Massage & Bodywork

NOVEMBER | DECEMBER 2021

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46 m a s s a g e & b o d y wo r k n ove m b e r/d e ce m b e r 2 0 2 1 education | SOMATIC RESEARCH "How Do You Feel Inside?" Why Narrative Medicine is Critical to Ethical Practice, Part 4 By Sasha Chaitow, PhD The last three articles in this series explored what I have called a "holistic revolution in biomedicine" in the form of narrative medicine—an approach to the clinical encounter designed to address ethical and practical shortcomings of the biopsychosocial approach. It is often confused with motivational interviewing, or a form of psychological profiling or compassionate listening. It is none of these, but it is more, based on a set of carefully honed protocols and principles standing on rich research. This final part of the series takes a critical look at the relevance of narrative medicine for manual therapy professions, especially in the context of big questions surrounding ethical practice. Why should you use it? Does it matter or is it just another fad? Why is it based on "narrative ethics" (and what are "narrative ethics?")? If you do want to use it, where do you start? DO NO HARM Especially since the pandemic broke out, the question of ethics has been repeatedly raised in many manual therapy circles. Whether to practice, how to think about scientific research, opinions on potential treatments, and, of course, the all-contentious vaccine have all been filtered through a lens of what is and is not "ethical." Ultimately, ethical practice rests on the principle "do no harm." 1 Obvious, right? We know in modern communication—from social media sound bites and slogans to in-depth research articles—few things are ever clear. And the first problem with "do no harm" is, what do you define as harm? Will you do greater harm by refusing treatment to someone in need or by risking viral exposure? To answer questions like this, medical science proposes the idea of relative risk. For example, for someone at risk of stroke, there are algorithms, based on input from thousands of MONSTERA/PEXELS.COM research studies, weighing the relative risk of stroke based on their health profile, compared to treatment options such as taking a daily aspirin to thin the blood and reduce stroke risk (but it might increase the risk of internal bleeding). The word relative here means the risk of stroke relative to the risk of bleeding based on a patient's profile, so it focuses only on the relationship between those two risks using data supported by evidence. A doctor may prescribe aspirin or not depending on those numbers. If we could use a similar algorithm for the question of relative risk of viral exposure versus the misery of chronic pain that may be alleviated by massage, it might be easier to come to a decision. However, COVID-19 is too new, and too unstable, to have enough data to input about its relative risk. Based on what we know, it seems safer to avoid exposure. But what about that chronic pain patient? Might missing their treatment push them over the edge into opioid abuse? Might it lead them toward damaging behaviors? Might they lose hope of ever getting better? Since we don't have the numbers to crunch, we must rely on experience and the evidence we do have, and make

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