The Case

The College received a complaint from a patient who was referred to physiotherapy after suffering a workplace injury. The patient noted that he booked his appointments with a specific physiotherapist, however he never actually received treatment from her and was instead treated by a physiotherapy student.

During the first appointment, the student performed an assessment on the patient and during the second appointment, the student assigned care to a physiotherapist assistant (PTA).

The patient didn’t have any concerns with the care he received from the student but questioned why he was never given the opportunity to consent to having a student involved in his care in the first place.

Although he filled out a checklist related to consent, the patient felt that there was no real discussion around the involvement of a PTA in his care.

The physiotherapist confirmed that she was not present for any of the appointments but was always at the clinic and available to the student if needed. She indicated that although it’s her usual practice to obtain consent from a patient to be assessed and treated by a student, she neglected to do so in this case. She indicated that this was an isolated incident and apologized to the patient for not getting valid, informed consent.

Even though the physiotherapy student told the patient that they were a student, the patient clearly did not understand the role and responsibility of the student and the physiotherapist.

The Standards

We’ve said it before, and we’ll say it again—obtaining consent is so much more than having patients tick some boxes and sign a form.

The physiotherapist must ensure that the patient understands what they are consenting to.

In this case, the patient may have signed the form but was still unaware that a student would be performing an assessment, or that some of the treatment would be assigned to a physiotherapist assistant.

A complaint could have been avoided if the physiotherapist had obtained valid, informed consent and if the student had been clearer about the involvement of PTAs. A little communication goes a long way!

When supervising a student, a physiotherapist doesn’t have to be on-site, but they do need to be available to intervene if needed. In this case the physiotherapist and the student were in regular communication and the PT was readily available for assistance. However, the Working with Physiotherapist Assistants Standard specifies that PTs must discuss the roles and responsibilities of the physiotherapist and the physiotherapist assistant with each patient.

The Outcome

Although the patient questioned whether a physiotherapy student should be allowed to perform an assessment at all, it is acceptable according to the College standard as long as the student has the knowledge, skill and judgment to deliver safe and competent care. As the patient did not express concerns with the actual treatment he received, the College believes this requirement was met.

The College did advise the PT to remind any students under her supervision that they should confer with her before delegating any tasks.

The physiotherapist apologized for not getting consent and quickly took steps to upgrade their knowledge by reviewing the standards, consulting resources on the College website and completing e-learning modules. Because of the PT’s initiative to rectify the issue and upgrade her skills, the College took no further action.

A reminder to all physiotherapists that it’s important to regularly review the standards and ensure that you’re meeting your professional obligations. The College has a number of resources including interactive e-learning modules, quizzes and checklists that can help.

Consent

Working with Physiotherapist Assistants Standard

Supervision Standard

Communication