Ahpra’s shared Code of conduct sets out a physiotherapist’s professional obligations concerning engaging in and maintaining effective communication with patients and other treating practitioners.

These obligations aim to promote good communication between physiotherapists and patients, ensuring that patients are fully informed and are able to participate in all aspects of their care. 

The effective communication in this code applies to physiotherapists’ conduct in every setting,
including in person, during technology-based consultations (eg, telehealth) and electronically through email and social media. 

The following discusses the implications arising from a potential clinical scenario regarding miscommunication.

Clinical scenario
 

Steven attends an initial consultation with physiotherapist Stacey. 

He presents with back pain caused by lifting heavy weights at the gym. 

Steven tells Stacey he has never seen a physiotherapist before and initially consulted his GP, who
prescribed anti-inflammatories, which did not assist. 

After assessing Steven, Stacey diagnoses him with a prolapsed disc. She provides treatment, including soft tissue massage, and prescribes some home-based exercises. 

Stacey starts with a small number of repetitions and tells Steven that if he feels better next session, they will increase the repetitions from three sets of eight per day to three sets of 15 per day.

Following the session, Steven sends Stacey an email to ask whether she would mind sending a letter to his GP to keep him in the loop about Steven’s progress. 

Stacey simply replies, ‘No, GPs are useless at dealing with back pain. Speak to you next week.’

The following week Steven has a telehealth appointment with Stacey to check on his pain and discuss his progress with the exercises. Steven reports feeling ‘much better’, attributing his increased range of
motion to his exercises. 

Stacey says to Steven that he is able to ‘start ramping up the exercises’. 

While it is not stated, Stacey intends this to mean that he can increase the repetitions of the home-based exercises to three sets of 15 per day as discussed in the previous appointment.

Unfortunately, Steven misunderstood what Stacey said and instead thought she was telling him he could go back to his usual gym program. 

Stacey does not clarify what she means and instead arranges a face-to-face consultation with Steven in a week.

The next day, Steven attends the gym, where he re-aggravates his prolapsed disc.

Steven attends his GP, who says he never heard from Stacey regarding the treatment.

Steven is annoyed that Stacey encouraged him to get back into exercise so soon, leading to a further injury, and at her failure to contact his GP. 

Steven decides to make a complaint against Stacey.

Stacey has breached her professional obligations under section 3.2 of the Code of conduct by:

• failing to communicate courteously, respectfully and compassionately with Steven in her email
• failing to listen to and respect Steven’s preference that Stacey keep his GP in the loop about the treatment
• failing to consider Steven’s health literacy (ability to understand health information)—in particular, that he has never seen a physiotherapist before—and to adjust her communication in response
• failing to appropriately communicate with Steven’s GP in regard to Steven’s health
• failing to confirm that Steven had understood what she said in regard to increasing the exercises.

Learnings and safeguards

The scenario of Stacey and Steven displays a number of common communication errors. 

In particular, Stacey’s comment regarding GPs is a breach of her communication obligations in which Stacey has shown a lack of respect for Steven’s views and preferences about his health and has failed to communicate in a courteous manner. 

Further, Stacey’s comment regarding Steven increasing his exercise caused a miscommunication. This
indicates that she did not ensure that he understood her instructions or consider his health literacy, especially given that he had not previously attended a physiotherapist.

The use of telehealth likely exacerbated the miscommunication because Stacey did not take time to gauge whether Steven understood her instructions regarding the exercises and was unable to receive any visual feedback from him.

Physiotherapists have a responsibility to ensure that all communication with patients is effective and clear. 

This becomes even more important in telehealth consultations, where a physiotherapist can have additional difficulties in confirming whether a patient has understood the provided instructions.

Breaches of professional obligations regarding communication have the potential to lead to distrust and a breakdown in the treating relationship between a physiotherapist and their patient, as in Stacey and Steven’s situation.

Safeguards against breaching professional obligations regarding communication include:

• having another colleague read over electronic communication with patients to ensure it is appropriate
• employing clear and straightforward language when speaking with patients
• requesting that a patient confirms what a physiotherapist has said, particularly where telehealth is being used
• providing written exercise plans to confirm in writing any exercises provided during a session
• being aware of a patient’s health literacy and adapting communication with a patient accordingly
• spending time reflecting on a practitioner’s own communication style and undertaking mentoring in this regard with a senior colleague.

If practitioners experience a miscommunication or are unsure about how best to discuss a particular health concern with a patient, they should seek assistance, including from a senior colleague.

Safeguards to help clinics ensure that all physiotherapists are practising effective communication may include training for all new staff on communication styles and professional obligations relating to
effective communication. 

Clinics can also organise regular meetings with staff to discuss effective communication and
how to best communicate with a variety of patients and health practitioners.

Clinics may also consider developing and implementing communication policies and procedures to cover communicating with other health practitioners and the provision of at-home exercises.

This article is part of the risk management series facilitated by APA’s insurance partner BMS and written together with leading health law firm Barry Nilsson.

Disclaimer: This article is facilitated by BMS Risk Solutions Pty Ltd (BMS) AFSL 461594, ABN 45161187890 and written by Barry Nilsson. BMS is the official and exclusive insurance broker for the APA member insurance program. Barry Nilsson communications are intended to provide commentary and general information. They should not be relied upon as legal advice. Formal legal advice should be sought in particular transactions or on matters of interest arising from this communication.