Physical therapists (PTs) have the opportunity to enter into longstanding treatment relationships with patients that are built not only on providing exceptional care but also on trust and mutual respect. With trust comes responsibility, however. Consider the following scenario and what constitutes responsible action by the PT.

Operation: Dodge

Jim has worked for 20 years as a PT at an outpatient clinic that is a satellite facility to the local hospital. While he sees many patients for just 1 episode of care, he also has a sizable clientele who he jokingly calls "my repeat offenders"—individuals who return to his care periodically over the years for help with new issues or when old ones flare up.

Carol is such a patient. She’s been seeing Jim since shortly after he started working at the clinic. She initially was referred by her primary care physician for pain in both knees—the left worse than the right, stemming from many years on her feet as a waitress, and before that from some tumbles she took during her days as a high school cheerleader. She’s always been a model patient—cheerful and faithfully adherent to Jim’s plan of care—but she has continued to wait tables, and it has taken a toll on her knees. Carol has been referred back to Jim essentially annually for flare-ups of pain and gradually increasing dysfunction. For years, her physician has been urging her to see an orthopedic surgeon, but she has resisted doing so—fearing that he or she might recommend surgery and insisting, at any rate, that "Jim always fixes me up."