Sports Physios

Sports Physiotherapists – On Field Treatment – Potential Risks

There's a reasonable probability that a player will sustain an injury when they are competing in either team or individual sports.  A physiotherapist charged with the care of a team or individuals on the field can have a considerable onus placed upon them to:

• assist in a player's physical conditioning,
• prevent injury,
• identify an injury, diagnose a physical condition or assess the degree of damage on the spot,
• minimise injury severity and exacerbation,
• maximise or expedite injury rehabilitation,
• determine fitness for activity,
• return the player to full (pre injury) competitive function.

All of these treatments and activities may be conducted in a pressurised and competitive environment. Irrespective of the level of the competition, the practicality of performing and recording the same diagnostic evaluations that you would in a clinic setting is obviously a difficult and challenging issue.  The danger to physiotherapists is that those decisions made in this environment may at some stage be questioned, particularly if there is an undesirable outcome, such as:

• a significant injury, perhaps emanating from a minor, or overlooked condition,
• preventable aggravation (discovered post event),
• a condition that prevents the player from resuming competition for a long period,
• a second opinion obtained post event that places doubt over the quality of the decision made by the attending physiotherapist.

If a physiotherapist's decisions and/or actions are challenged, the absence of clinical notes supporting their decisions (and/or communication between patient or others) could put his or her professional reputation at risk and leave them legally liable.

Clinical records are your best defence

The necessity of maintaining good contemporaneous clinical notes in general physiotherapy practice is well known throughout the profession.  The APA makes clear that high standards of professional competence include, amongst other things, keeping current and accurate clinical documentation. This principle is based on the widely accepted view that the primary purpose of the patient record is to contribute to the quality of patient care.

Records also play a key role in preventing and managing adverse outcomes. The physiotherapist providing professional services on the sporting field will similarly be held to a high standard with respect to documentation as it relates to the provision of treatment and advice.

Certainly the sporting field is a different environment to a clinician's professional rooms.  Nonetheless, the sports physiotherapist is still providing a professional service. Whilst the particular environment  and circumstances on of the sporting field will be taken into account in any review of an adverse outcome, being able to provide an objective record will assist the physiotherapist significantly if any legal action is taken.

Remember, clinical records can be admitted into evidence in legal proceedings. Good records will provide greater protection and assist in defending any allegation brought against a physiotherapist rather than their recollection of events alone. 

Record-keeping on the field

Even though record maintenance presents practical challenges, the onus is on a sports physiotherapist to keep a patient's records up-to-date.

Have you considered using a Dictaphone?  Used by various health practitioners, a Dictaphone could provide a more practical alternative to maintaining comprehensive treatment records whilst engaged in your professional capacity in the sporting context.  The transcription of your clinical observations and decisions made as soon as practical after the event helps you to record a more accurate account of the treatment and the professional advice provided.  Remember that good records will provide greater protection and assist in defending any allegation brought against a physiotherapist, than their recollection of events alone. Any measure that provides a practical solution in this regard should be sought.

In addition to the issue of keeping records and the practical difficulties that the sporting context may present, we also suggest you consider the following:

1. What contractual arrangements exist between the physiotherapist and the sporting organisation with respect to the provision of the physiotherapy service?
2. Is the physiotherapist engaged as an employee of the organisation or in some other capacity?
3. Does the sporting organisation's insurance cover the physiotherapist in the event of an adverse outcome?

It is essential that you establish precisely the nature and extent of your professional indemnity coverage so that you can be confident that your own interests, and those of the players in your care, are protected. 

To ensure you are fully protected in your capacity as a registered physiotherapist we recommend that you take out your own insurance policy.  This means that you are assured of protection and cover for your own legal costs even if allegations, or potential allegations, are found to be without merit.

Whether you normally work in the public sector or in private practice, it is prudent to have your own cover so that you are assured of financial support as an individual rather than having to rely on coverage provided by another party.

Finally, you should be confident that you know precisely what your professional indemnity arrangements are before you provide any professional services on the sporting field.