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Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
July, 2013, Vol. 13, Issue 07
Ethical Considerations for Pediatric Massage
By Tina Allen, LMT, CPMMT, CPMT, CIMT
The practice of massage therapy is generally regulated throughout the U.S. with many states having standard guidelines and a method of licensing/registering massage therapists and practitioners.As a therapist, you must always adhere to the guidelines mandated within the area (geographic location) you are practicing. When working with pediatric populations, it is especially important to have a solid grasp of legal mandate, as well as ethical considerations due to the fact that not everyone has a clear understanding of pediatric massage therapy. Clarity and consistency will help develop a professional understanding of nurturing touch as an important part of every child's life.
Within a pediatric healthcare practice, privacy, safety and care is of the utmost importance. While these same qualities are important for all clients, children require a practice of extra special care. By learning and following a professional code of ethics, you will not only be able to better assist clients, their families and other healthcare providers through interactions, but will also ensure you are received as a professional service.
What are Ethics?
As healthcare providers, we are judged on our technical competence in our profession and the ability to build trust in others. In order to project this allure of pride and confidence in our field, we must have it within ourselves; when you practice ethically not only do you have more pride in yourself, but also your profession. Traditionally, ethics is defined as a philosophy which seeks to address questions about morality; concepts of good and bad, right and wrong. Ethics encompasses our moral principles that govern a person's or group's behavior, the correctness of specified conduct and the discipline of dealing with what is good and bad and with moral duty and obligation.
Is It Legal?
Understanding the legality of your actions is an important factor in the decision-making process. With child clients, we face another layer of legality due to requirements of consent from not only the pediatric client, but also their parents/guardians, and in some cases, their healthcare provider.
Is It Ethical?
Professional ethical behavior relates to your actions and being sure they are consistent with the standards established or practiced by others in the same profession. It is best to adopt a standard of ethics that serves your practice and clients well and stick to it.
Is It Fair?
This is an area that is subjective and many people have a different understanding of what they feel is fair. We base our beliefs and understanding on what we feel is fair, while another may feel differently or may have chosen to do something in another way. Always reflect on whether the decision you are making may result in harm or an arbitrary benefit. If this is the case, then it is not considered "fair." With each child and family we must practice the same care and regard to safety, boundaries and scope of practice, no matter what.
Children need clear boundaries, as do health providers. It is imperative that we understand and follow good professional and personal boundaries to establish the best care.
Within the guidelines of informed consent, a client/patient must be fully informed of the care you wish to provide so they may make an educated choice in receiving hands-on care. This is the client's legal and ethical right to direct what happens with their care plan, their body and to consent to, or refuse therapy. For children, this may involve their parents or healthcare provider's request for you to provide massage therapy. Typically, a child is not calling you to schedule an appointment, but when a child says no to any part of the massage, or wishes to have it change, this is to be respected, whether the massage is medically ordered or not.
Many children don't understand what massage is or how it might be beneficial. Having a good explanation of massage therapy in terms they understand, along with why massage might be beneficial, will help you to inform and receive an appropriate consent to begin or continue your session.
Always respect cultural, ethnic and religious beliefs of the patient and family and do not impose your own beliefs or values. "The United States is becoming increasingly culturally diverse and this trend is expected to continue throughout the 21st century. One does not have to look far to see this reality, especially in metropolitan areas. In some cities (e.g., Miami, Los Angeles) persons in business and others must be bilingual to communicate. With the increase in cultural diversity comes a responsibility for ethical thoughtfulness on how this diversity affects health care practice." (Ludwick & Silva, August 14, 2000)
Working with children in hospice and palliative care can be emotionally different than working with other pediatric patients/clients. Not only are you dealing with your own belief system, but you may be challenged with the question, "What will happen when I die?" Children of all ages may pose this question. First, recognize your beliefs may not mirror those of the child or their family, and it is not your place to "fix it" or even answer it directly. You might try using a reflective response of, "What do you think will happen?" Listen to their response with open ears and mind. Do not judge, do not place your beliefs onto them and do not try changing their mind to your beliefs. You can always respond with an answer of, "That is definitely possible," or "That sounds lovely." The reality is whatever your beliefs may be, we do not know what will happen if the child is to pass, but being present is essential for the child.
Other Situations to Consider
Navigating the waters of massage can be tricky when you are working with children. The question of who is the client may be raised during the session. While it may seem obvious, when you work with children with special healthcare needs, you are often interacting with tired and stressed parents or healthcare providers who may need a shoulder massage. It is crucial to ask yourself if this seems appropriate, should a second appointment be scheduled for the caregivers or is it ethical to provide massage for the parents when referred to work with pediatric patient?
To Drink or Not to Drink
Should I offer my client a drink of water at the end of the session? In this question, we are reflecting on a typical practice of many massage practitioners. Offering a drink of water at the end of the session is almost industry standard, but not when dealing with children. Children can have many different healthcare concerns and may not be in a position to make this decision on their own. If they are undergoing medical treatment or have a special healthcare plan, having a drink of water could be harmful. Anything taken by mouth needs to be done under proper advisement, which is not your decision to make. Accordingly, it is out of your scope to determine if water is appropriate before, during or after your hands-on session.
What if I see signs of abuse or neglect, or if my pediatric client tells me they are experiencing abuse or are feeling suicidal? These type of events need to be reported as soon as possible. By working with the public as a healthcare provider we are mandated to report these situations. Some children have no one else they can speak with, or feel comfortable to talk to, so you may be it. If you have concerns that are real and legitimate, making an anonymous call or reporting it to your supervisor in a healthcare setting is required. First, do no harm, which means you should report when you feel harm has come or will come to your client.
How do I assess appropriate boundaries if my client is not able to communicate with me? Often times, communication is largely non-verbal. Always look at your client's body language and recognize their unique engagement and disengagement cues. If you feel you are not able to read your client's cues, or if communication is difficult, than speak with the client/patient's immediate care providers to seek guidance on communication. Parents and healthcare staff communicate with the child under their care on a daily basis and it is not safe to assume that you will already know how to recognize each child's cues. Taking the time to meet them at their level and communicate with those around them is extremely important.
Is it alright for me to accept gifts from my clients or their family members? Generally speaking no, this is not acceptable. Think carefully about why you are being given the gift and how this will impact the relationship. Remember, clients and family members sometimes struggle with receiving the generous gift you are offering, but it is simply what we do as massage therapists. Children may color you a picture or card as a thank you for their massage and this is generally acceptable to receive. However, if they offer you their favorite stuffed animal, it is best for you to ask them to keep it safe until you return another time.
Working with pediatric patients and clients is rewarding and different than working with any adult population. Knowing how best to communicate, maintain boundaries and practice ethically makes all of the difference to the child, their family and their healthcare team.
Click here for more information about Tina Allen, LMT, CPMMT, CPMT, CIMT.
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