The Case
The College received a complaint from a patient who indicated that while attending physiotherapy to treat an existing injury, they sustained additional injuries. The patient reported that the physiotherapist made them do exercises that were unnecessary and that they felt uncomfortable completing.
During the assessment, the physiotherapist asked the patient to step on and off a stool that was approximately six inches off the ground. The patient told the physiotherapist that they were afraid of heights and expressed concerns about completing the exercise.
The PT suggested that the patient hold their arm for additional support, but the patient lost their balance and fell off the step stool, injuring their foot. The patient believed the stool was unstable, causing the fall.
The PT told the patient that another appointment was waiting, so the patient paid their invoice and left the clinic. After returning home, the patient noticed bruising and swelling around their foot. The patient believed the PT rushed them out of the clinic to accommodate the next appointment and was “unprofessional” regarding the injury.
After cancelling their next physiotherapy appointment, the patient went to the hospital where the emergency room doctor diagnosed them with a fractured foot.
The physiotherapist explained that the patient fell while performing a functional test to assess leg control. They further noted it was difficult to determine what caused the fall as it happened quickly. The PT asked if the patient hit their head during the fall and encouraged them to rest. Although the patient mentioned pain in their foot, the physiotherapist did not think much of it at the time and did not want to keep the next patient waiting. The PT acknowledged that they did not follow their clinic’s policy to address adverse events.
The Standards
It is the responsibility of the physiotherapist to monitor a patient’s physical and emotional response throughout care. They must identify and respond to adverse events in an appropriate way that supports the overall wellbeing of the patient.
While the PT acknowledged that there is a plan to address adverse events at the clinic, they did not follow the plan with this particular patient.
Effective communication is key in adopting a patient-centred approach to physiotherapy care. The lack of communication from the PT following the incident made it challenging to understand the patient’s injury, and negatively impacted the level of trust in the therapeutic relationship. While the PT asked the patient if they hit their head, no further questions were asked to determine the severity of the injury or assess the patient’s wellbeing.
The Outcome
While the College was not concerned with the step test itself, there were significant concerns about the lack of professionalism from the physiotherapist following the incident.
Further, the PT did not appropriately identify and address an adverse event and the patient left the clinic on a fractured foot.
The College determined that these concerns were significant enough to require a Specified Continuing Education and Remediation Program (SCERP). All costs associated with the SCERP will be paid by the PT. The physiotherapist will also receive a caution that will appear on the Public Register.
Communication Skills
Essential Competencies for Physiotherapists