Learning from Complaint Trends – Communications

The College regularly receives complaints from clients alleging unprofessional communications, some leading clients feeling too uncomfortable to continue treatment with their physical therapist.

Such complaints include:

  • advice about diet that a physical therapist should not provide
  • fringe health remedies
  • invitations to meet/jointly attend events outside the therapeutic context
  • personal and intimate relationships
  • political views
  • sexual orientation/preferences/practices
  • sexualized extracurricular activities
  • traditional gender role biases

Below are examples of College complaints modified to protect anonymity:

What the client heard How the client felt The PTs response Improving the client experience
“I’m competing in a pole dancing competition this weekend, want to see my costume (picks up the phone to show client pictures)? It’s such a fun community of people. You’d fit right in, and it’d be great for your core. You should try it!” “I kept my responses short and tried to steer the conversation in another direction. I didn’t want to seem rude or closed-minded, so I agreed to look at the pictures and said I’d think about joining a class, but I was uncomfortable with the topic and didn’t want them to think of me that way.” “I was just trying to foster a connection with the client and provide a fun activity that would help improve their core strength to assist in their recovery. There was no indication the client was uncomfortable with the topic – they even said they’d try a class and asked me where I went.” Communicate in a way that fosters professional closeness and yet maintains a personal distance.  Conversations that respect professional boundaries contribute to client safety and build trust in the therapeutic relationship.

Be vigilant about comments that could be experienced as sexual in nature.  These comments can sexualize the treatment environment and shape a client’s experience of any touch received during physical therapy services. If the questions or comments are clinically relevant – provide the client with the clinical rationale or physical therapy context for the conversation.

“I’m sensing a lot of tension in your upper body. You should really try opening up your heart chakra and eat a lot of green foods to speed up your recovery.” “I didn’t understand why they were telling me this. I go there for physical therapy, and I want medical advice based on science, not spiritual/diet advice. Now I’m wondering if they’re providing me with quality care.” “The client asked how to speed up their recovery so they could get back to lifting. There’s evidence that emotional trauma is held in the body as tension and pain. The client was in a terrible accident, and I was just trying to give them every tool in my toolbox to help their recovery.” Avoid offering advice on topics that are outside of physical therapy scope of practice.  While it is within scope to discuss a variety of health topics in a general way, it is then required to refer the client to the appropriate health professional for client specific advice and recommendations on these health topics if they are not physical therapy related.
“You shouldn’t let your boyfriend treat you that way. I’d never say that to a lady. You deserve better. There are plenty fish in the sea, go find someone who will treat you right.” “I told them about something funny that my boyfriend did, and they took it all wrong and started giving advice like he’s this bad guy and I’m some kind of wallflower. Now they’re always asking me how my boyfriend’s treating me and if I’ve found someone new yet. I’m starting to think they’re interested in me or something. Eventually I couldn’t take it anymore, so I started going to another PT.” “The client was always complaining about their boyfriend, I was just trying to be nice and let them know they deserved better. It kind of became the thing we talked about during treatment. I had no idea they didn’t like it.” Recognize that making judgements/ giving advice about a client’s personal life, in the context of a therapeutic relationship, fails to meet standards and code of ethical conduct.  It doesn’t matter who initiated the conversation; it is the responsibility of the physical therapist to maintain professional boundaries and to redirect the conversation.
“You shouldn’t try to posses the people you love. My partner and I have an open relationship. Plus, adding new people to the mix keeps things interesting.” “It’s so inappropriate for a physical therapist to talk about their sex life, especially while I’m in a gown and their hands are on me. I didn’t know if they were trying to see if I was open to a relationship or what. I didn’t say anything, but I’ll never go back.” “The client initiated the topic of relationships and I assumed they had similar views because they were referred to me by another client who also has an open relationship. There was no indication they were uncomfortable with the conversation.” Sexualized comments such as this are never appropriate in the therapeutic relationship. Acknowledge that a power differential exists between the physical therapist and the client and that attempts to change the dynamic from professional to friendly can negatively impact the client.

Power differentials mean that most people will not tell a health professional to change the topic.

“Why are you in trade school? You’re so pretty and outgoing, you should be an actress or a flight attendant.” “It’s hard enough being in a male dominated field, I don’t need my physical therapist imposing gender stereotypes on me.” “The client is about to enter a field that will be physically demanding with many activities that could result in re-injury, I was just trying to point out some other options that would be less hard on their body.” Choosing language that is inclusive and does not reinforce traditional gender stereotypes builds trust within the therapeutic relationship.  The Code of Ethical Conduct requires that physical therapists respect diversity and provide care that is both culturally sensitive and appropriate.

According to the College Practice Standard 14: Professional Boundaries and Sexual Misconduct, clients can expect to be treated with integrity and respect, and that the physical therapist will maintain professional boundaries appropriate to the therapeutic relationship in all interactions.

This is what we tell clients they can expect from us, let’s be sure we deliver on that promise.