Chinese Massage Therapist (Tui Na) oral assessment prep

Knowledge: Strong rolling (gun fa) and deep pressure over the spine can fracture an osteoporotic vertebra and cause large haematomas in a client on warfarin. New night pain, weight loss and a prior fracture are red flags for malignancy, infection or a new fracture, which would need medical imaging and not massage.

Management: I would explain that I will not use strong techniques today and would not start the lumbar treatment at all until the practitioner has reviewed her. I would call the TCM practitioner, give a brief factual summary of the warfarin, osteoporosis, fracture and new night pain with weight loss, and ask for medical assessment. If the practitioner agrees that gentle work is safe, I would limit myself to light mo fa and gentle rou fa on the soft tissues away from the spine, with low pressure and short duration, and watch for bruising or pain. I would record what she told me and what the practitioner decided.

Ethics and communication: I should be honest that pain is not a measure of benefit and decline her request even though she is paying and insistent. The prescription arrived without her history, so I would tell the practitioner and suggest that the intake form include medicines and past fractures. I would keep her information confidential and share it only with the practitioner and her doctor.

Reference: WHO Benchmarks for Training in Traditional Chinese Medicine (2010) and Fritz, Fundamentals of Therapeutic Massage (Elsevier) and DOH TCIM Practitioners Scope of Practice (DOH/SOP/TCIM-Practitioners/HCWS/V2/2024)

Knowledge: Sudden severe neck pain with occipital headache, dizziness and slurred speech after minor neck strain are warning signs of vertebral artery dissection or a posterior circulation stroke. Cervical manipulation and rotation have been associated with arterial injury, and in this case it could cause harm. Recognising this, and not treating it, is my role.

Management: I would not perform any manoeuvre or massage on his neck. I would keep him seated or lying comfortably, check his speech, face and arm strength, and call 998 if there is any slurring, facial droop, weakness, double vision, difficulty walking, or if the symptoms are present now. I would tell the TCM practitioner at once, stay with him until the ambulance arrives, and note the time symptoms began, which the ambulance crew will need. If symptoms had resolved and he wanted a review, I would still ask the practitioner to arrange same-day medical assessment.

Ethics and communication: He has asked me for a specific technique, and I must say no clearly even though he is the client and expects it. I would not tell him it is just a trapped nerve. I would make a clear incident record and review with the practitioner that high-velocity cervical techniques are outside my delegated scope.

Reference: Wiseman and Ellis, Fundamentals of Chinese Medicine (Paradigm Publications) and DOH TCIM Practitioners Scope of Practice (DOH/SOP/TCIM-Practitioners/HCWS/V2/2024) and Fritz, Fundamentals of Therapeutic Massage (Elsevier)

Knowledge: A Chinese Massage Therapist must work under a TCM Practitioner and performs Tui Na on the practitioner's direction. Needling, cupping, moxibustion, herbal advice and diagnosis are not part of that role, and DOH scope lists massage therapists for Ayurveda and TCM massage only. A retrospective sign-off does not make an unauthorised procedure lawful or safe, and cupping can cause burns, bruising and infection.

Management: I would tell Mr Rashid kindly that I can perform only the Tui Na the practitioner has prescribed, and that acupuncture and cupping must be done by the practitioner or another suitable licensed professional. I would ask the manager for the name of the covering practitioner, check whether there is a current written prescription and whether the practitioner is reachable by telephone for the session, and if not, offer to rebook. If he agrees and the prescription is clear, I would do only the prescribed Tui Na, taking a short history including medicines and pain red flags.

Ethics and communication: Retrospective approval from the practitioner would not protect Mr Rashid or my licence. I would put my objection to the manager in writing and respectfully, and refuse to record a procedure that I did not do or that is outside scope. If pressure continued, I would report it to the licensing authority.

Reference: Unified Healthcare Professional Qualification Requirements (PQR), 3rd edition (MOHAP, DOH, DHA and SHA, April 2025) and DOH TCIM Practitioners Scope of Practice (DOH/SOP/TCIM-Practitioners/HCWS/V2/2024) and UAE Federal Decree-Law No. 4 of 2016 on Medical Liability

Knowledge: Fever with fast breathing, poor intake and fretfulness in a toddler may indicate pneumonia, a urinary or gastrointestinal infection, or dehydration, and can deteriorate quickly. Tui Na does not treat these conditions, and delaying medical assessment can cause harm. A febrile child should not receive massage because of discomfort and the risk of masking deterioration.

Management: I would stop before starting, thank the mother for telling me, and explain that I am worried because of the fever, fast breathing and poor drinking. I would tell the practitioner at once and ask for urgent medical assessment, and I would advise the mother to take him to a paediatrician or the emergency department today. I would call 998 if he is very drowsy, breathing with effort, has a blue tinge or has a fit. I would record what the mother reported, my observations, and the advice she was given.

Ethics and communication: I would be respectful of her cultural beliefs and of her grandmother's practices, and explain that Tui Na can be useful when he is well but that today he needs a doctor first. I would not make her feel that she was careless, and I would not take any risk on the child's behalf to keep her happy.

Reference: Maciocia, The Foundations of Chinese Medicine (Elsevier) and DOH TCIM Practitioners Scope of Practice (DOH/SOP/TCIM-Practitioners/HCWS/V2/2024) and UAE Federal Decree-Law No. 4 of 2016 on Medical Liability