Bosses sometimes ask therapists to treat patients who refuse care, don’t need it or are in advanced stages of illness, therapists say.

Recent interactions with OT colleagues in distress have left me wondering just how widespread the extreme pressure for productivity is. An Aug. 16 article in the Wall Street Journal provides some answers.

The article said the rate of classifying Medicare patients as recipients of ultra-high therapy (at least 720 minutes per week) has increased from just 7% in 2002 to a whopping 54% in 2013. The article stated many of these older adult patients are too frail to tolerate intense intervention, as their therapists are well aware.

I have been communicating with OTs across the country who are anxious because they are pushed to take actions they know are inappropriate and try to compress too much work into too little time. I know I’m preaching to the choir here, but I am compelled to state the obvious when things are going off the tracks for so many of us.

The Wall Street Journal story highlights a tragic case in which a frail 96-year-old man with dementia was the recipient of ultra-high therapy. If the report is accurate, the patient went into medical crisis and died weeks after being hospitalized for dehydration. I was mortified to read excerpts from the OT and SLP records that reflected how ill and disabled this gentleman was.

My heart goes out to those therapists. Although I don’t really know their side of the situation, I imagine they are like so many others across the U.S. who must follow rigid protocols and productivity demands. The article references interviews with healthcare providers and administrators across 17 states who indicated they had been pressured to reach the 720-minute ultra-high therapy level.

I know that many of us are hugely pressured to do as we’re told, as if we have no expertise or code of ethics. We worry about breaking the law by not delivering every minute of the therapy that has been prescribed, and by making errors in its documentation. We are threatened with write-ups and job termination.

But here’s the thing: You are an expert, and you have been educated and credentialed to evaluate and provide appropriate intervention and care to your patients. You do have ethical obligations to always put your patients’ best interests first. It’s right there in our Code of Ethics, and it should be engraved on our hearts. Honestly, I don’t worry nearly as much about the defraudment of Medicare as I do about the harm done to our patients, and the harm done to my colleagues by these circumstances.

I hope the Wall Street Journal and other news sources will continue to inform the public and our lawmakers about these kinds of issues. Patients and families should ask their professional care providers for guidance about plans they feel are more about revenue than compassion and quality care. We as care providers need to be sources of information and advocacy for our patients and their families.

For more, visit Consensus Statement on Clinical Judgment in Healthcare Settings by AOTA, APTA and ASHA.