The Case
The College received a complaint from a patient who regularly saw a physiotherapist for approximately six months. During this time, the PT confided in the patient that it was sometimes challenging to arrange childcare for their son, so they occasionally brought him to the clinic.
During one treatment session, the physiotherapist’s son entered the room while the patient was lying on the treatment table and the PT was actively performing treatment.
The patient was partially undressed but was draped. The PT briefly spoke to the child before removing him from the treatment room and locking the door, however the child intermittently knocked loudly on the door throughout the remainder of the session.
The patient noted that the physiotherapist did not acknowledge the disruption, apologize for the interruption or ask if the patient was comfortable continuing with the session. At the next appointment, the patient reiterated that the disruption made them uncomfortable and ask the PT to ensure that issues with childcare would not impact their sessions going forward.
During the final appointment and while the patient was lying partially dressed on the treatment table, the PT “abruptly announced” that they wanted to suspend treatment so they could pick up their son from school. The patient was taken aback but agreed to the suspension and the physiotherapist returned approximately 25 minutes later to resume treatment.
The patient expressed concerns that they were asked to suspend the treatment session while they were already in a vulnerable position and therefore could not provide informed consent. They also indicated that they felt like the physiotherapist did not fully appreciate the impact of the child’s presence at the clinic during treatment sessions and did not take appropriate measures to manage adverse events.
The Standards
The Boundaries and Sexual Abuse Standard sets the expectations for physiotherapists when managing boundaries within the therapeutic relationship. A physiotherapist must recognize the unique nature of each patient’s boundaries and be able to respond appropriately when a professional boundary is breached, including documenting the actions taken to address the breach in the record. The patient’s privacy was compromised when the child entered the treatment room and the therapeutic relationship was negatively impacted by the PT’s lack of acknowledgement of the boundary breach. Additionally, the PT did not include any information about the interruptions or conversations with the patient about the disruptions in the patient record.
Physiotherapists must obtain informed consent from patients for all aspects of treatment. In this case, the patient was in a vulnerable position when the PT asked to suspend treatment. There was no conversation about a possible interruption prior to starting treatment, and the PT did not appear to check their phone or receive any indication of an emergency. The patient felt that the physiotherapist took advantage of their position of power and did not consider that the patient was in a vulnerable position mid-treatment.
There was a lack of communication on behalf of the physiotherapist as they did not listen to the patient’s concerns, make reasonable efforts to get on the same page or foster trust with the patient by showing empathy and basic courtesy.
The Outcome
The physiotherapist was required to participate in a remedial program to address concerns related to communication, consent, record keeping, privacy and boundaries. The PT will meet with the College’s Senior Physiotherapist Advisor to review the appropriate standards and will submit a summary of key learning points following the discussion.
Boundaries and Sexual Abuse Standard
Consent
Communication Skills
Record Keeping