Julie Entwistle, C.Dir. (c), MBA, BHSc (OT), BSc (Health / Gerontology)
In my previous blog, “Client Consent in Health Care — No Means No,” I spoke of the importance of client consent. No means no. But what is often forgotten in health care, is that consent goes both ways. While a client has the right to “choose their provider,” this just means they can decline to be treated by, say, me. Or the next person. But that doesn’t mean they can go down a random roster of professionals to find the best fit. Why? Because their ability to “choose their provider” is trumped by the provider also being able to “choose” them as well.
There are three main situations when a provider may say “no” to a client:
Skills and Availability – The provider would be expected to decline if they lack the skills, knowledge, or expertise (“the competencies”) to treat the clients’ presenting problems. Taking on a client outside their skillset is unsafe for them professionally and for the client and their outcomes. This also applies to them already having a full complement of clients such that they don’t have the space to do the work within what is needed or expected.
Conflict – Providers cannot consent to provide services to someone if this places them in a conflict, which can happen if they know the individual, or if being their provider would violate an employment agreement or contract (i.e. if you meet them at Company A, you can’t then work with them at Company B). If the provider indicates a conflict, even if it seems minor to others (i.e. “I knew them in high school”), this must be respected. Note that the nature of the conflict does not need to be disclosed. Saying “I am in conflict” is enough.
Safety – The provider can also decline if providing services would be unsafe for them (physically, emotionally, environmentally). While some jobs are inherently unsafe by nature, health professionals are not required to put themselves at risk when working. This is especially true in the community where we are isolated and not protected by the surroundings of say a hospital or clinic space, where there are others (and buttons) to aid us quickly if needed.
As I said before, consent is a deal-breaker. Always. As occupational therapists, there are rules, laws, and regulatory matters to consider before taking on any client. Working with vulnerable and exposed people (emotionally, mentally and physically) requires providers to take consent seriously and this goes both ways when clients choose us, and when we choose them.