"...Listening, but not hearing what he was saying, so he pinched her abdominal fat, and told her that 15-year-olds are not supposed to have that." 

The Situation

A 15-year-old patient went to her first physiotherapy appointment at a clinic for treatment of back pain. After meeting with the patient and learning her symptoms, the physiotherapist asked the patient to unzip her pants, lower them to her underwear line and lie on her side facing the wall. The PT explained that he was going to apply a machine to her back and that she would feel a sensation. He then reached across the young woman from behind and grabbed the middle of her stomach and said she was “too young to have that,” referring to an excess of abdominal tissue. 
 
Following the appointment, the young patient told her mother about what had happened and the next day she and her mother reported the incident to their family physician. A complaint was made to the College of Physiotherapists of Ontario. 
 
In his written submission to the College, the physiotherapist said that he told the patient to undo her pants so that he could attach electrodes to her lumbar spine as part of the interferential current treatment. He reported that he checked on her twice and explained what he believed to be the cause of her back problems.

The Consequences

While there is no dispute as to what took place as both the complainant and the PTs' stories aligned, the Committee believed that the physiotherapist’s behaviour and subsequent response showed poor judgement and a lack of professionalism.
 
Physiotherapists are required to maintain professional relationships with patients by using their knowledge and judgement, and this extends to effective communication strategies and interpersonal skills. 

If the physiotherapist believed that his patient’s excess weight was a factor causing her back problems, it was up to him to find professional way to convey this message. And while the PT maintained that excess weight contributed to this patient’s back pain, there was no objective assessment data found in her patient record to support his clinical finding. 
 
Another area of concern was that the physiotherapist did not have the patient’s consent to grab her stomach. Obtaining consent and thoroughly explaining what the patient could expect is required. 

The Committee was particularly concerned by the PT’s statement that he was “not guilty of anything but perhaps insensitivity for not sugar-coating my remarks about her adipose tissue.” This showed a clear lack of understanding of his professional obligations and a lack of insight into the seriousness of the situation. 
 
To address the concerns about the physiotherapist’s lack of professionalism, poor communication style and limited understanding of how to obtain patient consent, the Committee required the physiotherapist to appear before the Committee to be cautioned.