Communication Frustration

The Case 

The College received a complaint from a patient who was frustrated with the care they received at a physiotherapy clinic.  

The patient began attending physiotherapy appointments after injuring their back. Part of their treatment plan involved Interferential Current (IFC) therapy where four electrode pads were placed on their mid back.  

During one appointment, a physiotherapist assistant (PTA) placed the pads closer together than the patient was used to from previous appointments. The patient wanted the pads further apart, like a different PTA had applied them in the past.  

The PTA gave the patient a call bell and left the room. When the IFC machine switched off 20 minutes later, the patient rang the bell four times, but the PTA did not return to the room.  

The patient said they could hear the PTA on the telephone, scheduling patients. Frustrated, the patient took the electrode pads off themself. When the PTA came back into the room, the PTA told the patient they should not have taken the pads off on their own.  

The patient returned for another appointment a week later and told the PTA they didn’t want IFC treatment because of their concerns with the electrode pad placement.  

Instead, the patient requested that pain-relief gel be applied to their back. The PTA told the patient the physiotherapist would come speak with them shortly, then left the room, closing the door. 

The patient took off their shirt and lay face down on the treatment table. For the next 20 minutes, they waited alone in the room. Eventually, cold and with their back aching, the patient put their shirt back on and left the clinic without talking to anyone.  

When contacted by the College, the physiotherapist said they weren’t aware the patient was waiting for them in the treatment room that day.  

As far as the electrode pad placement, the PT said both PTAs had followed the treatment plan. Each applied the pads to the patient’s back as instructed, although they used slightly different placement techniques.  

The physiotherapist also said they always give patients an opportunity to discuss any concerns they might have before starting treatment and if the physiotherapist is not directly providing treatment on a given day, they still check-in with the patient either before, after or during the appointment.  

The Standards 

Many of the issues in this case likely could have been avoided if there had been better communication between the physiotherapist and the PTAs.  

The Working with Physiotherapist Assistants Standard establishes that a physiotherapist who assigns care to an assistant remains responsible for all of that care.  

As stated in the Supervision Standard, physiotherapists must ensure anyone they’re supervising has the knowledge, skills and judgement to deliver safe and competent care.  

Physiotherapists are responsible for the actions of the PTAs they supervise and how those actions impact patient care. For that reason, open communication between a physiotherapist and their assistant is essential.  

Strategies for placing electrode pads can be somewhat subjective. But when the patient raised questions, the PTA should have reached out to the physiotherapist to resolve the matter instead of just continuing with the treatment.  

It’s also concerning the PTA appeared to forget about the patient waiting in the treatment room during the second appointment.  

The Outcome 

The committee decided to recommend the PT review several resources on working with physiotherapy assistants to ensure they are fully aware of their obligations going forward.  

No record of the incident or the recommendation will appear on the Public Register.  

Details of this case have been changed to maintain anonymity.