Gp referral & contraindication issues!!!

[Essence Within]

Fellow Geeks, can you enlighten me...

Lately I seem to be getting a lot of clients that are;on medication, have a medical condition or mental health issues. My insurers(the guild) have assured me, that if I dont get medical referral/permission then obviously I am not covered by my insurance. A letter to the doctor with a tear off signature part isnot acceptable either, it has to be written from doctor/specialist etc which they either dont have the time to do or will charge £15!

Now I am wanting to keep professional for my sake as well as the trade image however, I am constantly wandering how others manage? Surely, I am not the only one who has clients who are on medication, have diabetes or h. blood pressure etc. I feel like im not using my initiative and sorting out the serious from minor ones, however, the insurance clearly states what you have to do. So... are other therapists under different insurers who dont stipulate as much (surely most professional ones do?) or are they just doing clients they know they should nt be and hoping for the best?? Some people say im being too fussy and other places dont ask half as much, its driving me insane-as i look ott we would all like the money but not if it puts us at risk of putting someone at risk of an adverse reaction or getting us sued??

Some therapists say dependant on severity or if its controlled you can treat etc but how do you know this without go guidance?
am i being stupid and not understanding properly?

any advice or personal comment- greatfully received x x

 

[SJB]

Hi,
My mum is a GP Referral Consultant, basically she owns a gym which doctors refer their patients to, so they can get better. I work as a Therapist there and so literally all of my clients have medical problems, and are on all medications under the sun

There is no chance I would turn a client away because of their medical problem. You can always adapt a treatment. For example of a woman with breast cancer wanted a back massage, you would explain that she couldnt have this due to Lymph ect and offer her a manicure, pedicure, head massage etc.

Like the previous thread (sorry forgot the name) the client always knows their body better than what we as therapists do.

You can always have you consultation / disclaimer form, but if anything did happen, this does not stand up in court.

Anyway. after my 6 years, so far, in the industry, I have never had a problem, and like i say nearly all my clients have medical problems, and I;ve never written to their GP. If your unsure at anytime, just offer them another treatment.

Hope this helps a little

 

[daisyl]

Hi,
My mum is a GP Referral Consultant, basically she owns a gym which doctors refer their patients to, so they can get better. I work as a Therapist there and so literally all of my clients have medical problems, and are on all medications under the sun

There is no chance I would turn a client away because of their medical problem. You can always adapt a treatment. For example of a woman with breast cancer wanted a back massage, you would explain that she couldnt have this due to Lymph ect and offer her a manicure, pedicure, head massage etc.

Like the previous thread (sorry forgot the name) the client always knows their body better than what we as therapists do.

You can always have you consultation / disclaimer form, but if anything did happen, this does not stand up in court.

Anyway. after my 6 years, so far, in the industry, I have never had a problem, and like i say nearly all my clients have medical problems, and I;ve never written to their GP. If your unsure at anytime, just offer them another treatment.

Hope this helps a little

Really sensible approach. The reason GP's do not like to write referals is not because of not wanting to 'put their neck on the block' - really, they would be qualified enough to make that call - but simply because having to write a letter for every patient who had some degree of medical history for every beauty treatment going is simply not realistic. There are far more important issues to be dealt with.

I am not saying certain conditions are not important - but you should be able to make a sensible and realistic decision as to whether or not to treat someone. In all honesty are you really going to be causing that much harm for instance in a person with well controlled diabetes - NO. I am medically qualified, but basic common sense should prevail here.

 

[Essence Within]

but basic common sense should prevail here.

This is exactly my point, I do have common sense, however, I am referring to my insurance as they are the ones stating you need medical go ahead for almost everything! Yes, I am a bit of a worrier, so I suppose I do question more than others, but the director of the guild said 'it only takes one person' (meaning to have something go wrong) and you wont be covered. Now I am aware as long as I use my common sense and do adapt everything accordingly it would be rare for anything to happen. What is the point of having a consultation form other than to get a more informed view of your client and their lifestyle, when they dont even count for anything?? Thanks for your responses x

 

[jes]

Hmm, a very interesting thread.

Yes, You have to use your own initiative, but do not take any chances and if you do ask for a dr's letter, it's worth making sure it's genuine (I've had a couple of fake ones)

I do think it's worth making it clear that if you do take it upon yourself to make a decision and something goes wrong then you will be in trouble and without insurance.

 

[essentia]

This is such bug bear of mine as well. One electrolysis client of mine who has a blood disorder went to her GP for approval and the GP said to her - well I looked on the internet and cannot find any information!!! In the end I treated her - we are still waiting for a reply 6 months later!. You do form your own judgements though and experience will make things easier. What I do now is have a form where I get the GP's consent - they just have to tick boxes and sign it and this has proved successful as they do not have to write a letter and can hand it straight back to the client so I have a copy for my records and insurance company.

 

[Mrs.Clooney]

Fellow Geeks, can you enlighten me...

Lately I seem to be getting a lot of clients that are;on medication, have a medical condition or mental health issues. My insurers(the guild) have assured me, that if I dont get medical referral/permission then obviously I am not covered by my insurance. A letter to the doctor with a tear off signature part isnot acceptable either, it has to be written from doctor/specialist etc which they either dont have the time to do or will charge £15!

Now I am wanting to keep professional for my sake as well as the trade image however, I am constantly wandering how others manage? Surely, I am not the only one who has clients who are on medication, have diabetes or h. blood pressure etc. I feel like im not using my initiative and sorting out the serious from minor ones, however, the insurance clearly states what you have to do. So... are other therapists under different insurers who dont stipulate as much (surely most professional ones do?) or are they just doing clients they know they should nt be and hoping for the best?? Some people say im being too fussy and other places dont ask half as much, its driving me insane-as i look ott we would all like the money but not if it puts us at risk of putting someone at risk of an adverse reaction or getting us sued??

Some therapists say dependant on severity or if its controlled you can treat etc but how do you know this without go guidance?
am i being stupid and not understanding properly?

any advice or personal comment- greatfully received x x

If we were to turn away every patient with a medical condition (no matter how minor), most of us would have few clients. I am sure loads of clients don't even admit to having medical issues when going for beauty treatments.

I agree, I don't believe that the doctors are afraid to put their necks on the block. My husband is a doctor with 3 medical degrees. Why on earth would he want to waste his time writing letters for every patient who wants clearance for a beauty treatment when his time can be better spent doing what he has been trained to do...consult and treat sick patients.

Personally, I feel that the insurers are actually covering their backs, however it is also the responsibility of the therapist to make sure that she/he utilizes their training and experience to the full so that their clients are treated safely.

In all honesty, and I am well intentioned when I say this, try to relax and don't allow this to worry you :hug:. Beauty insurance is actually relatively inexpensive because the risks within the beauty industry are not high. I mean that you have to either be super clumsy and irresponsible or super malicious and dangerous to do any harm to your clients.

We are trained for a reason. If you trust your judgement with your training then you will have the information you need to make wise choices. I agree... allow common sense to prevail eg. If I was faced with a stable diabetic, then yes, I would treat albeit gently. There are most often always steps in any treatment which can be skipped if you feel there is a contraindication to that particular step.

For example, I have a client with a large varucca on her foot. I massage her feet and legs during a treatment, but she wears a large covering on the varucca and I avoid that particular area. I don't soak her feet either. No problems!

Be more confident and you will be fine. x

 

[Mrs.Clooney]

This is such bug bear of mine as well. One electrolysis client of mine who has a blood disorder went to her GP for approval and the GP said to her - well I looked on the internet and cannot find any information!!! In the end I treated her - we are still waiting for a reply 6 months later!. You do form your own judgements though and experience will make things easier. What I do now is have a form where I get the GP's consent - they just have to tick boxes and sign it and this has proved successful as they do not have to write a letter and can hand it straight back to the client so I have a copy for my records and insurance company.

I honestly don't think most GP's actually understand the specifics of what we see in the beauty industry because it is just not specific to what they do and see on a daily basis which is why |I believe that we can use our judgement sometimes.

 

[essentia]

I honestly don't think most GP's actually understand the specifics of what we see in the beauty industry because it is just not specific to what they do and see on a daily basis which is why |I believe that we can use our judgement sometimes.

Totally agree. I have to admit I have rarely felt it necessary over the years to seek GP approval but I am not careless either and always weigh up the situation and ask appropriate questions. However I am doing work for a portfolio for an examining board removing skin tags etc and I need consent as part of the criteria so I do have to get approval. A form that allows the GP to give consent with the least bother to them the better and I have found this definately the way to go. However in general beauty terms I agree that the poster should relax and have more confidence in her abilities. :hug:

 

[aangel]

this thread has got me thinking. I have a freind who is a diabetic, and i have been doing her nails quite regularly through my training. she has amazing nail beds and as she was my model for my exam, my trainer sugested i asked her to be a model for any comps in the future. how would the diabetes fair with that?
she has had nails for years, and i am gentle with her (especially compared with others she has been to in the past) but after reading up on the comp rules etc (very new to all this) it states about client cards for models. would they be reading this and thinking "oh my gosh" or noting the fact that i know about it and realising how to adapt the treatment?
sorry if im hijacking the thread, but i thought it best to put it here rather than start a new thread,
thanks x

 

[Essence Within]

thanks for the replies-all! very informative and i will take from it. I to was thinking about the fact that some people dont even say if there is something wrong.Its only when we are informed that it changes things Its like massage; the client could have it from their partner and there is no problem but because we are trained and are aware what changes it can have on the body, it puts us in a different position responsibility wise. I probably would be more confident if there wasnt so much conflicting eveidence. In college you are trained not to treat certain things(but then we were allowed to treat some people on some medication??) then the insurer states do's and dont's but then therapists with years of experience say, in most cases its ok. This is what is confusing and I think maybe i am being too cautious but so far have been going on my experience of what Iv been taught according to my training and my current insurers (employed work was just 'get on with it').

Example; if i treated a client that had controlled diabetes but was on medication, if for any reason they decided to say due to my therapy something adverse had happened, i wouldnt be covered, as i am meant to obtain written confirmation. So do most of you guys make your informed judgement and hope that nothing negative comes of it, as im presuming if like my insurers, you wouldnt be covered? Due to the fact our 'consultations' dont hold any strength ina court- it seems slightly pointless at time sother than gaining knowledge of client and how to treat effectively.




Thank you all x

 

[Mrs.Clooney]

In college you are trained not to treat certain things(but then we were allowed to treat some people on some medication??) then the insurer states do's and dont's but then therapists with years of experience say, in most cases its ok.

Example; if i treated a client that had controlled diabetes but was on medication, if for any reason they decided to say due to my therapy something adverse had happened, i wouldnt be covered, as i am meant to obtain written confirmation. So do most of you guys make your informed judgement and hope that nothing negative comes of it, as im presuming if like my insurers, you wouldnt be covered?

Thank you all x

You really do raise some very valid points and they are issues which make your head spin, I agree, but that is insurance for you I'm afraid , whether it be beauty, car, household or holiday insurance. You get tied up in all the teenie weenie print which goes on for pages in most cases and needs lawyer interpretation and refferal to XXX policy :grr:.

However, think about it, how dire can a situation be in beauty therapy if somebody wants to make a valid claim? Yes accidents can happen but sheer negligence is avoidable and ones training will always cover their a*ses too by saying that you must not do this or that.

However, I feel that this is assuming the student knows nothing and has no common sense... which most of us do... which is why the real learning actually begins when you leave college. Take your example for example: Why would a controlled diabetic on medication develop a problem? How could they?

Chances are that you would have to really gouge the cuticle out with a dirty cuticle tool, hack their eponychium with clippers and file the free edge down to the raw nail bed. That should do it !!

But are any of us taught to do this even on a healthy client? No! In all my years of nursing and the few that I have had in the beauty industry, I have never caused a diabetic to develop anything nasty from an injection to a dressing, simply because I was taught to follow procedure. This is why one should always be meticulous about correct sanitation, sterilization and method of treatment.

Okay I have harped on enough but I hope it makes sense. By the way, my tutor at college ran her own beauty business in a hospital treating patients, from diabetics to paraplegics with no problems. Her advice to us was to learn according to your college notes but in practicality, use your common sense.

 

[mum]

It's the 'teeny weeny' print that will get us every time!

This is actually a sign of the times. If your insurers have specifically told you that you need a GP's approval to treat a client with ANY medical condition then that is how it is and you have to do it.

We all know that GP's are far too busy and will only do it privately. But, if anything should happen, whether it is connected with your treatment or not, you will not be covered by your insurance as you have not followed the rules. It is expensive to deal with litigation even if you are convinced you are going to win.

Insurers are not silly and they know that many of their policy holders have done a very short course or a 'home learn'. They insure via the 'accreditation' method and so many courses should not be accredited for full professional insurance. Therefore they know that many will not have the knowledge or experience to deal correctly with contra indications so they cover themselves.

Of course common sense should prevail but if something goes wrong (your fault or not) you will not be covered!!! I think if you read the teeny weeny print you will find that you are not covered for much at all.

Fortunately, the incidence of litigation in the UK is fairly low so most of these policies have not been 'tested'. But while policies are issued to those with levels of training that are clearly unsuitable for 'professional' status the small print will continue to be there and I'm afraid common sense will not prevail when the insurers have categorically stated that a medical approval is required.

 

[daisyl]

It's the 'teeny weeny' print that will get us every time!

This is actually a sign of the times. If your insurers have specifically told you that you need a GP's approval to treat a client with ANY medical condition then that is how it is and you have to do it.

We all know that GP's are far too busy and will only do it privately. But, if anything should happen, whether it is connected with your treatment or not, you will not be covered by your insurance as you have not followed the rules. It is expensive to deal with litigation even if you are convinced you are going to win.

Insurers are not silly and they know that many of their policy holders have done a very short course or a 'home learn'. They insure via the 'accreditation' method and so many courses should not be accredited for full professional insurance. Therefore they know that many will not have the knowledge or experience to deal correctly with contra indications so they cover themselves.

Of course common sense should prevail but if something goes wrong (your fault or not) you will not be covered!!! I think if you read the teeny weeny print you will find that you are not covered for much at all.

Fortunately, the incidence of litigation in the UK is fairly low so most of these policies have not been 'tested'. But while policies are issued to those with levels of training that are clearly unsuitable for 'professional' status the small print will continue to be there and I'm afraid common sense will not prevail when the insurers have categorically stated that a medical approval is required.

I think you would find in a court of law the medical evidence would prevail, which would demonstrate that you as a beauty thereapist would not be indicated. IE - there would be some other indication/underlying condition and not your treatment. In other words -a well controlled diabetic, skin intact etc etc, completed history, would not be a contra-indication for a manicure or whatever else - so therefore you should have no concerns. All the necessary precautions were taken. In other words common sense!

 

[mum]

Daisyl I completely agree with you. However, (and maybe I didn't make it clear in my post) the point I am making is the fact that the thread starter was specifically told by her insurers that medical approval IS required. This cannot be argued with.

In a court of law of course there will be far more information that will exonerate a professional technician who has followed suitable measures. However, to get to that situation takes a lot of money and the insurance would not cover it.

Every day, common sense prevails, quite rightly. The alternative would be totally prohibitive to any form of the technicians business (there is a legal tern that I can't remember for this). The fact still remains that the insurers have their 'get out clause'.

I want to make technicians aware of this and therefore put even more importance on following the correct procedures.

I also want to draw attention to the fact that these policies are available to those that have taken the minimal level of training (e.g. 1 or 2 days) and the underwriters are more than aware that the knowledge is just not there. Therefore there will be many, many 'get out clauses' that, fortunately for the industry, do not often get tested in a court of law.

 

[angel fingers]

so are there any insurers who WOULD trust our judgement?

 

[mum]

so are there any insurers who WOULD trust our judgement?

Don't know the answer to that one! It's many years since I was involved with an insurance company to create a suitable policy for the nail industry (the old INA used to have a good one but membership was far from automatic and many were refused on qualification basis. For example we wouldn't accept any 'attendance' certificates. It was very tricky back then!)

The important thing is 'professionalism' and knowledge together with common sense.