Physiotherapy treatment without a doctor’s referral

Date published




The Physiotherapists Board of Hong Kong (the Board) recently held a disciplinary inquiry in respect of a Physiotherapist who had provided treatment to a patient without a referral from a doctor. We successfully defended the Physiotherapist at the Inquiry, establishing that the circumstances the patient faced were emergencies and in such circumstances the physiotherapist was obliged to provide treatment to the patient, despite the lack of a doctor’s referral.

In general, a registered Physiotherapist can only provide treatment to a patient with a doctor’s referral except under special circumstances. Part III of the Code of Practice of the Board (the Code) provides that:

“13.1 In broad terms a patient’s illness should be assessed or treated on referral from, or while having direct access to, a registered medical practitioner...” and

13.2 In emergencies and under certain other circumstances, a physiotherapist may be obliged to undertake some treatment without such previous referral. In such an eventuality the physiotherapist should ensure that such assessment and treatment as is undertaken be strictly limited to what the practitioner of physiotherapy has been trained to do.”

(emphasis added) 


  • An ex-employee of the Physiotherapist complained to the Board that his former employer had provided treatment to a patient without a doctor’s referral in breach of paragraph 13.1 of the Code.
  • In response, the Physiotherapist explained that the conditions of the patient gave rise to an emergency warranting treatment at the material time. Accordingly, he asserted that he had acted in accordance with the Code (paragraph 13.2 above) and was obliged to provide physiotherapy treatment to the patient, so was not guilty of professional misconduct.

Findings and Decision 

  • The Board accepted the evidence of the patient, who was also a registered nurse, that she was suffering from acute neck pain when she consulted the Physiotherapist. The pain was so severe that it affected the patient’s ability to breast feed her infant baby and perform her duties at work.
  • The Board accepted the evidence of the Physiotherapist that he had informed the patient that a doctor’s referral was required before he could provide treatment, but she could not provide this at that time as she directly approached the Physiotherapist when her neck pain exacerbated. His assessment revealed the patient was suffering from severe neck pain and under tremendous stress due to her dual roles as a working mother, who started her new job for just one month and fed her baby with breast milk only.
  • It found that emergency treatment was given after a thorough assessment was carried out. Two days after that treatment, the patient returned with a doctor’s referral letter.
  • For these reasons, the Board held that the conditions of the patient did give rise to an emergency and it was permissible under paragraph 13.2 of the Code for the Physiotherapist to provide physiotherapy treatment accordingly.


This decision is an important one as it provides registered Physiotherapists with the confidence to provide patients with urgent treatments in emergencies after thorough assessments, despite the absence of a doctor’s referral letter.

However, Physiotherapists should exercise caution and take necessary steps when emergency treatment is considered, to ensure they do not act in breach of the Code and place themselves at risk of removal from practice. 

Physiotherapists should remind their patients of the requirement to provide a doctor’s referral letter and conduct a thorough assessment before emergency treatment is provided and patient consent taken. These should all be properly and clearly documented in the records and a request for a referral letter to be provided.

Consent can also be taken from the patient for a call to be made to the treating General Practitioner to discuss the symptoms of the patient and request made. Contemporaneous records made at the material time are the strongest evidence relied upon by the Board and can greatly assist where a practitioner’s actions have been called into question.


Read more items in Hong Kong Medical Law Brief - October 2019