Case of the Month

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Missing: Consent, Communication and Acknowledgement

Feb 19, 2019

The Case

The College received a complaint from a patient soon after she attended a physiotherapy appointment which left her feeling confused about the treatment she received and uncomfortable about the way the physiotherapist interacted with her.

The patient had her first physiotherapy appointment for treatment of an ankle sprain. While she was on a plinth in a long-seated position with her hands behind her, the PT began explaining the nature of her injuries, using a textbook. The physiotherapist proceeded to place the book on the patient’s lap and repeatedly poked her thigh with his finger as he referenced the diagrams.

The patient was uncomfortable with how close the PT was to her during this explanation and did not understand why the contact with her upper thigh was relevant to the treatment of her ankle.

The physiotherapist then put the book away, told the patient that she would make a full recovery from her injuries and rubbed her upper back without acknowledgement or explanation, possibly in an effort to reassure her.

He then proceeded with mobilization of the ankle followed by an ankle stretch during which he placed the patient’s foot in his crotch area and she felt his genitals under her foot. After approximately 20–30 seconds he moved her foot to his upper thigh and continued with the stretch but did not acknowledge the contact with his crotch area.

Finally, when the patient was leaving the room at the end of the appointment the PT touched under her arm and the side of her breast without acknowledgement or explanation, possibly in an effort to guide her to another treatment room.

Following the appointment, the patient contacted the local police and then the College as she felt very uneasy about what had happened.

The Standards

Ensuring that patients have a solid understanding of the treatment and have provided valid, informed consent is a key component of competent physiotherapy care.

As outlined in the Boundaries and Sexual Abuse Standard, PTs need to appropriately manage the boundaries within the therapeutic relationship while recognizing that boundaries will be unique to each patient and their experiences. 

This case raised questions about whether or not the physiotherapist was touching the patient in a clinically appropriate way that would fall within the scope of physiotherapy. Further, could any of these touches have been sexual in nature?

The Outcome

The committee that considered this matter found that the PT had engaged in clinically inappropriate touching, violation of the patient’s personal boundaries and failure to obtain valid, informed consent for specific aspects of treatment.

The PT’s Certificate of Registration was suspended for three months, he received a reprimand, and is required to complete a two-year practice monitoring program and a boundaries education course, at his own expense. This information appears on the Public Register.

More About Consent

Boundaries and Sexual Abuse Standard

Communication Skills

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