Meet Rebecca (and Leila) ...
She is a personal trainer with Wholesome Fitness a boutique gym that mainly caters for women. As part of her duties, Rebecca is required to assess clients for any potential health-related risks and seek the expertise, guidance, and in some cases clearances from appropriate medical or allied health professionals.
Do many of your clients require medical referrals or clearances?
I would say approximately 20% although this varies from time to time and the severity of the condition/s also changes. Most of my clients are in their 30s, 40s and 50s so there are some conditions which I see more than others. For example postural issues, continence instability, and dietary concerns. Clearances are not usually required, although occasionally I do request them, for instances if a client has had major surgery, or is experiencing a chronic illness, just to be on the safe side.
What are the main medical and allied health professionals that you collaborate with?
Often the first point of call that I recommend to my clients is their local General Practitioner (GP), sometimes my clients don't have a regular doctor and don't feel comfortable explaining the situation to a stranger so I will write a referral letter for them outlining my appraisal tests and suspicions, this helps them to accurately communicate the message. I also send people to chiropractors and physiotherapists quite regularly, they can work wonders to correct joint alignment and muscle imbalance.
Every few months I arrange for some guest speakers to visit the gym and conduct a health-related seminar. Just last week we had a continence nurse advisor, she was brilliant, I was amazed by the number of questions the group had and her level of expertise at answering them. In the past, we have also had a dietician visit, because I cannot provide specific diet advice but I still like to help my clients with their body composition goals. A friend of mine is a psychologist and she has offered to visit and conduct a session as well, I'm looking forward to that one.
What is the process for completing a referral to a medical or allied health professional?
Once the pre-exercise health screening and fitness appraisal process is undertaken and if I have determined that the client is in a high-risk category I will evaluate the results and determine what type of medical or allied health professional is the best option for them. Often they are already seeing someone because their medical issues are already known to them. In this case, I will prepare a letter to their doctor outlining the proposed fitness program and seeking their guidance on whether it is appropriate. If they don't currently have a doctor, or if they were unaware of their medical symptoms, I will recommend a particular doctor or allied health professional using my knowledge of local practitioners. I have been working in this area for 15 years, so I know most of the local clinics and health professionals.
There are some really good resources and templates on the Fitness Australia website and I always make sure I utilise them. They help to ensure that all the necessary information is captured and the correct process is followed. It's really important that fitness professionals don't overstep our boundaries, we're not allowed to make a diagnosis or counsel clients regarding any specific medical problems.
One important aspect we must undertake is obtaining the informed consent of our clients before we commence any health screening, appraisals, or referral processes and also maintaining their privacy. Medical concerns can be quite nerve-wracking for people and they may have very specific wishes regarding who they discuss these problems with and when. For example, some of my older clients don't want to go to a male doctor, others don't want anyone else in the group or the larger gym facility to know about their condition.
After the referral process has occurred, are clients allowed to participate in fitness activities?
In most cases yes, it is very rare that I will stop a person from participating completely. Usually, we commence with a very low-intensity, low-impact routine until the medical advice is available. This may take a couple of weeks depending on when the client is able to visit the practitioner.
Once the medical clearance or advice is received I make sure I follow it to the letter. Most of the practitioners who I refer my clients to are familiar with my facility and basic program structure so they usually write quite thorough guidelines for me to follow. I make sure that I conduct regular appraisals to determine progress and provide updates to the relevant medical or allied health professional. As a result, they may adjust their recommendations to allow for more complex fitness activities to be undertaken. So far this system has worked well for all involved, and I have even seen some amazing health-related transformations.