Do You Ask For Doctor's Consent/Approval

[in my own world :D]

I started to have an interesting conversation with AnastasiaB in this Melanoma thread and decided to make a new discussion for it. I didn't research to see if this has already been discussed. If so someone post a link, but maybe we can all have a go at it (again).

She demands, and expects me to "do your best work honey!" each and every week, twice a week.

but, I trust them to make the choice for themselves as to how they want their bodies handled and we go on from there. My clients are my greatest and continuing source of information on the illness and pathology front - meds, techniques, etc they willingly share them all. They are discussed, and that's that. They choose and I do what they want.

I like this take on it, and I agree with you. I guess it is a matter of approach, particularly with new clients already presenting disease, to always let the client know that they are the decision makers regarding their health and comfort. Perhaps just having the stance that providing loving, caring nurturing touch can do no harm, then letting the client decide if it will be okay in their condition? I guess I am trying to specify how to a keep the situation from becoming a liability. Some clients presenting disease expect me to know how massage will affect their condition, and I don't know.

So if a new client comes in for their appointment, fills out the intake and says they have lupus, RA, had a masectomy last year, and they are having a mole removed (might be cancerous), what is your protocol? That is just hypothetical, but in the case of multiple things going on....sometimes I'm like :shock: is massage okay?

Admitedly, I am not up on pathology. So when I hear the list of diseases I'm racking my brain for the contraindications list I learned in school. And in school the message was, "you are health care providers, know your pathology and contraindications, educate your client" type of thing. I really just want to focus on the relaxation/stress management = breathing/peace/calm = wellbeing aspect of it all and I don't want to "treat" problems with massage. It's just not my angle.

But now I am rambling and spewing resentments...someone else chime in

Please keep it on board, if you can! I'm enjoying eavesdropping, here!
_________________
Sharon

What are your thoughts about it at the moment?

 

[Pure Jersey]

Thanks for starting this topic!

For known contraindications (or supposedly known contraindications, as research is repeatedly showing otherwise), since I am in WI, a state that regulates massage as healthcare, I am required to have the attending physician consent to treatment. It seems that swedish massage is more likely to cause concern, oddly enough! However, because I know research is showing all these concerns to be silly - such as the requirement to not massage anyone with active cancer because the increase in circulation may cause the cancer to spread faster has been disproved, and deemed silly because oncologists encourage their patients to exercise, which will increase their circulation more than a swedish massage will - and because I've had doctors say NO for the silliest of reasons when faced with the standard physicians release form, I have changed my form. I now send a form to the doctor that states, "your client, ______, has chosen to receive massage therapy............." I then have a space for the doctor to give specific limitations. Nowhere on the form do I ask permission for the client to receive massage, but assume that if that doctor *really* believes there is no touching allowed or the client will be harmed, he will just not sign the form.

Suddenly, the same doctor who wouldn't give permission to a client now has no specific limitations to her receiving massage. It was a matter of laziness (my opinion, and I admit to being opinionated :wink: ) and now I've turned it around so that laziness works in the favor of the client.

So far I haven't found any medical contraindications to Shiatsu with chronic conditions. Certainly I won't apply pressure to a broken bone or other acute conditions, but chronic conditions are not contraindicated.

 

[1st SIGN ??????]

For known contraindications (or supposedly known contraindications, as research is repeatedly showing otherwise), since I am in WI, a state that regulates massage as healthcare, I am required to have the attending physician consent to treatment.

itlatics added

I was unaware of this aspect of things. I think I read in a thread from Intuitouch that my state (GA) views massage as healthcare. I guess I am obligated to do the same.

 

["This Guy"]

Actually, it seems debateable here in WI. I was taught that we must obtain a physicians release in certain cases, but have heard from others that they were not taught that and do not always ask. I haven't been able to nail it down, so am going the CYA route - but with my "inform the physician and get his/her signature" rather than "request permission and get his/her signature".

 

[Ron Jay]

Interesting...

I've found that in all cases with new clients when an MD's OK is needed to proceed, the client hasn't returned, and when I call, it invariably is the client chose another option. In some cases (Oncology) the MD has said no out of ignorance. I'm working on those MDs :wink: to better inform them.

There have been a few instances where a long term client presented with symptoms, and I requested a script to continue. In all of those once the MD called to clairify my observations, they issued the script, and began a more in depth discussion of what I can provide.

Has anyone ran into similar situations?

 

[LD50]

renauddv, how receptive are the MD's to being educated by an MT?

Actually, since I've changed my release form, I have not had a single doctor say no to their client receiving massage. (I work primarily with seniors, so it does come up more frequently for me than for many of my colleagues.) I would love to engage in a conversation with physicians and other healthcare providers, but haven't found any to be receptive, other than at one chiropractic office. How do you open up that conversation in a way that engages them?

 

[wiemercats]

Some flatly won't give the time of day, others I've offered free sessions so that they can experience first hand. Peer referal has been the best door opener. Two of my best friends are MDs, one is maried to an MT, the other maried a lady from Hong Kong, and practiced there for a few years.
This gives them a better view of alternative therapies. When they talk to other MDs they open doors for me.
I have a hello package for clients to give to their MD or other providers that explains, and offers quarterly "shares" of notes with the clients signed concent. Offering Lymph Drainage has really helped with the oncologists, and once they see the physical results, and the positive shift in the patient, the referals become common.
Mind you with our provincial heath system, the HMO style us and them is not there.
Insurance Co's are still in the dark ages... workplace comp. is better... but most MTs are still cash, and the client has to chase down the Ins Co. for repay, and most have limits of between $200-300 max per year.

 

[Newts Man]

My protocol is now and always has been to discuss whatever presenting situation there is with my client. That individual is the greatest source of information regarding how whatever their ailment is is effecting them. With RA, lupus, fibromyalgia [my personal favorite and personal affliction], cancer, etc. I have found if the client has been diagnosed for a while he/she will be able to tell you what they are going through, what meds they are taking, what meds/supplements they know are working for them, and just what they want me to do for them whether it is advised by their physician or not. They give me consent to work on them and off we go. As I have said before, most of my clientele has been around for the biggest share of the time I've been in practice, so we all have a very good communications network going on anyway - and in a county of 50,000 people everyone knows someone who knows someone who knows something or someone who has more information on the subject, and if not, then there's always the internet for me to use to google or web, md something if I don't feel I am current enough on what is going on with my clients.... or, if my curiousity is getting itchy to learn something more about a type of cancer, ailment, whatever.

 

[eri]

I have a potential new client who has a list of medications, and almost as long a list of ailments. Ailments include congenital heart failure, kidney impaired function, HBP, GERD, gout.... all fall within a description offered by Ruth Werner called "Acromegaly".

This seems to me to be a prime example of where I would want to contact at least his primary care doc. It's an awful lot of liability in one little package!

 

[Hopefull]

physician permission

Whether or not I seek it depends on the patient. If it's a referral from my own DC, usually not. There are 2 kinds of referrals, one, where he says "call her for an appointment, and see her right before you see me", and the second is "you really should think about massage". In the first, he calls me and let's me know what I need to look at, or sends them with a note, which goes in their files. The second, I do what I think most appropriate considering the info they give me on the intake. I refer oncology work out. I'm not trained in it. If I determine that they need more than the most basic of cranio sacral therapy or have significant balance issues or edema issues, they get referred out. Plantar fasciitis is an easy one, so is capal tunnel and thoracic outlet syndrome. I've got experience with fibromyalgia and myofascial pain syndromes and have written an article comparing and contrasting them. If I'm doing pre and post surgery massage, I not only have the MDs permission, I send them copies of the SOAP notes.

 

[bella p]

physician permission

Whether or not I seek it depends on the patient. If it's a referral from my own DC, usually not. There are 2 kinds of referrals, one, where he says "call her for an appointment, and see her right before you see me", and the second is "you really should think about massage". In the first, he calls me and let's me know what I need to look at, or sends them with a note, which goes in their files. The second, I do what I think most appropriate considering the info they give me on the intake. I refer oncology work out. I'm not trained in it. If I determine that they need more than the most basic of cranio sacral therapy or have significant balance issues or edema issues, they get referred out. Plantar fasciitis is an easy one, so is capal tunnel and thoracic outlet syndrome. I've got experience with fibromyalgia and myofascial pain syndromes and have written an article comparing and contrasting them. If I'm doing pre and post surgery massage, I not only have the MDs permission, I send them copies of the SOAP notes.