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