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One Small Change: A physiotherapist on how to improve our health system

Allowing physios to refer patients for X-rays would greatly improve efficiency, says one professional

Dr Marie Ó Mír

Chartered physiotherapist

X-rays are a cost-effective and valuable imaging technology that can assist in the diagnosis of serious pathologies such as cancer, fractures and joint infection. However, in Ireland, physiotherapists are not legally permitted to refer patients for X-rays, as they are not one of the health professionals included in the legislation governing referrals for these investigations.

Instead the law requires physiotherapists to make an additional referral to a GP or consultant to allow for a request for X-rays. This involves considerable extra cost and delay both to the patient and the health service.

Physiotherapists in Ireland are managing entire episodes of patient care in musculoskeletal assessment clinics, emergency departments, fracture and respiratory clinics and private practice. And although the physiotherapist is independently assessing the patient and deciding whether a further diagnostic investigation is warranted, s/he must then refer the patient back to the consultant or GP to have the X-ray ordered, resulting in great inefficiency of care and extra cost to the patient.


This situation adds to medical staff workload unnecessarily, slows down the treatment process and lengthens patients’ journey. This is particularly pertinent in the Covid era when we should be ensuring our patient pathways are as efficient as possible and limiting the number of healthcare professionals patients need to interact with.

At a time where there is increased focus on waiting lists, physiotherapists are part of the solution. Since 2011, physiotherapists working in musculoskeletal assessment clinics have managed more than 180,000 patients on orthopaedic and rheumatology outpatient waiting lists. But 300 appointments per month are being wasted while physiotherapists source other medical professionals to order X-rays for them.

Physiotherapists in other countries such as Australia, Canada, New Zealand, Sweden, the Netherlands and UK are legally permitted to refer patients for X-rays with resultant reduction in costs for both the health service and the patient, and the streamlining of patient pathways.

The Irish Society of Chartered Physiotherapists presented a report to the Department of Health and HSE in March 2021, detailing the cost savings to be made. If the Department of Health is serious about delivering the Sláintecare aim of “right care, right place, right time”, the legislation should be amended to allow chartered physiotherapists refer their patients directly for X-rays.

  • As our health system begins to return to normal activity levels following the Covid-19 pandemic, we would like to hear about one change you would like to see. It can be something simple that annoys you, day in, day out, that is easily fixed, or it can be a small change in practice or attitude that would make life easier for everyone. Email with your suggestion or fill in the form below
Sylvia Thompson

Sylvia Thompson

Sylvia Thompson, a contributor to The Irish Times, writes about health, heritage and the environment