Case of the Month

Read real cases and their outcomes

  • 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

    Full story
    • record keeping
    • Communication
    • Case of the Month
    • physiotherapist
    • patient
    • mental health
    • assessment
  • Suspicious Spa Services

    Feb 05, 2020
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    • record keeping
    • patient records
    • practices
    • business
    • insurance
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  • Disappearing Act

    Jan 13, 2020
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    • leaving a practice
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    • false records
    • privacy
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  • The Truth Always Comes Out

    Dec 10, 2019
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    • criminal offence
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    • professional conduct
    • registrant
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  • Pay My Physio Bills

    Nov 20, 2019
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    • complaint
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  • All Together Now

    Oct 08, 2019
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    • physiotherapist
    • physiotherapy
    • neurological
    • hospital
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  • When a Quick Favour Becomes a Complaint

    Sep 09, 2019
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    • complaint
    • treatment
    • assessment
    • physiotherapy
    • regulated health professional
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    • record keeping
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  • Surprise, Your PT is Delisted

    Aug 15, 2019
    Full story
    • ethics
    • accounts
    • billing
    • fees
    • Fraud
    • physiotherapy
    • Case of the Month
    • physiotherapist
    • Delisted
    • benefits
    • insurance
  • Ticking a Box Isn’t Enough

    Jul 15, 2019
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    • Case of the Month
    • physiotherapist
    • patient
    • Communication
    • complaint
    • PTA
    • working with physiotherapist assistants
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  • Faking It

    Jun 07, 2019
    Full story
    • Consent
    • Assessments
    • billing
    • holding out
    • working with physiotherapist assistants
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    • physiotherapist assistant
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  • Supervising a Forgetful Student

    May 07, 2019
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  • The Clinic Owner Doesn’t Always Know Best

    Apr 10, 2019
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    • supervision
    • PTA
    • physiotherapy competency exam
    • physiotherapist assistant
    • assessment
    • independent practice
    • provisional practice
    • physiotherapist
    • holding out
    • Case of the Month
  • No Notes is Bad News

    Mar 18, 2019
    Full story
    • Case of the Month
    • ethics
    • Delisted
    • insurer
    • Consent
    • registration number
    • billing
    • fees
    • record keeping
  • Missing: Consent, Communication and Acknowledgement

    Feb 19, 2019
    Full story
    • complaint
    • treatment
    • Consent
    • Boundaries
    • physiotherapy scope
    • Communication
    • Case of the Month
  • Float On, but Don’t Say it’s Physiotherapy

    Jan 23, 2019
    Full story
    • insurance
    • Delisting
    • registration number
    • billing
    • fees
    • scope of practice
    • float therapy
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  • There is Such a Thing as Too Friendly

    Dec 11, 2018
    Full story
    • patient
    • physiotherapist
    • relationship
    • friendship
    • professional boundaries
    • therapeutic relationship
    • record keeping
    • informed consent
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    • mechanical traction
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    • billing
    • fees
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  • When Acupuncture Goes Very, Very Wrong

    Nov 13, 2018
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    • physiotherapist
    • physiotherapy
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  • 1,200 Hours Short of a Certificate

    Oct 19, 2018
    Full story
    • Ontario
    • College of Physiotherapists
    • physiotherapist
    • Case of the Month
    • practice hours
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  • Can’t We All Just Get Along?

    Sep 17, 2018
    Full story
    • specialty designations
    • restricted titles
    • PTA
    • physiotherapist assistant
    • physiotherapist
    • physiotherapy
    • relationships
    • collaborative care
    • Case of the Month
  • Don’t You Forget About Me

    Aug 21, 2018
    Full story
    • ICRC Committee
    • essential competencies
    • physiotherapy
    • acupuncture
    • Case of the Month

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