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Hello all,

 

I'm new to this forum but thought that I could get some unbiased points of view on the situation I am currently going through. 

 

I was recently terminated from my job (a chain massage "clinic") because I refused to work on a client who is currently undergoing chemo therapy. This client did have a very generic doctor's note in is file stating "may recieve massage therapy", I do not know if it was from his oncologist or his general practitioner. I AM NOT TRAINED IN ANY SORT OF ONCOLOGY MASSAGE, having said that, I declined to work on the client. At the end of my shift that day I was suspended because I refused to work on this client and subsequently fired.

 

I am not sure that oncology certification is a requirement the way prenatal massage certification is required to work on a client that is pregnant. I'm appalled, I really feel that I made the ethically correct decision not just for me but for the well being of the client.

 

Any advice, opinions, points of view are greatly appreciated!

 

Thanks.

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Thank you all for all of your feedback!!!!

At this chain we have about 5 minutes to speak with our client about intake information before we need to start the session. We aren't given any client files until the client arrives for the massage, usually flying in by the seat of their pants, right on the hour. So, we have 5 minutes before the massage to talk about the client's problems, medical issues, and for them to undress and 5 minutes after the massage for the client to dress and for us to "discuss" the massage before we have to go out and take our next client. The girls (age 19-26) that work at our front desk don't take any sort of information from clients when they book their appointments only if they want a "swedish" or "deep tissue" therapist.

I guess my biggest thing is that I have no training to work on oncology patients, I know 2 things: thier bodies are already under great duress and massage could put more stress on their bodies and that chemo radiation can come through the skin and contaminate (for lack of a better word) the therapist. I would NEVER want to do more harm to anyone especially someone who is already ill.

This facility offers no therapist support, none of the people that run it have an healthcare or massage knowledge. It is so frustrating.

The client was so angry with me for refusing massage, and I completely understand that, but if management had massage understanding and would have been able to speak to the client and diffuse the situation it might have been better.

This is definately a "get'em in get'em out" facility. I've never liked it but I felt like I was doing my job to the best of my ability, knowing that even though I was doing one massage after the next, I was giving each client what they wanted and needed, not just some generic massage.

It's good to know that my fellow therapists support my right to decline giving a massage if I'm not comfortable with the medical situation.!!!

Again thanks for all of your comments and well wishes!
Having just returned from the Oncology Massage Healing Summit, and having practiced oncology massage for 3 years (took Tracy Walton's "Caring for Clients With Cancer" workshop in 2007) I would NOT have worked on this client with a 5 minute intake form and a generic doctor's note. I teach Laws, Ethics, and Practice Management at a massage school and can assure you, LEGALLY, you would have been out of your scope of practice in the state of Florida (don't know where you are) and ETHICALLY, you would have been out of your scope, plus you do have the right to not work on a client. According to Tracy Walton's manual, some of the side effects or medical issues surrounding chemotherapy are:
low platelets, low white blood cells, anemia, fatigue, fever, skin changes, hair loss, mouth sores, nausea and vomiting, diarrhea, constipation, cachexia (weight loss), peripheral neuropathy, ports and catheters, and yes, possible elimination of chemotherapy products through the skin - ALL of these potential side effects or medical issues require altering a "regular" massage.

Oncology massage is EXTREMELY rewarding but additional training must be acquired before working on oncology clients.
I think you did what was right for you.When in doubt,refer them out.You should never be forced to work on someone you don't feel comfortable working with.Too bad the people you work for couldn't have been more understanding,or taken the time to find out what you are capable of doing or not doing.
I always follow my instinct,you know you will be sorry if you don't listen to that little voice inside your head.
You will find another job.Also you should make sure that the people who hire you know what you can and can not do.
A note means the clients doctor feels they are safe to have a massage and if you KNOW what you are doing,give them one if you don't KNOW then don't do it. I think you are in the right,would you have known to wear gloves?
Hang in there,everything will work out for you.
Peace,Emma

P.S. If I was going through chemo,I would want someone who knew what they were doing working on me and I would be happy if you told me you have never worked on someone going through chemo and you were not comfortable working with me.I would think you cared to not cause me any harm.
Right of refusal for treatment is an ethical consideration. Both patient/client and practitioner have that right. Enough said.

Rick Morgan said:
I give my therapists the right to refuse treatment for anyone. I do ask that they have a valid reason for doing so. In your case, certification was not required to perform the massage but I think your unease with the situation was warranted. How you handled it becomes the real question. Did you discuss your reluctance with your employer before hand? How old was the MD note? Did you have recent information about your clients health and status in treatment? Susan is right in that a good intake would answer the relevant questions and reveal if there were any contraindications. If after having the intake you felt massage wasn't a good idea, ie, their blood counts were bottomed out, you could always call the MD for clearance or discuss it with your boss with all the facts. You could also do a phone intake before the appointment time. There are so many variables when dealing with patients undergoing cancer treatment that to refuse to do work based on only the knowledge they are going through chemo wouldn't sit well with me as an employer, you would have to present me with a bit more info and rationale first.
Right of refusal for treatment is an ethical consideration. Both patient/client and practitioner have that right. Enough said.
Amen.

Allan J Jones said:
Right of refusal for treatment is an ethical consideration. Both patient/client and practitioner have that right. Enough said.
The teacher in me is dying to take this discussion in a different direction (which may mean a new discussion thread).

We have essentially uncovered the “true” topic, which is not clients undergoing cancer treatments.

It is right of refusal.

Ethics is part of it, but not all of it.

Anyone care to put a good working definition on the table so we can discuss.

Just remember that in questions of ethics, there is not a true right or wrong response.

And also remember that every decision we make, big or small, has consequences.
In addition to Susans topic, maybe we should also be thinking of ways to educate doctors on the best massage for the patient. So the note says the type of massage that is suitable and the type of qualifications the therapist should have ?

The way Venassa was treated is another topic, do we just let it go, or do we look at ways of supporting therapists in these cases. The Bosses who run these franchises need to know their behaviour is unexceptable and subject to penalty !
If we continue to address Vanessa’s topic, there needs to be some mention or focus on the client.

It was also her (the client’s) massage, her desire to feel better, and her time too.

Has anyone put themselves into the client’s shoes?

Jenifer moved into that direction, but it got lost in our “therapist rights” agenda.

My understanding is that the therapeutic relationship serves the client.

Am I missing something???
Ty, thanks for offering a very personal perspective.

Good Luck to you and Best Wishes.


Ty Capuano said:
Susan - I thought about the client in this scenario. We know our own bodies better than anyone and if he felt well enough to come in for a session, I hope someone at that franchise knew enough to give him a massage. Being a "cancer patient" the medical intervention is not comforting or nuturing. If a therapist can offer just those qualities that can be enough sometimes. Some doctors know this and that can be one reason to refer a patient for massage therapy.

Susan G. Salvo said:
If we continue to address Vanessa’s topic, there needs to be some mention or focus on the client.

It was also her (the client’s) massage, her desire to feel better, and her time too.

Has anyone put themselves into the client’s shoes?

.

My understanding is that the therapeutic relationship serves the client.

Emma put it perfectly =

If I was going through chemo,I would want someone who knew what they were doing working on me and I would be happy if you told me you have never worked on someone going through chemo and you were not comfortable working with me.I would think you cared to not cause me any harm.

Susan G. Salvo said:
If we continue to address Vanessa’s topic, there needs to be some mention or focus on the client.

It was also her (the client’s) massage, her desire to feel better, and her time too.

Has anyone put themselves into the client’s shoes?

Jenifer moved into that direction, but it got lost in our “therapist rights” agenda.

My understanding is that the therapeutic relationship serves the client.

Am I missing something???
I have two thoughts on this...

yes there needs to be some focus on the client, considering our practice facilitates nuturing and healing. and it is a shame that the client had to suffer because of this. i go back to Emma's comment (as Stephen also mentioned):

If I was going through chemo,I would want someone who knew what they were doing working on me and I would be happy if you told me you have never worked on someone going through chemo and you were not comfortable working with me.I would think you cared to not cause me any harm.


i would say the greatest show of concern we have for our clients is when we actually refuse one.

but i still have to go back to the franchise. there should be more accountability with THEM. They are the business owner. They are responsible for the client's well being. They are the ones that should be hiring professionals, facilitating/managing client/therapist relationships, and overseeing all aspects of the business. They did some of that at the TAIL end of the situation by firing her, yet not so much at the beginning in facilitating the relationship. They dictate ridiculous times for client/therapist consultations and just expect that everyone is there to get the cookie-cutter session. when the reality is that every client/therapist relationship is unique. it is the very foundation of what we do. and NOT every therapist is the perfect fit for every client. if we as therapists look past that, we WILL end up doing harm both to our clients as well as our profession.

Susan G. Salvo said:
If we continue to address Vanessa’s topic, there needs to be some mention or focus on the client.

It was also her (the client’s) massage, her desire to feel better, and her time too.

Has anyone put themselves into the client’s shoes?

Jenifer moved into that direction, but it got lost in our “therapist rights” agenda.

My understanding is that the therapeutic relationship serves the client.

Am I missing something???

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