Case of the Month
The Case
The College received a complaint from a patient who indicated that while attending physiotherapy to treat an existing injury, they sustained additional injuries. The patient reported that the physiotherapist made them do exercises that were unnecessary and that they felt uncomfortable completing.
During the assessment, the physiotherapist asked the patient to step on and off a stool that was approximately six inches off the ground. The patient told the physiotherapist that they were afraid of heights and expressed concerns about completing the exercise.
The PT suggested that the patient hold their arm for additional support, but the patient lost their balance and fell off the step stool, injuring their foot. The patient believed the stool was unstable, causing the fall.
The PT told the patient that another appointment was waiting, so the patient paid their invoice and left the clinic. After returning home, the patient noticed bruising and swelling around their foot. The patient believed the PT rushed them out of the clinic to accommodate the next appointment and was “unprofessional” regarding the injury.
After cancelling their next physiotherapy appointment, the patient went to the hospital where the emergency room doctor diagnosed them with a fractured foot.
The physiotherapist explained that the patient fell while performing a functional test to assess leg control. They further noted it was difficult to determine what caused the fall as it happened quickly. The PT asked if the patient hit their head during the fall and encouraged them to rest. Although the patient mentioned pain in their foot, the physiotherapist did not think much of it at the time and did not want to keep the next patient waiting. The PT acknowledged that they did not follow their clinic’s policy to address adverse events.
The Standards
It is the responsibility of the physiotherapist to monitor a patient’s physical and emotional response throughout care. They must identify and respond to adverse events in an appropriate way that supports the overall wellbeing of the patient.
While the PT acknowledged that there is a plan to address adverse events at the clinic, they did not follow the plan with this particular patient.
Effective communication is key in adopting a patient-centred approach to physiotherapy care. The lack of communication from the PT following the incident made it challenging to understand the patient’s injury, and negatively impacted the level of trust in the therapeutic relationship. While the PT asked the patient if they hit their head, no further questions were asked to determine the severity of the injury or assess the patient’s wellbeing.
The Outcome
While the College was not concerned with the step test itself, there were significant concerns about the lack of professionalism from the physiotherapist following the incident.
Further, the PT did not appropriately identify and address an adverse event and the patient left the clinic on a fractured foot.
The College determined that these concerns were significant enough to require a Specified Continuing Education and Remediation Program (SCERP). All costs associated with the SCERP will be paid by the PT. The physiotherapist will also receive a caution that will appear on the Public Register.
PTs should always ensure that safety of the patient comes first. If a patient expresses personal concerns over an exercise and does not feel that they are capable, the PT should ensure that the patient either carries out the exercise in a different manner, or chooses an alternative that is safer for the patient
Expressing respect for patients’ autonomy is a key in adopting patient-centered approach to physiotherapy care. In the example above, when patient expressed their concern about being afraid of height and not feeling comfortable performing the step stool test, PT should have not proceed further and would have respected patient’s decision.
What happened after the incident is also concerning as PT did not show any empathy, concerns or ensured that patient was able to ambulate and is safe to leave the clinic.
PT failed to perform effective communication with the patient that lead to mistrust in PT by the patient.
Safety for incoming patients is a priority for PTs, in addition to informed consent with the patients having knowledge of withdrawal of treatment at anytime.
Clear communication about the purpose of assesment is essential component of effective treatment. PT should explain the patient that this test will help him in designing a appropriate treatment plan. Also PT should address patient’s concern and provide alternative to the test or exercise. Additionally PT failed to manage adverse event and rushed the patient home without showing basic courtesy.
it is important to consider the safety of patient and monitor exercise therapy in a safe side according to ability of patients in order to avoid any other injury to patients during treatment.
Here, as pt mentioned afraid of height and not enough confident for ex where PT must have brought in different test/ ex to accommodate pt’s ability, as PT we must respect and know how is pt feeling at present moment and decide or modify treatment during session.
Good communication skills: showing basic courtesy, listening to the client and be clear about what the PT is going to assess, what are the benefits and risks of the PT assessment and taking precautionary steps to avoid any injuries during the assessment followed by planning the treatment protocol accordingly and confirming the client’s understanding about the same might be helpful in this case.
Clear communication and active listening skills by the PT could have prevented the foot fracture. When the Pt reports being afraid of heights, the PT is not to assume what heights the Pt would be afraid of and should have concerned the step a significant height.
Communication and understanding patient’s capability is important . There is lack of professionalism is this case . Patients with balance problem need constant supervision through out their assessment and Rx , even on their way out of Rx area to front door . Patient Fall should be addressed properly with proper documentation and communication with Patient .
PT should always ensure safety measures followed while doing an assessment or exercises. Always ensure and should ask the pt is okay and comfortable/perform to do, if pt express concerns or difficulty to do them, addressing the issue is the important thing for a PT and should opt for alternative method. It shows that therapeutic Relationship will negatively impact on the trust level.
In this case, it clearly shows PT didn’t fulfill the responsibilities such as safety measures during the intervention, communication skills – lack of showing basic courtesy, not listening to the pt concern and was not being clear with pt about risks and benefits in the treatment.