GP consent/complex medical needs

[Jourdan]

I have recently qualified and am starting voluntary work with a group of adults with severe physical disabilities and learning disabilities. I plan to do aromatherapy hand and foot massages; I have gone through their medical records and chosen the safest oils I can. The potential clients all have complex medical needs (epilepsy, organic brain damage etc) and so I asked for G.P. consent/advice to make sure my treatment wouldn't cause any problems or interact with medication - but the G.P. has declined to give consent. I am not sure what to do next - any advice would be muchly appreciated!

 

[gvruduha]

hi there,
GP consent has been hotly debated on healthypages, and you will find that it very rare for a GP to give consent to treat.

Obviously you need informed consent to treat, but this will come from your clients guardians etc, if they cannot give their own.

Unfortunately, you will probably know more than your GP about which oils are safe to use, and my advice would be, if you are unsure, then dont do it. Sorry to sound negative, but I always err on the side of caution, and if its something that I feel could be detrimental or dangerous to the client, then I stay well away.

One thing you have to remember is, even though you get consent to treat, the onus is on you to make sure that you do no harm.

I take it you have done an aromatherapy course? Is there any reason why you would need to use aromatherapy oils? I have worked with clients with severe physical and learning problems, and found that in most cases, hand and foot massage with basic oil was perfectly fine.

One last point that I would make is, even though you get consent from a guardian, remember that your client may not want the treatment, and some of the clients I (attempted) to treat, even though they could not speak etc, communicated in no uncertain terms that they didnt want touching.

I hope it works out well for you because it can be a really rewarding experience.

 

[AJ`]

Agree with everything sportstherapy has said. I have been working with special needs adults and children for many years and have never received permission or consent from their GP's - it has to be from the individual or the guardian.

There have been occasions when I have turned up to give a therapy and had to leave, as the client simply did not want any treatment - however, the next time, everything was fine and they enjoyed the treatment. I am not an aromatherapist, but do know of aromatherapists who have been giving treatments to the same clients - they usually just use a simple blend of base oil plus one other, nice smelling, essence, rather than trying to device a therapeutic application.

 

[Jamie in hiding]

I think the reason why Doctors refuse consent is that they simply do not want to take any responsibility should there be a problem. A trained and qualified aromatherapist/massage therapist does know more about the treatment effects of their therapy than a doctor anyhow. However, therapists may not know much about the pathology of the condition being treated, so it wise to get informed as much as possible on this. I recommend 'A massage therapist's guide to Pathology' - this book is informative and clearly states when you can or cannot treat a condition. Most doctors do not know the contraindications for giving a massage and which oils should or should not be used.

The important thing to think about is how can your client benefit from the treatment, and the list of benefits far outweighs the disadvantages. For a start if someone has a physical disability it is highly likely they will have poor circulation and therefore cold extremities that massage can greatly benefit.
Another point to be considered is the positive effect of touch - it is incredibly relaxing and releases chemicals that are pain relieving, and uplifting.

I have treated a wide range of clients with disabilities and it is rewarding work. As said before get consent from the patient, if they cannot give consent get it from their guardian. This is a good opportunity for you to do some really worthwhile work to people who would benefit greatly from it.

Binah
x

 

[eoyguqxa]

Thanks for all the replies.

There should not be any problem gaining consent from parents/guardians of the clients.

I am currently considering the option of carrying out the treatments with carrier oils and avoiding essential oils. This is a shame, as the due to theier disabilities the clients would benefit greatly from the sensory nature of using essential oils. The staff at the daycentre are also keen for me to carry out a full treatment if possible to gain maximum benefit for the clients.

I am confident that the actual massage will be perfectly safe, it is more the use of essetial oils and how they could effect the clients epilepsy or interfere with medication, as all the clients are on a large number of anti-eplileptics, anti-depressants, painkillers, etc. etc.

My plan of action (until the GP did not want to give consent) was to carry out a patch test on each EO before using it in a massage, to use a weak (1%) dilution, and to use the safest oils possible (I had decided on Lavender, Vetivert, Petitgrain, Rosewood and Cypress).

Does anyone know of any specific drug interactions for these oils? Or any good resources for finding out eo/drug interactions?

 

[Alex Fouleau]

Hi there Longvines,

I have been working at a day centre for people with learning disabilities since 1995, giving foot/hand or face/scalp massage, depending upon the individual's choice or requirement.

Whenever a new client wants to participate, a questionnaire/consent form is sent to their carers to fill in and return. In that, I state that as a matter of course I will be writing to let their GP know that they will be receiving aromatherapy and to ask if there are any issues they (the GP) think I should be aware of. To date, with over 40 of these letters sent to GPs, I've had two positive responses, and silence from the rest. I do include a section referring to the benefit of using aromatherapy:

"According to the International Journal of Aromatherapy (Vol 2, No 1, p.17) a blend of Chamomile, Ylang Ylang and Lavender essential oils has been employed in foot massage treatments at the St. Nicholas Therapy Unit in Shoreham, Sussex, to help ‘calm and relax, or stimulate and uplift the clients’. With repeated massage treatments, patients with mental disabilities and communication problems gradually became more relaxed and less anxious and for those with profound handicaps, Aromatherapy was found to be ‘invaluable as a means of making them feel involved and cared for’. "

I use 1% dilutions as many of the clients are on a cocktail of medication and only use single oils (Lavender, Marjoram, Petitgrain, Roman Chamomile, Frankincense, Patchouli and Geranium). The client has a smell of 2 -3 oils and indicates their choice, either verbally or non-verbally. To date we have had no cases of any abreactions. All the clients receive great benefit, both physiologically and psycho-emotionally. I've rarely had anyone show that they don't want their session.

Apart from the TLC element, I have people who have been in my groups from the start, who originally had terrible lower extremity circulatory problems; very cold and cyanosed legs/feet and/or oedema. Even though they only get 15 minutes once a week, excepting holidays, all have seen great improvement and even if they don't have the warmest of legs/feet, it's certainly better than it was at the beginning.

It is a very rewarding area to work in, from a job satisfaction point of view, so if you can, certainly go for it.

Hope this helps,

Regards,

 

[Camwesseget]

HI there, when I worked in a large NHS Trust I was involved in setting up CAM treatments within various departments. As part of the 'gaining consent planning' we approached the Trust Advisory Board and were informed that one cannot obtain consent from a parent or guardian to treat someone else. If the person was unable to give informed consent, then the treatments couldn't go ahead. The legal representative made it clear that to go ahead was to risk litigation for the therapist and the Trust should any harm come to the client, despite a guardian giving their consent. This is why doctors sometimes have to seek the help of the Law Courts when needing to treat someone who cannot give their own consent.

 

[rabcnesbit]

KPlewis - that's really useful info, thanks! I am glad you find this work rewarding

Reikimaster46 - again, thanks for the useful info! But this gets more and more complicated!

From a little research on the net it seems that guardians cannot legally give consent to those in their care who "lack capacity" -but any treatment must be judged to be in the patients best interests. I have discussed the treatments at length with the carers, met the clients, and studied the medical and personal histories of the clients at length to come up with a suitable treatment plan. I think that everyone involved is happy that the treatments are in the clients best interests, but I am still a little concerned about eo/drug interactions. I am going to have to do some homework here I think! I have found a few resources online:

http://www.medscape.com/druginfo/druginterchecker
http://www.drugs.com/drug_interactions.php

But I am pretty sure that in the main, drug-drug interactions with most essential oils just haven't been researched at all...

 

[A Thousand Words]

I do a fair bit of voluntary work, and it's something I get as much out of as the client, so I'm not unenthusiastic about the idea. However, I'm also a mainstream health professional, and I'm slightly taken aback that you seem to have been given access to these people's personal medical records. I would be horrified if a lay volunteer was given access to my own or a relatives medical records, and it's not something I would have allowed when I was working with vulnerable adults. That's not a comment about you, but about the staff who seem to have allowed this, and I think they could be on very shaky ground with their professional bodies and their employers about what appears (to me, from what you've descirbed) to be a breach of client confidentiality

 

[matt89 veteran of yahoo]

Surprised you are using rosewood as this is now protected due to being endangered. Linoloe wood is an alternative.

Patchouli

 

[Coog75]

Glad you mentioned that Patchouli. Aromatherapists have been using Howood as a substitute for the past 15 years, as Brazilian Rosewood has been over forested I know you didn't mention Sandalwood but Indian Sandalwood is now in a similar situation, very sad.

Binah
x

 

[Miss Laura]

Hmmmm, didn't know about sSndalwood (Indian) but I know the Rosewood has been like that a long time. Most good suppliers wont supply it anymore.

Haven't heard of Howood, my supplier doesn't have it on their site, will check it out.

Patchouli

 

[mstdean518]

CharisNLP - Although the position is unpaid the company interviewed me for the position and CRB'd me specifically for the position. The adults involved have complex medical needs therefore it is essential that if I am to carry out any treatments I am aware of any possible contraindications. The adults all have severe learning difficulties and are unable to communicate their medical needs to me, and it was more appropriate for me to take responsibility of looking at their records than to pass that responsibility onto one of their (non-medically trained) carers who may end up responsible if they didn't mention something pertinent and the clients health sufferred as a result.

Patchouli - I didn't realise rosewood was endangered, although a brief google shows me that this is the case: http://www.aromamedical.com/articles/rosewood.htm
Very sad! It was a standard oil used in my course and in my textbooks. I will not be purchasing it again in any case, thanks for bringing this to my attention.