The complex problem of identifying serious pathology in Musculoskeletal care: Managing clinical risk during the COVID pandemic and beyond

The expanding scope of physiotherapists has come with an increased level of responsibility to identify "red flag" signs and symptoms. Red flags can indicate the presence of serious pathology but are notoriously unreliable. This leaves diagnosis heavily reliant on diagnostic investigations which are generally a finite resource within healthcare organisations. The COVID pandemic seems to have further compounded the problem and the possibility of "missed" or "delayed" diagnosis is ever-present. This may present a threat to patients' lives, to clinicians' careers and wellbeing, and to organisations' finances and reputations. Although clinical risk in musculoskeletal physiotherapy may never be eliminated, there are opportunities to work towards minimising it. This professional issue will explore the complex problem of identifying serious pathology in musculoskeletal care and will propose strategies to manage the associated risks during the COVID pandemic and beyond. A video abstract is included in Appendix A.