BACKGROUND

Amanda is an occupational therapist and acts as an independent assessor for an insurance company. She receives a referral to assess for attendant care services in the home for a client named Michael. The insurance company provides Amanda with various tools to perform her assessment easily and efficiently. These tools include a detailed templated consent form, and a laptop with specialized software to make notes as she goes along. Amanda contacts Michael and sets up an appointment for the assessment.

Upon arriving at Michael’s home, Amanda asks Michael to sign the client consent form.  Michael has some questions about the consent form, which Amanda answers as he signs.. Amanda then proceeds with the assessment and has Michael demonstrate a variety of activities such as climbing stairs and transferring in and out of the bathtub. Amanda makes informal observations as they go through the assessment and makes notes on her laptop computer. After the assessment is done, Michael asks what the outcome is. Amanda explains she still needs to work through all the assessment findings before finalizing her recommendations. As she does not want him to worry, she adds a little comment: “You have nothing to worry about” and leaves the home.

Back at her office, Amanda reviews her notes, compiles a thorough and detailed report and sends it off to the insurance company. She realizes the amount of attendant care services she is recommending is less than what Michael wanted, but it is based on her professional opinion. The insurance company makes a determination of benefits based on her report. When Michael is informed of the outcome, he is extremely upset and files a complaint with the College.

Michael states the following in his complaint: 

  1. “Amanda was unethical and lied about the outcome of the report.”
  2. He did not agree to the assessment for the purpose of reducing his benefits.
  3. “Amanda acted unprofessionally and was on her computer through most of the assessment.”

CONSIDERATIONS 

Lessons to learn from Amanda


Concern 1: Amanda was unethical and lied to him about the outcome of his report


  • While Amanda’s last comment was intended to be kind-hearted and to relieve the client of worry, it was misinterpreted to mean the recommendations will be favourable to what the client wants and expects.
  • Occupational therapists are expected to be clear and transparent about the purpose and nature of the assessment and all possible outcomes of the findings, prior to initiating service.
  • Clear communication throughout the process is essential to preventing misunderstandings as seen in this case. Refer to COTO’s Standards for Assessments.

Concern 2: Michael did not agree to the assessment for the purpose of reducing his benefits


  • Amanda used a lengthy and complex consent form signed by the client as evidence that the client consented to the assessment process. Unfortunately, the form does not describe all the aspects of informed consent that are required to be discussed. It is unclear if the client understood the purpose and nature of the assessment, the risks and benefits of participating, and all possible outcomes such as a change to his benefits.
  • It is important to remember that obtaining informed consent is a discussion and process and is never merely the signing of a form.

Concern 3: Amanda acted unprofessionally and was on her computer through most of the assessment


  • It is clear from this complaint that the client did not understand what Amanda was doing while she was working on her laptop computer. In the initial conversation with the client, it is important to make sure the client understands how the assessment will take place.
  • Explain that you will be taking notes, either on a laptop, tablet, phone, or notebook.
  • Inform the client about any formal assessment tools and informal observations that you will use to gather information.

  • You may need to remind the client during the process of what you are doing so they do not misinterpret your actions. 

OUTCOME

While Amanda had the best intentions, a complaint was still filed against her. While there is no absolute recipe for avoiding a complaint, incorporating the lessons in this case study can help to reduce to chances of a complaint happening.

In this situation, as part of the resolution to the complaint, Amanda was required to review the Standards for Consent, Assessments, and Record Keeping, complete the PREP module and write a reflective paper about improving her practice processes.

When a client understands what will happen during an assessment and how the process works, they are less likely to be surprised and upset at the outcome of a report and thus less likely to complain to the College.

Following the Standards for Practice and ensuring your notes and records are in order, are important steps to ensure best practice. These materials also provide documentation of circumstances and rationale should a complaint be filed against you.


CONTACT

If you have questions about the application of College Standards and resources, contact the Practice Resource Service: 1.800.890.6570/416.214.1177x240 or practice@coto.org.

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