As a physiotherapist, you may from time to time find yourself being asked to provide advice or treatment to family or friends.

What are the risks of doing so?

Could a seemingly innocent dinner conversation become a claim? And are you covered for these situations under your insurance?

Let’s imagine you’re attending a friend’s birthday party and you run into your neighbour, who lives across the street.

He once helped you repair your bike and you’ve seen him many times over the years.

At the party, he tells you about the back pain he’s been experiencing after playing golf last weekend.

‘What would you suggest?’ he asks.

 It seems like an opportunity to help a good friend, so you offer him some tips.

But a few weeks later, it turns out that your neighbour misunderstood your advice.

You discover that your neighbour has filed a claim against you—what now?

What has been the outcome of previous cases involving family and friends?

In 2019, the Victorian Civil and Administrative Tribunal made a decision on the case of a practitioner who treated their spouse and child.

The case, XDH v Medical Board of Australia (Review and Regulation) [2019] VCAT 377, provides useful commentary on what to consider as well as the potential consequences for physiotherapists, should their conduct fall outside of the expected standard.

XDH v Medical Board of Australia

XDH was alleged to have inappropriately treated and prescribed medication to his wife and daughter over several years.

His wife had Alzheimer’s disease and chronic abdominal pain.

His daughter had a severe disability and was in permanent care.

XDH treated his daughter for ulcers on a lower limb and a wound on the scalp.

In considering this case, the Tribunal stated that ‘[i]t need not be shown that harm has arisen, or will arise, if a medical practitioner treats [their] family member, the rule is about a particular relationship and a response to it’.

Further, that ‘it is not necessary for it to be shown that there is an actual loss of objectivity, what is necessary is the potential of lack of objectivity in fact does exist’; however, ‘that there is inherent risk, such as lack of objectivity, in a medical practitioner treating his spouse…

This is a risk to the [practitioner] himself, his wife and to their relationship.

Thus… given the circumstances the [practitioner’s] lack of objectivity when treating his wife is likely to be far greater than that of any independent general practitioner.’

What are the risks?

Providing care to anyone with whom you have a close relationship comes with risks, including:

• a diminished standard of care due to the nature of the personal relationship influencing objectivity and judgement
• the provision of treatment and care outside of the practitioner’s area of expertise due to pressure or obligation arising from the relationship
• an inappropriate examination or assessment leading to adverse outcomes, arising from a desire to avoid an uncomfortable or sensitive situation
• a lack of informed consent and patient autonomy, arising from reluctance by the patient to decline a recommendation or seek alternative care.

What does the APA professional indemnity insurance policy cover?

The following section is authored by the APA’s insurance partner BMS.

As an APA member, you have exclusive access to the APA member insurance policy, which offers professional indemnity insurance.

This policy provides cover for your scope of practice as outlined by the APA.

Under this policy you are not covered for treating family members.

For more information visit the APA Member Insurance page. Please read the policy wording for more information.

What steps can you take to avoid risk?

Treatment of a family member, friend or community member is sometimes unavoidable, such as in an emergency.

You may consider having specific regard to the requirement to carry out an adequate assessment and not allow the personal relationship to impair clinical judgement.

However, it is worth noting that there are limited circumstances where it is considered appropriate and/or necessary for a practitioner to provide care to friends, family or anyone with whom they have a close relationship.

Here are some tips to avoid the risk:

• when treating a patient, be alert to maintaining professional boundaries and any loss of objectivity
• if you have a relationship with a patient outside of a professional relationship, consider whether it is appropriate to treat them. If in doubt, seek advice from a senior colleague or other appropriate professional
• maintain the usual good practice measures such as appropriate record keeping, obtaining informed consent and assessments
• complete ongoing education on this issue.

Learnings and safeguards

As you are aware, the treatment of family, friends and colleagues ought to be considered with caution.

Best practice requires all health professionals to exercise a high degree of caution when treating those with whom they have a non-professional relationship and, wherever possible, to recommend an alternative provider.

Under the APA professional indemnity insurance policy via BMS, cover is not included for treating family members.

Review your insurance policy and understand the details about treating those with whom you have a non-professional relationship.

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: Barry Nilsson Lawyers 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. BMS Risk Solutions Pty Ltd (BMS) AFSL 461594 ABN 45 161 187 980 is the official and exclusive insurance broker for the APA member insurance program. BMS is part of the wider BMS group, which is dedicated to providing coverage and value-added services to associations and their members.