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Often we feel the need to solve all

problems, despite at times not having the

expertise or others being more qualified

to provide such advice. The danger for

any physiotherapist is going too far. This

article is not about defining where and when

your role and advice should stop, as every

physiotherapist is different, but aims to

highlight areas where you should step back

and consider if you are the right person to

solve the problem.

Scenario one

A patient presents to you with a condition

for which they have been advised that

surgical intervention is required. However,

from your perspective, you believe there are

steps prior to surgical intervention that may

improve the patient’s outlook or reduce the

need for it.

The first area to consider is whether are

you qualified in the area being presented

and whether you have scientific evidence

supporting your approach. If you

have neither it makes it very difficult to

recommend an alternative to the patient,

and you are potentially opening yourself

up to litigation if the patient’s condition

deteriorates or problems arise from the

advice you provide. If you believe you are

suitably qualified and have supporting

evidence, then consider the following


recommend to the patient that they

make contact with the referring

specialist to discuss the options


agree on clear timelines with the

patient where decisions can be made

as to whether surgery intervention is

still required

if the referring medical specialist

rejects the proposed course of action,

advise the patient and make them

aware (ultimately, it is the patient’s

decision, not yours, and you can only

provide comment within your area of


if the patient agrees to your proposed

course of action, ensure at all times

that they are aware of the risks or any

issues undertaking your recommended

course of treatment

clearly document and communicate to

the patient your approach, including

the risks and issues discussed

clearly identify areas that the patient

needs to undertake away from the

practice to assist in the process

ensure any questions with respect to a

specialist’s advice are handled by the

specialist and not yourself (ultimately,

the patient may elect to proceed with

the specialist’s advice regardless of

your physiotherapy advice).

Scenario two

This scenario is slightly different, as a

doctor may refer a patient directly to you

as a way of deferring or avoiding surgical

intervention. In such a circumstance, you

need to decide when it is time to refer back

to the doctor. You should consider the

following approach:

clearly understand the patient’s

condition and referral, and, importantly,

what the potential outcome is if

physiotherapy fails to improve the

patient’s condition

clearly communicate this to the patient

if you agree with the doctor’s referral,

you need to clearly identify with the

patient that treatment may not be

Understanding your limitations


Continuing this series of good practice articles to support members, Insurance House pinpoints

how clinicians can identify and focus on their strengths.

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