Submitted By Anonymous
I once worked on a woman who lied on her intake form. She had just been released the previous week from a hospital in a distant state for a “mystery illness” that she was still taking antibiotics for. She said no one ever figured out what she had. She did not think this was my business. As the room was dimly lit for relaxation, I did not notice anything unusual on her legs and took what appeared to be a slight discoloration as a birthmark. It was only towards the end of the massage when I worked on the front of her legs that I felt something very hard and ropey under the skin with an octopus-like impression. You could feel tentacle-like extensions, radiating out from a single lump, with slight spider veins and discoloration. Having worked on thousands of people, I had never ever felt anything like it before. I immediately asked questions. After a number of questions she told me that I was asking the same things the doctors had asked at the emergency room last week and was annoyed that I thought it needed to be checked out. I felt it was unsafe for her to be getting a massage while still under treatment for this condition. She thought it had “gone away” because at the time she originally sought treatment it was much worse and discolored and such. I informed her that it was not yet “gone” and clearly palpable and she needs to follow up with her physician ASAP. She got quite insulting at this point, and began claiming “Jesus will heal me.” I warned her that she should have disclosed she was under treatment as it might not have been the best time for a massage and that I was trying to protect her. I explained whatever was going on was still present, but just under the skin. She was in denial. I was also very angry with her as I had no idea what SHE had exposed me to. We stopped the massage.
If you were confronted with the same situation again, how might you handle things differently?
Response from Anonymous
I don’t know if there is much different that I could have done. Perhaps just stop it and explain that I found something that does not feel safe to massage and let it go. She seemed very upset when I suggested she needs to follow up with a doctor.
Response from Institute for Integrative Healthcare Studies
Whether you are in a private practice or working for someone else, when you have a first time client it is important to do a thorough intake. This can be difficult if you are working for a spa where there is a standard procedure and intake may be less than adequate for certain medical conditions. At the very least the massage therapist needs to know what medications are being taken and why, as well as allergies, recent surgeries and recent injuries.
It is also important to have the client sign a statement indicating he or she has answered all questions honestly and with the knowledge that, if incorrect information is given, it can affect the efficacy of the massage. This can be a short statement at the end or beginning of the intake form itself, or a separate statement.
It is then up to the massage therapist to determine prior to and during the massage session if there are any contraindications or precautions. If something raises a red flag, like varicose veins, excessive or unexplained bruising, unhealed surgical scars or a rash, then the massage should be stopped and the client asked about it or informed it is there. In some cases the massage should be stopped completely (if problem caused will be systemic); in others it may simply mean moving on to another area (if problem area is restricted locally).
Even if the client insists on continuing, but the massage therapist is in doubt, it is the massage therapist who must make the final decision. In some cases communication with the client’s physician may be necessary to get clearance, in other cases it may just mean that a rash needs to clear up or a scar needs more healing time.
As always safety for the massage therapist and the client is of utmost importance.
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I’m a massage therapist and often confront this kind of situations when patient are not telling the truth about their health.
Most people get annoyed by being asked about certain health related conditions and therefore feel like their privacy has been invaded.
I have also run into this problem, with clients who either haven’t been informed about a problem, or who lie about it. I no longer work in dimly lit rooms because I have seen too many things that either put the client at risk, or me at risk, or both. Herpes, poison oak, ringworm, swelling from a compression vertebral fracture, bruises, varicose veins, skin cancers, other rashes, and perhaps others I’ve forgotten. Natural light can be very pleasant, and so can carefully chosen artificial light. If they want darkness, I cover their eyes with a hand towel. There was also a very well-educated, upper middle class client who didn’t get around to telling me she had AIDS for the first two years she was a regular client, who started regularly shaving her legs and nicking them before a massage. When she started doing that, I terminated her, needless to say.
Terminating a patients because they have AIDS/HIV is reprehensible. This disease responds very positively to massage and if you had taken proper courses on HhIV you would have known of how minimal or non-existent the danger of contracting the disease can be. Many clients would have no idea of the need to notify you because it is not contra-indicated, in fact, quite the opposite. If you can’t act as a true health professional, you shouldn’t be in the business.
I think in that case they did the appropriate thing since they were not properly trained in dealing with HIV/AIDS patients. In NC both the client and the therapist have the right to terminate the session at anytime. I think a better way to have handled it would have been to refer her to someone with the proper training that was not apprehensive about the condition.
I did not terminate her because she had HIV. I terminated her because she repeatedly shaved her legs before a massage, including nicking them, while well aware she had HIV, after agreeing that she would not ask me to work on her if she had open sores.
It is very easy to nick your legs shaving and not have a wound that is noticeable after the first 10-15 minutes…
Also, after it happened the first time, I specifically asked her not to shave her legs right before a massage.
In the case of ANYONE who has nicked their leg shaving, I inform them that the area must be covered or avoided, and I provide four sided bandages to encase the wound. It’s just Universal Precaution regardless of their medical state. I could just as easily have something that I could transmit to them .
I would have ended the session ensuring the client it was for her own safety and that is top priority. There is no need to argue with a client or make them feel bad for what is going on with them as most times they are fed up with the care they have already TRIED to receive. I would offer recommendations to another trusted healthcare professional if she felt like she needed another opinion. In the end it is the massage therapists professional responsibility to ensure the safety of their client, no matter how upset the client may get.
I find that most clients are impressed and grateful that I do a thorough intake, something a lot of them have never had before. The medication part can be tedious, but often I will just ask them to name the conditions for which they are taking the medication, if they can’t remember the drug name. Of course, old injuries are sometimes recalled into the massage when I have my hands on the leg or shoulder (I forgot I broke that ankle when I was a kid in soccer). Where it can get tricky sometimes is with conditions that are absolutely contraindicated (congestive heart failure) or require a Dr’s release (cancer treatment). There is often disappointment and resentment but it is better than causing harm.