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The women looked at me as if I was a prostitute. Men joked that they wanted a massage “with a happy ending” – physiotherapist Emilia recalls her professional start. A professional colleague who worked in the Kołobrzeg SPA received requests for an “erotische massage” and cards with the room number from German pensioners. They both complained to the employers, but heard that “the customer should be satisfied.” As many as 80 percent of employees are harassed by patients, announced the Washington Medical University, which has studied a thousand physiotherapists. There is also a problem in Poland – we heard in the Polish Physiotherapy Association.
30-year-old Mikołaj, after graduating from the Academy of Physical Education and Sport in Gdańsk, left for Kołobrzeg. He got a dream job – an exclusive SPA right by the sea, the Healthy Spine and Joints Clinic, professional rehabilitation equipment and grateful foreign patients. It quickly turned out that some of them expected him to provide services beyond the scope of his duties. “The first time the old lady put her hand in my pants, I didn’t know how to act. I just froze. I thought innocent flirting was all I could expect from a spa at the hotel. The most provocative were the German women who came several times a year. They put bills and cards with the room number in my pockets, asked for an “erotische massage”, simulated back pains and injuries just to undress. I felt embarrassed – these women were my mother’s age. ” – he says.
The story of Nicholas, like many others, had no sequel. When he turned to the hotel management and heard that what he was doing in his spare time was irrelevant and the most important thing was customer satisfaction. “I heard that I should feel honored and not be afraid of wealthy pensioners. I was practically given the green light to work after hours. I thought it was mainly women who work in this profession that face harassment. But sexual violence is very democratic, anyone can be a victim. ” The physiotherapist quit the “dream job” after six months …
How many healthcare professionals experience inappropriate behavior from patients? George Washington University School of Medicine and Health Sciences in Washington published the results of its research showing that 80 percent of physiotherapists experience sexual harassment by patients. Over the past year, roughly half of nearly a thousand respondents have experienced inappropriate touching, ambiguous comments, and sexual propositions and exposure of patients unjustified by the procedure performed. “These alarming results have negative consequences for both physiotherapists and patients – reporting harassment may result in removing both the patient and the physiotherapist from the procedures. The first loses the possibility of treatment, the second loses work, and additionally struggles with the psychological consequences of harassment, such as: shame, guilt, anxiety attacks, phobias and depression. ” – emphasized the author of the research, Jill Boissonnault. Similar conclusions were drawn by the statistics from the 90s carried out in the United States, Canada and Australia. Three decades later, little has changed, and the patient still cannot keep his hands to himself. The question is why?
“Let’s get to know each other better”
These words have been heard many times by Emilia, working as a physical therapist in social care. – Most of my patients are low-income people in need of constant care. Even though the manager always conducts an initial interview, every time I visit a new patient, I don’t know what awaits me. And the situations were different – he says.
When she started working in social care, the patient often locked the door behind him. He did not see a physical therapist, but an attractive woman. He started with innocent compliments, through “let’s get to know each other better”, ended with direct suggestions – he pointed to the part of the body that should be massaged – genitals. – I was scared, but kept a cool head. I changed the subject, and at the earliest opportunity I just ran away and never came back. Another patient tried to persuade me to drink vodka together in order to break the first ice. Now I also have a patient who makes bold remarks about what we might be doing together. Over time, I became immune to these types of comments. I learned to cut the topic short – short, blunt, sometimes brazenly. Thanks to this, the patient knows where the boundaries lie, and I can work calmly and do not feel harassed verbally or in any other way – adds Emilia.
Hypersexuality and dementia
According to the results of American studies, women – physical therapists who work with people with brain damage, dementia or delirium, most often experience inappropriate behavior on the part of patients. The risk of becoming a victim of harassment is greater when the physical therapist has worked for a short time (less than 5 years).
What do we know about the hypersexuality of people with dementia? Little – affects 2–17 percent of men and women struggling with dementia. The risk factors in this case are: lack of a sexual partner, lack of privacy, lack of stimulating activity, unfamiliar environment, depression and mania. To date, no effective intervention methods have been developed, and drugs that have the potential to help control this type of behavior have many side effects. According to the neuropsychologist Dr. Anna Barczak, excessive sexual desire in people with dementia and brain damage is a taboo subject in Poland. – Hypersexuality in this case is the result of dysfunction in the areas of the frontal lobes. They are responsible for regulating behavior and inhibiting impulses to socially unacceptable behavior. In the case of Alzheimer’s disease, such behavior is most often the result of the progression of neuropathological changes, and if these changes also involve the frontal lobes (in the later stages of the disease), such a phenomenon may occur. What’s more, people with Alzheimer’s do not recognize people, so if a physiotherapist has physical contact with a patient, he may be mistaken for a husband / wife or partner, and the patient responds naturally to touch – comments the neuropsychologist.
The patient is not denied
Emilia’s professional start resembled a false start. – Allusions and suggestions from people who found out that I was a masseuse were stereotypical – some women looked at me as if I was involved in prostitution, and men asked if they could sign up for a massage with a happy ending or a «very relaxing» massage. I think that the way television promotes masseuses, identifying them with women working in erotic massage parlors, closes people’s eyes to the real aspect of our work. ” – explains. Similarly, unpleasant stories happened to the aspiring masseuse when she applied for a job. As a rule, the potential employer replied that he was interested in her application, but he had to send a photo in his underwear, and preferably without it. The situation in which the supervisor or the employer uses the dependency relationship and commits behavior violating the dignity of the other party in legal terms is clear. We are dealing with harassment in the workplace. But what if the molester is a more or less aware patient? – It’s completely different. We are dealing with harassment in the workplace, but the perpetrator is either the patient or the client. Nevertheless, the consequences for the victim are similar. Even after twenty years, the experience of molestation in many physical therapists is traumatic. It is the greater, the greater the lack of support from superiors – explained the author of the American study Jill Boissonnault. She added that superiors intervene too late or not at all. Additionally, there is a lack of training to deal with inappropriate behavior on the part of patients. What can an injured physical therapist really do? Tell the perpetrator that he or she does not wish to make similar remarks or gestures? To object? For sure – we know that ignoring sexual harassment is often interpreted as consent. Only with whom is he to talk about it, if the employer can count mainly on the fact that the washing machine will sweep the problem under the rug?
For MedTvoiLokona, Dr. Agnieszka Stępień, president of the Polish Physiotherapy Association
It is difficult to assess whether the problem of sexual harassment affects as many physiotherapists in Poland as in the United States, because no large-scale studies have been conducted in this area so far. The problem does exist, but it is difficult to define it because it depends on many factors, such as age, personality, health condition, and the individual needs of patients and their expectations. The cooperation of a physiotherapist with an athlete requires a different approach and qualifications than cooperation with a child or teenager, a person with pain, brain injury, elderly or a client who uses the services of a physiotherapist for relaxation.
The specificity of the work of a physiotherapist often requires establishing a personal relationship with the sick person we deal with, penetrating into their life, learning about not only physical, but also mental and social limitations. Such close interaction, involvement of the physiotherapist, his touch may be misinterpreted by the patient.
Physiotherapists dealing with people with damage to the central nervous system and employed in SPA centers and massage parlors are mainly exposed to uncontrolled behavior on the part of patients. While unpleasant behavior on the part of people with cognitive impairment, in old age or with brain damage may be considered justified, humiliating treatment of a physiotherapist, depreciating his qualifications and requiring the service offered in SPA centers and massage parlors to be exceeded is reprehensible.
A completely different threat for the physiotherapist is the “dissatisfaction” and the demanding attitude of the patient or client who had excessive expectations. Therefore, any attempted sexual harassment must be reported to the employer and documented. Some insurance packages include the option of protecting physiotherapists from dissatisfied clients.
A physical therapist may become a victim of sexual harassment, but at the same time may be accused of crossing a certain line that is difficult to define. For this reason, clear boundaries in the relationship with the patient or client should be set so that the principles of professional ethics of the physiotherapist profession and respect for the dignity of both cooperating parties are followed.