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Establishing consent to treatment of a sensitive area of a patient’s body

Case study: Establishing consent to treatment of a sensitive area of a patient’s body

Brad is a new RMT who works in a boutique spa. His semi-regular patient, Alanna, returns for a treatment. Alanna usually requests a full-body relaxation massage but today she explains that she did a 10-kilometre charity run the day before. Alanna asks Brad to work on her gluteals and calves to reduce the soreness from her run.

After completing a quick physical assessment, Brad and Alanna discuss and agree that a gentle, general sports treatment to her calves and gluteals would be the best treatment option for today. Brad asks for consent to treat Alanna’s calves and gluteals. During this discussion, Brad explains how he will provide treatment and tells Alanna which areas of her body he will work on. He outlines anticipated benefits, his therapeutic rationale for treatment, and encourages Alanna to provide feedback for depth of pressure throughout the treatment. Brad also explains to Alanna how he proposes she disrobe, and how he will use draping during the treatment. Finally, Brad gives Alanna an opportunity to ask questions. She provides verbal consent which  Brad documents while he’s outside of the room to allow her to prepare for treatment. During the massage, Alanna seems very relaxed.

Brad decides to alter the treatment in order to reduce tension in Alanna’s adductors, but does not say anything to her about this, not wanting to interrupt her rest. Brad is certain that Alanna will find the treatment to her adductors helpful and therapeutic after her run. He knows that Alanna trusts him, because she has returned to seek treatment over several visits. Brad works the entire length of the adductors, even very close to the pubic region, but does not check in with his patient about working in this area.

Alanna becomes frightened and uncomfortable, unsure why Brad is touching her close to her pubic region, but feels frozen, unable to speak up or leave. After she leaves the treatment that day, Alanna makes a complaint to CMTBC about Brad.

Did Brad’s actions meet the consent standard of practice and the boundaries standard of practice?

No. Brad’s actions did not meet the consent standard of practice; his actions were also out of keeping with the boundaries standard of practice. Brad did not monitor and renew consent before beginning treatment near areas of Alanna’s body that she may consider to be sensitive or private: the adductors and pubic region.

Brad failed to recognize that there are individual differences in levels of comfort with touch and physical contact, particularly touch in areas that an individual might consider sensitive or private. Brad did not communicate the intent of his therapeutic touch to Alanna before and during his treatment of a sensitive and potentially sexualized area of her body, instead relying on the existing trust in the patient-therapist relationship.

An RMT is required to obtain a patient’s consent when changing the treatment plan, as explored in other case studies. In this case, obtaining Alanna’s consent was particularly important given the area in which Brad decided to deliver treatment. Because Brad did not obtain Alanna’s consent, she misperceived his intent and actions and left the treatment feeling traumatized and in distress. Brad could have prevented this by renewing and reconfirming consent to his revised treatment plan, and ensuring that he communicated clearly and thoroughly about his therapeutic intent.

Brad could also have handled this situation differently by letting Alanna know that it would be beneficial to work on her adductors near her pubic region, during a subsequent visit. This would provide Alanna with more time to consider a treatment plan that involves work near areas of her body that she considers sensitive and private. It would help to avoid making Alanna feel pressured to agree to something that is outside her goals and expectations for treatment, or that makes her feel uncomfortable.

Consent standard of practice case studies

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