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Obtaining consent from an existing patient

Case study: Obtaining consent from an existing patient

Lee is a long-time patient who has not received massage therapy for several months. When she enters the clinic, her RMT, Gina, greets her warmly. Gina always enjoys seeing Lee because they share an interest in design and decorating. They have interesting conversations and Gina enjoys Lee’s sense of humour.

Lee sustained several bouts of low back pain over the past five years. Gina treated her repeatedly for facet joint and piriformis syndromes. Expecting a similar concern, Gina asks Lee how her back is feeling. Lee says that her back is a bit sore but not too bad. Gina does not assess Lee and encourages her to get onto the massage table as usual.  She notices that Lee seems to have put on a bit of weight but doesn’t mention it because she knows that Lee is sensitive about her weight and body image.

Once Lee is on the table, Gina knocks, enters the treatment room, and undrapes Lee’s back. After giving Lee a similar treatment to previous visits, Gina asks Lee to turn over onto her back. While lying supine, Lee eagerly smiles at Gina and says, “I can’t keep it a secret anymore. Guess what? We’re going to have a baby!”

“I am so happy for you,” says Gina and gives Lee a ‘high five’. Gina appreciates how excited Lee must be since they have both discussed wanting babies during previous conversations. She realizes that this must be the reason for Lee’s weight gain, too. Gina spends the next few minutes asking about Lee’s plans for the birth and how Lee will decorate the nursery. They continue their conversation until the end of the treatment time.

Do Gina’s actions meet the consent standard of practice?

No. Gina exhibits significant disregard for the consent standard of practice. Gina has fallen into a treatment habit with Lee and has forgotten her professional role. She assumes that this treatment is no different than the others, and does not ask Lee about her treatment goals. If she had, she might have learned sooner about the pregnancy. Despite the months since Lee’s last treatment, Gina does not bother to assess Lee and assumes that low back pain has brought her into the clinic once again. She doesn’t ask if Lee has any questions or concerns. Gina is proceeding with an existing treatment plan she had in mind for Lee that has not changed despite a significant change in Lee’s presenting condition. Gina is in violation of her practice standards; she is unaware of Lee’s current condition.

Gina does not recognize the need for special treatment considerations and positioning adaptations as a result of Lee’s pregnancy. She missed an important opportunity to educate Lee on the role that massage therapy might play throughout Lee’s pregnancy. Gina expresses more interest in how the nursery will be decorated than inquiring professionally about Lee’s stage of pregnancy and other health concerns.

This case demonstrates the need to establish a new treatment plan based on a change in circumstances. New treatment plans require that RMTs revisit, revise, obtain, and document the patient’s informed consent.

Consent standard of practice case studies

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