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Raising the Bar in Rehab

Right to Refusal

Published October 25, 2012 3:37 PM by Lisa Mueller

I've gone into a few restaurants or cafes, as I'm sure most of you have, and noticed signs at the cash register or on the walls stating the business' right to refuse service to anyone at anytime. I would guess it isn't often that a company needs to use that right against a potential client but having the security of the policy is likely reassuring to its employees at times. I haven't done a lot of research on this subject yet, but I'm wondering if such a policy exists for physical therapists. Is there ever a time when we can refuse to treat a patient? And if so, when?

Many times I worked with patients in the ICU who were in the hospital for alcohol withdrawal or drug overdoses. Sometimes they were capable of attending to the task at hand but often the patients couldn't safely participate in bed mobility, transfers or gait training. Saying that physical therapy was inappropriate was dependent on the patient's inability to follow cues or to stay awake, for example. But what if a patient was appropriate for physical therapy, had clear deficits that required intervention, but the therapist (for some reason) did not feel comfortable treating the patient? Can the therapist refuse to provide physical therapy?

Physical therapists have an obligation to remain professional, set aside differences and promote the needs of their patients as the primary focus. I'm human. Sometimes I can't bite my tongue anymore. Sometimes I reach a point where the best thing for my patient is to be treated by someone else. I'd like to describe these experiences to you, but to protect those who were involved I think it's best that the Internet doesn't publish every waking moment of my life as a physical therapist. The few times when this happens, I explain the situation to my manager, and each time I have been supported in my decision-making and rationale for postponing a patient's treatment.

Does our profession have guidelines protecting our right to refuse service, as so many restaurants do? I'd like to read over the APTA website and see if there's anything listed. I'm not sure if it's the responsibility of the employer or the profession to create standards protecting physical therapists from situations that could be damaging.

Have you ever been in a situation where you couldn't treat a patient? How did you handle it?


This is an interesting blog.  I have refused to treat someone because they would spit and curse whenever I came to their room.  Another therapist saw the patient.

What if the patient is a prisoner, a convicted murderer or a child molester?  A drunk driver?  What if the patient has different religious or political beliefs than me?

All in all we should focus on getting the patient better provided it is safe to do so.  We often have to put our personal views aside so we can treat patients as objectively as possible.

Jason Marketti October 26, 2012 4:39 PM

My company has a policy that when the safety of staff is at risk, even with an armed guard (I have worked in some rough neighbourhoods in home care) then we can discharge a case. Likewise if a person capable of following a plan of care (or has a proxy capable of ensuring a plan of care is followed) but choses not to, they can be discharged.

I think your practice of discussing the case with your manager and stepping aside is both practical and an act of kindness. In so doing you are assuring that the patient gets the best treatment possible free from the difficulties you two have working together. This is a technique that is useful rather infrequently as there shouldn't be a whole host of people one couldn't work with.

Dean Metz October 25, 2012 6:52 PM

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