In Good Faith...?

Due to random set of circumstances I recently found out that someone has been delivering physiotherapy treatments within the SIRA NSW compensation scheme and he is not a registered physiotherapist or any other registered allied health professional. Let’s call him Ted*.

My enquiries culminated in a discussion with the owner of the practice (let’s call him Fidel*) and he confirmed that Ted was not a physiotherapist and was a “physiotherapist aide.”

Fidel explained that there might have been a misunderstanding and it was usual practice at their company for a registered physiotherapist to completed the initial assessment, submit the allied health request and then the physiotherapy aide would deliver the treatment plan.

When I referred Fidel to the SIRA workers compensation guide for allied health practitioners (specifically the bit about approval for allied health practitioners) his response was that he and I must have differing interpretations of the guidelines. Furthermore, he had already spoken with a claim manager about the use of physiotherapy aides to deliver treatments and was told by the claim manager that it was “okay.”

Fidel asked me: “Did Ted actually tell anyone that he was a physiotherapist?” citing misunderstanding could have been as a result of a patient’s poor English language skills.

My response to Fidel was something to the effect of:

Whilst speaking in Ted’s presence, talking with Ted directly, talking about Ted with others, referring to Ted as the physiotherapist, making appointments for physiotherapy with Ted, speaking with Ted about physiotherapy treatments and discussing (with Ted) the physiotherapy treatment plan – Ted never (ever) corrected any reference to him being a physiotherapist. Also I don't believe limited English language skills was relevant in this matter.

Fidel had a number of other explanations and reiterated their company policy enabling physiotherapy aides to deliver treatments under the SIRA NSW compensation scheme. He also explained how Ted was finishing his studies and only had one module left to complete making him eligible for full registration.

(Side note: Clinical placement for students is a vital part of their development and learning. I have been a student, I have taught students and believe that they should be given every opportunity to interact with patients under appropriate supervision. This matter is not about clinical student placement.)

I directly questioned Fidel about delivery of treatments for one of my cases. I wanted to know who conducted the initial assessment and who has been delivering subsequent services.

Fidel responded that a registered physiotherapist within the practice would have conducted an initial assessment and then handed over to Ted. He explained that Ted was being “supervised” by a registered physiotherapist who was “always in the room” as Ted delivered services to the patient.

(Another side note: A point of interest is that Fidel’s name is on the allied health recovery request and this patient confirmed he has never treated her)

Fidel and I spent some more time discussing the allied health treatment provider guidelines and concluded that we had different interpretations. My understanding of the guideline is that the treatment provider must have the appropriate registrations and qualifications and (as required) SIRA approval to deliver treatment under the scheme.

Fidel’s understanding was different to mine and when he questioned my understanding, I said that I had spent the past year developing and facilitating professional development courses on this exact topic.

Fidel then committed to ensuring that he would speak with his team to minimise any misunderstanding of Ted’s role. He was going to “flag with his team” that all patients on my cases are (only) to be treated by registered physiotherapists. I bluntly replied - this should be the expectation for all patients, not just mine. (argh)

I work in compo in good faith.

In good faith that the those delivering services in the scheme have some understanding of what they’re doing and some intention of doing the right thing. As an allied health professional myself and having being a treatment provider in the past, I hold my peers to a higher standard and hold company owners accountable for understanding the guidelines and regulations in which they have chosen to deliver services.

After the call with Fidel I wrote out my case notes, notified the claims manager and submitted a statement with confidence that the matter was being addressed and investigated.

I spent days reflecting upon this conversation.

I mused that sometimes people make mistakes. (I know I have)

I can understand people making business decisions based on profit over patient care. (I’ve been there)

I see how guidelines can be misinterpreted. (Yep. That too.)

So, you can only imagine my annoyance when I was to find out that about one week prior to my discovery about Ted - someone else had already raised the concern with Fidel.

Imagine my disappointment when the patient contacted me flustered and questioning what she should do because she was booked into an appointment to see Ted – after I had spoken with Fidel.

I don’t know what will be the outcome of this investigation. I don’t know what will be the consequence (if any).

We work in good faith that those around us are also trying to do the right thing.

It feels fucking awful when you find out that they’re not.

*names have been changed (but you know who you are)