Professional issues in physiotherapy

SOLOMON T. (PT)
JIMMA UNIVERSITY
INSTITUTE OF HEALTH
SCIENCE
Department of PHYSIOTHERAPY

5/2/2022 1
 Objectives of the presentation
1. Describe about professional autonomy
2. Discuss on physiotherapy ethical principles
3. Explain about informed consent
4. Discuss on patient/clients’ rights in physiotherapy
5. Describe about standards of physiotherapy practice
6. Discuss on physiotherapy quality service
7. Discuss on the relationships of physiotherapy with
other health professionals

5/2/2022 2
 Autonomy
• Autonomy — is the ability of a practitioner to make
independent judgments;
– including the ability to initiate, provide services,
alter physical therapy interventions or terminate
services

• PT should have the freedom to exercise their

professional judgment and decision making,
– wherever they practice, so long as this is within the
physical therapist's knowledge, competence and
scope of practice
5/2/2022 3
 Continued
• PT operate as independent practitioners, as well as
members of health service provider teams

• They are able to act as first contact practitioners

• Patients/clients may seek direct services without

referral from another health care professional

5/2/2022 4
 Continued
• The actions of individual PT’s are their own
responsibility

• PT professional decisions cannot be controlled or

compromised by employers, members of other
professions or other individuals

5/2/2022 5
 Ethical responsibilities of physical therapists

• WCPT expects its member organizations to:

– have a code of ethics or code of conduct

– publish, promote and circulate their code of ethics

for the benefit of its stakeholders

– have procedures for monitoring the practice of

their members, disciplinary procedures

5/2/2022 6
 Continued
• Codes of practice/conduct - are ethical rules and
principles that form an obligatory part of Professional
practice

• They may be established by the physical therapy

profession or incorporated into national rules and
laws

• What is Ethics ?

5/2/2022 7
 Cont …
• Ethics -the rules of conduct recognized in certain
departments of human life.
• Medical ethics, have common features in different
countries.

• However, each country adopts certain modifications;

– According to prevailing local culture, religious
beliefs, social norms and standards of public health
practice
• E.g. Abortion

5/2/2022 8
 Cont …
• Ethics has systematic rules or principles governing
right conduct.

• Practitioners, upon entering a profession, is

empowered with the responsibility to adhere to the
standards of ethical practice and conduct set by the
profession.

5/2/2022 9
 Why study medical ethics?
• “As long as the clinician is a knowledgeable and
skilful , ethics doesn’t matter.”

• “Ethics is learned in the family, not in school.”

• “Medical ethics is learned by observing how senior

clinicians act, not from books or lectures.”

5/2/2022 10
 Why do we study ethics?

• To help health professional identify moral and ethical

issues,

• To know what is right and wrong about what should

and should not be done for and to client,

• To know and respect the issues of human rights

(individual and public)

5/2/2022 11
 Current situation of medical practice

• Health service has changed a lot

• Patients /clients are better informed

• Litigation is more common

5/2/2022 12
 WCPT ethical principles
Ethical principle 1:
Physical therapists respect the rights and dignity
of all individuals
• Clients’ has the right to service regardless of age,
gender, race, nationality, religion, ethnic origin, creed,
colour, sexual orientation, disability, health status or
politics
• Physical therapists should assure that patients/clients
have the right to:
– the highest quality physical therapy services
– information about the physical therapy services
5/2/2022 13
Ethical principle 2:
Physical therapists obey with the laws and
regulations governing the practice of physical
therapy in the country in which they practice

• Physical therapists will have a full understanding of

the laws and regulations governing the practice of
physical therapy

• They have the right to refuse to treat or otherwise

intervene when, in their opinion, the service is not in
the best interests of the patient/client

5/2/2022 14
Ethical principle 3:
Physical therapists accept responsibility for the
exercise of sound judgment

• Physical therapists are professionally independent

and autonomous practitioners

• They make independent judgments in the provision of

services for which they have knowledge and skills

5/2/2022 15
 Cont…
• With each patient/client, PT undertake appropriate
examination/assessment

• In light of the diagnosis and other relevant

information the PTs determine the prognosis/plan of
care and implement the interventions/treatment

5/2/2022 16
 Cont…
• PT shall inform and discharge the patient/client
– When the goals have been achieved or further
benefits can no longer be obtained

• When the diagnosis is not clear or the required

intervention is not within the realm of PTs practice,
– Then the PTs shall inform the patient/client and
facilitate a referral to other professionals

5/2/2022 17
 Cont…
• Delegation

• PT have the right to expect co-operation from their

colleagues

5/2/2022 18
Ethical principle 4:
Physical therapists provide honest, competent and
accountable professional services

• Physical therapists shall:

– Ensure that their conduct is professional at all
times
– Deliver timely, patient/client-specific physical
therapy intervention/treatment

– Ensure that patients/clients understand the nature

of the service being provided, (both time and
5/2/2022
financial) 19
 Cont…

– Undertake a continuous professional development

programs /CPD
– Maintain appropriate patient/client records

– Not allow their services to be misused

– E.g. Syragium massage
– Not disclose any information about a patient/client
to a third party
• without the client's permission or prior
knowledge, unless such disclosure is required
by law
5/2/2022 20
 Ethical principle 5:
 Physical therapists are committed to providing quality
services
• Physical therapists shall:
– Be aware of the currently accepted standards of practice
and undertake activities which measure their conformity

– Support research that contributes to improved patient/client

interventions and service delivery

– keep up to date with the best evidence available and

implement it in their practice

– Support quality education in academic and clinical settings

5/2/2022 21
 Ethical principle 6:
Physical therapists are entitled to a just and fair
level of remuneration for their services
• Physical therapists shall:
– ensure that their fee schedules are based on current
market conditions

– ensure that fees charged offer value for money

– ensure that influence is not used for personal gain

5/2/2022 22
Ethical principle 7:
 Physical therapists provide accurate information to
customers about physical therapy and its provisions
• Physical therapists:
– Shall participate in public education program,
providing information about the profession
– May advertise their services E.g. At 102.2 FM radio
or Television programs
– Shall not use false, misleading, deceptive, unfair or
sensational statements or claims

– Shall claim only those titles which correctly describe

their professional status
5/2/2022 23
Ethical principle 8:
Physical therapists contribute;
– to the planning and development of services that
address the health needs of the community

• Physical therapists are obliged to work toward

achieving justice in the provision of health services
for all people

5/2/2022 24
 Informed consent
• Informed consent is a principle that competent
individuals are entitled to choose freely whether to
participate in assessment/treatment/research

• In order to obtain the valid consent

– Adequately understanding of the information
– Subjects arrived at a decision without having been subjected
to force, undue influence or intimidation

• The information must include

– All potential and significant risks, benefits and likely
outcomes
– Taking into account their age, emotional state and cognitive
ability
5/2/2022 25
 Patients’/clients’ right
– Patients’/clients’ right to quality physical therapy
services

– Patients’/clients’ right to information

– Patients’/clients’ right to confidentiality

– Patients’/clients’ right to access to data

– Patients’/clients’ right to health education

– Patients’/clients’ right to dignity

5/2/2022 26
 Physiotherapy standards of practice, quality
care and patient satisfaction

 Standard 1 (respect for individual)

• The patient’s privacy and dignity shall be

respected
– In all aspects of the physiotherapeutic relationship
and at all times

5/2/2022 27
 Standard 2 (informed consent)
– The patient’s consent is obtained before starting
any examination or treatment

– Treatment options, including significant benefits,

risks and side effects, are discussed with the
patient

– The patient is given the opportunity to ask

questions for clarification

5/2/2022 28
 Standard 3 (confidentiality)
– Ensure that there is privacy when discussing
personal details

– The written consent of patients is obtained before

using identifiable clinical information,
• photographs, videos etc. for teaching,
publication or other purposes

5/2/2022 29
 Standard 4 (assessment)
• In order to deliver effective PT intervention

• Assessment has to be conducted to gather information

relating to clients problems

• SOAP

5/2/2022 30
 Standard 5 (recording)

• The physiotherapist provides written evidence of data

• The findings of the clinical assessment are explained

to the patient

5/2/2022 31
 Standard 6 (treatment)
• Taking account of the patient’s problems,

– at least one published, standardized, valid, reliable

and responsive outcome measure is chosen

– and used to evaluate the change in the patient’s

health status

5/2/2022 32
 Standard 7 (Transfer/discharge/ referral)
– The patient is involved with the arrangements for
their transfer of care/discharge

– Arrangements for the transfer of care/discharge are

recorded in the patient’s record

– When the care of a patient is transferred,

information is transmit to those involved in their
on-going care

5/2/2022 33
 Standard 8 (Communication with patients)
• Physiotherapists communicate effectively with
patients and/or their carers/relatives
– Physiotherapists communicate openly and honestly
with patients

– Communication of a sensitive nature is undertaken

in a private environment
– Language used should be easily understood by the
person receiving it

5/2/2022 34
Standard 9 (Communication with other health
professionals)
• Physiotherapists communicate effectively with other
health professionals

– Follow locally agreed systems for referral

– Provide information for multidisciplinary
assessments, planned transfers and discharges

– Aware of the roles of the other members of the

multidisciplinary team
– Physiotherapists communicate with other health
5/2/2022
professionals involved in the patient’s care 35
 Standard 10 (Documentation)
• Every patient who receives physiotherapy must have
a record
– Patient records are started from the time of the
initial contact
– Patient records are written immediately after the
intervention or before the end of the day of the
contact
– Patient records are kept securely
– Physiotherapists adhere to the local/national
policies when asked by the patient to view their
patient record
5/2/2022 36
 Standard 11 (Patient Safety)
• Patients are treated in an environment that is safe for
patients, PT’s and carers
– Environmental, personal hygiene and infection
control procedures are followed

– All equipment is safe, fit for purpose and ensures

patient, carer and physiotherapist safety

– Faulty equipment is taken out of use immediately

– The patient is given instructions on the safe use of
any equipment issued
5/2/2022 37
 Quality Care
• Quality depends on the integration of:
– What happens to the patient

– The care delivered by health professionals

– The management and coordination of the

department

– The external environment where regulations and

policies are made

5/2/2022 38
 Cont…

• Safe: Care should be safe for patients in healthcare

facilities

• Effective: The scientific evidence behind health care

should be applied and serve as the standard in the
delivery of care

• Efficient: Care and service should be cost effective

5/2/2022 39
 Cont…
• Timely: Patients should experience no waits or delays
in receiving care and service

• Patient-centered: The care should revolve around the

patient, respect patient preferences

• Equitable: Unequal treatment or disparities in care

should be eradicated

5/2/2022 40
 Relationships with other health professionals
 PT practice in partnership with other health professionals
to provide services to patients/clients

 A multidisciplinary team (MDT) approach for care and

service is the basis of health care

 MDT refers to the fact that many different disciplines

work together toward a common goal

5/2/2022 41
 Professional practice
• Evidence based practice

• Clinical record keeping

• Private practice

5/2/2022 42
 Evidence based practice (EBP)

• It is an approach to health care in which health

professionals use the best available evidence from
research to make clinical decisions for patients

• Health care is individualized and always changing

and involves uncertainties and probabilities

5/2/2022 43
Be in group of three and discuss for 3’ ?

What is the importance of clinical record

keeping?

5/2/2022 44
 Importance of Clinical Record Keeping

• Professional Requirement
• Ethical Requirement

• Medico- Legal Requirement

• Ensures safe and effective clinical practice

• Continuity of patient/ client care

• Evaluation of patient/ client care

• Service evaluation/ clinical audit

5/2/2022 45
 Private practices
• WCPT advocates that PT as autonomous practitioners
should be allowed to engage in private practice

• Free of restrictions imposed by other professions on

how they should practice

• PT working in private practice should deliver services

to patients within their scope of practice

5/2/2022 46
 Questions??
Comments??
Thank you!!

5/2/2022 47