College Blog 

In the spirit of transparency, we encourage open debate and constructive criticism. For this to be effective, comments need to remain professional and respectful. Comments will be reviewed and posts that include personal attacks, unfounded allegations, unverified facts, product pitches, or profanity will not be published. 

Up Close and Personal

Mar 11, 2020

The Case

The College received a complaint from a patient who was referred to physiotherapy by the Workplace Safety Insurance Board (WSIB) claims process following an injury sustained at work. The patient attended a hospital-based program and participated in two independent assessments with a physiotherapist to clarify her diagnosis, make recommendations for treatment and develop return to work strategies.

During the first assessment, the patient was surprised that the physiotherapist asked many questions related to her mental health and psychological state. The patient noted that she found the questions to be so invasive and unrelated to physiotherapy that she initially believed the PT was a psychologist or psychiatrist.

The patient indicated that as someone who was diagnosed with agoraphobia, she felt the physiotherapist invaded her personal space and was confrontational with her.

The patient also expressed concerns about the second assessment. She indicated that she believed that the assessment took too long, that she felt the assessment was inadequate as the physiotherapist did not touch her, and that the PT did not share critical information with other members of her health care team including surgeons.

The PT noted that during the first assessment, the patient completed a self-report screening tool for measuring depression. Her answers indicated symptoms of severe depression, so the PT asked additional questions to complete a risk assessment and subsequently recommend further psychological assessment.

The physiotherapist specified that she shared details from her conversation with the patient with a psychologist who supported a referral to the mental health speciality clinic.

The PT further clarified that the assessment was longer than normal due to the complexity of the case and the fact that the patient was late for the assessment, meaning that schedules had to be readjusted to accommodate her.

The Standards

As outlined in the Essential Competency Profile for Physiotherapists in Canada, during the assessment PTs must interview clients to gather relevant information about health conditions and personal and environmental factors.

They must also identify urgent health conditions that require immediate attention and take appropriate action and identify non-urgent health conditions that may benefit from a referral to another service.

While psychological health does not fall within the scope of physiotherapy, in the best interest of the patient, PTs should take note of red flags, offer information about resources and support, and refer to a more appropriate health professional.

The Outcome

Psychological health often influences and impacts the recovery of physical injury, so it’s reasonable that a physiotherapist would ask additional questions about psychological health as required.

The physiotherapist’s response closely mirrored what was included in the clinical record and the clinical notes were very detailed.

The College was satisfied the PT’s communication with the patient was professional and that her clinical judgement was sound with respect to recommendations for the patient’s future treatment.

As such, the College took no further action regarding this complaint.

Takeaways

This is a good example of a case where strong record keeping supported the physiotherapist’s account of treatment and interaction with the patient.

Although the College took no further action, the PT should still reflect on his practice. Perhaps communication with the patient could have been stronger so that she had a better understanding of why the physiotherapist was collecting information about her mental health.

Essential Competency Profile for Physiotherapists

Strategies to Support Patients at Risk

Record Keeping

Communication Skills

Leave a comment
  1. Maliha | Oct 01, 2023
    I appreciate the college supporting the physiotherapist by identifying the cause of such behavior the physiotherapist saw a few warnings and attempted to assemble more data to investigate them. In addition, he reported that his communications and clinical records were finished and elaborated on great expert practice.
  2. Luciana S | Feb 05, 2023
    Great job  to the PT in identifying red flags and trying to provide resources to better assist this patient.
  3. Rahi S . | Dec 26, 2022
    PT should always document any conversations with the patient  that are emotionally /Psychological involved which could impact the treatment or recovery .
  4. Gregory Nason | Dec 11, 2022
    This is a good scenario where communication between PT and patient is vital. Before diving into this deep conversation about the patient's mental health, it is important that the PT informs the patient about why they are asking about mental health and the correlation to physical health. 
  5. DIPAK CHUNARA | Nov 05, 2022
    Communication with pt, is main, essential key. Before pt, leaves clinic(Place), pt should be clear about what was happening and why. this is very good scenario.
  6. Mohammad Yazdchi | Aug 26, 2022
    I think PT need to knw about mental health of patients because it can help PT to have appropriate behavior with patient to understand them better but PT should consider that too much question make the patients bored and uncomfortable. 
  7. Urvashi Patel | Aug 14, 2022
    Good practice from PT, trying to include all relevant information needed in order for patients recovery.
  8. Sanil Taneja | Jul 29, 2022
    Its a very good and strong example for how PT is supported being fully compliant with the standards.
  9. Heli Pancholi | Jul 11, 2022
    PT has to know all the health conditions, but it is important to keep in mind that to be precise and explanation has to be strong enough.
  10. Avanti Shah | May 29, 2022
    I would say job well done by PT , however strong communication with patient could have prevent any complaints
  11. Tony | Apr 13, 2022
    I always find that when patients are running late for their appointment, you have to really ask what is my highest priority today? I do think mental health is very important but if I had limited time, I would want to address my patient's highest concern and assess that as soon as possible. During follow-up visits after I would try to gather more relevant information as the treatment takes place. However, with all of this being said, I was not present during the assessment to comment on the physiotherapist. 
  12. Jaskirat Kaur | Apr 01, 2022
    Psychological factors play an important role in chronic conditions. They may sometimes be the underlying cause or a trigger to physical symptoms. The physiotherapist saw some red flags and tried to gather more information to explore them. Moreover, he documented his interactions and his clinical records were complete and elaborate. It reflects good professional practice.
  13. Mitchell Caprelli | Jan 11, 2022
    Communication is a important role as PTs. It is always important to properly communicate with patients to ensure they understand why questions are being asked as to prevent the patient from feeling uncomfortable or feel like their privacy is being breeched 
  14. Proud PT | Mar 17, 2020

    It’s nice to see the College supporting a physiotherapist who is clearly trying to do a thorough job by identifying red flags that may require referral to another specialist or professional.  

    Good job College in reinforcing that identifying when another health service is required is a key competency!

    The Public needs this information.

     

    Leave a comment

    Comment Form
    back

    Have a Question?

    advice@collegept.org or 647-484-8800 or 1-800-583-5885 ext. 241