Imagine this: you’ve just finished a great session with a patient recovering from a knee injury. You suggest a particular brace that could support their progress – and it just so happens that your clinic sells the very same model. You genuinely believe it’s the best option… but could that recommendation be seen as a conflict of interest?

In physiotherapy, trust is everything. Patients rely on your professional judgement to guide their care. Yet, the line between good intentions and perceived self-interest can be surprisingly thin. Conflicts of interest (COIs) don’t automatically mean you’re doing the wrong thing. What matters is how they’re managed. As outlined by the Australian Health Practitioner Regulation Agency (AHPRA), practitioners have an ethical and legal responsibility to act with transparency, placing patient wellbeing above all else.

We explore how conflicts of interest arise in physiotherapy, what Australian regulations say about managing them, and the practical steps you can take to stay transparent, ethical and trusted in your care.

A conflict of interest happens when your professional judgement could be seen to be influenced by personal interests. The Physiotherapy Board of Australia’s Code of Conduct states, “A conflict of interest in practice arises when a practitioner, entrusted with acting in the interests of a patient or client, also has financial, professional or personal interests or relationships with third parties which may affect his or her care of the patient or client.”
There are three main types of conflicts to be aware of:

1. Actual conflicts: These occur when your personal interest directly clashes with your duty of care. Example: You receive a commission from a supplier for every rehab tool you sell, and you recommend that product to patients.
2. Potential conflicts: These exist when a situation could develop into a conflict, even if it hasn’t yet. Example: You’re considering investing in a local Pilates studio where you refer your patients for ongoing therapy.
3. Perceived conflicts: These arise when others could reasonably believe your decision-making might be biased. Example: You treat your sibling or close friend and charge them less.

Conflicts of interest can arise in subtle ways, often without any bad intentions. What matters is recognising them early and knowing how to respond transparently. Here are some of the most common examples physiotherapists come across in everyday practice:

1. Referral Incentives
This happens when money or rewards influence who you send your patients to. For example, a physiotherapist might get a small payment for referring someone to a local imaging clinic or another health provider. Even if that provider is good, not being upfront about the payment can cause ethical concerns. AHPRA’s Code of Conduct says health professionals shouldn’t let money or other rewards affect, or even appear to affect, their clinical judgement.

Best practice: Always be open about any referral payments or partnerships. Being transparent builds trust and helps protect you from complaints.

2. Product Sales
Selling braces, supplements, or rehab equipment within your clinic can be convenient for patients, but risky if not handled correctly. If you’re recommending a product that earns you profit, you must make this clear. Otherwise, patients might question whether the advice is based on clinical benefit or financial gain.

Best practice: Offer choices. Let patients know there are alternative suppliers and provide written disclosure if your clinic profits from sales.

3. Dual Relationships
Treating family members, friends, or business partners can blur professional boundaries. The Physiotherapy Board of Australia’s professional boundaries guideline warns against relationships where emotional involvement or personal interest could affect care quality.

Best practice: Where possible, refer loved ones or close friends to another practitioner. If you must treat them, keep detailed records and ensure consent is informed and documented.

4. Research and Education Partnerships
Conflicts can also arise in research or educational settings. For example, you might be involved in a study where participants are also your patients, or you could benefit professionally from positive results. Transparency with participants is essential. They must understand your role and any potential benefits you may derive from it.

5. Workplace and External Roles
Many physiotherapists juggle multiple positions: in private practice, hospitals, sports teams, or teaching roles. Sometimes, these roles can overlap. For instance, a physio working for a sporting club might also see team members privately, leading to potential confidentiality or financial conflicts.

Best practice: Be upfront about dual roles and avoid situations where one responsibility could influence another.
Managing conflicts of interest isn’t about avoiding every potential situation – it’s about being honest, open and proactive.

Do’s: What You Should Do

• Disclose early and clearly: If you stand to benefit from a product, referral, or partnership, let your patient know before they decide. Example: “Just so you’re aware, our clinic stocks this brace for convenience, but you’re welcome to purchase it elsewhere.”
• Document everything: Keep written records of disclosures and related discussions.
• Offer alternatives: Always provide patient choice, it keeps decisions patient-centred.
• Seek guidance and peer input: Contact AHPRA’s ethics support service if unsure.
• Be transparent with dual roles: Make your responsibilities clear across workplaces or teams.

Don’ts: What to Avoid

• Don’t assume patients “don’t care”.
• Don’t let financial incentives guide treatment. Avoid pay-per-referral setups.
• Don’t treat close friends or family unless necessary. It’s difficult to stay objective.

Consider including a Conflict of Interest Statement in your clinic paperwork or at reception: