Good Practice: Managing Therapeutic Relationships - Time to say goodbye?

  •   August 13, 2014


When is it OK for a physiotherapist to decline to see a patient?

There are times when physiotherapists can and do discontinue treatment for patients requiring ongoing care. Perhaps there is an issue in the therapeutic relationship1 that makes it appropriate to end the relationship, or perhaps you have simply exhausted your ability to help the patient and you think they need to seek treatment elsewhere. It is important to know when it’s acceptable to end a therapeutic relationship and how to proceed.


A physiotherapist has the right to discharge a patient requiring ongoing treatment if:

  1. The patient does not cooperate or comply with the treatment plan rendering the services ineffective.2
  2. The physiotherapist has reasonable grounds to believe the patient will verbally, physically, or emotionally abuse them.2
  3. The physiotherapist has arranged to transfer the patient to another physiotherapist or healthcare provider who is able to offer a different approach to treatment.2


What do you do?

While it may seem like an attractive option to move in the middle of the night and leave no forwarding address, you do have a professional obligation to discuss the situation with your patient. Physiotherapy Alberta’s Guide to Managing Challenging Situations2 provides direction for how to work though this type of situation.2 Here are some steps to take:

  1. Plan the conversation, what you will do and say when you speak with the patient.2
  2. Communicate the plan you are proposing. If you recommend they see a different physiotherapist, provide the patient with a list of alternate treatment providers and be prepared to follow up with them for a reasonable period of time until the patient can transition to a new care provider.3
  3. If you think the patient really needs to see their family physician rather than another physiotherapist, be clear with that message and explain your rationale.3
  4. Document the conversation and be objective and professional. When deciding where to place this documentation, consider if the situation you are documenting is clinically relevant. If not, you should document it in a separate location.2

How you manage a patient who is always late for treatment will be considerably different from how you manage a patient who is abusive. Physiotherapy Alberta does not expect members to put themselves or others in the work environment in abusive or dangerous situations. When the decision to discharge the patient is less urgent, the best practice is to arrange for alternate services or give the patient a reasonable opportunity to arrange these services prior to discontinuing treatment.


References:

  1. College of Physical Therapists of Alberta. Therapeutic relationships: Establishing and maintaining professional boundaries. Edmonton: College of Physical Therapists of Alberta, 2007. http://www.physiotherapyalberta.ca/files/resource_guide_therapeutic_relations.pdf
  2. Physiotherapy Alberta, College + Association. Managing Challenging Situations: A resource guide for physiotherapists. Edmonton: College of Physical Therapists of Alberta, 2007. http://www.physiotherapyalberta.ca/files/resource_guide_managing_challenging_situations.pdf
  3. Physiotherapy Alberta, College + Association. Standards of Practice for Alberta Physiotherapists. Edmonton: College of Physical Therapists of Alberta, 2012. http://www.physiotherapyalberta.ca/files/practice_standards_all_2012_revised.pdf