Just Making Conversation

The Case

The College received a complaint from a caregiver of a patient who was referred to physiotherapy by their physician. The complaint detailed concerns with the physiotherapist’s professionalism and communication.

The caregiver attended the physiotherapy appointments with the patient and noted that the PT asked the patient a number of questions about their aspirations, interests and hobbies. They also indicated that the physiotherapist questioned the physician’s diagnosis, but still recommended that the patient attend physiotherapy appointments twice a week.

The caregiver said the patient became increasingly uncomfortable with the physiotherapist over the course of the appointments because they felt that the PT asked them too many personal questions, they did not adequately explain the diagnosis or treatment, and the appointments went longer than scheduled.

The patient and caregiver ultimately called the clinic to cancel the remainder of the appointments, citing a family emergency. After hearing of the cancellations, the PT called the patient later that evening to follow up, which the caregiver and patient found highly inappropriate.

The physiotherapist indicated that they asked the patient a series of questions to try and build trust and establish a positive therapeutic rapport. They also clarified that they called the phone number on the intake form without realizing it was the patient’s personal number. They acknowledged that making that call in the evening after their shift could make the patient uncomfortable.

The Standards

As part of an effort to build and maintain rapport and trust (which are key components of patient-centred care), physiotherapists will often engage their patients in conversation. However, PTs must always ensure that their patients are comfortable and that professional boundaries are maintained.

As outlined the College’s Boundaries and Sexual Abuse Standard, physiotherapists must recognize that each patient’s boundaries will be unique to their own experiences, including their culture, age, values, or experiences of trauma. Although the PT indicated that it is normal practice for them to engage patients in casual conversation, they acknowledged that they should have been more attuned to the reactions from this patient and adjusted their approach accordingly.

It’s important that physiotherapists use clear and effective communication to manage patient expectations about physiotherapy assessment and treatment. In their response, the PT identified areas where their communication could be improved, including appointment duration.

Although the physiotherapist called the only number that was included on the intake form to ask about the cancelled appointments, they should have considered how the timing and circumstances may have been an issue. Communication with patients regarding non-urgent matters is best conducted during regular business hours.

The Outcome

In reviewing the patient record the Committee didn’t identify any concerns with the assessment or treatment of the patient, however the Committee fully appreciates the sentiments and opinions of the patient and their caregiver concerning their comfort with the physiotherapist.

Upon self-reflection, the physiotherapist acknowledged areas of practice specifically related to boundaries and communication that they plan to work on.

The Committee provided the physiotherapist with advice and recommendations to strengthen their practice in these areas, including a comprehensive review of College resources and the completion of associated learning modules.

Boundaries and Sexual Abuse Standard

Boundaries and Sexual Abuse Standard E-Learning Module

Communication Skills