When Breaking Up is Hard to Do

You’ve been seeing Janet for several months. She’s an elderly widow who first came to you following a knee replacement. She recovered quite well and is ready to be discharged.

The problem is, Janet really likes you and wants to continue coming for therapy. She makes weekly appointments for the treatment of back pain. But, you are aware that your treatment is not having a particular therapeutic benefit, except perhaps for a placebo effect.

Janet doesn’t need physiotherapy: she needs company, caring and some gentle exercise.

You know that the Professional Misconduct Regulation makes it an offence to continue treating a patient where treatment is unnecessary, but when you try to persuade Janet to stop coming, she gets tearful. The last time you saw her, she brought you a tray of homemade brownies to thank you for keeping her as a patient. You feel very guilty about hurting her, but you don’t feel comfortable carrying on with her care.

What do you do?

Our Practice Advisor, gets calls about scenarios like this pretty frequently. I’ve written before about the physiotherapist’s obligation to maintain professional boundaries.  It’s worth acknowledging that often it’s patients who wish to step over that line. They want care they don’t need, they want to be your friends, they want to set you up with their sisters or brothers, and this can put you in an uncomfortable situation. You worry about hurting their feelings. You worry that they’ll make a complaint about you if you discharge them.

Let’s be clear.  You are entitled to discharge patients, who no longer need your care, even if they don’t want to go.

The regulation says that you must not discontinue needed professional services except in certain circumstances. A physiotherapist is entitled to discontinue care in a variety of circumstances, including situations where the patient is abusive or non-compliant with the treatment plan.

You can read more detail in the regulation itself, but the bottom line is that if the patient is in need of ongoing treatment, you should help them to find an alternative physiotherapist, or at least make sure they have time to do that for themselves.

But in Janet’s case, she no longer needs treatment.

As in all interactions with patients, you will want to be respectful in your communications and you should always note the conversation in the patient’s chart.  But when the time comes for you to end the relationship, whether it’s because they are violating boundaries or for any other reason, you are entitled to do so.

You are responsible for the therapeutic relationship, and sometimes that will mean you need to end it.

We’d love to hear from you about how you handle patients who are having a hard time letting go or manage challenging relationships.

 

Resources:

Therapeutic Relationships and Professional Boundaries

Guide to Therapeutic Relationships and Professional Boundaries

Managing Challenging Interpersonal Situations When Providing Patient Care

Guide to Managing Challenging Interpersonal Situations When Providing Patient Care

 

4 thoughts on “When Breaking Up is Hard to Do

  1. A placebo effect is still an effect. The therapeutic alliance a therapist makes with their patient usually enhances the results of the true clinical skills he/she provides.

    If the visits are making the patient feel better and you believe they may feel worse without the weekly ‘touching base,’ then treatment should continue, even if the goal is maintenance of current function.

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  2. I agree with the first poster. If the patient is benefiting because she will otherwise decondition without further treatment, what’s the harm? I’d argue that treatment is not unnecessary in this case and NOT professional misconduct.

    As for working in OHIP, the patient would be asked to pay with her own funding once OHIP coverage runs out. Simple as that.

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  3. It is easy for you to say, when you working in OHIP, most patients thinks they are entitled to have right to receive treatment forever. Please call the college, how many complaints comes from OHIP patients.

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