Where’s the Consent?

The Case

The College received a complaint from a patient who was seeing a physiotherapist for shoulder pain.

Treatment initially focused on pain management and gentle exercises. As the patient’s symptoms improved, the physiotherapist introduced different techniques, including hands-on manipulation and stretching.

During one appointment, the physiotherapist stretched the patient’s neck and the patient experienced significant pain.

Although the patient did not clearly say “stop,” they later reported feeling confused about what was happening and whether they had agreed to it.

A review of the patient’s record showed they had signed a consent form at the beginning of treatment, but there was no evidence of ongoing consent.

The Standards

Health-care providers, including physiotherapists, are legally required to obtain patients’ informed consent to treatment. This requirement is also outlined in the Assessment, Diagnosis, Treatment Standard.

Physiotherapists must ensure patients understand the proposed treatment, including its benefits, risks and alternatives, and have the opportunity to ask questions.

Getting a patient to sign a consent form during their first appointment does not meet the requirements for consent. Consent should be an ongoing conversation that continues throughout assessment and treatment, and needs to be documented in the patient record.

A patient should never be confused or surprised by what happens during their appointment.

In this case, although the patient had signed a consent form, there was no evidence that ongoing consent had been obtained or documented as treatment evolved.

The Outcome

The committee decided to recommend that the physiotherapist review a variety of resources on consent and communication.

Resources