This is a heavy topic to explore, but challenging or disrespectful behavior and abuse is unfortunately something physical therapists are negotiating every day. Insults, prejudice, and even physical violence directed at doctors, nurses, and other healthcare professionals appears to be a growing problem (can you relate?).
Recent studies and surveys reveal alarmingly high rates of practitioners reporting experiences of verbal harassment, discrimination, and outright assault from patients and their families.
This disturbing trend seems to reflect declining trust and respect for medical authority across society. However, abuse is never acceptable, and clinicians have the right to a safe working environment free from harm.
For physical therapists in particular, managing difficult patients and de-escalating tense situations is increasingly becoming part of the job.
A recent study found that 93% of early career physical therapists reported experiencing some form of patient-related intimidation or disruptive behavior. Another survey of over 600 physicians revealed that nearly 60% had been subject to abusive remarks from patients, with almost 10% reporting racial, religious, gender, or appearance-related insults. Shockingly, 2% of respondents reported experiencing physical abuse or assault. (See our footnotes below for further reading on these studies.)
The consequences of this abuse can be severe, leading to emotional distress, burnout, and practitioners leaving the profession entirely. In one study of medical students, those who experienced frequent discrimination ended up having higher rates of depression and suicidal ideation. Abuse from patients clearly takes a toll on clinicians over time.
As a physical therapist, how can you recognize when a difficult doctor-patient relationship crosses the line into abuse? Be alert for any of the following red flags:
- Prejudiced comments or insults regarding your age, gender, race, religion, appearance, or other personal characteristics
- Yelling, threats, profanity, or other aggressive language
- Demeaning, sarcastic, or belittling remarks
- Unwanted sexual advances or harassment
- Throwing objects in frustration
- Making threats against you, your practice, or your license
- Any type of physical aggression such as grabbing, shoving, or assault
- Trust your instincts – if a patient’s behavior makes you feel unsafe or afraid, that’s a clear sign of an abusive situation that needs to be addressed. Don’t downplay it or make excuses for them. You have a right to a safe working environment.
Action list for Physical Therapists to reduce and respond to abusive and challenging behavior.
- Discuss the gaps in basic training regarding setting limits with verbally aggressive or disrespectful patients.
- Prioritize well-being without condoning destructive behavior.
Misconceptions about Expressing Anger:
- Debunk the idea that therapy is a platform for unfiltered anger expression.
- Highlight the importance of regulating and expressing anger within the bounds of a respectful professional relationship.
Treatment of Therapists
- Challenge the implicit belief that therapists must endure disrespect and abuse for the patient to heal.
- Emphasize the right to set boundaries and the importance of maintaining a safe therapeutic space.
Recognizing Abusive Behavior:
- Explore different forms of abuse or unacceptable behaviors, such as name-calling, stalking, threats, and physical violence. Therapists might have let this pass many times, but now recognize this behavior for what it is.
- Acknowledge that this behavior will not be tolerated, this might be a management policy which is communicated to clients as part of their onboarding, or regular sessions.
Therapist’s Role in Prevention:
- Create a stable and predictable therapeutic environment to minimize patient dysregulation.
- Avoid common triggers for aggression and aggression-provoking behaviors.
Assessment and Setting Clear Limits:
- Access a patient’s history of violence before proceeding with therapy.
- Provide guidance on setting clear limits at the beginning of therapy, stating consequences for unacceptable behavior.
Managing Aggression during Sessions:
- Suggest interventions like breaks for cooling off if a patient becomes increasingly aggressive.
- Follow through on consequences and avoiding continued engagement during escalated situations.
- Know when to walk away – If the situation escalates out of control, remove yourself and get help immediately. Don’t stay and risk harm.
Developing Emotional Resilience:
- Acknowledge the emotional toll of abuse, build resilience.
- Take self-care seriously, including regular supervision, counseling, or peer support.
- Do not take anger personally, stay grounded and composed.
- Seek supervision or consult with colleagues when faced with challenging cases.
- Emphasize the importance of a strong support system within the professional community.
Legal and Ethical Considerations:
- Understand the legal and ethical obligations regarding client confidentiality and therapist safety.
- Know when to involve authorities if necessary.
- Have others present when necessary – Request that a colleague or security guard be present with abusive patients. There is safety in numbers.
Reflecting and Learning:
- Reflect on challenging experiences and learn from them.
- Engage in professional development and training related to handling difficult cases.
- Additionally, always document any abusive incidents thoroughly in the patient’s medical record. This creates a paper trail in case you need evidence later for disciplinary actions or even legal charges in extreme cases.
Going Forward Together
Challenging behavior and abuse to health care professionals is not just within the physical therapy industry, it is across the board with medical, care and service colleagues. The behavior must be recognized and challenged. By working together and discussing issues openly, therapists can drive change.
Clearly this disturbing trend of disrespect and violence toward healthcare professionals needs to be addressed on a systemic level. Professional organizations should provide assertiveness training and self-defense courses to help clinicians set boundaries and defuse volatile situations. State licensing boards could establish reporting channels and disciplinary processes to penalize abusive patients. Healthcare employers need better security policies and crisis response protocols.
The healthcare system cannot function without the expertise, compassion, and dedication of its practitioners. Yet abuse and disrespect are driving talented clinicians out of the very professions society depends upon most. This disturbing trend must be reversed, or we risk losing our brightest healers. The time has come for a renewed culture of respect in medicine.
Supporting Clinicians Through Mentorship and Community
For individual practitioners dealing with abusive patients today, organizations like The Sisu Practice provide invaluable support through mentorship programs, assertiveness training, and online community building. Founded by physical therapist Dr. Hollie Neujahr, The Sisu Practice understands the challenges clinicians face in upholding boundaries and managing difficult patients in today’s complex healthcare environment.
The Sisu Practice offers one-on-one mentorship for therapists at all career stages to help build confidence, resilience, and coping skills when faced with demanding patients. Their assertiveness training empowers clinicians to stand up to abusive behavior while maintaining professionalism. Sisu also fosters an online community for practitioners to share stories, exchange tips, and remind one another they aren’t alone. With the right mix of self-care, communication tactics, and peer support, therapists can gain the tools to thrive.
Founded by physical therapist Dr. Hollie Neujahr, The Sisu Practice provide mentorship and community to help clinicians navigate challenging patient relationships, uphold boundaries, and cultivate resilience in today’s complex healthcare environment. With self-care, assertiveness training, and peer support, therapists can gain skills to de-escalate tense situations and thrive in practice.
The Sisu Practice is here to help you grow professionally and achieve your dreams. A place to cultivate grit, resilience, and reach for your next growth opportunity. Whether that dream is physical health, performance improvement, career growth, and development, or professional education, we are here for you.