Information & Guidance on Preventing Professional Misconduct
The Patient Relations program developed by the College of Physical Therapists of British Columbia aims to provide information and guidance to registrants about how to prevent professional misconduct of a sexual nature when providing client care.
The College is a not for profit organization responsible to regulate the practice of physical therapists in British Columbia (BC). This regulatory role is primarily about protecting the public; the College sets standards for registrants and investigates complaints received from the public about the practice of registered physical therapists.
The College is required to follow two key pieces of legislation as regulators of physical therapists. One is the Health Professions Act; Section 16 (2) (f) speaks to the requirement to establish a patient relations program. The other is the Physical Therapists Regulation, which again requires a patient relations program as described in Section 7.
If you have a concern about the practice of a registered physical therapist in BC:
- contact the College at (604) 742-6556
- file a formal complaint (see Making a Complaint)
What Happens if a Complaint is Received?
A complaint of sexual misconduct against a physical therapist could result in disciplinary action by the College against the registrant.
Additionally, a complainant could choose to take civil action and / or pursue criminal charges (a physical therapist could be charged with sexual abuse and sexual harassment).
What is Professional Misconduct of Sexual Nature?
Sexual misconduct includes:
- sexual intercourse or other forms of physical sexual relations between the registrant and the client,
- touching, of a sexual nature, of the client by the registrant, or
- behaviour or remarks of a sexual nature by the registrant towards the client.
Physical Therapists Provide Safe & Respectful Care
Physical therapists must recognize that in any client relationship, no matter who the client is, there is an imbalance of power. By the very nature of the relationship, the physical therapist holds more power than the client because the client relies on physical therapist for care. There are ways to lessen that power imbalance, such as by using a client-centred care model, but there will always be some imbalance inherent in any physical therapy encounter.
Zero Tolerance of Sexual Misconduct by a Registrant
Professional misconduct of a sexual nature is a misuse of power that violates the human dignity of clients seeking physical therapy care for themselves and / or their relatives. It is characterized as a violation of the relationship of trust and confidence that exists between clients and healthcare professionals. Such professional misconduct by any registrants, providing any type of physical therapy care, in any practice settings, will not be tolerated by the College.
Unwanted Attention from a Client
The situation may occur when a client shows unwanted attention or attempts to initiate an unwanted personal relationship with a physical therapist The unwanted attention could be intentional, unintentional, related to medication the client is taking, to an undisclosed health condition, or to cognitive challenges. In all situations, the physical therapist should try to immediately curtail the attention and should document any boundary blurring or violation that occurs, including the action taken to re-establish the professional boundaries of the therapeutic relationship. Make use of support networks, consult with colleagues or a supervisor, or contact the College for assistance.
It is the physical therapist’s duty to establish, maintain, and monitor the boundaries of a therapeutic relationship, and to take action if a boundary has been blurred or crossed. In that situation, roles need to be clarified by the physical therapist, and treatment goals re-established. If the therapeutic relationship can not be re-established, it is the duty of the physical therapist to ensure that the client is not adversely affected by any interruption in physical therapy care.
How to Avoid Misunderstandings
- Use clear and direct communication with clients, use correct terminology for body parts, and use an interpreter whenever necessary.
- Be aware that professional misconduct of a sexual nature includes actions or comments that a reasonable person would know are unwanted or would create discomfort. Seek opportunities to learn about multi-cultural attitudes and behaviours that are appropriate, so that professional misconduct of a sexual nature does not occur as a result of ignorance.
- Do not use behaviour, gestures, expressions, or comments that are seductive or sexually demeaning to a client. Never comment on or criticize a client’s sexual orientation.
- Never initiate or participate in conversations or jokes with clients regarding sexual preferences or fantasies.
- Seek and document consent prior to working in or around private areas (even if you obtained consent at the beginning of treatment).
- Acknowledge any incidences of accidental or incidental touch in sensitive areas, apologize and seek consent to continue with treatment. Document the incident, have the patient initial it if possible.
- Inform the patient that they can withdraw their consent to treatment at any time.
- Ask the patient to tell you if / when they feel uncomfortable.
Where’s the Line? Professional Boundaries in the Therapeutic Relationship
In Where’s the Line? Professional Boundaries in the Therapeutic Relationship (PDF), the components of the therapeutic relationship (power, trust, respect, and sensitivity) are discussed. Clients are often vulnerable when they receive physical therapy care – they can be in pain, they are often asked to undress, they are asked to disclose personal and sometimes sensitive information. Physical therapists should be aware of and sensitive to the client’s perspective and respectful of the vulnerability they experience.
What is Physical Therapy?
CPTBC’s What is Physical Therapy? (PDF) publication is a resource for clients new to physical therapy. It explains what to expect in a session. Guidelines also remind physical therapists that clients are often unaware that they may be asked to disrobe, or that the physical therapist’s hands may be placed on their bare skin. Tips on communication help the client and physical therapist navigate these scenarios.
Video: Tips on Building Professional Relationship with Clients
CPTBC’s video “Tips on Building Professional Relationships with Clients” provides guidelines on how physical therapists can build and maintain professional patient relations in their practice.
CPTBC’s Advice to Consider Material
One of CPTBC’s Advice to Consider topics provides an example of how physical closeness led to a misunderstanding between a female client and a male physical therapist.
A few factors contributed to the misunderstanding, especially the request made to the client by an administrative staff person to change into a gown before the client met the physical therapist.
The result? A missed opportunity for the physical therapist to establish rapport and trust with the client before being asked to disrobe. And the client did not have a chance to hear an explanation about what to expect during assessment and treatment before being asked to disrobe.
Code of Ethical Conduct
CPTBC’s Code of Ethical Conduct (PDF) reinforces that physical therapists have an ethical responsibility to maintain professional boundaries that honour and respect the therapeutic relationship with clients.
Health Professions Act
Physical therapist registrants are required to report sexual misconduct if they have grounds to believe that another registrant of CPTBC or a registrant of another college has engaged in sexual misconduct. This requirement is described in the Health Professions Act Section 32.4.
Annual Self Report
Every year, registered physical therapists must complete the Annual Self Report (ASR) before they are eligible to renew their registration for another year. The ASR is “an interactive online tool that provides an opportunity to support continuing competence by expanding a physical therapist’s knowledge and understanding of professional, legal, and ethical obligations.” ASR questions related to professional boundaries are included and the answers help registrants to learn more about how to prevent incidences of professional misconduct in their practice.