The Code of Ethical Conduct is essential as an ethical and moral anchor to physiotherapy practice. It applies to all physiotherapists throughout all contexts of practice and is a foundational document for the profession. Contained within the Code of Ethical Conduct are principles which emphasize the pursuit of excellence in all professional activities, as well as the ability to act with integrity, accountability and good judgment in the best interests of the client, the public, the individual (self), and the profession.
In regards to accountability and working in the best interests of the client, public, and profession, The Code of Ethical Conduct states the following:
“Be professionally and morally responsible for addressing incompetent, unsafe, illegal, or unethical practice of any health-care provider and legally responsible for reporting conduct that puts the client at risk to the appropriate authority/ies”
Physiotherapists will cross paths with one another frequently in their career. You may take over a caseload, fill in for someone on vacation, have clients that move from another physiotherapist to you, etc. Along the way you may encounter a physiotherapist who is struggling in their practice, having difficulty abiding by the legislated requirements or the Standards of Practice, or is being unethical in their practice. You have the above expectation from the Code of Ethical Conduct to guide you but how do you follow it? What actions should you take?
These topics have been addressed in some ways in Good Practice: Know Your Responsibilities and in Tattling Vs. Telling: Professionalism in Practice but the following scenarios will focus on a few different aspects not already covered.
What are physiotherapists responsibilities to one another?
Daryl is a physiotherapist who takes over some clients for a co-worker who is away on vacation for a few weeks. They review the physiotherapist’s documentation in preparation for their day but find the level of documentation is insufficient and does not provide a complete clinical picture.
Daryl is frustrated with the physiotherapist that they would leave them to care for their clients with little documentation of assessment findings, treatments that were carried out, and treatment plans for them to follow.
Daryl knows he is “professionally and morally responsible…” to address the situation but is unsure of what to actually do in this situation. Fortunately, there are different ways to address his concerns in a way that is beneficial to the physiotherapist, to their clients, and to the profession.
A lack of documentation and/or very poor documentation are significant issues when it comes to client care, safety, consent, complaints, etc. and should be addressed immediately.
In this scenario Daryl and the physiotherapist both work at the same clinic. Daryl could approach the clinician once they are back from vacation or bring it to the attention of the clinic manager. Both actions should include some supports to assist the clinician or at minimum some follow-up to ensure there is a positive change in the physiotherapist’s documentation habits. Ideally, clinic management assumes this role of ongoing support, mentorship, and chart auditing until satisfied there is a permanent positive behaviour change.
What about care that is questionable?
A few months later Daryl assesses a new client who is three months post-op for a total knee replacement. During the assessment the client reports their previous physiotherapist’s care increased their pain and swelling in their knee. After gathering more details regarding the care provided and seeing the exercises prescribed to the client, Daryl feels the physiotherapist was not providing care that was according to best-practice guidelines and wasn’t listening to the client when they were reporting worsening symptoms.
In this scenario there are a few differences. First, the physiotherapist is not a co-worker of Daryl’s but works at a competing clinic a few blocks away. Second, the care provided wasn’t necessarily a breach of the Standards of Practice but was causing potential harm to the client. It is important to recognize that physiotherapy isn’t following recipe cards and practice often looks different from one physiotherapist to the other, but what do you do when you feel another physiotherapist’s practice has the potential for harm?
This is a bit more challenging to address as it requires reaching out to someone you may not know. When there is no pre-existing relationship that you can build from, physiotherapists will often just take over the client’s care, address the client’s concerns, and move on. But this does not meet the requirements of physiotherapists to address care that is potentially unsafe or incompetent.
As a custodian under the Health Information Act, Daryl does not require the client’s consent to contact the other physiotherapist to discuss the client’s reports.
If you find yourself in a situation like the one Daryl is in, whether you are the one providing feedback or receiving it, you should always remain professional and respectful. No one likes to be criticized. Often those providing the feedback find it uncomfortable to do so. If you are providing feedback, keep in mind the goal of the communication is to provide feedback on the care you were told was provided, and realize that you may only be getting part of the story from the client.
Therefore, you should stick to the facts as were relayed to you by the client and not stray into assumptions or jump to conclusions. It is an opportunity to discuss client care and provide the physiotherapist with a chance to reflect on their practice. Your role is to make them aware of the what the client’s experience of them was.
What About Mandatory Reporting?
Often there are questions around whether you are legally required to report a situation to the College. To be clear mandatory reporting for physiotherapists is required in a number of circumstances, including:
- Anytime there is reasonable grounds to believe that another health professional sexually abused or engaged in sexual misconduct (Sections 57(1.1) and 127.2(1) of the Health Professions Act).
- If employment is terminated or suspended (or the physiotherapist resigned) because of unprofessional conduct. “If, because of conduct that in the opinion of the employer is unprofessional conduct, the employment of a regulated member is terminated or suspended or the regulated member resigns, the employer must […] notify the College’s Complaints Director.” (Section 57(1) of the Health Professions Act)
- Situations of abuse, neglect, and other circumstances that would require intervention for minors (Child, Youth and Family Enhancement Act).
- Situations of abuse, neglect, and other circumstances that would require intervention for dependent adults who are receiving publicly funded care or support services (Protection of Persons in Care Act).
- If the physiotherapist is charged or convicted of a criminal offense under the Criminal Code of Canada, they are required to report this to the College Registrar.
Note: It is beyond the scope of this article to provide an exhaustive review of all mandatory reporting requirements applicable to physiotherapists. You can find resources on Mandatory Reporting:
- For Employers: Mandatory Reporting
- Episode 38: Understanding Mandatory Reporting
- A Physiotherapist’s Duty with Mandatory Reporting
The Code of Ethical Conduct is a foundational guidance document for physiotherapists. Physiotherapists should strive to abide by the Code and use it to guide their actions when faced with challenging situations. Addressing incompetent, unsafe, unethical, or illegal practice can be challenging but it is your responsibility to find a way to do so in order to protect the public and the profession.
Action Items
- Be willing to have conversations with those around you regarding their practice when you notice significant issues with their practice.
- Be a part of helping the profession by actively addressing care that is not meeting expectations in the Standards of Practice or legislative requirements.
- Be aware of what constitutes mandatory reporting.
