Issue link: https://www.massageandbodyworkdigital.com/i/588318
F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 39 PATHOLOGY PERSPECTIVES Your client reports that she had a minor transient ischemic attack six months ago. What area of her body must be treated with the most caution? a. Anterior triangle of the neck b. Suboccipital triangle c. Calves d. Between the scapulae The correct answer is A, but the second-most correct answer would be, "Excuse me, let me just check my pathology book." Cognitive Domain Level 3: Problem Solving For the purposes of entry-level pathology education, the cognitive domains of Level 2 and 3 are often interchangeable, with room for more extensive exploration in Level 3 thinking. The point is to support problem solving with credible information that has been analyzed and evaluated by the learner or practitioner. Affective and Interpersonal Domains When teaching and learning about pathology stretches beyond the processing of facts into strategies, then we begin to cross over into education about ethics and communication. I have supported this by providing some "What Would You Do?" questions intended to spark conversations rather than to lead to specific conclusions. Here is an example: You have volunteered to work at an outpatient dialysis facility where patients with end-stage renal failure are treated. Your client today is Rick, a 56-year-old man on disability because he has lost one leg below the knee and half of his other foot due to diabetes. Rick is about 80 pounds overweight and it is obvious from the smell he is a heavy smoker. His hands are grimy, and although he says he feels fine, he has a heavy, phlegmy cough. You have agreed to give Rick a 30-minute gentle massage while he is receiving his dialysis treatment. You will be working with his arms and hands and possibly his neck, shoulders, and head. Make a list of the questions you want to ask. Also, pay attention to whatever reactions and personal responses you have about working with Rick. Do you have any concerns? How can they be answered? When you discuss this prospective client with your classmates, are their reactions similar to yours? CALL TO ACTION Readers of this article are not likely to be shopping for an entry-level pathology book, but you are called on to be critical thinkers. The next time you see a client with a condition that you're not familiar with, I encourage you to put on your critical thinking/ clinical reasoning cap. Before you ask your Facebook group, go to credible sources of information, either in print or online. A Massage Therapist's Guide to Pathology is a good place to start, but it's not the only good place to start. Other pathology texts have different strengths, and I also hope to see the ability to do a good PubMed (www.pubmed. gov) search become part of our job description. Here is an example of the rest of that decision-making process: • Find out how this condition affects function: What does it do to sensation, circulation, the integrity of the skin? What other systems might be involved? What medications might alter your choices, and in what ways? • Identify the possible risks and benefits of your style of massage therapy for your client's situation. • Make a session plan that minimizes or eliminates the risks and maximizes potential benefits. • Record your results. This process is the essence of evidence-informed practice, the essence of clinical reasoning, and the essence of best practices. It is vital this becomes our standard of care and a reasonable expectation for every massage therapist—newbies and veterans alike. Our clients deserve no less. I am proud to provide a resource that supports our soon-to-be colleagues in raising the bar for the practice of massage therapy. I hope it helps to move our profession toward this goal. Notes 1. Foundation for Critical Thinking, "Defining Critical Thinking," accessed November 2015, www.criticalthinking.org/pages/ defining-critical-thinking/766. 2. Coalition of National Massage Therapy Organizations, "Entry-Level Massage Education Blueprint," accessed November 2015, under "Anatomy, Physiology, and Pathology," www. elapmassage.org/_files/ELAP_Blueprint.pdf. 3. Ibid. Ruth Werner, BCTMB is a former massage therapist, a writer, and a continuing education provider approved by the NCBTMB. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2015), now in its sixth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com.