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If you have ever felt the powerlessness of undergoing a medical procedure without fully understanding what to expect, you know the importance of informed consent.
Informed consent, a concept that was born into the medical field in the early 1960s, served as the initial nudge of a major shift in consumer empowerment known today as "patient's rights." Prior to the establishment of informed consent, a patient was relatively powerless in relationship to a doctor's authority over medical- and health-care matters. Doctors and other medical professionals held a certain power over their patients simply because they had knowledge and information that patients were not privy to. Diagnoses, prognoses and procedures were secretive and mysterious; patients were uninformed bystanders in their own health care.
Because of informed consent, patients have the right to know about, and fully participate in, their own care. The patient, or their guardian, must now give full consent for most medical care, except in emergencies where no one is capable of giving consent. The patient also has the right to withhold or withdraw consent at any time. The consent given is not considered to be valid unless the patient is informed of all the procedures they are expected to undergo, the reason for the procedures, the possible risks and benefits, and reasonable alternatives to the procedure. Most importantly, the patient must understand the information.
It has become a customary practice for the providers of many services outside of the medical arena to utilize informed consent. The consumer is now advised about what needs to be done, or what is expected to happen, before the service is rendered, and the consumer must agree, either verbally or in writing, to the service. For example, an auto mechanic should contact you before he starts any work to your vehicle to let you know what the problem is, and what the estimated cost is as well. No work should be done before you consent, which also goes for changes to the problem or estimate that would require another consent. Like patients' rights, consumers' rights are protected more now than ever before.
In theory, informed consent appears to be an adequate method of protecting both the service provider and the consumer. At least legally, when the provider imparts information, offers an explanation of what is to occur, and the consumer consents, litigation is less likely to occur. In the professional relationship between a massage therapist and a client, however, viewing informed consent only from a legally debatable standpoint is inadequate. Informed consent between a massage therapist and client, instead, can provide the foundation and framework of an ethically safe experience.
Under the best ethical conditions, informed consent is a twofold agreement in which, before the treatment begins, the client and practitioner have a shared objective for the treatment or procedure and its outcome. Ethically speaking, the client needs to be well-informed, not merely informed. A recent personal experience demonstrates the distinct difference.
Last November, I underwent a successful surgery for DeQuervain's tendinitis. The surgeon explained the reasons for the surgery, the length of the recuperation period, and gave me a pamphlet that offered standard preoperative requirements and information. When I asked him very specific, detailed questions about the procedure, anesthesia, and rehabilitation protocol, he answered cordially, but appeared somewhat rushed and annoyed. Overall, between the information he provided, and from what I learned about the disease, I felt informed and prepared for the surgery.
Exhibit A.
CLIENT AGREEMENT
I, _________________________, understand that the massage therapy given to me by ___________________ is for the purposes of stress reduction, pain reduction, relief from muscle tension, increasing circulation, or specific reasons noted here:
I understand that massage therapy does not diagnose illness or disease, or any other disorder, and that the massage therapist does not prescribe medical treatment or pharmaceuticals, nor are spinal manipulations part of massage therapy.
I understand that massage therapy is not a substitute for medical examinations or medical care, and that it is recommended that I am concurrently working with my primary caregiver for any condition I may have.
I have stated all my known physical conditions, medical conditions, and medications, and I will keep the massage therapist updated on any changes.
| ___________________ |
___________________ |
| Client signature |
Date |
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Soon after my arrival, I realized all the feelings of powerlessness and vulnerability of being a patient, and I noticed many seemingly insignificant things that were not done that could have comforted me. For instance, the woman who greeted me when I arrived neglected to introduce herself or explain what she was about to do, as she ushered me to the room where I was to have an IV inserted. The anesthesiologist did not introduce himself either, nor did he offer information to me as to what kind of anesthesia I would have, beyond saying that I would feel very relaxed. It turned out that I was completely unconscious from the time I got onto the operating table until I was ushered to the recovery area. Also, I was not informed that I could have changed my dressing after three days. Through my experience, I realized, once again, the importance of fully preparing my clients about what to expect before, during and after a massage.
Massage therapists tend to be very adept at offering information to their clients. The following ideas are presented for your consideration of ways to keep clients well-informed. Please use any or all of them in your efforts to provide a better, more ethically safe and sound experience for your clients.
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Introduce yourself when new clients arrive for their appointments with a firm, friendly handshake. Inform them that you are their massage therapist.
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Using a client agreement form see p. 138 can eliminate any misunderstandings about what massage is and what it is not.
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Be aware of why the client is seeking massage. Ask the initial question, "Why are you seeking massage at this time?" Then, ask the client at each pretreatment assessment thereafter what their goal is for the session. Meet their expectations if possible, or when it is not possible, explain why.
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Assume nothing, and expect clients to assume nothing, especially if they are new to massage and/or to you. Inform clients about what to expect by offering them a "Welcome" form to read after they fill out their medical history.
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During the massage, verbally inform the client when you are moving to more vulnerable areas, such as the anterior neck, medial thigh and abdomen.
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Verbally inform the client when you are about to rest your own body on the table, get up onto the table to assist your body mechanics or to assist with stretches.
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Inform the client when your work gets deeper, and check in to see if it is tolerable.
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Inform the client five minutes before the massage is to end, and ask them if they would like you to move your focus to an area that may need more attention.
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Perform tapotement only after explaining what it is and obtaining the client's permission. At the end of a relaxing treatment, it can be a startling experience to be awakened from a semisleep state to unexpected
tapotement.
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Don't surprise the client. Remember that information, knowledge, and the right to refuse offers personal power to the client who is in a vulnerable, relaxed state.
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Inform the client about what to expect after the massage. For example, when suitable, tell the client that soreness or tenderness may be experienced the next day.
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Cover all bases with your clients so that neither you nor the client will face a situation without some preparedness. Let the only surprise be how much clients enjoyed the experience, and how impressed they were by your consideration and caring during the massage.
Dianne Polseno, former chair of the AMTA National Ethics Subcommittee, is a practicing massage therapist, practical nurse, and author and publisher of Comprehensive Review Manual For Massage Therapists. The academic director and a teacher at Bancroft School of Massage Therapy, she receives mail at: 1 Raymond St., North Smithfield, RI 20896-8215 and E-mail at:
dipol@aol.com.
Related Books For More Information
1. McIntosh, Nina. The Educated Heart. Memphis: Decatur Bainbridge Press, 1999.
2. Redleaf, Angelica & Susan A. Baird. Behind Closed Doors: Gender, Sexuality, and Touch in the Doctor/Patient Relationship. Westport, CT: Auburn House, 1998.
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