Physiotherapists who use a website as platform for their services tend to offer one of two types of service:
- where their website provides advice and information
- where their website acts as a gateway for patients to access a secure site to enter into a one-to-one virtual professional relationship.
Advice provided over open-access non-secure websites may be general advice on physiotherapy topics only and must not be tailored to the individual requirements of an enquirer nor be specific advice designed to address the concerns of individual patients or clients.
Any general advice must be reviewed on a regular basis to ensure that it is accurate and up to date and all such communications should carry a message clearly stating that the advice is general in nature and patients requiring individual advice should consult their own therapist. In these circumstances of providing general advice, no duty of care would be established and it is most unlikely that the provision of such a general service could give rise to a claim in negligence law. If the advice is too specific, anyone using the information on the website who subsequently suffered harm might try to argue that you owed them a duty of care and therefore that you could have been negligent.
There are examples of web-based services that offer personalised advice and management to patients via a secure fee-paying log-in for services. However, you must remember that if you start entering into personalised assessment of a person's injury needs, or provide tailored intervention, you create a duty of care to that person, and thus you must only offer any intervention based on appropriate assessment; and you will need to consider whether you can give such advice purely online or whether at some point you will need to see the person for an in person face-to-face consultation. This would be particularly pertinent if you are offering diagnosis and prognosis - giving a diagnosis is personalised care so you can only do this after proper consultation and assessment.
You must consider where your website is based and hosted, and there should be a statement explaining the legal status of your terms and conditions for the use of your information. Your CSP PLI does not provide cover for claims brought in the jurisdictions of the USA and Canada, and consequently CSP members should be advised not to provide specific advice services to individuals in North America.
The CSP scheme only covers individual members and does not include cover for any claim brought against a website or organisation owned by a CSP member, or any other organisation for whom, or on whose behalf, the member is acting.
Skype or other virtual face-to-face technologies
Providing physiotherapy services over the internet or via any computer or any electronic system accessible outside the insured’s premises is covered by the PLI scheme subject to T&C’s. You must consider the countries from which patients may access your services because it may affect your PLI cover:
- NO cover is provided for services delivered in Australia (via the internet or otherwise) other than when travelling to Australia with a British team or British based organisation.
- NO claims are covered in the USA/Canada for any advice or treatments given to US or Canadian nationals in their own territory (via the internet or otherwise) ,nor are any claims covered within the policy for any claims brought within the jurisdiction of US or Canadian Courts (regardless of the nationality of the claimant.)
Consequently CSP members are advised not to provide specific advice services via Skype to individuals in continental North America.
Writing for publication
As background a physiotherapist must always distinguish between their role in providing advice for:
- a) topics in general. This would be general physiotherapy advice that is not tailored to the individual needs of the audience/enquirer and could be found from other sources by the audience/enquirer e.g. another book, leaflet, DVD etc.
- b) a specific named patient/person in relation to a specifically assessed and identified injury/issue. This would be physiotherapy advice and/or intervention that is given as a result of a full and appropriate assessment and identification of individual and tailored needs and that is provided by a registered physiotherapist.
Both activities are regarded as being within the scope of physiotherapy practice and are therefore included within the CSP PLI scheme.
When writing or creating for publication in books, DVDs or media broadcasts aimed at patients or the general public, or producing DVDs, the fundamental assumption must be that your audience - or potential audience - could be unknown to you, and is unassessed and undiagnosed and may not be suitable to follow your programme or advice.
There must be regular caveats that the advice is of a generalist nature and could not take into account the particular physical or medical condition of individual audience members; that information is meant to be practical and informative but is not intended to be a substitute for professional advice; that the information available is not meant to replace any relationship that exists between an audience member and their GP, hospital specialist or other healthcare professional.
Any advice given in such publications must be reviewed on a regular basis to ensure that it is accurate and up to date and all such communications should carry a message clearly stating that the advice is general in nature and patients/persons requiring individual advice should consult their own therapist. In these circumstances, no duty of care would be established.
Where you choose to provide a book/publication or DVD made by you to one of your patients for whom you do have a duty of care, your duty extends to ensuring that the contents of the book/publication or DVD are suitable for your patient’s needs, and the patient should be explicitly advised as to whether any parts of the book/publication or DVD are not suitable to their condition. In this circumstance the provision of a book/publication or DVD to the patient which resulted in the patient suffering harm could give rise to a claim of negligence against you.
For specific insurance related enquiries you can contact the CSP insurance brokers:
Graybrook Insurance Brokers Ltd
8 Chandlers Way
South Woodham Ferrers
Essex CM3 5TB