The physiotherapist- patient relationship is underpinned by the principles of transparency, confidentiality and trust. Use of the internet, email, texting and social media do not change those principles.
The internet, email, texting and other methods of electronic communication are useful tools, which can help health professionals communicate with patients and one another, find information and participate in specialised, worldwide medical and physiotherapy discussion groups. The internet can also empower patients and allow them to inform themselves about their condition and treatment.
New Zealand law
1. Use of internet and electronic communication
1.1. Physiotherapists need to be aware of the limitations of any method of communication they or their patients use and to ensure they do not attempt to provide a service, which puts patient safety at risk.
1.2. Physiotherapists are also reminded that patients have rights under New Zealand’s privacy laws and the Code of Health and Disability Services Consumers’ Rights with respect to electronic communication, as they do with all other forms of communication.
1.3. Physiotherapists must behave respectfully towards colleagues in any electronic communication and not include dismissiveness, indifference, bullying, verbal abuse, harassment or discrimination. Colleagues must not be discussed on social media.
1.4. Physiotherapists must ensure their websites, and use of social media does not bring the profession into disrepute.
2. Use of the internet for information by patients
2.1. Patients sometimes come to physiotherapists with detailed information about their conditions obtained from the Internet and may wish to discuss this with you. Sometimes the information is of poor quality and creates unrealistic expectations. In such cases, care should be taken to provide sound reasons why the patient should reject the information and where possible, provide evidence to support the alternative advice or treatment that you are recommending.
2.2. You should not discourage patients from using the Internet to research their condition or treatment but may need to remind them that Internet research cannot take the place of a face-to-face consultation.
3. Use of email, texting and social media
Communication of health information
3.1.Whatever method you use to communicate health information to patients or other health professionals, you must consider issues of privacy, security and the sensitivity of that information. The Health Information Privacy Code 1994 applies rules to the health sector to ensure the protection of individual privacy. You must ensure that you act within the rules it outlines.
3.2. Email, texting and other electronic media provide a quick and efficient form of communication that is often appreciated by patients. If you choose to use this form of communication, advise your patients of any limits you would like to place on its use. For example, you should advise patients not to use email if urgent advice is required and that communication will usually only take place during normal business hours.
3.3. If you send patient information electronically, ensure that the quality of the information is preserved (take particular care with images and formatting).
3.4. If you choose to video a patient for their use (for example posture, gait or exercise prescription), use their own device that they can take away rather than sending it to them via messaging or email.
3.5. There are security issues specific to the use of email. It is difficult to verify a person’s identity from an email; some families and groups share a common email address, and a number of different people may access computers (particularly family computers). For these reasons, check with the patient before sending them sensitive information by email.
3.6. You must keep clear and accurate patient records that report any information provided electronically by the patient that:
- is clinically relevant
- reflects a decision they have made about treatment
- is needed for the provision of ongoing care (such as a change in contact details)
The patient record must document any correspondence you send to the patient that includes:
- relevant clinical information
- options for treatment
- decisions made and the reasons for them
- the proposed management plan.
3.7. Comply with accepted principles such as the Health on the Net Foundation (HON) Code of Conduct, when publishing information on the Internet.
Use of social media
3.8. Physiotherapists should use caution when publishing information where members of the public can access it. In particular, do not disclose information about yourself that might undermine your relationship with patients. Similarly, do not disclose information that might identify and cause distress to colleagues, patients and their families.
3.9. Physiotherapists must remain professional in their use of social media to seek out information about your patients. Patients have expectations of privacy and may choose not to disclose certain information to you in a clinical setting — even when that information is openly accessible online. If you consider that it is medically necessary to access your patients’ websites or online profiles, seek their permission before accessing those sites. Confirm the accuracy and relevance of online information with the patient before using it to inform your clinical decision-making or entering it into the patient record (see Rule 10, Health Information Privacy Code (1994).
Aotearoa New Zealand Code of Ethics and Professional Conduct (2018) Principle 8 and 10
Physiotherapy practice thresholds in Australia & Aotearoa New Zealand (2015) Key competencies 1.1, 2.2, 3.2 and 5.2
Guidelines: Social Media and Electronic Communication. A nurse’s guide to safe use of social media and electronic forms of communication. Published by the Nursing Council of New Zealand.
Physiotherapy health records standard
Social Media and the Medical Profession Published by NZ Medical Council
Physiotherapy New Zealand (2013) Social Media e-book for Physiotherapists (Members only).
The Aotearoa New Zealand Code of Ethics and Professional Conduct
This statement is scheduled for review in 2023. Legislative and/or technical changes may make this statement obsolete before this review date.
This document has relied heavily on the Medical Council of New Zealand’s Statement on the use of the Internet and electronic communication as physiotherapists and doctors face similar issues. We acknowledge The Medical Council of New Zealand for their generosity in allowing us to use and appropriately amend their document.