Issue link: https://www.massageandbodyworkdigital.com/i/1488451
56 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 3 of exercise they should do or avoid, for instance. But it is not a doctor's job to decide whether your massage is safe. That is such an important sentence, I will repeat it: It is not a doctor's job to decide whether your massage is safe. This is partly because the term massage can mean anything from manual lymphatic drainage to Rolfing, with all modalities in between—and the safe practice parameters along that spectrum vary. It's also because doctors are not formally educated about massage therapy, so it is impossible to predict whether their assumptions about your work are accurate. But do you know who is educated about massage therapy? Massage therapists. And, like it or not, the responsibility to determine whether massage is safe lies solely with the practitioner. We may want more information about a client's situation to make the best choices, but getting more information is not the same as asking someone else to tell us whether our work is safe. Reason 3: A Doctor's Permission or Prescription Will Protect the Massage Therapist from Legal Action if a Client Is Injured This is a common misconception. If a massage therapist injures a client by working outside their scope of practice and not delivering an appropriate standard of care (see Standard of Care, Scope of Practice, page 57), it doesn't matter if they have a prescription from a medical doctor for massage—the client's injury is the massage therapist's ethical and legal responsibility. On the other hand, a practitioner who seeks appropriate consultation with the client's health-care team demonstrates due diligence in working safely, effectively, and within scope of practice, and that may provide some legal shelter. But once again, consultation is not the same as permission. Ultimately, only two people have to agree for a massage to take place: a client and a practitioner who works within an appropriate scope of practice and provides an appropriate standard of care. The primary- care doctor doesn't But that authority is probably underinformed about the risks and benefits of massage therapy, and that green light may not provide all the input we need. We might want someone in charge to give us permission to work. But what we need is more information to work safely. Those are two different things. WHY DO WE WANT A DOCTOR'S NOTE? The concept of the doctor's note is one I have struggled with since I went to massage school about a million years ago. My instruction, when we had questions about our clients' safety, was to "call their doctor." As if that would work. Even in the early '80s, this wasn't practical advice—I couldn't call my own doctor and get someone on the line, much less trying to call someone else's. And, assuming such a thing were even possible, then what? What is the purpose of calling the doctor? Why do we want a doctor's approval for our work? I identify three main reasons massage therapists want to get a doctor's note, which have varying levels of usefulness: • Doctors know more about anatomy, physiology, and pathology than massage therapists. • A doctor's note will ensure massage therapy is safe. • A doctor's permission or prescription will protect the massage therapist from legal action if the client is injured. Reason 1: Doctors Know More about Anatomy, Physiology, and Pathology than Massage Therapists Most massage therapists in the US get a solid introduction to important concepts in anatomy and physiology, and at least some information about how pathologies alter function. But this education often doesn't feel like an adequate base on which to make decisions about massage therapy in the context of complicated health challenges. So naturally, we want to go to the experts on this topic— and that means our clients' health-care providers. This is a completely reasonable strategy, and to the extent that getting information about the details of a client's health situation might help massage therapists make better choices, this is a great reason to have a conversation with a doctor or other health-care provider. Note: Having a conversation is not the same as asking permission. Reason 2: A Doctor's Note Will Ensure Massage Therapy is Safe Doctors should (and mostly do) give reliable advice for their patients in the context of many activities of daily living—whether it's safe for them to drive, or what kinds