Chapter 8: Practicing a Hands-on Profession in a Hands-off World

INTRODUCTION

Physical therapy is at its core a hands-on profession, It has become increasingly more challenging to practice safely and effectively when trust has been eroded by a few bad actors in health care who have made national headlines for sexual abuse. Our actions are guided by the foundation of the social contract between patient and clinician, Trust. In addition, regulations provide clear boundaries, and our professional behaviors are guided by our Code of Ethics and Standards of Ethical Conduct (Figure 8-1).

What is sexual misconduct and if you suspect it or see it …. What will you do about it?

Sexual misconduct is defined as:

1. Engaging in or soliciting sexual relationships, whether consensual or non-consensual, while a physical therapist or physical therapist assistant/patient relationship exists.

2. Making sexual advances, requesting sexual favors or engaging in other verbal conduct or physical contact of a sexual nature with patients or clients (MPA 6th Edition).

The Code of Ethics provides excellent guidance regarding sexual misconduct and harassment. 4E) Physical Therapists/Physical Therapist Assistants shall not engage in any sexual relationship with any of their patients and clients, supervisees, or students.

4F) Physical Therapists/Physical Therapist Assistants shall not harass anyone verbally, physically, emotionally, or sexually. Consult your practice act for explicit guidance. Most have some type of guidance regarding how long after the therapist patient relationship has ended before one can enter into a social relationship with a former patient. A word of caution here. As primary care providers for many patients the professional relationship is ongoing. We no longer talk about discharge but rather episodes of care that come to a conclusion recognizing that a new episode of care can begin at anytime.

As hands on practitioners, we always have to recognize that there is an increased vulnerability and chance that our actions may be misinterpreted, and we have to rely on excellent communication to make sure that the patient always understands what we are doing and why and is empowered to stop the interventions if they feel uncomfortable. True informed consent is critical here and it is important to remember that informed consent particularly for sensitive treatment is never sufficient if done just once when treatment commences. Informed consent is ongoing and modified as the treatment changes and progresses. The Code of Ethics provides clear guidance about this in Principle 2C: Physical therapists shall provide the information necessary to allow patients or their surrogates to make informed decisions about physical therapist care or participation in clinical research. The challenge is to leave no room for interpretation. Ask yourself the following questions throughout the patient contact. Where are your hands and how is that perceived? What is the intent of your hand placement ...