Standard
The physiotherapist must identify, avoid or otherwise mitigate, and disclose any real, potential, or perceived conflicts of interest.
Expected outcome
Patients can expect that the physiotherapist delivers physiotherapy services that are in patients’ best interests and that real, potential, or perceived conflicts of interest are avoided or mitigated and disclosed.
Performance expectations
The physiotherapist:
- Identifies situations of real, potential or perceived conflicts of interest involving themselves or someone with whom they have a close personal relationship.
- Does not enter into any agreement or arrangement that prevents or could prevent the physiotherapist from putting the needs and interests of the patient first.
- Does not participate in any activity which could compromise professional judgment. Examples include, but are not limited to:
- Paying for or providing other benefits to other parties in return for referrals.
- Providing referrals to other parties in return for payment or other benefits.
- Contract terms which incentivize the sale of physiotherapy products or non-physiotherapy services by the physiotherapist, by providing financial or other benefits to the physiotherapist for doing so.
- Contract terms which incentivize the physiotherapist to discharge patients following a specified number of visits in return for financial or other benefits without regard for patients’ best interests and beyond their customary reimbursement for providing physiotherapy care.
- Contract terms which include financial or other benefits if the physiotherapist provides more than a specified number of treatment sessions to a patient.
- Self-referring existing patients to their own services without ensuring transparent disclosure to the patient and offering alternative options.
- If selling products, must inform the patient that they have the option to purchase the product from another supplier, and that their choice to do so will not affect their physiotherapy services.
- Avoids participating in other activities that a reasonable person would conclude pose a real, potential, or perceived conflict of interest.
- In situations where a conflict of interest cannot be avoided, the physiotherapist must take steps to mitigate the conflict by:
- Providing full disclosure of the conflict of interest to patients and others as appropriate,
- Making the patient aware of practical alternatives if there are any, and
- Documenting in a complete, transparent, and timely manner how the conflict was managed.
Definitions
- Conflict of Interest
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When a reasonable person could conclude that the physiotherapist’s duty to act in the patient’s best interests while exercising their professional expertise or judgment may be affected or influenced by competing interests or relationships. Competing interests may be financial, non-financial, or social in nature.
A conflict of interest may be actual, potential or perceived and can exist even if the physiotherapist is confident that their professional judgment is not being influenced by the conflicting interest or relationship.
- Close personal relationship
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Where the physiotherapist’s ability to be objective and impartial, and to fulfill their professional obligations may be impaired due to the nature of the personal relationship. Close personal relationships typically exist between an individual and their romantic or sexual partner, children, parents, and close friends, but may also exist between individuals and other relatives, business partners, past romantic partners and others.
- Financial gain
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In the context of physiotherapy practice and conflict of interest, financial gain refers to instances where physiotherapists receive financial benefits beyond their customary reimbursement in return for specific and preferential transactions, arrangements, or recommendations. Examples include reimbursement in return for providing referrals to others, receiving kickbacks from products or non-PT service sales, and receiving financial bonuses that are contingent on achieving specific, inflated billing targets.
- Mitigate
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Proactively taking action to lessen the impact or severity of any real, potential, or perceived conflicts of interest to the greatest extent possible. Physiotherapists must ensure that patient interests are protected and any conflicts that could compromise quality of care are addressed effectively.
- Other benefits
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Include but are not limited to: gifts of materials or equipment (beyond gifts of a token or cultural nature that are of insignificant monetary value), preferential access to facilities, or provision of promotional activities that would typically be paid for by the physiotherapist, that have the potential to harm or affect patient care, professional judgment and/or trust in the profession.
- Referral
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A recommendation or direction that a patient seek care or services from another provider or specialist. This includes self-referrals where a physiotherapist refers existing patients to their own services, for example in another practice setting. Referrals are not limited to the formal process of directing a patient to a medical specialist.