“With increasing professional autonomy and independence in clinical decision making and judgments, physical therapists face increasingly complex ethical issues in their professional practice.”1 In an attempt to ensure that physical therapists (PT’s) engage in legal and ethical practice, most states require PT’s to pass a jurisprudence examination as a part of obtaining licensure. I have worked as a licensed physical therapist since 2009 and have taken jurisprudence exams for the states of California, Maryland, Georgia, and the District of Columbia. Each state has their own variations of what constitutes the professional practice of the PT. Additionally, the American Physical Therapy Association (APTA) (physical therapy’s professional organization) has developed a specific code of ethics that they encourage and recommend all PT’s to abide by. I would like to go through each of these principles and provide examples from everyday PT practice regarding how these principles may be either employed or violated.
APTA Code of Ethics2
· PT’s shall respect the inherent dignity and rights of all individuals
o Example: Patient A has come in to the PT clinic for an evaluation of his shoulder. The PT requests that Patient A remove his shirt for better access to his shoulder. When Patient A asks for a gown as a covering, the PT laughs at Patient A and exclaims, “Men can roam around shirtless.”
§ This is a clear violation of Patient A’s dignity and rights. PT’s are taught to properly “drape” a patient when removal of clothing is necessary whether they are male or female.
· PT’s shall be trustworthy and compassionate in addressing the rights and needs of patient/clients
o A PT would violate this code if patient confidentiality were breached.
§ Example: 2 patients are in a PT gym at the same time. Patient A is completing therapeutic exercise, while Patient B is receiving manual therapy by the therapist. Patient B asks “what’s wrong with Patient A?” If the PT discloses the diagnosis or even the “injury story” without Patient A’s consent, then the PT has breached Patient A’s confidentiality.
· PT’s shall be accountable for making sound professional judgments
o Example: Patient D was seen by the physical therapist’s co-worker Jane during the last treatment session, and received dry needling to her left upper trap due to cervical pain and headaches. However this week Patient D is seeing PT Kelly. PT Kelly has only been trained in dry needling of the lower extremities, but is qualified to perform manual techniques in the cervical region. PT Kelly makes sound professional judgment by choosing not to dry needle an area she has not received training in, explains this to Patient D, and proceeds with manual treatment to the cervical spine.
· PT’s shall demonstrate integrity in their relationships with patient/clients, families, colleagues, students, research participants, other health care providers, employers, payers, and the public
o Example: Patient F has been treated by a spectrum of health care providers including massage therapists, chiropractors, orthopedic doctors and podiatrists and is not happy with the treatment she has received from chiropractors and orthopedic doctors. As a result, Patient F proceeds to bad mouth and swear off ever utilizing these professionals again. The PT is able to maintain professional integrity in this situation by listening and being attentive to patient F’s concerns, while also respectably choosing not to agree with Patient F, recognizing that everyone makes mistakes.
· PT’s shall fulfill their legal and professional obligations
o Example: PT Dane happens to be double-booked with 2 patients who have Medicare as their primary insurance. If Medicare patients are seen together during a PT session, the session must be billed as a group therapy session. PT Dane however, chooses to bill each patient separately as reimbursement payments are more for individual sessions. PT Dane has violated this ethical code and in doing so has completed Medicare fraud.
· PT’s shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, abilities, and professional behaviors
o Example: Every state requires continuing education typically of 30-40 hours every 2 years.
§ PT Sonya has had a child over the past year and though she has 20 hours of continuing education, she has not had the time to take additional continuing education classes before the due date of her license renewal. If Sonya does not renew her license, she cannot work until her license is renewed. In order to continue to work to support her family, Sonya decides to lie about her continuing education hours stating that she has completed them, with hopes that the state board will not audit her this year. Sonya has just violated this ethical code and has jeopardized her licensure.
· PT’s shall promote organizational behaviors and business practices that benefit patient/clients and society
o Example: Company A utilizes both PT’s and licensed physical therapy assistants. PT John, and PTA Sally both are respectable practitioners and patients love them. PTA Sally has a good friend that needs treatment and makes an appointment on Sally’s schedule. PTA Sally does not tell PT John about this visit until 30 minutes into the session and asks PT John to perform a quick evaluation so that Sally can continue treatment with the appropriate documentation.
§ If management from Company A, allowed PTA Sally to continue this without repercussion, this ethical code is violated, as PTA’s are not allowed to perform any treatment unless a patient is properly evaluated by a licensed PT. This type of activity threatens PT John’s licensure.
· PT’s shall participate in efforts to meet the health needs of people locally, nationally, or globally
o Example: This code can be responsibly employed by the PT by offering occasional pro bono services to patient’s with financial hardship, by extending hours so that patient’s who have to work still have access to PT services, or by participating in local and national health events such as fairs and/or conventions.
Physical therapists are skilled professionals in movement science and face ethical issues every day in clinical practice. The above examples are just some of the ways APTA’s code of ethics can either be employed or violated. It is imperative that PT’s continue to strive for excellence in their ethical and moral conduct, while it is also imperative that educational programs continue to teach and stress the importance of ethics in practice.
1. Clare M. Delany, Ian Edwards, Gail M. Jensen, Elizabeth Skinner, “Closing the gap between ethics knowledge and practice through active engagement: An applied model of physical therapy ethics,” Phys Ther, (July 90, 2010): 1068-1078.
2. Code of Ethics for the Physical Therapist. apta.org