Non-treating physiotherapists are those who are contracted or employed by a third party to undertake an independent assessment for a second opinion, expert advice (used in legal proceedings), assessment for employment suitability, and eligibility for health services or compensation.
- The purpose of the physiotherapy assessment varies depending upon the role of the third party. A non-treating physiotherapist’s assessment may take several forms, including a consultation with the patient, physical examination, or a file review of the patient’s medical and physiotherapy history.
- Physiotherapists, who are employed by a third party and perform independent assessments of patients, are required to maintain a professional standard of care and are expected to meet the standards of practice outlined in this statement.
New Zealand law
1. The role of the non-treating physiotherapist
1.1. As the non-treating physiotherapist, the role is to perform a physiotherapy assessment and provide an impartial physiotherapy opinion to the third party. As the title indicates, the role does not include providing any form of treatment to the patient.
1.2. Decisions made by a third party will be influenced by your opinion, and this may affect the outcome for the patient. Therefore, the Physiotherapy Board (Board) considers that in making a recommendation there is a responsibility to ensure that the professional opinion and recommendations are accurate, objective and based on all the available evidence.
1.3. The treating physiotherapist should be informed when an assessment is to be conducted by the non-treating physiotherapist for a third party. The results and any recommendations of the assessment should be communicated with the treating physiotherapist, if appropriate.
2. Performing physiotherapy assessments
2.1. If the physiotherapist does not consider themselves suitably qualified to conduct the assessment or identifies a conflict of interest, they must decline the referral and do not have to provide the third party with an explanation.
2.2. If the third party considers that a physical assessment is not required, they must be satisfied (and be able to justify) that they have all the information necessary to make an accurate assessment without performing a physical assessment or speaking with the patient.
2.3. The basis of the relationship between the patient and the non-treating physiotherapist is not the same as that between the patient and their treating physiotherapist, so it is important to ensure a high professional standard of care as these patients are often vulnerable.
2.4. The patient must be treated with respect, to ensure the assessment is free from coercion, discrimination, harassment and exploitation (Right 2, Code of Health and Disability Services Consumers’ Rights).
3. Effective communication and informed consent
Poor communication with a patient can lead to unmet expectations, misunderstandings and confusion about the non-treating physiotherapist’s responsibility to the patient.
Therefore, when assessing the patient:
3.1. The physiotherapist must ensure the patient understands the purpose of the physiotherapy assessment and the physiotherapist’s role. This explanation should include discussion about the differences between the roles of non-treating physiotherapist and the patient’s own
3.2. The physiotherapist must explain what will happen during the assessment and ensure the patient is informed of what the physiotherapist is doing throughout the consultation. This includes explaining the scope of the consultation and any tests the assessment may require.
3.3. The physiotherapist must obtain the patient’s informed consent and ensure the patient adequately understands that any aspect of the physiotherapy assessment may be included in the report to the third party. The patient must also be advised that he or she has the right to withdraw from the assessment at any time, and be informed of any relevant policy held by the third party in relation to the withdrawal of consent and the process that should be followed to organise another assessment with a different physiotherapist. In either of these circumstances, the physiotherapist should record in the report to the third party at what point the assessment was terminated and why.
3.4. The physiotherapist must explain and ensure that the patient understands what will happen after the consultation. Specifically, the patient understands that the report will be the property of the third party. Any questions or requests for information should be directed to the third party.
4. Recording a consultation
4.1. A patient may want to record the consultation by video or audiotape. This request should be considered carefully and, if the physiotherapist does not consent, the third-party should be asked to arrange for another physiotherapist to conduct the assessment.
5. Reports for the third party
5.1. Once the physiotherapy assessment has been completed, it is standard practice for the physiotherapist who performed the assessment to provide a written report to the third party with their physiotherapy opinion. The report must be accurate and objective. If there is a concern the physiotherapist’s opinion cannot be accurate, based on all the information provided in the file, this must be stated in the report. Further methods of investigation can be recommended if appropriate such as medical referral and x-rays.
5.2. If there has been any documentation or information provided by the third party, this should be listed as part of the report.
5.3. If the third party has requested recommendations (such as suitability for an employment position), these recommendations must not compromise the patient’s safety.
6. Physiotherapy assessments by the patient’s own physiotherapist.
6.1. In some circumstances, the patient’s usual physiotherapist will be requested to perform an assessment that would otherwise be performed by a non-treating physiotherapist. This is usually because the patient lives in an isolated area where a non-treating physiotherapist is unavailable. In this situation, the physiotherapist should explain the difference in their role.
6.2. The physiotherapist must ensure that any assessment of a current patient to a third party is accurate, objective and based on all the available evidence.
7. File assessments by a non-treating physiotherapist
7.1. The physiotherapist may be employed or contracted as a non-treating physiotherapist to perform an assessment based solely on information in the patient’s file. In such circumstances, and as with any other form of assessment, you must be satisfied that you have all the information necessary and a physical examination is not required before providing your professional opinion or recommendation.
7.2 It is not acceptable to include conclusions in the report to the third party unless the physiotherapist was confident and can justify that consulting with the patient or the patient’s own physiotherapist was not necessary.
8. Financial influences for the non-treating physiotherapist
8.1. The physiotherapist must not allow the financial interests of either the patient or the third party to influence their assessment, opinion or recommendations.
Aotearoa Physiotherapy Code of Ethics and Professional Conduct (2018).