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December 14, 2009

Consumer Choice

We have spent a lot of time this past week discussing consumer choice, otherwise known as direct access to physical therapy. Forty-four states have some form of consumer direct access to physical therapy, while four other states are currently hammering out legislation for direct access to PT. Only Alabama and one other state do not allow people to access physical therapy directly without a physician's referral.

The president of the APTA, Scott Ward, spoke at the graduating class' commencement. He talked about the "Thanksgiving consult," where family members ask for medical opinions. For us here in Alabama, it technically would be illegal to give PT advice. Of course, my family asks me for advice about their medications, which I know little about and is definitely out of my scope of practice. Fellow pharmacists, brace yourselves. I'm unleashing them on you!

So, I have this neighbor with back problems who wanted me to work on their back. As a PT student, it would be unethical for me work on this person. I could lose any opportunity to ever get a license if I treated this person. However, as a massage therapist, back pain is one of those conditions that we commonly address. But I let my massage license lapse, so technically, I should not treat a consumer.

Now I'm going to venture into a gray area here. My understanding of massage law is that charging money or bartering goods for massage therapy services requires a license. So if you perform massage on a willing participant without charging them for the services, this does not constitute practicing without a license. Why that is, I suspect, is because massage therapy is not considered skilled service (kind of insulting to the professionals that work hard to be skilled purveyors of their services). From Medicare, skilled service:

A service that is ordinarily considered nonskilled could be considered a skilled therapy service in cases in which there is clear documentation that, because of special medical complications, skilled rehabilitation personnel are required to perform or supervise the service or to observe the patient. However, the importance of a particular service to a patient or the frequency with which it must be performed does not, by itself, make a nonskilled service into a skilled service.

So here is my question (and I have this same query out to my ethics instructor): At what point does the administration of massage become physical therapy treatment? I await the input of my peers from both industries.

tags: massage massagetherapy wellness massage therapy bodywork health massage ethics ethics

Posted by linda at December 14, 2009 8:16 PM