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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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If the client had a doctor's note saying it was okay to receive massage, I personally would have given the massage. It may have appeared to the business owner that you were claiming that you know better than the doctor since you refused to do it.
I can understand your reluctance to work on the client. to me a "generic" doctor's note would not be enough either to go through with a session. did you ask any questions of the client? did the massage franchise give you any heads up that you were going to be working on this client? have they had other MTs work on the client? seems to me they should have told you ahead of time and then allowed that client to book with someone either more experienced or someone that has already worked on the client. personally i don't see why you should have been fired. but then again, i've never been a big fan of massage franchises. can you collect unemployment? if so i would just let it go. if they are fighting you on that then i would talk to a lawyer.
What are the applicable written policies of the company? As far as rightful or wrongful termination that is really all that matters. The doctors note did not stipulate any modality restrictions. Since he was getting Chemo you could have asked if the cancer had been removed successfully and if yes this is just a regular massage. Anything else the Physician took responsibilty. That said, I find it disrespectful to the profession that so many chains have disciplinary action for refusing to work on a client. The clients get choice but the Therapist does not. They are strictly looking at dollars and not the nature of the profession in my opinion.
Hey Vanessa,

I agree with Laura. We also have a fiduciary responsibility to our clients (acting in their best interest).

Unless there risk involved (to the client or the therapist), I would have done the massage.

Massage is often used as palliative care (which may have been the goal in this case). A thorough client intake would have ruled out any contraindications and revealed an appropriate treatment plan for this particular client.

But it doesn’t sound like an intake was conducted. Is that true?

A good rule of thumb is to see your client as a person first; then his or her disease and disability as a secondary consideration.
I would agree to this however if she is working at a franchise, i believe it should be up to the franchise when booking a session to be certain that clients are matched up to MTs according to needs/skill level/etc. Not every MT is suited to work with every client. we know this based on our own practice. does anyone here truly believe they are suited to work with every client that can walk through the door? if so I would say you are rather bold in your assumptions. by nature the very foundation of our practice is the connection we make with the client. a forced connection would have been a bad massage even if she were giving it her best. In my private practice I dictate who i will work on, but in a franchise it should be their responsibility to make that match.

and legally...should she have been terminated? in corporate america we are usually given 3 strikes (all written into our files) before we are terminated. seems to me there's something not right with the way this was handle. but that's just my .02

Susan G. Salvo said:
Hey Vanessa,

I agree with Laura. We also have a fiduciary responsibility to our clients (acting in their best interest).

Unless there risk involved (to the client or the therapist), I would have done the massage.

Massage is often used as palliative care (which may have been the goal in this case). A thorough client intake would have ruled out any contraindications and revealed an appropriate treatment plan for this particular client.

But it doesn’t sound like an intake was conducted. Is that true?

A good rule of thumb is to see your client as a person first; then his or her disease and disability as a secondary consideration.
Hi Vanessa
I attended Gayle Mcdonnalds massage for people with cancer course some years back.
She said you must use surgical gloves whilst massaging people during chemo as some of the chemo can be secreted through the skin. She herself was tested having not used gloves and found to have absorbed some chemo.
So technically yes, you can massage patients having chemo but you do need to know what you are doing and how to protect yourself. If your employer knew you have experience in this area and sent this person to you because they had trained you and then you refused then of course they would be correct to sack you.As this is clearly not the case then well done you ! nothing wrong with your common sense !

Some of the comments on here are from people who should know the above !!!

Hopefully you will find better employment elsewhere .

All the best Venessa
Vanessa, don't where you're practicing but in Utah you don't need a prenatal massage certificate to perform work on a client that is pregnant. I've worked on numerous pregnant clients... some research, some confidence some experience is really all that's needed.

Stephen, other than what Ms McDonannald said about the chemo, I would like to know if there is any research supporting this. I've gone thru chemo 3 times and none of the therapists had any concerns working on me after I got the ok from the doc. I've also done massage on clients who have gone thru chemo.....again, no problems. Just askin'
Stephen, thanks for bring gloves into the equation.

Some things to consider…

Medication residue can be found on the client’s skin for up to 24 hours when certain chemotherapeutic agents are used (e.g., Thiotepa, Cyclophosphamide).

These medications are potentially harmful unless gloves are worn during this time to reduce exposure.

HOWEVER, since any chemotherapy may cause your client to feel ill after the treatment, it is best to postpone massage until the day AFTER your client receives chemotherapy.

This “day of rest” for your client also puts massage therapy after the 24 hour window.

A through intake would have lead Vanessa to these (and other) safe practice decisions.

Choice, this info is fairly new. I stumbled across it when working on the second edition of Mosby’s Pathology for Massage Therapists (2009 pub date). It came to me via an oncology nurse and then was confirmed (in the review process) by an oncologist.

Hope this helps, guys.

This is a great discussion. Thanks Vanessa for starting it.
I am just a lowly student, but in my first term we learned that you absolutely have the choice to refuse massage to anyone, so the franchise is in the wrong right there. We also learned from the beginning to NOT work on anyone going through chemo until next semester when we learn more about it, the contraindications and the various effects. This was taught to us by instructors who work on cancer patients on a regular basis and stress the need to be knowledgable and cautious.

You had every right to refuse and I may have as well if I felt that I lacked the knowledge & did not feel secure. The lack of security would have inhibited your intuition and would have been felt by the client.

Shame on your former employer. They should have respected your choice and handed the client on to someone else. It sounds like they don't give a crap what is wrong with someone, so long as they get their $60.

I wouldn't let them get away with it. Not that you need to sue... just write a little letter to your local paper :)
I'm wondering with it being a franchise scenario....just how much time is alloted for a thorough intake to begin with.

Susan G. Salvo said:
Stephen, thanks for bring gloves into the equation.

Some things to consider…

Medication residue can be found on the client’s skin for up to 24 hours when certain chemotherapeutic agents are used (e.g., Thiotepa, Cyclophosphamide).

These medications are potentially harmful unless gloves are worn during this time to reduce exposure.

HOWEVER, since any chemotherapy may cause your client to feel ill after the treatment, it is best to postpone massage until the day AFTER your client receives chemotherapy.

This “day of rest” for your client also puts massage therapy after the 24 hour window.

A through intake would have lead Vanessa to these (and other) safe practice decisions.
Good point Lisa......

Rick, also good point. Lots of times, the way a situation is handled makes all the difference in the way it is received. A good intake would definitely have been advised. Also, Vanessa, did you talk with your employer before hand about any problems you might have in working on clients with certain conditions...maybe you didn't feel comfortable enough (lack of knowledge of a specific condition, for ex)..........or did they even give you the opportunity.

Susan, thanks for the info. I did get my massage a couple of weeks after each treatment. I not only wouldn't get one during or right after....I for one DIDN"T want one....too sick I guess that's just another book I need to pick up.
Laura Allen said:
If the client had a doctor's note saying it was okay to receive massage, I personally would have given the massage. It may have appeared to the business owner that you were claiming that you know better than the doctor since you refused to do it.

In all honesty, I don't think the majority of doctors have a clue as to what massge therapy is or how it affects the body. If the note had given specific modalities or directive (i.e. no deep work, lymphatic only) I might have felt more comfortable doing the massage. Thanks for the feedback!

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