Most physical therapists face sexual harassment from patients

Inappropriate patient sexual behavior remains a common experience for physical therapists during their careers, according to a recent U.S. study.

More than 80 percent of nearly 900 physical therapists surveyed said they have encountered sexual remarks, touches, indecent exposure and sexual assault. Almost half said they’ve experienced one of these situations in the past year - numbers that haven’t changed since the last major surveys in the 1990s.

“The numbers stand for themselves, and it’s quite alarming,” said lead author Jill Boissonnault of the George Washington University School of Medicine and Health Sciences in Washington, D.C.

U.S. health care professionals have 16 times greater risk for non-fatal violence at work than other fields, the study authors write in the journal Physical Therapy.

“Many of us are not trained in how to deal with this behavior, which can lead to consequences for both the physical therapist and the patient, who may be discharged from care early when this happens,” Boissonnault told Reuters Health by phone.

The most recent studies that focused specifically on patient sexual harassment and physical therapists were done in the United States, Canada and Australia in the late 1990s, the study team notes. At that time, nearly 80 percent of therapists said they had experienced sexual harassment, and one quarter of those reported psychological consequences such as anger, guilt, fear, anxiety and depression.

“It’s important to pull out those particular numbers because sexual harassment by a patient is a different situation than with a coworker or boss,” said Ziadee Cambier of the Swedish Medical Center in Seattle, a coauthor of the study.

“We have a duty of care to the patient,” Cambier told Reuters Health in a phone interview. “The way we address that behavior is entangled with meeting the healthcare needs of the patient and our own ethical and legal obligations.”

The research team surveyed 892 physical therapists and physical therapy students across the country, recruited through physical therapy academic programs and the American Physical Therapy Association. About 80 percent of the participants were women, and 60 percent reported working with patients who had dementia, delirium or brain injuries. Most said they treated an equal number of male and female patients.

Researchers found that 84 percent of survey participants had experienced inappropriate patient sexual behavior during their career, and 47 percent experienced it during the last year. Women reported significantly higher rates of harassment, especially staring, suggestive remarks, inappropriate touches, date requests, sexual gestures, requests for sexual activity and masturbation.

Several factors increased the risk of experiencing inappropriate behavior, such as routinely working with patients with brain impairments and having fewer than five years of direct patient experience. Harassment was most common between a female therapist and male patient. Treating mostly male patients increased the odds of harassment by almost 400 percent, and treating an equal mix of patients doubled the odds, as compared to those who mainly treated female patients.

In the open-ended portion of the survey, therapists shared details about some of their experiences and how they were affected. “It was disturbing to me, and even twenty years later it makes me upset,” one said.

Several physical therapists also talked about the lack of support, training and policies related to patient sexual harassment. “I was told that when patients were inappropriate with me, it was ‘part of the job,’” one therapist reported. “I did not have support from management to address the situation or to take further steps.”

Future studies should also look at organizational policies and practices about employee safety, said Paul Spector of the University of South Florida in Tampa, who was not involved in the study.

“In organizations with a good climate, supervisors are supportive,” he told Reuters Health by email. “There are policies in place to prevent this experience and respond appropriately when it happens.”

Educating patients about professional guidelines may be helpful as well, he added.

“The public should be aware and appreciate what the providers who help them when they are ill have to put up with,” Spector said. “Maybe a little understanding might encourage people to treat them with more kindness.”