Issues around professionalism and ethics, by their very nature, are not black and white.  In every situation there are grey areas that must be considered and examined.  This toolkit will help to guide you in thinking about issues, and how to prevent and solve them.  For convenience they are divided into six broad categories. 

1. Awareness

Many who face questions about ethics and professionalism claim that they were unaware that they were doing anything wrong.  Ignorance is not a valid excuse, especially in a self-regulated profession.  It is the responsibility of all involved in the provision of physiotherapy services to be aware of the rules.  Being aware of good business practices will go a long way in helping to prevent incidents of fraud, waste and abuse.

  • Ensure that you have the proper policies and procedures in place, especially concerning billing practices and audits
  • Be aware of the rules and standards of practice concerning the provision and funding of physiotherapy services
  • Look at potential issues from multiple viewpoints.  Sometimes, issues are not as ‘black and white’ as they might appear at first glance


2. Clarification

There are many resources available to help you clarify issues and make good decisions.  Informally, you can seek input from trusted colleagues and friends.  Provincial physiotherapy regulators are a valuable source of information regarding standards of practice and regulations.  Insurance companies and other third party payers can help to clarify the specifics of their particular payment rules. Encourage patients to review the limitations of their extended health benefits plan.  As the old adage says, “An ounce of prevention is worth a pound of cure” or, it is easier to prevent problems than to solve them later.

  • Sometimes just talking about a situation can help you see where there could be grey areas in your business practices
  • If you have questions about what you can or can’t do in the provision of physiotherapy services, reach out to your provincial regulator for advice
  • Ask questions of third-party payers to clarify their billing requirements
  • Review your mandatory reporting obligations


3. Decision Making

After you have gathered the information needed to clarify the issues for your particular concern, you need to make a decision.  This involves weighing the pros and cons. As physiotherapy is a self-regulating profession, it is important that provincial standards of practice and regulations be considered in the decision making process. Additionally, the code of ethics must be considered and upheld in all aspects of physiotherapy practice.

  • Use available decision-making tools and the code of ethics to help you decide
  • In a self-regulated profession it is important that your personal interests never come before the interests of the clients
  • Do you have enough information to make a decision?


4. Communication

The next step is communication. The best way to communicate will depend on the situation and the relationships of the people involved. In order to change practice, a policy for staff or patients can be created. However, having difficult conversations and/or taking a stand may be necessary.

  • Prepare for difficult conversations ahead of time
  • Plan these conversations carefully and keep an open mind
  • Use active listening skills and do not interrupt


5. Reporting

After you carefully consider the facts, you may decide that you have an obligation to report something.  At this time, you will need to carefully document your findings. You will then determine to whom it should be reported, as well as the process to follow. Keep detailed notes of your conversations.

  • Is a patient’s safety at risk? If yes, act now. Don’t delay.
  • Have you reported to everyone who needs to know? E.g. patient, employer, insurer, regulatory body
  • Ensure that you have all the facts


6. Prevention

Life would be much easier if we all avoided stepping over the line. By recognizing areas at risk of fraud, organizations can put in safeguards and policies and procedures. These should be monitored or audited regularly to detect issues early. You must also ensure they meet the needs of the ever-changing health care system.

  • What needs to be put in place in order to prevent incidents of fraud, abuse and waste from occurring in your workplace?
  • How can we learn from past mistakes or the mistakes of others?
  • Quick Tip: start with changing your passwords periodically.


In a perfect world, there would be no ethical or professional dilemmas facing you in your work life.  However, we all are aware that the world is not always perfect.  There will be times when you have an uncomfortable feeling around a conversation or situation, when your ‘spidey-senses’ are tingling. These resources will help to name what is bothering you and lead you to make the best decision. Allowing an unethical situation to continue could make it worse- potentially harming your reputation or the reputation of the physiotherapy profession.