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What’s Vaccination Got to Do with It?

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By: Richard Steinecke, Counsel at Steinecke Maciura LeBlanc (SML) Law

A new patient enters a clinic wearing a double mask, gloves and a face shield. The patient says: “I desperately need to see a physiotherapist. Has everyone here been vaccinated with Pfizer?”

How should you respond?

As tired as we are of hearing it, COVID-19 is somewhat unprecedented. The approaches that physiotherapists might have taken to other transmissible diseases, such as influenza, likely do not apply, at least not in exactly the same way.

Generally, physiotherapists are not required to disclose their own health status. Personal health information is highly personal and human rights principles usually allow practitioners to keep it private. Most of the time a physiotherapist is not required to provide this information to a patient. (Whether an employer can require such disclosure is a complex legal issue that is beyond the scope of this article.)

However, there may be some exceptions to this general principle. For example, a particularly vulnerable patient who will be receiving treatment that involves extended periods of exposure in a confined space in a context where COVID-19, or a particularly transmissible variant of it, is prevalent in the region at the time. Or in instances where the physiotherapist may have been exposed to COVID, the patient may be entitled to receive disclosure about vaccination status as part of the informed consent process (i.e., where there is a reasonable risk of harm to the patient).

Physiotherapists are expected to exercise professional judgment based on the latest scientific evidence, public health guidance and the specific circumstances.

Another potential circumstance is that soon there is likely going to be an assumption by patients that all practitioners who assess and treat them are vaccinated. In some circumstances this could result in a proactive duty to notify the patient if you are not vaccinated, even if they do not ask. The College cannot provide definitive rules about this, especially since circumstances relating to the pandemic continue to change so rapidly.

Where disclosure is not required, physiotherapists may voluntarily choose to tell patients or otherwise make their vaccination status public. Such disclosure may provide some reassurance to patients and help build rapport with them. However, how such disclosure is made is important. The disclosure should not suggest that vaccination is within the scope of practice or expertise of physiotherapy. Nor should it involve inaccurate or unverifiable statements.

For example, advising a patient who has immune disorder that a vaccination will be effective for them is not appropriate. Further, a statement that because you are vaccinated there is no chance that you can transmit COVID-19 to patients would not be supported by public health information available at the time of writing.

Careful consideration should be given to how disclosure about vaccination status can appropriately be made on social media. Statements should be factual. Statements should not assert superiority over other physiotherapists because of your vaccination status. While greater latitude (e.g., expressions of relief or joy) might be given to personal social media platforms to which patients do not have apparent access, a suitable degree of professionalism should accompany posts on platforms associated with your practices or platforms that patients might follow.

Similarly, physiotherapists should not disclose their unvaccinated status in a way that is inconsistent with public health guidance or currently available evidence. For example, a physiotherapist may tell a patient who asks that they are not vaccinated, however, it would not be appropriate to advocate, explicitly or implicitly, against vaccination to individual patients or on social media. Even if your professional status does not accompany a post on social media, viewers can usually ascertain that you are a physiotherapist.

Physiotherapists need to be cautious in advising patients about vaccination choices because this topic is outside of the scope of practice and expertise of physiotherapy. A factual statement of public health guidance along with a referral to additional resources after providing a disclaimer about the scope of practice and expertise of physiotherapy can be acceptable. However, expressions of personal opinion or the giving of apparent professional advice would be inappropriate. Even providing the reasons why you were or were not vaccinated can come across as providing a professional opinion.

If a patient wants to transfer their care because of your unvaccinated status (or because you decline to reveal your status), you should ensure a smooth transition including providing a copy of your records as promptly and easily as possible.

The above situation also raises interesting questions.

When can a PT ask a patient about their vaccination status? A patient should only be asked questions about their health status if it is relevant to their care.

How is the information relevant to the patient’s care? Often the information will be irrelevant to physiotherapy assessment and treatment. As a human rights matter, patients are entitled to care regardless of their vaccination status. If usual screening and universal precautions are adequate for the context, then there is no need for you to ask the question. Patients should not be stigmatized for their vaccination status. However, exceptions might exist where the best, recent scientific evidence is that physiotherapists should employ additional precautions (beyond usual screening and universal precautions) for unvaccinated clients. Then the information could be relevant.

The College is not asking physiotherapists to disclose their COVID-19 or vaccination status to the College for monitoring purposes. The College presumes that PTs will act appropriately if they have likely exposure to, demonstrate any symptoms of, or have been given a diagnosis related to COVID-19.

COVID-19 Vaccination FAQs

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Public Comments

  1. “Further, a statement that because you are vaccinated there is no chance that you can transmit COVID-19 to patients would not be supported by public health information available at the time of writing.”

    “However, exceptions might exist where the best, recent scientific evidence is that physiotherapists should employ additional precautions (beyond usual screening and universal precautions) for unvaccinated clients.”

    The college is contradicting itself, in the second statement, it is suggesting that the vaccination status of the pt will affect transmissibility of the virus and that PT should take additional precautionary measures if they are unvaccinated.

    Please explain,

    Thank you

  2. Hi John

    Thanks for your question. Please contact the Practice Advice team and they would be happy to provide further clarification. They can be reached at 1-800-583-5885 (extension 241) or by email at advice@collegept.org.

  3. Considering the adverse reactions post vaccination that have been reported through VAERS including blood clots, Bell’s palsy, neurological issues, it seems to be in the patient’s best interest that the physiotherapist inquires about recent vaccination when taking patient’s history. I assessed patients that developed radiculopathy, had acute episode of sciatica, had an enlarged calf with a negative Homan’s Test to name a few. All these happened within 2-7 days post vaccination and were always on the side of the inoculation.

    All these do come under physiotherapist’s expertise and differential diagnosis is important.

  4. Hello,

    I believe John’s question above deserves an open written response for everyone to see. That would be in my opinion an expected part of an open discussion. A question asked in a polite and professional way deserves an answer.

    We can all learn from a dialogue.

    Thank you.

  5. Hi Nicole,

    Thanks for your comment. As part of your assessment and gathering of subjective information, it is good practice to ask the patient if anything has changed since the last time you saw them, or if there is anything impacting their health that could influence your approach to treatment.

  6. Regarding, “When can a PT ask a patient about their vaccination status? A patient should only be asked questions about their health status if it is relevant to their care.” Isn’t all health related information relevant to all healthcare providers? We, for example, take thorough health histories on every patient we see so that we can properly and thoroughly understand their health status. No information is out of bounds and we can’t determine any information’s relevance until after we hear the information. Additionally, we have been required to ask every patient COVID-19 related questions at every visit over the last year and the vaccine question is the most relevant COVID-19 question. As a result, it seems like there is never a time when the vaccine question is irrelevant to clinical practice as a physiotherapist. So, based on this information, can more clarity be provided when it might be or would be inappropriate to ask a patient if they are vaccinated? I certainly can’t imagine any scenario in which that information is not in some way or another related to practicing as a regulated healthcare provider. Thank you.

  7. Vaccinated status does not mean that vaccinated practitioner is safer practitioner than one who is not vaccinated. Your suggestion that we should disclose our vaccination status to provide reassurance to patients implies that we should provide the patient false sense of security when in fact The current evidence is that vaccination protects only the person who is vaccinated (as it decreases the symptoms) and not in any way anyone else. Especially due to new variants constantly emerging. So providing our personal health information should not be suggested by the College in order not to contribute to misleading the public, especially during these very sensitive times.

  8. Hi Miriam,

    Thanks for your comment. To further clarify, the first comment highlighted by John is in regards to physiotherapists advising patients regarding vaccines. This is not within the scope of practice for physiotherapy. As such, physiotherapists may choose to disclose their vaccination status however, as noted in the blog, they should not make comments to patients about the efficacy or use of vaccines, such as the PT cannot transmit COVID-19 because they are vaccinated. A statement that individuals who are fully vaccinated cannot transmit the virus to others is outside the practice of physiotherapy and not currently supported by public health information.

    The second comment highlighted by John speaks to treatment of a patient who has disclosed that they are not vaccinated and the potential for physiotherapists to employ additional screening measures or precautions, if supported by scientific evidence and Public Health Guidance at the time. As of right now, physiotherapists must continue to follow all measures detailed in the College’s Return to Work guidance for all patients.

  9. Nicole, there is also a long history of orthopaedic manual therapy research related to the interactions of manual therapy and the autonomic nervous system (ANS). This is very important during COVID-times because the human body’s immune response is partially controlled by the ANS. Not only have vaccinations been repeatedly and consistently correlated with a temporarily increased risk of autonomic dysfunction, but the physiotherapy profession has long been used to help manage ANS symptoms. In fact, the ANS has been shown to play a minor or major role in a wide range of conditions including but not limited to: dysautonomia, POTS, T4 syndrome, diabetes, osteoporosis, RA, OA, chronic lower back pain, tendinopathy, ACL injury, acute surgical pain, Parkinson disease, spinal cord injury, MS, stroke, COPD, myocardial infarction, and sepsis. Why is this so important for physios? Well, if the vaccination (or an illness) can promote an ANS response and the ANS is linked to all of these relevant physio topics then it is 100% reasonable to expect that some patients with these conditions will have an exacerbation of their non-vaccine symptoms in the days/weeks after receiving the vaccination. I have seen this over and over again and my patients find it very helpful when I educate them about what the relevant research says. By educating patients about published scientific findings I am often able to decrease catastrophizing, which is an important way for physios to help control pain and other relevant variables. Stated otherwise, vaccine status cannot be separated from a thorough physiotherapy examination and management strategy.

  10. Wanting to know a healthcare provider’s vaccination status is potentially not just about issues related to potential transmission of SARS-CoV-2. For example, we purport to work in an evidence-based profession, which should mean that we keep up to date on scientific evidence and abide by it when working in the clinic. It is certainly true that much of the evidence in our profession is open to interpretation but the available evidence on the vaccine is far more specific and much less open to interpretation. As a result, it is completely plausible that a patient would justifiably not want to work with an unvaccinated healthcare professional. If that professional isn’t following expert advice on vaccination then maybe they also aren’t following other forms of expert advice within their area of clinical practice. Whether or not a healthcare professional is vaccinated could imply not only that they are not up to date on healthcare science but also that they don’t take the risk of getting COVID-19 seriously, which could in turn indicate that they are less likely to implement other public health recommendations that could keep them and their patients safe. While I have seen no scientific evidence regarding these particular variables, it is completely understandable if a patient decides to not work with a physiotherapist that is not vaccinated.

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