Case of the Month

Read real cases and their outcomes

It’s Just Cosmetic

Aug 18, 2020

The Case

The College received a report from a member of the public detailing concerns about a physiotherapist. In particular, the report noted that the PT was performing cosmetic acupuncture, which is a controlled act outside the scope of practice of physiotherapy. The physiotherapist referred to themselves as a “facial acupuncture specialist” even though they did not complete a recognized speciality designation certification program and did not have proper authorization from a regulatory college to use a speciality title.

The reporter brought the information forward to the College because she was concerned about the safety of the public as facial acupuncture carries a lot of risk and practitioners generally obtain post-graduate education to perform it safely.

The physiotherapist advertised the services under a natural skin health clinic operating in a fitness facility that is not owned by a regulated health professional. Both the PT and the clinic advertised cosmetic acupuncture services on social media. The fitness facility did not employ a registered acupuncturist.

The physiotherapist confirmed that they offered cosmetic acupuncture to patients and noted that they began doing so after completing training in Traditional Acupuncture Facial Rejuvenation. They acknowledged that cosmetic acupuncture is not within the scope of practice of physiotherapy, but said they were unaware that they were not authorized to perform acupuncture beyond the scope of practice of physiotherapy. Additionally, when they signed their acupuncture records, they did not use their PT designation.

The PT was rostered to perform acupuncture with the College, however their cosmetic acupuncture practice treated conditions including wrinkles and acne, which fall outside the scope of practice of physiotherapy.

The Standards

The Controlled Acts and Restricted Activities Standard stipulates that every controlled act performed by a physiotherapist, including acupuncture, must be within the scope of practice of physiotherapy. The standard also states that physiotherapists must have the authority to perform a controlled act. While physiotherapists can roster to perform acupuncture, they can only provide acupuncture in accordance with the standards of practice and within the scope of practice for physiotherapy.

It was concerning that the physiotherapist didn’t know that they were unable to perform acupuncture outside the scope of practice for physiotherapy, as every PT who rosters to perform a controlled act must complete a declaration stating that they have reviewed, and understand, the College’s Controlled Acts and Restricted Activities Standard.

If the PT intended to provide acupuncture services outside the scope of practice of physiotherapy, they should have registered with an appropriate regulatory college where cosmetic acupuncture is an acceptable service and within the scope of practice.

The College’s Restricted Titles, Credentials and Specialty Designations Standard states, “Registrants must not use the ‘physiotherapist’ title when they are practicing outside of the scope of practice of physiotherapy.” Although the PT indicated that their cosmetic acupuncture practice was separate from their physiotherapy practice, it is still possible that members of the public could be misled by the physiotherapy designation.

The Outcome

Given the above information, which of the following outcomes do you think is most appropriate? Use the comment section below to share your thoughts.

a. The PT should receive advice/recommendations and participate in a practice enhancement program to ensure that they understand the standards of practice

b. The physiotherapist knew that they were operating outside the scope of practice and putting patients at risk – they should be suspended

c. The PT should receive a caution, which appears on the Public Register, and participate in a practice enhancement program

d. It appears that the physiotherapist genuinely didn’t realize they were doing anything wrong and they seem remorseful – the College should take no action

 

Controlled Acts and Restricted Activities Standard

Restricted Titles, Credentials and Specialty Designations Standard

Leave a comment
  1. Yunhee Choi | Jul 31, 2023

    My answer is A, D

    If a PT used their tile as acupuncture specialist when performined the facial acupuncture, it will be fine.

    But a PT should get some advice from the college about the situation so, the PT can avoid the break the controlled actions.

    Also, the PT informed the patient about their title and restriced actions.

    That is why my answer is A, D

  2. DEMELIN C. TANYAG | Jul 14, 2023
    MY ANSWER IS A . I FIRMLY BELIEVED THAT THE COLLEGE WILL ADHERE THE SCOPE OF PRACTICE TO ALL PHYSIOTHERAPIST.
  3. GS | Feb 24, 2023

    Ans A- The PT should receive advice/recommendations and participate in a practice enhancement program to ensure that they understand the standards of practice. 

    I think that the PT should be reminded of proper evidence based practice and the respective standards to ensure that this does not happen again. A review of the training material would also be a good idea and I feel that talking to someone who is experienced in the area of practice and is well versed with facial acupuncture could guide him and clear his specific doubts regarding the same. 

     

  4. Vrunda Patel | Feb 12, 2023
    I would go with option A as I think reviewing the practice enhancement program would help the PT to understand the limitations and scope of practice. It is also important for PT to know how to keep his practices of Physiotherapy and cosmetic acupuncture separate.
  5. Brayden G | Jan 29, 2023
    I would go with option A because they are given the opportunity to learn from this situation and they will have a plan to enhance their understanding of the professional standards while continuing to practice.
  6. Mahesh Somasekharan Nair | Jan 10, 2023
    I will go with option A as my answer, because it is tough to establish a clear fault in this case 
  7. Gregory Nason | Nov 30, 2022
    Though the Physiotherapist did seem remorseful and did not realize they were operating outside of the scope of practice they should be cautioned and discuss an action plan moving forward. Option A.
  8. Shivani D. | Nov 07, 2022
    Option A would be an appropriate choice in this case. The registered PT must have the knowledge of scope of practice and if they practice restricted activities without the knowledge of the college then practice enhancement program would be helpful to make sure that they have understood standard of practice correctly. 
  9. Mohammad Yazdchi | Aug 25, 2022
    Because I am registered acupuncturist too,it is so clear to me that a PT in not allowed to do cosmetic acupuncture since PT only can do acupuncture for patient if he or she would be rostered.
  10. Urvashi Patel | Aug 11, 2022
    I think A is an appropriate answer 
  11. Sanil | Jul 26, 2022

    Option 'A' or 'D'

    'A' The PT should receive advice/recommendations and participate in a practice enhancement program to ensure that they understand the standards of practice. 

    If physiotherapist clearly informed the client that he is not performing the act as part of physiotherapy, then I would go for 'D' 

  12. Muhammad Aleem Azhar | May 23, 2022
    I will go with option A or c, because even physiotherapist claim that he or she is unaware but it is responsibility of Physiotherapist to remain aware of all standards related to his or her profession.
  13. Alicia | Mar 20, 2022
    I am concerned that the physiotherapist did not know that this was outside of their scope of practice. As a healthcare practitioner of any kind it is your job to know what your limitations are and what you can and cannot do. I think options A or C would both be appropriate in this case. 
  14. Jaskirat Kaur | Mar 13, 2022

    According to me; the PT was not entirely at fault as he was unaware that he was not authorized to perform acupuncture beyond the scope of practice of physiotherapy. He did not use PT designation which was the right thing to do. However, option A (PT should receive advice/recommendations and participate in a practice enhancement program to ensure that they understand the standards of practice) would help him to improve his understanding to carry out better practice in the future.

  15. VARUN SINGH | Feb 26, 2022

    a. The PT should receive advice/recommendations and participate in a practice enhancement program to ensure that they understand the standards of practice. 

    The above scenario explains that PT was rostered with college of physiotherapists for preforming acupuncture which was for cosmetic purposes, rather, for physiotherapeutic purposes. This would require PT to roster or register with the appropriate college.

    Given this, above solution to this situation would explain the need and importance of the rostering with the appropriate college to the PT. Also, this would prevent misleading information to the community about the role of the person providing care. Finally, this would also help in regulating and monitoring the adverse scenarios, if any, from the appropriate colleges under which the activity falls for public safety.    

  16. Prateek Gupta | Feb 13, 2022
    Option A is correct since the PT should provide recommedations and follow evidence based treatment plans. Additionally, ensure that the patient should be informed about the treatment and recommendations. 
  17. Mitchell Caprelli | Jan 11, 2022
    A- I believe that it is important that the PT ensures they act accordingly to the College rules and regulations, and further learning should be done to prevent a future incident similar to this one 
  18. Tanya | Sep 25, 2020

    You wrote: “Registrants must not use the ‘physiotherapist’ title when they are practicing outside of the scope of practice of physiotherapy.” Although the PT indicated that their cosmetic acupuncture practice was separate from their physiotherapy practice, it is still possible that members of the public could be misled by the physiotherapy designation.

    My question is: I am not clear what you are saying: that he should not allowed to do perform it even though he is trained to do so, just because he is also a physiotherapist.

    Hence, there should be no reprimanding of this physiotherapist

  19. . | Sep 24, 2020
    D! Unless she was signing off as a physiotherapist, charging her client's for a physiotherapy treatment or she either admitted to or there is proof that she led her client's to believe she was performing acupuncture related to physiotherapy, then she did no wrong. She was not a physiotherapist in this situation - she was indeed just a facial acupuncture specialist.  You state, 'it is possible the public could be misled' - that is no reason for any action to take place, because it is also POSSIBLE that the public was not misled at all. There should actually be an option E - It appears as though the physiotherapist did not do anything wrong, and if she did, there is no way to proof it at this time. Therefore, the College should definitely not take any action. 
  20. UJ | Sep 24, 2020
    I realize Physiotherapist is not using his designation as a PT to do that treatment and he didn't even know that what he is doing is wrong. I believe option D is the answer.
  21. Leah | Sep 18, 2020

    If practicing not as a physio and no holding themselves as a physio for this service then the college has limited concern.  Also, the practitioner is educated in this realm and not as a physio. (not as stated by the public complainant). The reporter who brought this forward to the college seems knowledgeable about this field beyond that of a public citizen. Is this perhaps about limiting competition in this field.   A toss up of A or D.  By publishing this as a case of the month it has brought education to the member and other practitioners so I feel D is the best choice.

  22. opinion | Sep 13, 2020
    D
  23. SKS | Sep 08, 2020

    -In my opinion, the physiotherapist knew that they are operating beyond the scope of physiotherapist practice as he/she was not using the physiotherapy designation in the records. Why was it so? It means they were well aware of the norms.

    I think b is the correct choice. He/she was putting patients at risk. 

  24. Sahar | Aug 28, 2020

    The PT was rostered to perform acupuncture by the college but cosmetic acupuncture falls outside the scope of practice of physiotherapy, therefore before practicing it, the PT should have confirmed with the college whether he/she is authorized to do so. 

    The PT should receive advice/recommendations and participate in a practice enhancement program to ensure that they understand the standards of practice

  25. Manpreet | Aug 28, 2020
    I feel Option- A is appropriate.
  26. RANA | Aug 24, 2020

    It is a hard case and first time to hear about such problem . So my answer is (D)

    The college should take no action.

  27. Oyetunde Oyewole | Aug 19, 2020
    It appears the PT may not have known they were operating outside the scope of practice of physiotherapy. However, they also seemed to want to separate the cosmetic acupuncture practice from physiotherapy. I believe they would benefit from advice/recommendations and a practice enhancement program.
  28. Laura | Aug 19, 2020

    I feel that A is the most appropriate response from the College. 

    A. The PT should receive advice/recommendations and participate in a practice enhancement program to ensure that they understand the standards of practice

  29. vnaga | Aug 19, 2020
    The physiotherapist knew that they were operating outside the scope of practice and putting patients at risk – they should be suspended
  30. Faustus Antonio | Aug 19, 2020
    It appears that the physiotherapist genuinely didn’t realize they were doing anything wrong and they seem remorseful – the College should take no action
  31. Andrew | Aug 19, 2020
    If the physiotherapist clearly has stated to clientele that this is not physiotherapy in any capacity, and the clientele is giving clear informed consent, then the physiotherapist did no wrong.  There may be no governing body to do such acupuncture. The physiotherapist is not a physiotherapist in this situation (and charted as such) and to say that the public could be misled appears to be an easy way to find an act of guilt where none exists.  The answer should be "d. It appears that the physiotherapist genuinely didn’t realize they were doing anything wrong and they seem remorseful – the College should take no action"

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