Chapter 09: Clinician Acceptance (or Non-Acceptance) of Massage Therapy

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Chapter 09: Clinician Acceptance (or Non-Acceptance) of Massage Therapy

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In this chapter, Ms. Sumler talks about why clinicians may refuse to send their patients for therapeutic massage, usually out of a lack of information about how specifically this type of massage is tailored to the needs and limitations of patients undergoing specific treatments. She gives examples of how she and others in massage therapy opened communications with clinicians to provide education and overcome resistance. Next she confirms that acceptance has greatly improved since she started with MD Anderson, provides some reasons why, and notes that Department of Palliative Care and Rehabilitative Medicine has helped by championing their value.

Identifier

Sumler,PSS_02_20180910

Publication Date

9-20-2018

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Overview; Overview; Definitions, Explanations, Translations; Professional Path; Professional Practice; The Professional at Work; Building/Transforming the Institution; Obstacles, Challenges; Patients; Patients, Treatment, Survivors; Cancer and Disease; Discovery and Success; MD Anderson Culture; Working Environment

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Tacey A. Rosolowski, Ph.D.:

Now, what about from the perspective of clinicians? I mean, I know from talking to some of the individuals I mentioned earlier that this—mainstream medicine is still really the norm here, and there are people who are very suspicious or dismissive. What have you heard from people? What’s your experience of encountering kind of difficulties in accepting more complementary approaches?

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

I think maybe two categories, and one is where clinicians feel extremely protective of their patients, and so they might look at massage as something that could hurt them, because either, one, they don’t know what a massage is, or just basically massage could be anything, and so, unfortunately, in our field there’s not just a real set definition of what that is. And so I do think massage could hurt some of our patients. It needs to be modified to be safe. So that’s what I’ve had. I’ve had people tell me, “Well, not my patient. You’re not going to touch my patient.”

Tacey A. Rosolowski, Ph.D.:

So how do you respond in that situation?

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

I try to speak to them in a language that will help to also work in developing trust, and so then I’ll find out what their concerns are. “Oh, well, their platelets are too low. They would—I’m afraid that they’ll get bruised.” And then I can say, “Well, what I would be doing would be like light lotioning.” And then they’d say, “Oh. Well, they might like that, and that would—might feel good, and they could actually—their skin is really dry; (laughs) they could use lotioning.” So it may just change the conversation to direct it... So usually what I want to let them know is in a patient like this my concerns are this, and I would make these adjustments. This would be my goal to help them; this is how I would adjust it, to—

Tacey A. Rosolowski, Ph.D.:

Because you... I’m sorry.

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

Just to let them know that these are the concerns that I would have, or I might say—and ask them also, “What are your concerns?” So...

Tacey A. Rosolowski, Ph.D.:

Because you were really clear last time. I mean, oncology massage is not just anything. I mean, it’s a very rigorous process, as you folks have started to define it, and it’s extremely attentive to the physical condition of the patient, and facilitating their treatment, rather than doing anything that could undermine it. Yeah. So it’s almost like an education issue. So that’s one clinician, not my patient. What are some of the other sources of resistance that a clinician might have?

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

I guess that’s pretty... I guess that’s pretty much it. Like, either—in the early days, this would not... Because our orders used to come from the primary team, not from our physicians, the orders for massage. And so there were a few that just would refuse to write an order for their patient. (laughs) And so I remember once—it had to come from the primary oncologist, the order, at one point. And so one patient asked their physician for (laughs) the order, and they wouldn’t write it, so then they were getting radiation, so they asked the radiation oncologist, who wrote an order, and then they came, but it wasn’t one we could accept, and so then we had this—I had this dilemma. So then I contacted the primary [oncologist], who said—then wrote an order saying as long as that patient was under the care of Radiation Oncology they could get massage.

Tacey A. Rosolowski, Ph.D.:

And you never found out what the person’s resistance was.

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

They were kind of … [ ] They just felt like it wasn’t—they weren’t open to hear about it. They weren’t—they’re no longer here, (laughs) who this person was, but... Yeah, it was just sort of a blocked communication that never changed. We did presentations and tried to open that relationship. But I think one thing that helped, that was beneficial, was when we... We have our guidelines, but then sometimes there might be something, like a new treatment that’s coming out, (laughs) or a new procedure, and I’ll talk about a couple of those, that I think has helped to build trust with clinicians. And so, for instance, when we opened up the Proton Therapy [Center], that was new [and] not in our guidelines. And so I—we spoke with—kind of seeking their guidance for our guidelines. “Here’s the guidelines that we have. Here’s what we have for radiation oncology, during radiation; after radiation; these are our concerns. How would proton therapy be different?” And then we started getting lots of referrals from radiation oncologists. At that point we could get our referrals from other—any of the physicians, so that kind of changed. Recently, we’ve started seeing—I started noticing more and more patients who were having lymph node transplants, and lymphovenous bypasses for treating lymphedema. And that’s something new that we’re doing here. So we had no guidelines on that. And so I had a patient who I was going to be seeing, and I had read that she had had several bypasses and lymph nodes and [transfers] done. And so I contacted her plastic surgeon and told him, “Well, these are my concerns. This is what I would normally do with a patient who either has lymphedema or is at risk of lymphedema, to be safe. And what are—and I’m looking to you to help me know what can I do. Like, how long after surgery...?” I said, “After surgery, I would think for at least eight weeks I wouldn’t even touch that area, but this is what I would do after that.” And so then I was able to have a conversation where he was, “I think what you’ve proposed sounds good, and that I have seen”—he said, “and I have seen patients get worsening lymphedema who had vigorous massage outside.” So I think it’s good to know that. Like, the clinicians will see things that happen from outside, and [ ] if they don’t know what we’re doing, then that’s a legitimate precaution that they would have.

Tacey A. Rosolowski, Ph.D.:

Well, it also sends a really good message. If you’re being proactive and saying, okay, this new treatment’s coming down, I’m going to approach that person, I imagine that builds a lot of trust right there.

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

Yeah, I think it makes a big difference, and so I’ve reached out a number of times with the plastic surgeons, but I’ll also sometimes send patients back. So, for instance, after a patient’s had a mastectomy, reconstruction surgery, we have a breast bolster that we’ll use for patients who have implants, and—or just really any woman who wants to use it, but primarily it’s with a patient who has tissue expanders or they have implants. [ ] It’s foam and it has cutouts for the breasts when they’re laying facedown on the table. And so women, in general, most women find it really comfortable, and women will go—I’ve had women just burst into tears because they’re like, “I’m a stomach sleeper. I didn’t think I could ever sleep on my stomach again.” And I’ll say, “Well, I’ve talked with a plastic surgeon about you being able to use this for an hour during massage. I don’t know if you can sleep on it overnight, so talk to your doctor about it. I’ll send him a note that you’re going to do that.” (laughs) And they’ll go, “Okay.” And so now I’m getting feedback from patients saying, “Oh, my plastic surgeon says, ‘Oh, go—just go to Integrative Medicine for massage. Like, they know what they’re doing down there.’” So I think that we can really build these relationships, and I’m really grateful for the information that I get from them. And then now they know if—until they release that patient to be able to use that bolster, I’m going to—when I work on their back, I’m going to have them sit up on the side of the table first. Then they’re going to lie on their back for the rest of the massage, so that’ll be safe.

Tacey A. Rosolowski, Ph.D.:

Wow. I mean, that’s really an interesting story that is about just creating the personal relationship, convincing the individual, each individual, that yeah, it’s going to be okay. Have you experienced that...? Well, you mentioned that people say yes, send people down to massage, they know what they’re doing down there, so there is a word-of-mouth kind of thing happening.

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

Yeah. Yeah.

Tacey A. Rosolowski, Ph.D.:

Yeah. That’s very effective. Now, what have you noticed over the years? How has acceptance improved, or is there anything different about the process now?

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

I think the acceptance has improved a lot. I think our process has changed, and so I think before we would try to... Initially, patients had to have a referral for full-body massage, but for inpatient massage patients could self-refer. And so there really wasn’t that—we weren’t building that relationship with the other clinicians. And so I think that’s really different now. And we didn’t have our own physicians in our own department. And so on all different levels we have a different relationship. We spent a long time at one, for a number of years, writing thank-you letters (laughs) to every physician that referred to us, and in those letters we would also “Thank you for”—kind of what I said similar earlier—like, “Thank you for referring this patient for this. In a patient like this, these would be my concerns. This is what I would do, and these were the results and what the patient said.” And so it was just kind of very short, very specific to that patient, and where they could see, oh, I have other patients like this, and then they could get the feedback also from that patient, yeah, this is helping, so I have other patients that this could help, too.

Tacey A. Rosolowski, Ph.D.:

So thank-you letter as educational opportunity. (laughter)

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

Yeah.

Tacey A. Rosolowski, Ph.D.:

Yeah, yeah. Who came up with the idea for the thank-you letters?

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

I think that was Richard Lee, Dr. Lee. [had the idea to write thank you letters. Ben Konzen, MD suggested writing letters detailing therapeutic concerns, evidenced based goals and safe massage modifications.]

Tacey A. Rosolowski, Ph.D.:

Yeah, that’s a great idea. So what do you think would be helpful next to increase acceptance within the institution?

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

Hmm... (laughs) My goodness.

Tacey A. Rosolowski, Ph.D.:

Well, maybe you can come back to that.

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

Yeah.

Tacey A. Rosolowski, Ph.D.:

Yeah, yeah. Because it’s just always a process, you know?

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

Yeah.

Tacey A. Rosolowski, Ph.D.:

Talk to me a little bit more generally about kind of... Well, let me back up, because I know you’ve worked with—you did some research with, worked on some research studies with Eduardo Bruera [oral history interview] and with some other folks. So obviously you have connections beyond Integrative Medicine, in other departments. Dr. Bruera’s in Palliative Care. So you’re in this community of folks who are kind of struggling with—kind of going against the main tide of the institution. So tell me about working with those folks, I mean, what they say, your community, your perspective. How’s that community kind of working together to make some acceptance happen?

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

Like kind of the greater community for Integrative Medicine with Palliative Care and Rehabilitation Medicine?

Tacey A. Rosolowski, Ph.D.:

Mm-hmm.

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

They have just been, since I started here, a tremendous support, just a really... They were our champions, I would say. I think myself, personally, I learned so much, and was able to develop tremendously because of them, but even from the very beginning, we first started having inpatient massage was where we first started, and one of the advanced practice nurses wrote our notes, because we couldn’t dictate at that time. We attended their discharge planning meetings every week, and so I got to really hear their team talk, and be accepted as part of the team, and invited into the conversation of how could I help this patient, or... And so I always felt a lot of respect from all their team members, and not all of them really were pro-massage, but they were open to see how it could help their patients, and make referrals for their patients, even if they didn’t start out that way. I think they initially just decided to be open about it. And so I think with Rehab we just were very clear about what was the manual therapy that Rehab would do, (laughs) and what were the—what were their goals, and then what did we do, and what were our goals. And so it was very—pretty clear about who was going to see what patients, and always felt like we referred to each other when sometimes somebody was coming to the wrong place, basically.

Tacey A. Rosolowski, Ph.D.:

Yeah, so that’s an interesting example of kind of bringing something new into the institution, and sort of defining what’s the scope of work, and how do they dovetail, and all of that. Yeah. And I’m sure there were some moments of real... Did you find territory wars there at all? I mean, did people kind of like, “No, I don’t want you taking over,” or...?

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

I never felt that, so I never felt that way. I’m not sure what... (laughs)

Tacey A. Rosolowski, Ph.D.:

Were there people from Rehab Medicine that were maybe a little concerned that maybe massage was taking over some of the work of Rehab, or...? I was just curious.

Pamela Austin Sat Siri Sumler, LMT, BCTMB, CLT, E-RYT:

Yeah, not really, that I heard. I know that we have always tried to be really clear, because sometimes it’s just, I think, also confusing to patients, so they might come in, and they—because in the community they may go to a massage therapist for a lymphedema treatment, and so then they might show up with me and want that. But now that patients aren’t just referring directly, they are first meeting with our medical team first, that doesn’t happen anymore. But so if Rehab was concerned, I didn’t hear those concerns, (laughs) because... And also, when we first started massage our medical supervisor was Ki Shin, who was from Physical Medicine. And so he was just fabulous. He met with Curtiss and I, our other massage therapist, regularly. Kind of he helped create our guidelines. Anything new that was outside of our guidelines that we didn’t know, we would contact him, and he immediately would educate us. So it felt like we were pretty in line with what our scope was.

Chapter 09: Clinician Acceptance (or Non-Acceptance) of Massage Therapy

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