In some or all consultations a physiotherapist or patient may want, or be required to have, an additional person or persons present. When an additional person attends a consultation, the physiotherapist and the patient should understand their respective rights to grant or withhold consent, and understand when the attendance of an additional person is mandatory. The role and function of the additional person should be understood by all parties. The patient’s right to confidentiality and privacy must be considered when arranging for an additional person to be present.
Definition and role of the additional person
The role of the additional person during a consultation will be determined by the physiotherapist and the patient. An additional person may be present to participate in any one of the following roles:
- a support person for the patient who is chosen by the patient and may include friends, whānau and family
- a chaperone present during the consultation at the physiotherapist’s request to add a layer of protection for the physiotherapist and patient
- an observer for the physiotherapist; commonly used for education including peer review for continuing professional development. This observer is often another physiotherapist
- an interpreter for the patient to assist in the patient/physiotherapist communication
- a student or other health professional involved in training; as part of their education
- a Board or Registrar appointed supervisor for a physiotherapist with Board imposed supervision.
- a Board or Registrar appointed physiotherapist to review a physiotherapist’s competence
New Zealand law
The Code of Health and Disability Services Consumers’ Rights 1996 states that patients have the right to have one or more support persons of their choice present. These rights extend to those occasions where the patient is participating in teaching or research (Right 8 and 9, respectively).
1. Informed consent
Informed consent must be obtained and documented for any additional person or persons to be present during a consultation (refer Aotearoa New Zealand Code of Ethics and Professional Conduct 2.8, Informed consent standard). If any additional person is present during a consultation, they should be formally introduced.
2. Support person/whānau
2.1. Every patient has the right to have one or more support persons of his or her choice present, except where safety may be compromised, or another patient’s rights may be unreasonably infringed.
2.2. The support person may be present during all or part of the assessment and treatment to provide support for the patient. Any aspect of an assessment or treatment may cause discomfort or confusion and the patient has the right to request one or more support people in attendance. The function and role of the support person focuses on the needs of the patient, whether it be holding the patient’s hand, observing the consultation or asking questions on behalf of the patient.
3.1. Chaperones may be used in any situation where the patient or physiotherapist may feel uncomfortable.
A physiotherapist may request a chaperone for a number of reasons:
- their presence adds a layer of protection for the physiotherapist and the patient
- to acknowledge a patient’s vulnerability and to ensure a patient’s dignity is preserved at all times
- it is the policy of the organisation or practice to have an additional person in attendance
- to assist the health professional during the assessment and treatment (for example – may assist with undressing/dressing patients as required)
- to provide emotional comfort and reassurance.
4. An observer
4.1. An observer may be used for continual professional development to assess the physiotherapist, with the intention of providing advice and guidance on how the physiotherapist can improve his or her skills.
4.2. The role of the observer is to observe the consultation or part of a consultation on the physiotherapist’s behalf. The level of the observer’s interaction in the consultation should be agreed to before the consultation is initiated, both between the physiotherapist and observer, and between the physiotherapist and patient.
- The patient must be provided with an explanation prior to the consultation, without the observer presence, about the role that the observer may take in the consultation and asked whether they consent to have the observer present during the consultation.
5. An interpreter
5.1. An interpreter should be present to assist during the communication between the physiotherapist and patient, when necessary and practicable. An interpreter may assist with translating a different language or with the communication or understanding of someone with a disability or alternative form of communication (e.g. sign language). Trained interpreters are less likely to make errors and are more likely to understand confidentiality, and improve outcomes.
- Whānau and family, particularly those under 16 years old, should not be used as interpreters, except in emergencies, due to potential power, and/or cultural issues, and/or conflicts of interest. (refer Aotearoa New Zealand Code of Ethics and Professional Conduct 2.5)
6. A student
6.1. As part of their education, health professional students need the opportunity to access and learn from physiotherapists or other health professionals through on-the-job training. This includes observing and participating in patient consultations.
6.2. If a physiotherapist requests to have one or more students attend a consultation, the patient must be provided with an explanation prior to the consultation, without the student(s) presence, about the role that the student(s) may take in the consultation and asked whether they consent to have the student observe or participate in the consultation.
7. A ‘Board appointed’ supervisor
Supervision, when required by the Board, means the monitoring of, and reporting on, the performance of a health practitioner by a professional peer (Health Practitioners Competence Assurance Act 2003 Part 1, section 5). The supervisor, in this case, is a physiotherapist appointed by the Board and is independent of the physiotherapist being supervised.
7.1. Some physiotherapists may have a condition imposed on their registration or annual practising certificate that requires a ‘Board appointed’ supervisor to be present during certain consultations. This condition may be imposed as part of the Board’s Return to Practice programme or as a result of disciplinary action against the physiotherapist and is intended to provide protection for
7.2. The physiotherapist who has a ‘Board appointed’ supervision condition on their practice must inform any employer of the condition.
7.3. The presence of a ‘Board appointed’ supervisor is not optional, and if a patient does not agree with this requirement, the patient will need to see another physiotherapist. A physiotherapist with a ‘Board appointed’ supervision condition must, if questioned by the patient, disclose the reason for this requirement.
Aotearoa New Zealand Code of Ethics and Professional Conduct (2018) Principle 2
Physiotherapy New Zealand Position Statement (2012), Clear sexual boundaries in the patient – physiotherapist relationship: a guide for physiotherapists / patients.