This blog comes from the College's Patient Relations Committee.

The College of Physiotherapists of Ontario continues to receive a high number of complaints from patients about boundary crossings and sexual abuse. Many of these complaints are related to the unexpected touch of a patient’s undergarments or body parts, or comments made by physiotherapists towards the patient while care is being provided. To help address this concerning trend, the Professional Issues Self-Assessment (PISA) exercise for 2022 focused solely on issues of professional boundaries.

One of the PISA questions asked physiotherapists about their responsibility when it comes to filing a mandatory report if they became aware of another physiotherapist making comments of a sexual nature to a patient.

As an important reminder, comments of a sexual nature do constitute sexual abuse. However, in looking at the results for this PISA question, almost 600 physiotherapists responded that they did not consider comments of a sexual nature to be sexual abuse and did not understand the need to file a mandatory report with the College.

As it says in the Boundaries and Sexual Abuse Standard, sexual abuse of a patient includes:

• Sexual intercourse or other forms of physical sexual relations between the physiotherapist and the patient

• Touching, of a sexual nature, of the patient by the physiotherapist

• Behaviour or remarks of a sexual nature by the physiotherapist towards the patient

By law, physiotherapists are required to report sexual abuse or suspected sexual abuse of a patient by any regulated health professional.

If you learn that a PT or other regulated health care provider may have sexually abused a patient (and yes, this includes behaviour or remarks of a sexual nature) or has been engaged in a relationship with a current or former patient (who was discharged from care within the last year), a report must be filed with the College of the health care provider. Failure to file the report may result in disciplinary action against you, including significant fines.

Sexual abuse is a critical offense, and the College takes all reports of sexual abuse extremely seriously. Being found to have committed sexual abuse can result in the physiotherapist’s license being taken away. It can also result in extreme trauma inflicted on a patient.

In some cases, investigations suggest that the physiotherapist’s intent was to provide therapeutic hands-on care, but a lack of understanding of the therapeutic intent of the treatment caused an uncomfortable or unsafe experience for the patient.

Physiotherapists can do more to ensure that patients understand the therapeutic intent by using clear communication and by seeking more specific permissions.

The College has a Boundaries and Sexual Abuse Standard, as well as a resource on Consent to help PTs (and anyone else who is interested) in understanding their professional responsibilities. We encourage you to complete the e-learning modules from both Standards to deepen your understanding of these important issues. 

Boundaries and Sexual Abuse E-learning Module   

Consent E-learning Module

How to Avoid Misunderstandings

• Use clear and direct communication with patients, use correct terminology for body parts, and use an interpreter if necessary.
• Be aware that sexual abuse includes touching, behaviours, or remarks of a sexual nature. Seek opportunities to learn about multi-cultural attitudes and behaviours that are appropriate, so that patients are not harmed because of the PT’s cultural ignorance.

• Do not use behaviour, gestures, expressions, or comments that are seductive or sexually demeaning to a patient. Never comment on or criticize a patient’s gender or sexual orientation.
• Never initiate or participate in conversations or jokes with patients about sexual preferences or fantasies. Don’t discuss movies or TV shows that have sexual content.
• Seek and document consent before working in or around sensitive areas (even if you obtained consent at the beginning of treatment).
• Acknowledge any occurrences of accidental or incidental touch in sensitive areas, apologize and get consent to continue the treatment. Document the incident, have the patient initial it if possible.
• Avoid practicing with a cell phone or anything else in your front pocket as it might accidentally touch the patient.
• Inform the patient that they can withdraw their consent to treatment at any time.
• Ask the patient to tell you if or when they feel uncomfortable.

(The above resource was developed by the College of Physical Therapists of British Columbia (CPTBC) to assist physiotherapists in avoiding misunderstandings, and teach them how to address a boundary breach, like an unintentional touch.)

We encourage everyone to review the College's guidance around boundaries, sexual abuse, consent, and communication, and carefully consider how to apply these principles when delivering physiotherapy care. For a deeper learning experience, read the Handbook on Sensitive Practice for Health Care Professionals.

Please share this blog with colleagues and take time to review the resources together. Consider role playing aspects of this communication with colleagues so that it becomes integrated into your practices. Creating a safe therapeutic experience will enhance your patient’s outcomes, which benefits both the patient and the physiotherapist.

Additional Resources: 

Communication Skills

Cases of the Month

Handbook on Sensitive Practice for Health Care Professionals

How to Avoid Misunderstandings in a Clinical Setting (2-minute video)

How to Develop a Sensitive Practice (2-minute video)