Good Practice: Are you Selling Snake Oil?

Every now and then the College of Physiotherapists of Alberta offices are host to some hot debates - the kind that only happen when you gather a group of opinionated and passionate people. Recently, one of these debates erupted on the subject of accountability, and more particularly, what an individual practitioner’s responsibilities are when they are selling their treatments.

We all sell services in the context of physiotherapy practice, whether we are selling directly to patients, to third party payers, or to Alberta Health Services. If you are being paid to be a physiotherapist, you are selling your services.

Having sat on the Conduct Committee for a number of years, I have heard more than one complaint from a patient who paid for services and did not get better. They presented to the Committee with the belief that the physiotherapist’s practice must have been unskilled, or they would have recovered. As difficult as it was to explain to these individuals that treatment doesn’t always work and there are no guarantees; that doesn’t make the treatment unskilled or inappropriate. But is that the whole story?

I don’t think it is.

Whether you are being paid an hourly wage to provide services in your local hospital or charging for a series of private practice treatment sessions, you have a professional responsibility to sell treatment that works.

This responsibility is supported by the following requirements found in the Standards of Practice and Code of Ethical Conduct:

Code of Ethical Conduct – Responsibilities to the Public: 

• Assess the quality and impact of their services regularly.

Code of Ethical Conduct – Ethical Principles

• Beneficence guides the practitioner to do what is good with respect to the welfare of the client. In physiotherapy practice, the physiotherapist should provide benefit to the client’s health.

Evidence-Informed Practice Standard of Practice:

• Critically appraises evidence relevant to the practice setting, population served, and available assessment and treatment options before integrating evidence into practice.
• Incorporates critically appraised physiotherapy-related evidence into assessment and treatment plans.
• Integrates critical thinking and professional judgment into client-centered care, evaluating their practice in terms of client outcomes, and modifying approaches based on this self-reflective process.

Documentation and Record Keeping Standard of Practice:

• Includes in the chart record detailed chronological information including details of treatment provided and client response to treatment, including results of reassessments.

Advertising Standard of Practice:

• Engages in advertising, marketing, and promotional activities that are truthful, accurate, and verifiable and does not engage in or allow advertising, marketing, and promotional activities that are deceptive or misleading.
• Does not use advertisements that make unsubstantiated claims, foster unrealistic expectations, or provide guarantees of successful outcomes.

Communication Standard of Practice:

• Communicates professionally, clearly, effectively, and in a timely manner to support and promote quality physiotherapy services.

Conflict of Interest Standard of Practice:

• Does not participate in any activity which could compromise professional judgment, or which is for personal gain. 

Physiotherapists are accountable for the quality of care they offer to their patients and are accountable to the College of Physiotherapists of Alberta for their professional conduct. 

It is expected physiotherapists value the client’s best interest or avoid activities in which professional judgment could be compromised or is for the sole purpose of personal gain.

Let me ask you this: are you selling expensive treatments that have little to no evidence to support their use? Are you selling effective treatments, but not providing them in an adequate dose to be effective? Are you working for a business that places priority on revenue generation over clinical considerations? Does your business model include practices such as referring to other health professionals as part of a “suite of services”, whether or not the patient requires those services or is seeking them? Or does your business encourage patients to “use up” their benefits before the end of the benefit year, regardless of the patient’s healthcare needs?

I can hear the arguments already. How can you have valid evidence about what will work for a 67-year-old, female, eastern European immigrant who has spent her whole life working as a housekeeper for a hotel chain? She is too individual to have a study that tells me how to manage her back pain. And, what about my clinical experience? I know what works.

You’re right. Your clinical experience does count, and client-centered service does require that we tailor our treatment to our patients’ needs.

However, the Standards of Practice and provisions of the Code of Ethical Conduct cited earlier in this article clearly tell us that we are expected to track our outcomes and demonstrate the effect of our treatments, both for our individual patients over time and for larger patient groups (such as all the patients in your practice who have back pain, or all your total hip replacement patients).

If we are selling something that isn’t designed to work in the long term, we run the risk of being called frauds. Worse, we run the risk of deserving the title.

When a patient comes to the college disgruntled that they spent hundreds of dollars on a treatment that was ultimately ineffective and has been told “it works in 80% of patients, too bad you’re part of the 20%” something seems a bit off to me. My question for the physiotherapist is: If the treatment wasn’t working, why did you keep going? Were you just lining your pockets? Did you not evaluate the impact that your treatment plan was having? Neither behavior meets the Standards of Practice.

What about the multidisciplinary business that gathers information about a patient’s extended health benefit coverage and then intentionally sets out to use up all of that coverage, physiotherapy and otherwise, regardless of the patient’s actual needs? If you think that you don’t have a duty to say something about that practice, you are wrong.

These types of behaviours do not exemplify accountability in action. The College of Physiotherapists of Alberta requires that you, the regulated member, ensure that your practice of physiotherapy meets the Standards of Practice and Code of Ethical Conduct, and when the actions of your employer impede your ability to adhere to the standards, you work with your employer to correct the situation.

Physiotherapists enjoy a high level of public trust and respect. Let’s make sure that through our actions as professionals and our accountability to those we serve, we continue to deserve this trust and respect.

Leanne Loranger, PT, Practice Advisor

Page updated: 20/08/2026