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All healthcare professionals are expected to be accountable. Physical therapists are of course no exception—accountability is one of the virtues that is a core value of the profession. The confusion that occurs regarding accountability centers on who the PT is accountable to, because in many cases there may be multiple equally compelling demands on the PT. At all times the first and primary demand for accountability is a result of the patient-therapist relationship. It is always important to keep this relationship in mind through all interactions, as it is the foundation of the ethical and clinical decision making that physical therapists engage in. Of course it would be simple if that were the only party that the PT was accountable to, but there are many. The PT also has to be accountable to the organization that they work within, whether employed, contracted, or self-employed. In addition, the PT has a responsibility to the profession. How do the actions of the PT impact the profession as a whole? How is each PT accountable to maintaining the reputation of physical therapy and helping physical therapy to continue to grow and develop? There is also accountability to society. How will our actions impact things like access to care and promotion of health and wellness? No less important is the accountability the physical therapist must have to themselves. A physical therapist is more vulnerable to poor ethical and clinical decisions when his or her own well-being is compromised, in which case the PT must take the responsibility to recognize his or her own vulnerability. Accountability is complex and integral to fulfilling our responsibilities to our patients, fully cognizant that we do not practice in isolation and that we are part of a healthcare team and organization with responsibilities to society. In the cases that follow, we will look at accountability from several different vantage points.

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Best interest determination

Physical therapists (PTs) in the acute care setting are expected not only to be excellent care providers, but also to provide the healthcare team with expert guidance on whether and in what setting additional care is appropriate. There are factors, however, that can cloud the issue of where the patient goes next. Consider the following scenario.

Brad is a PT at an acute care hospital. He finds the practice setting challenging but deeply gratifying, as he plays an important role in improving the condition of patients who are recovering from significant debilitation due to illness or injury.

Patients and their families rely on Brad’s guidance as post-discharge options are weighed. In which setting will the family member do best? Long-term acute care? A subacute facility? Acute rehab? Home care? Brad takes pride in his ability to walk patients ...

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