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Journey of a DPT Student

Morals vs. Rules

Published March 11, 2014 4:30 PM by Lauren Rosso

I was having a conversation with a fellow classmate about interacting with patients outside the clinic, and we got to wondering about what's allowed and not allowed. In the particular case that we were talking about, my friend ran into a patient over his lunch break. The patient, a 20-something male with CP who has a tough time walking, was having lunch at the same place. My friend sat down and finished his lunch with the patient. When they were leaving, he offered to give the patient a ride back to the clinic, which was just across the parking lot but a significant walk for this guy. He offered without even thinking, but wondered afterward if his decision was the most responsible.

Without question, I would have done the same thing. I can't imagine saying goodbye and watching this person struggle to walk back to the same place that I was driving. At the same time, however, I recognize the legalities and risks involved with something as simple as this. So where do we draw the line? I'm sure this is one of many examples I'll encounter over the years. I'm bound to see patients at restaurants, bars, sporting events etc. So what's the best approach? Pretend like you don't know them? Wait for them to initiate conversation?

I feel like I get to know my patients very well during their plan of care. I learn about their lives, work, families and interests. My first instinct if I see them in the community is going to be to ask them how they are doing, not avoid them.

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The fine line regarding patient/health care professional relationships is difficult in any setting, but particularly with physical therapist. We spend a lot of our treatment sessions building repoire, gaining trust, and getting to know the patient on several different levels.  While it is important for the patients to feel that you care about them as a person and are connected with them, defining these lines is an important part of effective and legal treatment. I think one way to address these potential issues is to discuss and acknowledge them with your patients from the beginning - particularly patients who you anticipate seeing in other settings or around the community. They can recognize limitations that are placed on us in terms of liablity and legality, so making these issues known to them and being honest puts everything out in the open. They know we care about them outside the therapy session, and are aware of reasons we may not be able to interact with/care for them because of potential hazards. We are still going to be faced with grey areas, and ultimately need to choose the option that will minimize risks and not question our license or liability, but extending our clinical judgement outside the clinic.

Alison Sloan April 9, 2014 8:22 AM

I believe that the therapist patient relationship is very important.  There is a fine line that hardly anyone talks about between being professional and getting too personal with the patient.  As a therapist, you should care about all of your patients’ well-being and want to a build a relationship filled with trust so that one can improve his or her situation.  Just from the amount of time and the nature of the work, relationships build and people become close.  That within itself could lead to some problems if not handled correctly and it is established that this is a professional relationship.  I do not feel like your friend was in the wrong for asking to take the patient to the clinic.  Regardless of whether it is your patient or not at the time, in a situation like that doing the right thing trumps everything else in my opinion.  I feel if it is something you would do to help out a person that you weren’t treating than it should be ok to help a person that you are treating.  We are in the business of helping people so I believe that we should help as much as we can.  

Chad, Physical Therapy - ECU March 15, 2014 2:06 PM
Greenville NC

Liability, Liability, Liability. That patient made it over there somehow with no intention of you taking him back. His plans were to get back by himself or he had other arrangements. Possibly a challenge or a goal he may have set for himself. Even when we do home visits we do not take our patients with us. They must ride with their family members. How about this comment, Hey Oh Bob the PT is a great therapist, but a really bad driver, I'll never ride with him again. Or what happens if you really do have an accident? Sorry, I would speak to him, if I saw him, but would not ask to give him a ride and I certainly would not expect him to ask me for a ride. But, if you want to ask the Professionals, Just go to the HPSO website.

Donald Meadows, Physical Therapy - PTA March 13, 2014 10:48 PM
Robertsdale AL

I think running into patients during social outings is a very common occurrence.  Like your friend I would have also offered the man a ride to the clinic.  Perhaps too far would have been offering a ride home rather than the common place of work.  I think that keeping the conversation neutral is a very good idea especially when the patient is with other people.  Bringing up therapy and patient information would be a violation of HIPPA.  However, if the patient chooses to share their progress and recent information I would be happy to listen.  Relationships will form between patients and PT and I think that it is okay for these to expand into public interactions.  

Kara Clowers, Physical Therapy - Student March 12, 2014 2:11 PM
Greenville NC

I have run into family and patients while shopping with my own family.  Do not make it awkward.  Some of the patients were half naked when I saw them at the hospital or SNF.  Keep the conversation neutral and tell them they look well and it has been nice seeing them.  

Remember the professional distance and closeness with the patients and all will be well.  

Jason Marketti March 12, 2014 12:41 AM

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