Manual Therapies Week 11
Case Study – Fictional Example
Case Study Marika Kahawai is a successful manual therapist who sees forty clients per week. She treats Wednesday – Sunday at her home clinic and often sees her last client as late as 9pm. Marika does not have dedicated clinic computers or booking systems, and so uses her mobile phone’s calendar for bookings and SMS for confirming appointments. Recently, Marika has been treating two men from her local rugby club on a very regular basis. The first, Gary, recommended her to the other one (Jared) and they have all been seeing her weekly since that time. Each of them has brought her in a great deal of business because they talk frequently about her at the club. She estimates that, between the two of them, they have brought her fifteen new clients. Marika plays touch rugby in the same rugby club and she is well known and liked there. As with most players, it’s common for her to stay and have a few beers after the game in the small, busy club house. As a contribution to the club, Marika frequently volunteers to treat before and after games. On those days, she sometimes treats Gary on the club’s table after everyone has left, as it is more convenient when she is already set up for treating. Last week, Gary gave Marika a lift in to the club, because her car had broken down. Gary wasn’t playing that day, so Marika gave him a free treatment after the games, to say thank you. Since the bar was still open afterward, they both had a couple of beers with the winning team afterward. Marika was frustrated because Gary paid for the beer and wouldn’t let her use her own money. Yesterday, when she was treating Jared, he asked her if Gary had taken her anywhere nice yet. When Marika asked Jared what he meant, he was surprised, saying “Everyone knows you’re dating”. Knowing that she shouldn’t ever have a relationship with a client, Marika was concerned about this impression and tried to explain to Jared that there was no relationship between she and Gary. She wondered who had started the rumour and what she should do.
Discussion Questions
How did this situation occur?
What has Marika done wrong, if anything?
What has Gary done wrong, if anything?
What should Marika do now?
Massage & Myotherapy Australia States: ‘Ethical behaviour is not simply compliance with legal requirements; it extends to honesty, equity, integrity, and social responsibility in all dealings. It is behaviour that holds up to disclosure and to public scrutiny. Members and the public can register a complaint with Massage & Myotherapy Australia at any time… the relevant legal authority or jurisdiction such as The National Ethics Committee which is appointed by the Association’s Board can also hear or refer such matters’.
The following list gives some examples of the warning signs of unclear boundaries and the unprofessional conduct including harassment and sexual misconduct.
Massage and Myotherapy Australia:
- personal conversation intruding on the clinical work
- body contact e.g. pats on the shoulder, hugs
- not charging or billing for treatment
- practitioner anecdotal comments, e.g. you have beautiful eyes/skin …
- trips or social events outside the clinic
- dinner, lunches or offers of alcohol
- personal telephone, personal social media or personal
- SMS contact
- giving a client a lift home
- client or practitioner insisting on the last appointment of the day
- giving a client an inappropriate gift
- poor or inadequate draping.
- operating outside of normal business hours. Marika has bought herself into question in the case scenario because legally their is an Imbalance of power in the therapist and client relationship. She is at risk of losing her licence and insurance .
To prevent the situation going any further Marika needs to tell Gary that the relationship is a client therapist one. It might be hard, however she will need to redefine her practice and start documenting and setting boundaries with an appointment diary. If Gary or any other club member reports her she will be reviewed by the relevant authorities.
I have answered some other posts with suggestions of how to redefine her practice, however here are a few dot points as follows:
- Appointment diary
- Relevant documentation
- Client notice that she is not available by phone outside work hours
- A clinic phone instead of her personal phone
- Discussion with Rugby club president about whether premises are suitable for massage appointments and in what capacity
- If a free massage is given it must be stated that it is on behalf of the rugby club, not Marika or her business. It should be focusing on point of recovery / or for preparation before playing the game. It is not ideal and should not be limited to just one club member. All documentation must be completed every time Marika does a treatment. Client and Marika must sign informed consent to treat.
Staying back after the social gathering for a treatment can send the wrong message, even if its for a game the next day, or for recovery after a game. There needs to be clear guidelines in place, and the client and practitioner need to sign paperwork, so that if the practitioner offers a free treatment this must be stated for both to sign, that is for the purposes of preparation / recovery from Rugby only. The details of the treatment must be recorded. Before the treatment Marika could explain the formality / terms and conditions to Gary to make the professional boundaries clearer. I don’t think this would be seen as ‘conceited’ because Marika has a legal obligation to her client. Additionally, if Marika chooses to have a beer with the club, it should be after a treatment. It can be okay for Marika to say, the treatment is free today, feel free to shout me a beer at the club later. She still runs the risk of creating the wrong impression, however that is to her discretion. It is still an issue that Gary might be seen as favoured by other club members. There is also still a risk of unwanted attention by Gary, and both people are at risk if they stay after club hours without any other members present, because the law see’s the Practitioner as holding the balance of power, Maria could lose her license and insurance to practice. If she really wants to do this, perhaps she books people in at the club after the game, with others present, and she keeps an appointment diary of availability – she might donate 1 free massage per month to each member for example. Her insurance needs to be up to date and specify she can practice outside of her place of business.