Doctor's Note?

[Beach Blondie]

I occasionally send clients to get a doctor's permission before giving them a massage. I have heard that "it's hard to get a doctor to fill out anything." This was from an obese, elderly woman who had been previously been diagnosed with Osteoporosis. She says she's normal now. I asked her if that meant normal or normal for her age. She doesn't know. She wants me to perform traction on her neck. Her PT does. I won't. She continues to come to me; and, continues to ask for traction! The second situation isn't as clear-cut. I gave my doctor's form to a woman with RA and a family history of diabetes. She says she needs to lose about 100 lbs. I think that's a high estimate; but, I don't weigh my clients!  I overheard her tell someone that she takes at least sixteen pills in the morning. I wanted to err on the side of caution so I gave her the paper, before the day of her appointment . She threw the paper back at me and said "I don't need this. I never had to do that before." A couple of other therapists think I'm overly cautious. Am I? And, what contraindications do you get notes for? Opinions, please.

 

[fancypantsy]

The overweight diabetic RA client wouldn't fill out your client intake form???  I NEVER work on any client without them filling out an intake form, personal friends included!  You need to do what makes YOU feel comfortable and confident in this situation.  Some therapists never have their clients fill out any forms and they are fine with that.  I am not.  I like to be a bit more cautious.  It is for the health and safety of the client, as well as for my own protection against potential legal action, should anything happen.  

 

[purpleshamrock]

I've had a similar situation where a woman came in and had a stroke two months before she came in.  She was on a bloodthinner so I let her know she would need doc's permission and I would need a signed note and/or call from the doctor.  I could tell she was upset but better safe than sorry.I rarely have to ask for doctors permission for things but I have when there is unexplained edema, or client is taking lasix.  I think you are doing the right thing.  It's way better to not get involved with a client who could possibly become a lawsuit and/or other problem that could weigh on your conscious.If someone doesn't fill out your form, then don't accept them as a client.

 

[KALAHARI]

To clarify, they didn't have a problem with the client intake form. آ They had a problem with asking the doctor to fill out the Physician's Permission form. It's one page and would probably only take a minute of the Doctor's time. jujubean, I got my form from the Successful Business Handbook from ABMP. They send you one when you purchase insurance from them.I'm wondering what the norm is as well. Do any of you not have them fill out an Intake Form? آ For the ones that do, under what conditions do you have them get Dr's permission?Thanks for your opinion  and support, kathryn. Still not sure if I should "lighten up."

 

[cookingkay1955]

I'm still in school, studying Pathology this semester.  Our school strongly promotes getting doctor's permission when there is a question of risk. With a client who has had a stroke recently, I would think the doctor would want to have input into whatever treatment the client was getting that might impact their condition.On the other hand, I have often wondered how receptive a doctor would be to signing off on any responsibility. I have not had to deal with situations like yours yet, but I would agree with Kathryn. It's better that you are covered. The client who comes in saying don't worry about it ends up being the one with 3 lawyers as soon as anything happens.

 

[Rick Rick]

I think if you feel it necessary to have an MD sign a release for massage, continue that practice. Don't ever let it give you peace of mind that you have the MD standing behind you. They'll be the first to deny any wrong doing and find the best lawyer to question you and your massage intake form, charting session notes, and your massage expertise/ethics. I would recommend you get the MD release, explain why you need this to the client{generally for client safety} and  then only work what you feel comfortable with each client and their condition. Example: I refused to work on a pregnant mom  who passed out every time she got out of bed. She was hospitalized her last trimester. They wanted her to have massage on the pregnancy table and an RN had to be present in case she lost consciousness. MD gave approval but I refused because I felt there were too many unknowns. Bottom line is it's my license I worked hard for and I want massage to be given in the best way for everyone. I've been in practice for 5 years and have had to refuse 3 people.

 

[CourtneyJo]

From a clients standpoint, my massage therapist wants the doctors ok before he does deep tissue work on some cancer patients.  I have melanoma and I had to get the ok from my oncologist die to lymph work involved.

 

[robert m]

I agree with BJB-LMP.  When conditions affect circulation is when I'm most concerned about getting a note:  kidney conditions, heart, especially.  But, as you've encountered, most doctor's either won't give a note, or give a note that won't cover my okole anyway.  Bottom line is being able to offer Reiki, and gentle stretching or specific work.  If someone comes to me with a kink in his neck, I'll do treatment work, stretching, etc on that particularl area.  As I understand it, it's full body circulatory massage that's the concern.  And, I've wondered, as we've discussed in previous subjects, how dangerous it actually is.  

 

[FrEe BiRd]

By the way,  I don't believe diabetes is contraindicated except on extremeties with numbness (concern over working deeply when client has no feeling to monitor pressure).