Learn about maintaining professional boundaries, understanding the consequences of misconduct, and discovering how you can contribute to a safer, more ethical healthcare environment. This article is based on a 2024 webinar presentation by Mira Mariano, Samantha Mohn-Johnsen, and Sherri Paru.
Sexual misconduct in healthcare is a significant issue, though it is minimally studied and often underreported. Recent studies, including one funded by the Healthcare Regulatory Research Institute and conducted by Catherine Dower, have shown that 15% of misconduct cases in healthcare are of a sexual nature. In physical therapy, data from a commonly used liability insurance company revealed that 18% of defended cases in 2020 were related to sexual misconduct. Despite these numbers, only 5% to 10% of cases reported to medical boards are of a sexual nature, indicating a severe underreporting problem. Some patients may be hesitant to report, but even those who want to report may be unsure how to submit a complaint.
A 2017 study found that 84% of physical therapy students and clinicians had experienced inappropriate sexual behaviors, with 47% reporting such experiences in the past twelve months. This highlights the need for increased awareness and proactive measures to address and prevent sexual misconduct in physical therapy.
The patient-provider relationship in physical therapy is unique due to the frequent, direct, one-on-one nature of the interactions. This relationship inherently involves a power dynamic, where the provider holds a position of authority, and the patient is in a vulnerable state. This dynamic can be influenced by various factors, including gender, age, and access to resources. For instance, a young female therapist treating an older, successful male patient may feel an imbalance in power despite the inherent authority of the provider role. It is crucial for physical therapists to recognize and navigate these dynamics to maintain professional boundaries and prevent misconduct. (Learn more by watching FSBPT videos on Power Dynamics and the Nature of Relationships.)
Healthcare providers have a responsibility to report concerns to protect patients, themselves, and the profession. This responsibility includes effective communication, consistently obtaining consent, and treating everyone with a trauma-informed approach. Providers should not assume that patients will voice their discomfort; instead, they should proactively ensure that their actions are appropriate and respectful.
Effective communication and informed consent are critical components to maintaining ethical boundaries in physical therapy. Providers must clearly communicate their intentions, obtain informed consent for all procedures, and continuously reassess these boundaries throughout the treatment process. Miscommunication or a lack of consent can lead to misunderstandings and potential misconduct. By fostering open and transparent communication, physical therapists can build trust with their patients and ensure that their actions are always in the best interest of the patient.
Every practitioner has the potential to violate boundaries. Preventing boundary violations requires a proactive approach from physical therapists. Some key strategies include:
When physical therapists encounter inappropriate behavior from a patient, it is essential to respond promptly and professionally. This involves addressing the behavior directly, reinforcing established boundaries, and seeking support if necessary. Ignoring or dismissing inappropriate behavior can lead to further issues and potential misconduct. By taking a firm and proactive approach, therapists can maintain a safe and respectful therapeutic environment.
To effectively address such challenges, education and training play a crucial role in preventing sexual misconduct in physical therapy. By including discussions on ethical boundaries, power dynamics, and communication strategies in the curriculum, educational institutions can better prepare future therapists to navigate these complex situations. Furthermore, ongoing professional development and training are vital for practicing therapists, as they help ensure that professionals remain informed about best practices and emerging issues in the field.
Sexual misconduct in physical therapy is a serious issue that requires ongoing attention and proactive measures. By understanding the prevalence of misconduct, recognizing the dynamics of the patient-provider relationship, and implementing strategies to maintain ethical boundaries, physical therapists can contribute to a safer and more ethical healthcare environment.
Mira Mariano is serving her second term on the Virginia Board of Physical Therapy and is Vice-Chair after previously serving as Chair. She is faculty in the DPT program at Old Dominion University with a master’s degree in Orthopedic physical therapy and PhD in urban services and urban education from the same institution. Mira's bachelor’s degree in physical therapy is from the University of Pittsburgh. She is board-certified as an Orthopedic Clinical Specialist since 1999 and she continues her clinical practice in concierge physical therapy at ODU Monarch Physical Therapy. She is engaged in professional service on the FSBPT Sexual Misconduct & Boundaries Committee, mentoring students, and scholarly activities in fall risks, physical therapy education, and incontinence in female athletes.
Samantha Mohn-Johnsen is an Associate Professor and the Director of Clinical Education for the Department of Physical Therapy at the College of St. Scholastica. Samantha completed her doctor of physical therapy training at the University of Wisconsin- La Crosse in 2008 and has an educational doctorate in healthcare education and leadership from Clarkson College in 2018. She has practice expertise in both orthopedics and pediatrics and currently practices locally in inpatient pediatrics and the NICU. She is an active member of the MN State Board of physical therapy and participates in regulation at the national level as a member of the Sexual Misconduct and Boundary Issues Committee.
Sherri Paru has served as the clinical advisor and investigator for the Oregon Board of Physical Therapy since 2002. Sherri is currently the chair of the Sexual Misconduct and Boundaries Committee for FSBPT. She has served on the FSBPT’s Education and Nominating committees and was awarded the FSBPT Outstanding Service Award in 2021. Sherri is a certified investigator through the Council on Licensure Enforcement and Regulation (CLEAR) and serves on several CLEAR training and planning committees. Sherri has presented at the annual meeting for the FSBPT, FSMB, and CLEAR on the topics of investigations, ethics, and professional boundaries.