As a health regulator, the College exists to serve the public interest and ensure patients have access to safe, ethical, competent and equitable care.  

Along with supporting physiotherapists in the delivery of high-quality care, it’s also our job to investigate complaints or concerns about PTs who may be falling short of their professional obligations.  

In this month’s blog, we go over some trends in the types of complaints we see and share essential takeaways.  

Communication Is Key  

Most of the concerns we receive at the College involve an element of a breakdown in communication.  

In many of these cases, the patient walks away from a session with a physiotherapist feeling like they haven’t been heard or that they didn’t know what the physiotherapist was going to do and why.  

When we hear from the physiotherapists who are the subjects of these complaints, they sometimes talk about an approach to care that feels more directive as opposed to collaborative. 

Inadequate communication can put patients at risk, especially when treatment is near sensitive areas like the groin or breasts.  

In these cases, additional communication, ongoing consent and appropriate draping are essential to ensure the comfort and safety of the patient. 

For those looking to refresh their skills in this area, the College’s module series, Transitioning to Practice In Ontario, includes excellent resources on consent, person-centered care and patient safety.  

Avoid Bad Business Practices 

The College continues to see business models where a physiotherapist is being included in the model of care because of their access to third-party insurance benefits. 

For example, physiotherapists may not be involved in the initial assessment of a patient, or their involvement may be limited. We are seeing more assessments happening virtually, which can be an excellent way to support the delivery of patient care. However, in some cases, the assessment is too generic and there is no follow up at all by the PT.  

As a reminder, physiotherapy care must include an assessment. Assessments cannot be delegated to a physiotherapist assistant. Physiotherapists are also responsible for communicating a diagnosis, developing a treatment plan, monitoring, re-evaluating and documenting a patient’s responses throughout the course of treatment and changing the treatment plan as necessary.  

Personal Training Is Not Physiotherapy  

The College still sees cases where physiotherapists are working in gyms or fitness centres, but care of their patients is being driven by a personal trainer or a business owner who is not a regulated healthcare professional.  

In some cases, the physiotherapist will do an assessment, then provide a vague and insufficient diagnosis like “lack of core strength.” 

When we look at the patient record, it’s a physiotherapist assistant (for example a personal trainer) who is leading the treatment. When the patient gets worse or is not progressing, there is no reassessment by the physiotherapist. All of this care is billed under the physiotherapist’s name and registration number. 

In some cases, patients attend sessions after suffering a new injury and are still not assessed or reassessed by a PT. 

This kind of arrangement clearly does not meet the requirements of the Working with Physiotherapist Assistants Standard and the Assessment, Diagnosis, Treatment Standard.  

Key Reminders 

1. Ensure you know the physiotherapy scope of practice and you are working within it.  

2. Make sure you do the assessment, use clinical reasoning to determine the physiotherapy diagnosis, and work collaboratively with your patient to establish meaningful goals and determine an evidence-informed treatment plan. Physiotherapists should be doing re-assessments in general, but especially when their patient isn’t progressing or perhaps their condition is getting worse. Physiotherapists should be preparing their patients for discharge and talking about this, so the patient isn’t surprised when it happens. 

3. Communicate effectively and get consent in an ongoing way. Ensure there is appropriate draping and look for verbal and nonverbal cues regarding discomfort. 

4. Invite feedback from patients on the care they received. 

5. Regularly review the College’s standards to remain up-to-date and knowledgeable about the expectations so you can implement them in your daily practice. Call or email the College’s Practice Advisors if you have questions. They’ll be happy to help you.