with moral courage from the fight for the Iron Throne. As Kidder4 described, there are many inhibitors of moral courage encountered in current health care practice:
- Organizational cultures that stifle discussion regarding unethical behaviors and tolerate unethical acts
- Willingness to compromise personal and professional standards to avoid social isolation from peers or to secure a promotion/favoritism within the organization
- Unwillingness to face the tough challenge of addressing unethical behaviors
- Indifference to ethical values
- Apathy of bystanders who lack the moral courage to take action
- Group think that supports a united decision to turn the other way when unethical behaviors are taking place
- Tendency to redefine unethical behaviors as acceptable
Now, if you're a Game of Thrones fan, I am sure you recognize these failings occurring over and over again in multiple characters over multiple seasons. Health care, and our acute care practice, is not immune from the same problems. Failings of moral courage, coupled with expectations that as health care providers we have an obligation to confront, inevitably lead to unmet expectations. And if not addressed openly and honestly, these unmet expectations begin to cut away at trust and relationships. What is needed is not only the moral courage to act as our code of ethics dictates, but to also address instances when the moral courage we expect isn't present in others. No one is going to perfectly embody such a high standard of behavior in every moment, but we need to support one another and push one another to be the best for our patients and their interests. It is not in perfection we find the good, but in the continuing quest for perfection. We owe it to our patients, to their families and loved ones, and to our colleagues to just that. Or as was said in Game of Thrones, “I failed. Good. Now go fail again.”1
Sharon L. Gorman, PT, DPTSc
Board-Certified Geriatric Clinical Specialist,
Fellow, National Academies of Practice
President, Academy of Acute Care Physical Therapy
2. Murray JS. Moral courage in healthcare: acting ethically even in the presence of risk. Online J Issues Nurs. 2010;15(3):2. doi:10.3912/OJIN.Vol15No03Man02.
4. Kidder RM. Moral Courage. New York, NY: Harper Collins Publishers; 2005:211.