Massage & Bodywork

January/February 2010

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ethics and etiquette BY TERRIE YARDLEY-NOHR DISCERNING DISCLOSURE Sharing Client Information Are your clients disclosing too little information about their health? Are some disclosing too much about their personal lives? In each of these situations, what are the responsibilities of the massage therapist? It can be challenging to know what to do. The term disclosure refers to sharing or revealing information between clients, therapists, and other health- care professionals. First and foremost, therapists expect clients to disclose all health-related information when doing an initial intake and interview. But how many times have you been performing a massage and come across a scar, sign, or symptom that could be a concerning pathology that wasn't revealed during intake? Although you've interviewed the client, she may say she simply forgot, or did not feel it was relevant. This can be both frustrating and potentially dangerous, because this manifestation may contraindicate massage. Therapists are forced to decide whether or not to proceed or end the session or treatment plan. CLIENT NON-DISCLOSURE Clients may not disclose information for one of the following reasons: • They forget. • They do not understand that certain information can be relevant. • They do not feel comfortable revealing the information. • The intake form doesn't provide enough space for thorough answers or the interview process feels rushed. Clients can forget certain aspects about their health that therapists feel are relevant to treatment. A client complaining of neck pain may not understand the relevance of an accident and injury that occurred years ago. Information may surface during the session because the client suddenly remembers as a therapist is working in a particular area. A situation such as this creates a good opportunity to educate the client on how all of this information interrelates. Many times the client begins to see the connection with symptoms she has had for years and can begin to understand more fully about the injury. Our expectations as therapists are the result of knowing clients' health histories. Therapists need information to assess the type of work that needs to be done, or whether massage can be performed at all. Helping clients understand the importance of this information is paramount. Asking a question such as "Are you under a doctor's care?" may be answered no, even though the client is currently taking medication. Rephrasing the question to "When was your last 102 massage & bodywork january/february 2010 visit to the doctor?" may help you obtain more information. This could be followed up with what the visit was for, the diagnosis, and medications that may have been prescribed. Including questions that can reveal more is a great way to obtain the information a therapist feels is important. We cannot assume clients will know what information their massage therapist needs. TO TREAT OR NOT TO TREAT As doctors are referring more of their patients to massage therapists for treatment, it is important for medical professionals to know about the possible side effects or contraindications for massage. Many therapists have taken the time to talk with doctors who are referring clients or have sent information concerning possible contraindications. Therapists can be challenged with a client for whom a doctor has recommended or prescribed massage. If the therapist knows that a doctor has recommended a client with a contraindicated condition, should a treatment still be performed? It would not be ethical or good business to knowingly treat a client just because she has been referred. In some states, the massage therapy laws state a therapist can refuse to treat for any reasonable cause. If a therapist chooses to not treat a client because of a condition, it would be helpful to send the referring doctor a note, thanking him for the referral and letting him know that the patient

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