The College received a complaint from a patient who was receiving care at a publicly funded clinic. The patient said he spent very little time with the PT and all his treatments were delivered by the secretary who would come into the room and apply a heat pack and IFC and then leave for 20 minutes. When he brought his concerns to the attention of the clinic manager he was told the PT would speak with him at his next appointment.  

The PT advised that the clinic is very busy as they treat a number of patients who have different funding sources including OHIP, WSIB, and extended health benefits. The PT said he completed a comprehensive assessment and then assigned the delivery of the treatment plan to the support person.

What is the College requirement?

A physiotherapist must have the patient’s (or patient’s substitute decision maker’s) consent to include support personnel in the provision of care, as outlined in the Standard. Patients have the right to make informed decisions about who provides their health care.

What happened?

The College launched an investigation into the registered PT and presented its findings to the Inquiries, Complaints and Reports Committee. The Committee reviewed all the information as was able to confirm that the assessment in the patient chart was thorough and the proposed treatment plan was reasonable and based on the clinical findings. The panel also confirmed there were significant issues identified by the complainant: 

• there did not appear to be any evidence the PT obtained the patient’s informed consent to involve a support person in the delivery of the treatment plan,
• it appeared the PT did not explain to the patient the relationship between the PT and the support person to clarify their respective roles and responsibilities in relation to the treatment plan.

The Eventual Consequences

The panel determined that a written caution was warranted in the circumstances. 

The caution highlighted the physiotherapist’s responsibility to:

1. obtain informed consent from each patient or his/her substitute decision maker for the involvement of a physiotherapist support person in the delivery of the physiotherapy treatment plan;

2. explain to each patient the relationship between the physiotherapist and the physiotherapist  support person for the purposes of clarifying their individual roles and responsibilities in the  assessment, reassessment and progression of the physiotherapy treatment plan.

Informed consent is a key foundation of accountable physiotherapy practice. Physiotherapists should always have a discussion with patients about who will be delivering their care. A notation to this effect must always appear in the patient record.