Valid Reasons to Terminate a Patient
The Patient is Harassing You or Your Staff
Harassment can come in many forms, including visual, verbal, and physical offenses. (1) Regardless of the presentation, it is unpleasant, alarming, and often threatening to the subject. Here, we’ll consider three types of inappropriate conduct: sexual behaviors, racial harassment, and non-consensual contact.
Sexual harassment is often the first variation to come to mind for most physical therapists, and with good reason: more than 80% of PTs report having experienced some form of inappropriate patient sexual behavior (IPSB) during their career. (2,3) Nearly 70% of physical therapist have experienced at least one episode of IPSB that would qualify as full-blown sexual harassment. (2)
If a patient makes sexually-charged comments or advances towards you or another staff member, this compromises your ability to ethically care for that patient. (4) In addition, it can compromise your safety and well-being: you may feel uncomfortable and unsafe at work, and your risk of experience negative psychological symptoms such as guilt, fear, and depression is elevated. (3)
Physical therapists who are members of minority racial and ethnic groups face an additional challenge at work: the potential for race-based harassment.
Physical therapy is often viewed as a “White profession”, both by the public and other professionals. (5) Non-white physical therapists frequently experience racial discrimination from institutions, colleagues, and patients. (5) Patients may make inappropriate comments or jokes about a therapist’s racial background, or even decline to be seen by a non-White physical therapist. (5)
Physical therapists who are the victims of racial discrimination or harassment may feel undervalued in the workplace, come to doubt their own skills, and feel isolated and unable to address these threats (5) If a patient is using your race or a colleague’s as an excuse to behave poorly, you have every right to terminate that patient.
Stalking and Inappropriate Contact
While physical therapists often develop close and friendly relationships with their patients during the course of care, this is no excuse for patients to violate your professional boundaries. If a patient is contacting you outside of the clinic without your permission, be it via phone, personal email, or physical pursuit, they have crossed the line. (6)
The Patient is a Threat to your Professional Safety
In addition to threatening your personal well-being, inappropriate patient behaviors can also put your license and career at risk. Consider the following:
- A patient attempts to involve you in an illegal or unsafe activity. (6)
- A patient lies to you and/or attempts to cheat you or your practice out of time or money. (6)
- A patient is malingering – feigning disability or frailty to “work the system” and gain access to care they don’t actually need. (6)
All of these situations are threats to your professional credentials and your conduct record. If you are privy to such activities without documenting them and taking action to address them, your professional ethics could be called into question.
How to Deal When Terminating a Patient
Step 1: Take a deep breath
Before you attempt to manage a harassing or threatening patient, take the time you need to step away and collect yourself. Ask a neutral third party, such as an office manager, to step in if needed. (7)
Step 2: Document like it’s your job (it is)
As a PT, you know all about defensible documentation. Use those same skills to record as much detail as possible about the incident, and save this information in the medical record for future reference. (6) Having an established, written termination policy for your clinic can help ensure that you cover all your legal bases (4).
Step 3: Notify the patient (and their referring physician, if applicable)
The standard recommendation for notifying a patient of termination is a certified letter, preferably from a standardized template. (4,7) If your patient was referred by a physician, do the physician the professional courtesy of informing them that you are no longer able to manage their patient’s care. (4) In some cases, it may also be necessary to notify the patient’s health plan of the termination. (7)