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Treatment, Interrupted

Sep 22, 2020

The Case

The College received a complaint from a patient who regularly saw a physiotherapist for approximately six months. During this time, the PT confided in the patient that it was sometimes challenging to arrange childcare for their son, so they occasionally brought him to the clinic.

During one treatment session, the physiotherapist’s son entered the room while the patient was lying on the treatment table and the PT was actively performing treatment.

The patient was partially undressed but was draped. The PT briefly spoke to the child before removing him from the treatment room and locking the door, however the child intermittently knocked loudly on the door throughout the remainder of the session.

The patient noted that the physiotherapist did not acknowledge the disruption, apologize for the interruption or ask if the patient was comfortable continuing with the session. At the next appointment, the patient reiterated that the disruption made them uncomfortable and ask the PT to ensure that issues with childcare would not impact their sessions going forward.

During the final appointment and while the patient was lying partially dressed on the treatment table, the PT “abruptly announced” that they wanted to suspend treatment so they could pick up their son from school. The patient was taken aback but agreed to the suspension and the physiotherapist returned approximately 25 minutes later to resume treatment.

The patient expressed concerns that they were asked to suspend the treatment session while they were already in a vulnerable position and therefore could not provide informed consent. They also indicated that they felt like the physiotherapist did not fully appreciate the impact of the child’s presence at the clinic during treatment sessions and did not take appropriate measures to manage adverse events.

The Standards

The Boundaries and Sexual Abuse Standard sets the expectations for physiotherapists when managing boundaries within the therapeutic relationship. A physiotherapist must recognize the unique nature of each patient’s boundaries and be able to respond appropriately when a professional boundary is breached, including documenting the actions taken to address the breach in the record. The patient’s privacy was compromised when the child entered the treatment room and the therapeutic relationship was negatively impacted by the PT’s lack of acknowledgement of the boundary breach. Additionally, the PT did not include any information about the interruptions or conversations with the patient about the disruptions in the patient record.

Physiotherapists must obtain informed consent from patients for all aspects of treatment. In this case, the patient was in a vulnerable position when the PT asked to suspend treatment. There was no conversation about a possible interruption prior to starting treatment, and the PT did not appear to check their phone or receive any indication of an emergency. The patient felt that the physiotherapist took advantage of their position of power and did not consider that the patient was in a vulnerable position mid-treatment.

There was a lack of communication on behalf of the physiotherapist as they did not listen to the patient’s concerns, make reasonable efforts to get on the same page or foster trust with the patient by showing empathy and basic courtesy.

The Outcome

The physiotherapist was required to participate in a remedial program to address concerns related to communication, consent, record keeping, privacy and boundaries. The PT will meet with the College’s Senior Physiotherapist Advisor to review the appropriate standards and will submit a summary of key learning points following the discussion.

Boundaries and Sexual Abuse Standard

Consent

Communication Skills

Record Keeping

Leave a comment
  1. Komal Patel | Feb 23, 2023
    It is clear case of neglection of how would a patient feel? PT would have inform patient in advance about picking up the child from school. PT would also be apologetic about the incident where the kid came in to a room in between treatment session. 
  2. Shreya Bhavsar | Dec 19, 2022
    In this case, it was clear scenario of lack of communication and informed consent prior to starting the examination or treatment session. For PT, it is essential to keep those factors in mind to have healthy therapeutic relationship between PT and patients.
  3. Rahi Shah | Dec 06, 2022
    The PT should have informed about the absence to the patient prior to starting the treatment or set the appointment in the different time. The PT clearly lacked communication and informed consent.
  4. Gregory Nason | Nov 28, 2022
    As a Physio who does not have children, I had never considered a scenario as such. This was very interesting to think about and a great case to study. 
  5. Sarah Velho-Bellavance | Nov 24, 2022
    Communication and informed consent are key aspects to having a fair and professional relationship. The PT failed to create a safe environment for the patient.
  6. Sarah Hill | Oct 15, 2022
    Interesting case
  7. DIPAK CHUNARA | Oct 09, 2022
    PT must put pt first, while treatment session was going on, prior clear communication and consent were missing which led to imbalance of power hence PT lost trust and professional relationship with pt.
  8. Mohammad Yazdchi | Aug 25, 2022
    It is important that the Pt consider the best interest of her patient and should figure out about her child care not to disturb her patient treatment.
  9. Heli Pancholi | Jul 08, 2022
    PT can not leave the rx in-between and resume it after 25 min, this seems very unprofessional could have set up appointment early or later. 
  10. Neha | Jun 24, 2022
    Its is important to listen to the patient and address there concerns, and any interruptions in the treatment needs to be informed.
  11. Avanti Shah | May 25, 2022
    PT should acknowledge the situation , an effective communication is the key to understand patient's concerns.
  12. Prateek Gupta | May 05, 2022
    Informed consent is a critical aspect of patient education and it becomes the responsibility of the physical therapist to provide evidence based education to the patient re: care, benefits, risks, procedure and time involvement, prior to gathering informed consent.
  13. Sneha Bhosle | Mar 25, 2022
    In the above scenario PT should have acknowledged the disruption and apologized when the treatment session was interrupted. PT should obtain patient’s consent  and make sure patient is comfortable before continuing with the treatment. 
  14. Dhananjay Padwal | Mar 22, 2022
    It is very important to acknowledge patient concerns and inform patient in advance  about any possible treatment interruptions. Clear communication was missing
  15. Pooja Vyas | Mar 16, 2022
    Effective communication and informed consent would have made things slightly easier for the patient. Sometimes, there could be family emergencies that might disrupt a treatment session and the PT might need to rush immediately, clear communication would have saved the day.
  16. Eimen shahbaz | Mar 13, 2022

    How can this situation be handled? Female PT who have kids and they need to work as well. How can they ensure the balance between work and kids?

     

  17. Azmina Moosa | Feb 22, 2022
    It is important for the PT to always consider a 'Patient-Centered" approach of treatment.  Leaving patient in a vulnerable position and not able to provide the appropriate consent is inappropriate as described in the above scenario.
  18. Jessica Buffam | Feb 06, 2022
    Informed consent and ensuring the patient is in an appropriate state to provide informed consent are vital in all situations. It is also important for a physiotherapist to respect patient boundaries and be apologetic when these boundaries have been breached, discuss this with the patient and document the situation.
  19. Prateek Gupta | Jan 23, 2022

    Informed consent is a critical aspect of patient education and it becomes the responsibility of the physical therapist to provide evidence based education to the patient re: care, benefits, risks, procedure and time involvement, prior to gathering informed consent.

  20. Mitchell Caprelli | Jan 10, 2022
    Informed consent is critical regardless of the situation. The patient was left in a vulnerable position and was not able to provide the appropriate consent required. PTs should always make sure that the patient is first and their rights are accounted for at all times. 
  21. Kwok Chan | Jan 03, 2022

    It's important for the PT to address this boundary between professional and personal upon the initial assessment, especially if this is to disrupt the flow of treatment and hinder the therapeutic relationship. Consent was not implied at times when the child interrupted as well as when the PT took a leave of absence. 

    Communication is key amongst the two parties to develop a fair and professional relationship. 

  22. Kb | Oct 27, 2020

    It is important to flag that guidance for workplaces has been one of flexibility and understanding, including regarding parenting responsibilities during pandemic.  While boundaries need to be maintained, in some cases need they may need to be redefined so that professionals can continue to practice in the current environment. 

    As an employer with a predominantly female workforce, we are working to ensure our care providing staff are not disenfranchised because they have children. 

    In the above scenario much would be case specific, and a mitigation plan should be in place to reduce/eliminate interruptions.  This being said, having to interrupt a treatment/visit due to a call from school is a scenario we and many other employers have faced.  In this case it is understood that, if the clinician can not delay their parental obligations, they may need to end the visit early and leave (after ensuring the client was safe and communicating the modification in care plan that had been envisaged).

    This may exist, but if it does not my recommendation is that guidance reflects current evolving realities with a balanced lens that also reflects rights (of the clinician) protected in all jurisdictions.

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