What You Say and How You Say It

The Case

The College received a complaint from a patient who expressed concerns with the way their physiotherapist communicated with them. The patient attended two physiotherapy appointments, where the physiotherapist made several comments that made the patient feel uncomfortable.

During the assessment, the PT was testing the patient’s wrist and said to the physiotherapy resident who was observing the session: “this patient is loosey goosey.” The physiotherapist then clarified that they didn’t mean “that kind of loosey goosey.”

During the same appointment, the physiotherapist commented on the patient’s long legs, asked the patient if they were a gymnast, and told the patient that they were too tall. All of these comments made the patient feel very uncomfortable.

During the second appointment, the physiotherapist took the patient’s temperature in the waiting room before starting the appointment, in accordance with COVID restrictions at the time. While standing directly in front the patient, the physiotherapist said: “I can see it your eyes that something is bothering you.”

Later while the patient was sitting with a hot pack on their back during treatment, the physiotherapist placed their hand on the patient’s shoulder and said: “There is something bothering you, I can see it.” The physiotherapist then said: “What am I going to do with you? Hit you with a sledgehammer.”

The patient decided to stop seeing the physiotherapist after two appointments. The patient said the physiotherapist made them feel uncomfortable and didn’t communicate with them in a way that was respectful or professional.

The physiotherapist said they were deeply apologetic that the patient felt uncomfortable following treatment, but the PT also said that their comments were misinterpreted and taken out of context. The physiotherapist did not intend for the comments to be harmful or disrespectful.

The Standards

The importance of open, transparent communication with patients cannot be stressed enough. Effective communication is key in setting and maintaining appropriate boundaries within the therapeutic relationship, as outlined in the Boundaries and Sexual Abuse Standard.

Physiotherapists should use patient-centred language based on the patient’s needs and sensitivities. Physiotherapists should use plain language, so the patient understands what the PT is trying to convey. In this case, a misunderstanding could have been avoided if the physiotherapist used language that was more clinically oriented or explained why they were asking certain questions.

The patient was uncomfortable with the physiotherapist repeatedly asking what was bothering them, particularly when the physiotherapist was standing in close proximity. The physiotherapist indicated that they were using the “Biopsychosocial Model” of treatment, which is commonly used for patients with chronic pain and is based on the idea that to understand a patient’s medical condition, practitioners should consider psychological and social factors as well as biological factors. However, it is important to note that the physiotherapist didn’t explain this treatment model to the patient and the clinical record didn’t include any information about these conversations.

There are key components to effective communication including using plain language to explain what’s happening and why, being culturally sensitive, giving the patient the opportunity to ask questions, taking time to confirm understanding with the patient, and being mindful of body language. In accordance with the Record Keeping Standard, these conversations should be documented in the patient’s chart.

The Outcome

The Committee determined that the issues were significant enough to require that the physiotherapist participate in a Specified Continuing Educational or Remediation Program (SCERP) focused on communication, professionalism and record keeping.

All costs associated with the SCERP will be paid by the physiotherapist, and a summary of the SCERP will be posted on the Public Register.

Boundaries and Sexual Abuse Standard

Communication Skills

The Power of the Unwritten Standard

Record Keeping Standard