Professional conduct, ethics, boundary issues, and mandatory reporting
What this domain tests
This domain tests professional judgment when clinical skill is not the issue: conflicts of interest, patient boundaries, honesty, and legally required reports. Questions often place the therapist in a small-community or social-media situation.
Core rules and concepts
- The PT owes the patient a fiduciary duty: put the patient's interests first, be honest about fees and services, and avoid exploiting the therapeutic relationship.
- Sexual contact with a patient is prohibited. Romantic or business relationships that create a conflict, dual relationships that impair judgment, and gifts that create obligation are boundary risks. Social media contact should not blur the professional relationship or disclose patient information.
- Mandatory reporting includes suspected child abuse or neglect and suspected adult abuse, neglect, or exploitation under New Hampshire law. Licensees must cooperate with Board investigations and must not promise confidentiality that would prevent a required report.
- When a boundary issue arises, set limits, document objectively, consult a supervisor or the Board, and transfer care if the relationship cannot remain professional.
Worked example
A long-term patient gives the PT an expensive watch after discharge. Accepting it could create an obligation and blur boundaries. The PT declines politely, explains the professional boundary, and documents the conversation without shaming the patient. If the patient persists or the relationship becomes personal, the PT should consult and consider ending the professional relationship appropriately.
Traps that cost marks
Do not treat a boundary crossing as harmless because the patient initiated it. Do not disclose patient information in a public social media post even without a name. Do not delay a mandated abuse report to investigate personally.
Exam focus
Identify the duty first: patient welfare, honesty, confidentiality, boundary protection, or legal reporting. Then choose the least intrusive action that protects the patient and complies with the law.