Guide:
Duty of Care Standard

If you are leaving a practice and there’s no physiotherapist available to take over your patients, your priority is to make sure they still have options for continuing their care.

• Work with your employer to determine how and when patients will be informed of your departure.
• Provide patients with options for ongoing care, which may include:
  o Supplying a list of physiotherapists or clinics in the area
  o Offering an appropriate home exercise program to help them maintain progress until they can connect with another provider.
• Document all communications with patients about their care transition to support continuity and transparency.
• Where appropriate, inform patients about how to access their health records if they wish to share them with a new provider.

The Leaving a Practice Checklist outlines all the things you’ll need to do before you leave.

If a patient is acting inappropriately or being disrespectful, but there is no immediate threat to your safety, the goal is to manage the behaviour while maintaining your professional boundaries.

You may address the behaviour directly by:

• Describing the behaviour to your patient objectively and explain why it is a problem for you, the clinic, or perhaps other patients.
• Outlining your expectations for behaviour and explaining the potential consequences if their behaviour continues.
• Monitoring the situation and following up as needed to ensure expectations are clear.
• Documenting the incident and the steps you’ve taken to manage the situation.

If a professional boundary has been breached and reasonable steps have not resolved the issue, you may choose to end treatment and, where appropriate, assist the patient in transferring care to another provider.

If you feel unsafe or believe there is a risk of harm from your patient, safety is your first priority. You may discontinue treatment immediately unless there is a patient emergency requiring your intervention.

As the standard notes, there are some situations where you may discontinue treatment without providing continuity of care, such as when:

• The patient is abusive (whether physically, verbally, emotionally, or sexually), or you have reasonable grounds to believe they will become abusive.
• A professional boundary violation has occurred and all reasonable steps to restore the boundary have been unsuccessful.

In cases where a serious boundary violation has occurred, you should assess whether the situation can be managed and whether the boundary can be restored before deciding to discontinue care. If all reasonable steps have been taken to manage the behaviour but the issue persists, discontinuing care without providing for continuity may be appropriate.

You must always document your reasons for discharge, communicate your decision clearly, and ensure you are meeting your legal and ethical responsibilities throughout the process.

No, you cannot decline to provide needed treatment solely because a patient has a strong or unpleasant odour. As a physiotherapist, you have an obligation to prioritize patient care and not allow personal preferences to interfere with your professional responsibilities.

That said, if an odour is affecting your ability to provide safe and effective care, it is appropriate to raise the issue respectfully. Aim to describe the concern objectively and without judgement, and offer a suggestion. For example, you might say: “Your clothing smells strongly of cigarette smoke and it is impacting my ability to provide treatment to you. Would it be possible for you to bring some freshly washed clothes to change into when you arrive for your appointment?”

These conversations can be sensitive. Use your professional judgement to maintain a respectful tone and focus on finding a collaborative solution that supports both your ability to provide care and the patient’s dignity.