Case of the Month
The Case
The College received a complaint from a patient who attended physiotherapy to address issues with posture from degenerative disc disease and stenosis. The patient expressed concerns with the assessment, diagnosis and treatment they received from their physiotherapist, as well as the PT’s communication skills.
Treatment goals for the patient included reducing their mid-thoracic pain and a home exercise plan. In pursuit of these goals, the treatment plan included working on the patient’s range of motion, stretching and strengthening, as well as modalities, soft tissue technique and manual therapy as needed to relieve pain.
The patient found that the exercises were difficult and painful, even after the PT adjusted the home exercise plan. After receiving treatment, the patient couldn’t sleep due to severe back pain. The patient’s physician informed them that they had a torn muscle in their back that would require injections and further physiotherapy.
After they stopped treatment, the patient found out that their physiotherapist was a Physiotherapy Resident – something that they did not understand at the start of treatment.
The PT Resident believed they provided the patient with appropriate care based on the medical history, diagnosis and identified goals. The PT Resident also maintained that they obtained consent from the patient before each treatment session and that they took reasonable steps to ensure the treatment and exercises were safe and effective.
The patient record showed that the designation of “physiotherapist” appeared below the PT Resident’s signature. The PT Resident did sign the assessment form with a notation that could have indicated that they were a Physiotherapy Resident, but the notation was illegible.
The Standards
Physiotherapists (and PT Residents) should always communicate openly with patients to help them understand the treatment plan. This is also an important part of obtaining consent. In this case, the PT Resident acknowledged that they could have done a better job of ensuring that the patient understood the treatment plan.
Physiotherapists must ensure that they obtain informed consent for any treatment they provide or plan to develop. Informed consent is more than just a signature on a form – it requires having a discussion with the patient about the proposed treatment, the risks of the proposed treatment, its benefits, and any alternatives that are available to the proposed treatment. The clinical record included a signed consent form as well as documentation that verbal consent was obtained on several occasions, however the patient did not fully understand the treatment plan or the role of a PT Resident. The PT Resident should have had a more fulsome discussion with the patient so they could better understand what they were consenting to.
Regarding assessment, diagnosis and treatment – any treatment provided by physiotherapists should be clinically justified and for treatment to be clinically justified, it must be necessary or potentially beneficial to the patient. Excessive or unnecessary treatment is unacceptable. Physiotherapy is a healing profession and patient safety should always be at the forefront of any physiotherapist’s approach to patient care.
The Outcome
It is unfortunate that the patient did not find their physiotherapy treatment to be beneficial, however in reviewing all the available information, the Committee did not find any concerns related to treatment or patient safety. The treatment plan appeared to be clinically indicated and the PT Resident took steps to ensure patient safety, including adjusting the home exercise plan.
Regarding other aspects of the complaint including communication, consent and the use of the Physiotherapy Resident title, the Committee determined that the PT Resident would benefit from advice and recommendations. Notably, the PT Resident must ensure that patients understand their role as a physiotherapy resident and have enough information to understand and consent to the treatment plan.
Restricted Titles, Credentials and Specialty Designations Standard
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