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Ethical Dilemmas 5

Ethical Dilemmas 5

Lowell Baxter has completed three weeks of physical therapy after suffering from a back injury. While unable to work, Lowell has been going three times a week to see therapist Eve Nye who has been working for three months at a new clinic and is still learning the ropes.

After Mr. Baxter's ninth treatment, his physician, Dr. Felton Cranz, explained that he had made good progress. Lowell no longer needed PT (physical therapy) but was unable to return to his physically demanding job. He continued the home exercise regimen that Ms. Nye had given him. Dr. Cranz, who was not adverse to ordering additional physical therapy if necessary, told Lowell to call him if he had any further problems.


One month later, Mr. Baxter called Dr. Cranz's office and told the nurse that there had been "a flare up" in his lower back. After talking with the doctor, the nurse called Lowell and told him that Dr. Cranz ordered another round of PT, 3 times a week for 3 weeks, which he should begin right away.


During his third session, while telling Eve about his recent activities, Lowell mentioned that on a rainy night, while coaching his daughter's soccer team, he slipped and fell. He said that this happened "a couple of days" before the "flare up". Eve asked if he told his doctor about this latest fall. Surprised at the question, Lowell replied, "Well, no. Why would I? Anyway, I was having some painful twinges in my back before I slipped. Besides I fell on the soft grass. I'm sure I didn't hurt myself when I slipped. Dr. Cranz is always so busy and I don't need to waste his time with this. He told me after I finished my sessions a month ago that I might need another round of PT anyway. I feel better after our therapy sessions.” And then he changed the subject.


Mr. Baxter complained of increased pain with radiation down his left leg when he saw Ms. Nye on his fifth visit. During her evaluation, Eve concluded that his pain was different from the pain he experienced after the first fall and was almost certainly related to the second fall. She explained this to Lowell and suggested to him that he talk to his doctor to ensure that he received the appropriate treatment. However, Lowell kept insisting that he didn’t want to bother his doctor with this.


On his seventh visit, Mr. Baxter is visibly fatigued and short-tempered. He complains of weakness and numbness in his left leg. Eve strongly encourages him to talk with Dr. Cranz, but he still refuses.


Ms. Nye suggests talking with Dr. Cranz instead of him and telling him about Lowell’s fall at the soccer game and the onset of numbness and weakness in his leg. "No," blurts Mr. Baxter. "I don't want you to say anything. It's none of your business! This is my injury, and I don't want to bother him with this. You have to respect my wishes. Your job is to do therapy; not to interfere. Now, let's get on with it!"



  • What should Eve Nye do now and why?
  • What could Eve Nye have done earlier?
  • If you were a physical therapist, how would you have dealt with Lowell Baxter?


Prepared By: Dr. Mehyar Al-khashroum
Edited By: Miss Araz Kahvedjian

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