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education MASSAGE THERAPY AS HEALTH CARE The events of this year have us asking ourselves, and wrestling with, a variety of questions as a profession: How can massage therapists be a part of health care if we are deemed "nonessential" when the chips are down? Or, how can we call ourselves health-care providers if we're not able to provide care in times of obvious suffering? As MTs, we have to ask the right questions to find useful answers. We have to ask questions that are not skewed by opinion or assumption. The questions above are not good ones. They are complaints. At best, they are disgruntled tantrums disguised as questions. I know this because that is how they feel inside me when I ask them. Maybe a better question is: What does it mean to be essential? This question puts us in the same shoes as the clinicians and practitioners who are typically deemed essential. They ask this question every day. Is this surgery essential? Is this medication, procedure, and/or medical device essential? The heart of this inquiry is whether their intervention and presence in the care equation has a greater likelihood of benefit than harm. Under normal circumstances, massage therapists have the good fortune to know that, when properly adapted, massage therapy can be accurately described as Ask the Right Questions By Cal Cates a "low-risk intervention." It is the job of every health-care provider to know when their involvement tips the scales from benefit to possible harm. A few of the massage therapists who work with me had the opportunity last year to work with a patient in the ICU over a period of months. The patient was visibly and actively dying from complicated disease processes that could not be prevented. As what would prove to be the end of her life approached, her kidneys began to fail. The attending physician asked a nephrologist to consult on the case. The nephrologist assessed the patient's condition. She felt clear that their intervention would only prolong the patient's suffering and possibly even hasten death. They all wished a better answer had been available, but it was the nephrologist's responsibility to know that her intervention would have caused unnecessary and avoidable harm. Understanding this dynamic is key. The physician called the nephrologist because the physician knew they could trust this nephrologist to make a safe and ethical decision about how best to care for this patient. If the nephrologist had decided to move forward with a futile and potentially injurious intervention, this would likely have damaged the relationship and trust between these two providers. Myriad scenarios could be discussed, but none of them would result in increased trust or rapport between these two clinicians. When the attending physician requests a consult for a patient in the future, they will feel safe and confident in the judgment of this other provider. Being a health-care provider means understanding that sometimes good care means choosing to remove yourself from care. When the facts make it impossible to offer a compelling case for benefit over harm, we must make the responsible, collaborative, and ethical decision to remove ourselves from care. We have to be clear about when our actions can result in unnecessary and avoidable harm, but there is still plenty of room for us to continue to advocate for massage therapists' role in health care. Sometimes, being a health-care provider means referring out or just plain sitting out. No matter what type of care you provide, there are times when your otherwise essential care is not a good fit. We must understand this if we are going to participate in a larger community of care. It is essential to our belonging among other health-care providers. Cal Cates is an educator, writer, and speaker on topics ranging from massage therapy in the hospital setting to end of life care and massage therapy policy and regulation. A founding director of the Society for Oncology Massage from 2007– 2014 and current executive director and founder of Healwell, Cates works within and beyond the massage therapy community to elevate the level of practice and integration of massage overall and in health care specifically. Cates also is the cocreator of the podcast Massage Therapy Without Borders. N e w ! A B M P P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p . 41

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