Advice can be a dangerous and slippery slope for practitioners in large part because they may have some knowledge and experience regarding a topic that is health- related, but not strictly within their scope of practice. If you have found an effective nutritional supplement or exercise program that relieves the same symptoms your client is experiencing, you may have a strong impulse to share that information with your client. Or, you may want to warn your client away from a health regime that you consider ineffective or potentially dangerous. When giving your point of view, make sure you delineate a professional recommendation, based on years of experience and study, from suggestions or opinions of a more personal or general nature. Help your client distinguish between subject matter in which you are, and are not, professionally qualified. If a health or medical issue is outside your scope of practice, recommend that the client see a qualified health professional regarding the matter. General guidelines require clients to be informed of the nature of their condition and the proposed treatment or procedure, its purpose, risks and benefits and their probability, risks and benefits of alternatives, and risks and benefits of not receiving the treatment. Failure to obtain adequate informed consent renders a health care professional liable for negligence or battery and constitutes medical malpractice. While informed consent is a well-established practice, it often fails to meet its stated purpose. Recent research findings strongly suggest that procedures to obtain informed consent may not adequately promote the patient’s comprehension of the information provided, rendering the consent not truly “informed.” Studies suggest that a majority of patients do not read a consent form before signing it, and less than half of the U.S. population understands commonly used medical terms. Additionally, clients with limited reading ability are at increased risk for medical errors, due to problems reading medication bottles, appointment slips, self-care instructions, and health education brochures. These clients are also likely to have trouble reading materials intended to aid in obtaining informed consent. Several methods of improving the procedures of obtaining informed consent have been proposed, including improving the readability of consent forms, asking clients for recall to establish understanding, adding additional stimuli, such as multimedia presentations and providing written information. The following section discusses “best practices” for informed consent forms, but also applies to other written material intended for the client. In order to ensure that clients understand the procedure to which they are consenting, it is important that all materials be presented in a comprehensible manner. Written health care materials, such as consent forms, are often written with a relatively complex sentence structure and vocabulary, making it difficult for the average adult to interpret the information. In addition, providing these materials in the language the client finds most familiar is likely to increase comprehension substantially for many individuals. Providing written information to clients regarding their diagnoses, proposed treatments, and other information given during informed consent discussion allows the patient to refer back to such information, which promotes comprehension. Some investigators have proposed that clients should receive written consent forms days before receiving a procedure.
practicing medicine without a license. If you believe your client has a serious medical condition or may have suffered an injury, tell the client immediately and refer him/her to the appropriate health care professional. Do not discuss the condition with the client’s doctor or anyone else unless you have explicit permission from the client to do so. Be sure to document your referral and the reasons for it in the client record. Keep scope of practice in mind when you give advice or make recommendations to clients. While listening attentively to your client is a relatively risk-free venture, sharing your opinions is not. Depending on the topic of conversation and your specific comments, you may be engaging in high-risk behavior whenever you have casual conversations with a client. Resisting requests for “advice” in any subject outside your areas of expertise is your safest option, but it is natural to be drawn into discussions with a client, especially one you’ve come to know well.
Patient autonomy, informed consent, and right to refuse Informed consent refers to a patient’s right to understand his or her condition and participate in decisions regarding that care or condition. The patient, or patient’s guardian, is required to sign a written statement acknowledging agreement to proposed treatment terms and awareness of the known risk factors associated with them. It is through this process that a health care practitioner informs a patient about the risks and benefits of a proposed
therapy and allows the patient to decide whether the therapy will be undertaken. It is based on the moral and legal premise of patient autonomy, and is the formal application of the client’s right to make decisions about his/ her own health care. The principle of autonomy (self-rule) is based on the principle of respect for persons, which holds that individual persons have the right to make their own choices and develop their own life plan. In a health care setting, the principle of autonomy translates into the principle of informed consent: You shall not treat a client without his/her informed consent. In order to affirm autonomy, every effort must be made to discuss treatment preferences with clients and to document them in written records. In massage therapy, informed consent usually takes the form of an agreement between the practitioner and client that states their shared objectives, proposed treatment plan, expected outcome(s), and anticipated time frame for results. It may also refer to the client’s medical history, asserting that the client has informed the practitioner about all known physical or medical conditions and current medications, and will inform the practitioner if any of these conditions change. The notice of informed consent in massage therapy typically includes a statement explaining the role of massage therapy in pain and stress reduction or other specified purpose, and its limitations: ● Massage therapy does not take the place of medical examinations, care, or treatment. ● The practitioner is not a doctor and does not diagnose medical conditions or prescribe medication. ● Clients should continue to consult their primary caregivers or other specialists for ongoing health care and medical conditions. ● Clients should consult their primary caregiver to review health care recommendations before making significant changes in their health and exercise regimen or diet. In addition to being an ethical obligation of caregivers, legislation in all 50 states requires that clients be informed of all important aspects of a treatment and/or procedures, although the details of these laws and statutes differ greatly.
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Book Code: MIL1224
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