Ryan Young Sport Massage

On November 20 & 21st, 2010, I had the privilege of attending the Introduction to Sport Massage workshop presented by Ryan Young, BSc, RMT, SMT (cc) at Accel Physiotherapy and Sport Performance Centre in Halifax, Nova Scotia.

I knew it was going to be a great course, as Ryan is a colleague of mine (he’s also my massage therapist), but the course content and presentation far exceeded my expectations.

The Saturday started off with an overview of Sports Massage Therapy, and how it plays a role in not only high level athletics, but also its role at junior and local levels.  The role of the massage therapist at sporting events was explained very succinctly, as Ryan himself has participated at such events as the 2010 IAAF World Junior Track & Field Championships. Later on that day, Ryan proceeded to discuss the function and application of massage therapy at various stages of competition.  This included a discussion of appropriate techniques, as well as demonstration and practice of their application.

Sunday morning started bright and early as we jumped into discussing techniques, seeing a demo, and practicing.   Later that day we discussed the psychology of the athlete, as well as poly-clinic etiquette for massage therapists.  Ryan also addressed questions about membership and candidature in the Canadian Sport Massage Therapists Association for those who are interested in pursuing certification.

(also please note that this course counts toward 8 CEU’s with MTANS)

After a full weekend I had a lot to think about, and since that time I have begun to modify some of my own treatment techniques using pointers that Ryan gave us.  Not surprisingly, anyone will respond well to these Swedish techniques, and I have found them to be very effective with my MVA (motor-vehicle accident) clients and even those in chronic pain.

Overall, I would rate this workshop and instructor 10/10 for relevance, organization, knowledge and presentation.  I highly recommend the Introduction to Sport Massage course to anyone looking to expand his or her knowledge and technical skills, even if you only ever plan on using it in your in-house clinical treatments.

On an even more exciting note, Ryan is the lead massage therapist for the 2011 Jeux Canada Games here in Halifax, and I am looking forward to hearing stories about the games, the athletes and the poly-clinic when the Games wrap up. These are exciting times for massage therapy, let me tell you!

Ryan’s website is RyanYoungSportMassage.com if you would like to contact him about setting up a course in your area. For further information on sports massage therapy in Canada, please go to the Canadian Sport Massage Therapist Association website.

Massage Therapists – Prevent Insurance Fraud

In my previous article “Massage Therapy and Insurance Fraud”, I discussed at length the situations in which a massage therapist may find him or herself in a case of fraudulent billing.

It’s important to remember that direct billing of an insurance company is a privilege that our profession has worked very hard to achieve. Fraudulent billing not only detracts from the integrity of the massage therapy profession, it also calls into question your integrity as a therapist and person. Your insurance billing identification should be treated like your passport, driver’s license and social security/insurance number, and protected at all times.

Assuming that you yourself aren’t committing insurance fraud, I have some suggestions which may help you avoid this slippery legal and professional slope, and protect your license while working in a business.

1) If you are a contractor, you have the right to establish your cancellation/no-show policy and conduct your business as you see fit (within reason). Ask the clinic and co-worker what their policies are concerning missed appointments and non-compliance. If their policies seem reasonable, then it is to your advantage to be consistent with the business in which you work.

If you are an employee, unfortunately you are pretty much stuck with following the guidelines of your employer.

2) If front-office staff is responsible for booking the appointments on your behalf, ask them if clients are advised when booking appointments of the no-show and cancellation policies. No? This makes it a little more awkward, but I would suggest – if the front office staff will not, or forgets, to mention the policy – creating a waiver which is part of the health history intake. This waiver should state your policies, and you should not only ensure it has been read and signed, you may also want to verbalize this to your clients before treatment.

3) Do you do your own billing? If not, whether or not you have signed a waiver permitting front-office staff to bill for you, you need to keep a close eye on your account.

If the business in which you work has asked you to sign a waiver permitting them to bill on your behalf, you may want to provide your own addendum which states that you do not give permission to bill on your behalf for i) treatments which didn’t occur or not provided by you ii) last minute cancellations or no-shows, iii) treatments other than the accepted massage therapy treatment modalities. (consult your professional association or college to find out which modalities are grouped under massage therapy in your jurisdiction). You may also want to include that the liability lies with the management for any of the above situations. Don’t forget to get the clinic or spa manager to sign the addendum to the waiver.

(realistically, I doubt that many clinic or spa managers will do this, but it’s worth a try. Remember that your billing number is your responsibility, and if no such agreement exists, you will likely take the heat if the insurance fraud allegation comes up)

4) Every week or so, compare your insurance account with the list of treatments you have provided. If you notice that there are charges for treatments that never occurred or you didn’t provide, I recommend that you bring it to the attention of the clinic/business owner, and front office staff in writing. Give everyone the benefit of the doubt, and assume that this was an error. Advise the clinic that you will have to notify the insurance company to reimburse them – note, however, that if you haven’t received the money, you expect the clinic/business to reimburse the insurance. A refusal on their part to do this is not a good sign of their honesty. If this is the case, send them another letter and …

5) Mail yourself a copy for good measure (and don’t open it, put it in a safe place. The postmark can be used to verify dates should the law ever become involved). Use registered mail to send the clinic the letter and print the receipt of when the clinic received it.

6) In the case of 4 & 5, you may need to find another place to practice, so get moving on that – after all, all signs would indicate that perhaps that the business where you work is involved in fraud, or is, at the very least, unethical. Do you really want your name and professional reputation associated with that? I didn’t think so.

Keeping these above points in mind will help you maintain your professional integrity and raise the transparency of the profession. Only by doing so will the massage therapy profession position itself as a health care industry deserving of insurance billing privileges.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

Massage Therapy and Insurance Fraud

An unfortunate trend seems to be rearing its ugly head in the massage therapy profession in Nova Scotia, Canada. Could fraudulent billing by businesses and massage therapists be the beginning of the end of insurance coverage for massage therapy services?

In most areas of North America, and Canada in particular, the massage therapy profession has long been promoting itself as a viable and legitimate health care modality. For several years massage therapists belonging to professional colleges and associations in Canada have been privileged to have our services covered by private and motor vehicle insurance, allowing us to build our practices upon an expanding base of savvy health care consumers.

In the recent months, however, it has come to the our attention as a profession that BlueCross insurance is rightfully investigating allegations of insurance fraud, and has gone so far to revoke direct billing rights of some businesses found to process fraudulent claims. BlueCross has also gone so far as to re-establish the direct billing Terms of Use agreement by massage therapists – but the general fear is that if this privilege continues to be abused it will eventually be revoked, leaving many of us out in the cold with a client base who will no longer be able to afford, or be willing to pay for, our services.

What is insurance fraud?

For our purposes, a simple definition of insurance fraud (please see my source FraudEducation.com) would be “criminal act requiring a material and intentional misrepresentation in order to obtain a benefit.”

This intentional misrepresentation regarding massage therapy services could possibly encompass:

1) Billing an insurance company for a therapeutic massage treatment that never happened (for example, a therapist or clinic bills insurance for a missed appointment)

As I have mentioned in my previous article Massage Therapy and Preventing Missed Appointment by Clients , I prefer to let one missed appointment go without penalty to the client, but in the event that it happens a second time, you need to be prepared to stand strong in case your client refuses to pay. Under no circumstance should the therapist allow these missed appointments to go by without bringing it to the client’s attention. Clients must understand that a therapist or clinic is unable to “just bill insurance” and you will not commit insurance fraud to let them off the hook. If a client won’t pay the fee, then it is better to discharge the patient from your care and document the events leading up to the dismissal.

In the case of a patient undergoing treatment in a motor vehicle insurance claim, it is necessary to document not only subjective and objective findings, but their compliance to your treatment plan and home care. If you find that a client is always late, misses appointments and doesn’t do suggested home care, you can discharge a patient for “non-compliance”. Clients should be informed up front that being discharged for non-compliance will not work in their favour, and that any further requests for treatment will not likely be granted, as the insurance company will not take the request seriously. After all, if a client is unable or unwilling to follow a previous treatment plan, then he or she is unlikely to be compliant in the future.

2) Performing treatments which are excessive and unnecessary.

There is a difference between what we think is necessary and what is considered excessive treatment – this is difficult, as a massage therapist working on MVA clients may identify a need for more treatments than the insurance tables deem appropriate. However, very few people need treatment more than a couple of times a week, unless you have specialized in a therapy such as Manual Lymph Drainage (aka MLD or Lymphatic Drainage), which is most effective initially in several treatments in a shorter time frame. I would have to say that if you can’t document objective findings which demonstrate an improvement in your client’s condition, or you can’t propose a reasonable treatment plan, you will probably find that your client will get limited treatments approved by insurance.

As massage therapists are not considered primary health care providers, our clinical impression is often trumped by a diagnosis of physician, chiropractor or physiotherapist. There’s not a lot we can do about that, but the reality is that in the past there have been therapists who have treated insurance coverage like a cash cow, instead of a tool to help their clients get needed treatment. (Not only is this fraudulent, but it is also unethical on the part of the therapist.).This quite rightfully has led insurance companies to view the profession with a bit of trepidation and suspicion, which is why a primary health care provider’s opinion will be taken over a massage therapist’s.

3) Billing an insurance company for a “massage therapy treatment” but performing another service (for example, a body treatment, such as a mud wrap. This has been alleged to be happening in Nova Scotia in spa settings.)

4) Using the billing number of a registered or licensed massage therapist by another party to perform services.

In the case of billing spa or esthetic treatments as “massage therapy”, or an unqualified practitioner using a therapists billing number, this is absolutely inexcusable. This practice has resulted in several spas being investigated. To my knowledge, there is at least one spa in Halifax that has had BlueCross direct billing privileges revoked, with several more under investigation.

Unfortunately for some of the therapists involved, this fraudulent billing has happened without their knowledge, and while I know this may seem little suspect, I really believe that a lot of therapists have been put in a no-win situation. In most spas and some clinics, therapists do not have access to the system which allows them to process the charges, so they sign a waiver allowing the business to do this admin work on their behalf. If a greedy business owner wants his or her cut of the action, they may instruct admin staff to bill a mud wrap or pedicure as massage therapy. If a client is aware that this is happening, then the client is every bit at fault as the therapist. I would also like to point out that a therapist signing a waiver does not imply that they are in agreement with fraudulent billing practices, and many are not offered a choice of refusing to sign.

Does Fraudulent Billing = Professional Misconduct?

Any one of the above mentioned situations is not only considered fraudulent, but may also be considered professional misconduct by a professional college or association. Part of required client records according to the CMTO is a financial record – this includes not only the date and time of the treatment, but also of the treating therapist, duration, the fee, and how it was paid. Any falsification of client records is considered professional misconduct.

If a therapist’s billing number is fraudulently used, should the therapist have to reimburse the insurance company? Or should it be the spa or business’s responsibility? Who is culpable of fraud?

I have discussed this at length with several friends and colleagues of mine. While I do agree that it is a therapist’s responsibility to oversee his or her account with the insurance company, I do not necessarily agree that a therapist should be held responsible for reimbursing the insurance company if the spa or clinic fraudulently billed it on his or her behalf and the therapist did not receive the money. This places many therapists in a very difficult situation as they often don’t have access to the company system to review the billing. It will be interesting to see how this all unfolds and if it results in criminal charges of fraud for spas and businesses, and professional misconduct of therapists.

For further reading, please go to the post “Massage Therapists – Prevent Insurance Fraud”.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

How Do I Choose the Best Massage Therapy Education or School?

If you are considering a career in massage therapy, you need to make sure that you are going to purse the best education possible. This choice will set the stage for years to come, so choose your school wisely. After all, the best massage therapy education won’t be cheap or easy, but it will set you up for future success as a massage professional if you decide to go for it.

Here are some quick tips on how to choose the best education possible:

1. Get to know the massage therapy regulations in your state or province concerning the practice of massage therapy. Does the school in which you are interested comply with the standards? Is the college or education program recognized by these regulatory bodies?

2. How successful are previous graduates? Do they own their own businesses, or are they working in the type of field in which you’re interested? For example, sports, rehabilitation, spa etc. Keep in mind that someone’s ambition is not dependent on the school where they went, but a good educational foundation will help set a therapist up for success.

3. How interested are potential employers in the school’s graduates? For example, how many students have jobs before graduation, and where are the jobs located? (hint: graduates who are going to well-established and reputable clinics are an indication of the quality of the massage training program.)

4. Is there a job board at the school? What types of employers are actively seeking the graduates?

5. Are the students and graduates generally happy with the program?

6. Do students have the opportunity to treat members of the public at a student clinic, and do they have opportunities to network with professionals in the industry?

7. What do current massage therapists think of the program you want to pursue? No school is perfect, but if you get an overall thumbs up for the program then it will in all likelihood be worth your while.

There are several great options for massage therapy education, so sometimes it may just come down to how a college “feels” to you. If you get good feedback from students and professionals alike, and the school “feels” right to you, you can be quite confident that you are pursuing the best massage therapy education for your needs.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

A Massage Therapy Career – What’s Your Motivation?

I remember the days before I began my massage therapy career. After getting a treatment, I used to float out of the clinic, eternally grateful to my therapist for holding my migraine headaches at bay for another two weeks. Yes, even before I began massage school, I wore rose colored glasses and thought that when I became a therapist, I would save the world, one treatment and one client at a time.

Then school began, and the reality of what I was undertaking hit me. Since I had left a great career in high tech with equally great benefits, gone was the hefty paycheck, and the “love and fluff” of only ever being on the receiving end of a massage. It was really hard, being in class for 7 hours a day and then going home to study some more. And the detail, my God, the detail – how many nights did I dream of that darn Kreb’s cycle, and of muscle origins and insertions (and not of Brad Pitt, either!). Then came the task of learning the hands-on aspect of the profession, the subtle nuances of giving a great treatment (the subtlety and greatness of which didn’t even happen for me until after I graduated. I had the treatment part down quite well, however.) I lived and breathed massage therapy as most of us do, and loved every minute of it.

In hindsight I realize that while I had the most altruistic motivation when I started my massage therapy education, eventually the reality hit home that this was actually (gulp) a career. I would have to pay rent and bills with the earnings of this endeavor, and with that reality came a little less altruism. After all, not only did I have to pay my living expenses, I would also have to pay student loans and eventually a car payment once my vehicle had finally had it. Wow. I hadn’t really thought of that.

So, what’s your motivation for a career in massage therapy? Are you in it purely for financial gain, or is it altruistic? If it’s for financial gain, you might want to consider another career path, for several reasons, not the least of which is the human cost of looking at clients like a cash machine. If it’s about helping others, can you see beyond the client to see the business side of the profession? Do you really think that you can save the world, one client at a time, or do you have a bit more realistic vision of how the profession will play out in your life. Let me just say that to be altruistic is great, but it will in all likelihood change during the course of massage therapy college, when you realize that there are limitations to what massage therapy can do for others. In fact, I noticed this decrease in idealism not only in myself, but also former students, and it is well explained and quantified in an article published in the International Journal of Therapeutic Massage & Bodywork.

During my second year of college, my chiropractor told me something that sticks with me to this day. She said “You will help about 80% of your clients to some degree. There will be 10% who are completely better from your treatments, and 10% whom you won’t help at all. Don’t let that last 10% discourage you from your work. You will still make a positive difference in so many lives.” What a brilliant woman she is! (and she was so right).

Before you take the plunge into a massage therapy career, take the time to examine your motivation and learn as much as you can. And, if you decide to go for it, don’t let the fact that your motivation might change upset or discourage you, you will still be true to your inner saint and help countless people with your skills.

If you are ready to start your Massage Therapy career, click HERE to Find a School, or look on the menu bar at the top of the page. Good luck!!!!

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

Massage Therapy Students – Is a high GPA an indication of future success?

As a former Massage Therapy educator I always encourage students to strive to be their best academically, as the knowledge learned in school is the foundation of a career. However, “average students” – don’t despair! A high GPA is only one of many indicators of potential success in your future as a massage therapist.

What makes a great massage therapist? Is it academic intelligence and a high GPA, or is it a deeper, intangible quality which makes someone successful in this profession?

I recently read an article in the May 2009 issue of Massage Magazine – “How GPA Affects Success” – and I can say that while some great points were made, I don’t entirely agree with the sentiment that a high GPA is the primary indicator of commitment to, or future success in, the massage therapy profession. My opinion is based not only on my 7 years of post-secondary education and work history in various industries, but also as a massage therapist of 9 years, and as a massage therapy educator for 3 of those years.

When I graduated in July of 2000 from a really intense, 2200-hour massage therapy diploma program, I was not at the top of the class. While I was a good student with an above average GPA, I was not at the top of the heap in spite of the fact that I attended class, avidly learned new techniques and worked darn hard throughout my two year program. (our passing grade was 70% for each course) There were many like me at graduation, and at that time, I was just grateful to have finished with decent marks and a job. And truthfully, working in the profession is when my real education began.

Observing my former classmates and, more recently, former students, what has struck me the most is that while some students were technically and academically very gifted, this didn’t necessarily translate into success in business or practice. What gives? What makes an “average” student an exceptional therapist or entrepreneur, and what makes a “stellar” student with a high GPA just “average” in real life?

My colleagues and I have discussed this at length, as we are often approached by other massage therapists who are looking to hire for their clinics. In summary, here is what employers or clinics tend to look for:

1) If a student has good attendance, and comes prepared to class, exams and clinic, he or she is proving reliability. Attendance record is usually one of the first things I am asked about a student from an interested clinic or therapist, and is always the first thing I mention if I am asked about a student therapist.

It is possible to get great marks with poor attendance, some people just know how to study for the test, and some people are great performers during practical exams. Is it fair? No, but life isn’t fair either, so an average student has to prove his or her value in other ways.

The lack of reliability is a huge problem in the massage therapy industry. I have observed that therapists who lean excessively toward the “free spirit” part of their personalities are usually the first to cancel work if, say, they have an invitation to a barbeque or the snow is good for skiing. As a result, the therapist and clinic gain a reputation for being unreliable and lose clients. So, if you demonstrate a lack of reliability in school, you’re setting yourself up for failure.

2) Does the student have passion for the profession, and a desire to learn? Nothing great is ever achieved without passion, so if a student is decidedly unenthusiastic about the profession then he or she is not a good bet for longevity in the industry. Of course, people who are very passionate about learning will do well in school and achieve a high GPA, but this isn’t the same as being passionate about the profession. Once the challenge of academia has ended, is he or she passionate enough about massage therapy to carry on, striving to be the best therapist he or she can be?

3) How does the student get along with teachers, staff, and other students? This is an indication of a student’s ability to work well with a variety of people.

If I’ve said it once, I’ve said it a million times – instructors and classmates will be colleagues some day, so a student who makes an effort to be pleasant, social and reasonable (when times get rough) is a great catch for a clinic that is looking to hire. Let’s face it, a great academic history doesn’t mean a thing if a massage therapist lacks communication and people skills, or if he or she is “cold”.

Case in point: Former colleagues and I have refused to provide references to students who were at the top of the class, but who were trouble-makers, rude or condescending to our fellow instructors and staff. After all, I wouldn’t want to hire someone only to find out a few months down the road that a person was a trouble-maker, rude or condescending to me, my staff or clients. (not to mention that I would take issue with the person who gave a good reference for this same therapist.)

4) Does the student have a good intuitive sense concerning treatment, and does he or she have good hands. Technique can be taught, and a therapist with no real natural gift for touch can be technically perfect and effective, but great hands and intuition are really born and developed, not made. This isn’t to say that I wouldn’t hire a therapist who maybe seemed to lack a little on the “intuitive hands”, it would really depend on what I needed. And please note, I have seen some of the greatest gifts for touch from students who only had an average GPA.

5) Academic performance comes last on this “must have” list. What I would look for is a student who was solid in his or her foundation, not necessarily at the top of the heap. On the other end of the spectrum, I wouldn’t be interested in hiring a student with a “barely passing” GPA either.

What is really important is how a student is able to integrate what he or she knows and apply it to individual clients. There is no formula to a great treatment, and everything learned in school is just a guideline. I have found that many students with an extremely high GPA tend to be perfectionists and a little rigid at times, always wanting an exact formula to make a treatment effective, and this elusive formula just doesn’t exist. Flexibility and the willingness to experiment with techniques can create fantastic results with clients, so
creativity shouldn’t be underestimated.

Of course, if your massage therapy program allows transfer of credits to other diplomas or degrees, or if you’d like to continue your education elsewhere, then a higher GPA will work to your advantage TO A POINT. Keep in mind that the older you get the more life and work experience you have, and many academic programs take this into account when you apply, so all is not lost with an average GPA.

I would like to mention that learning styles differ, and some people just don’t do well in a traditional academic type setting. Most massage therapy programs are very intense, and it takes a while to integrate all of this knowledge and for it to “gel”. This process of “geling” actually usually happens when a new graduate begins his or her practice in the real world, and can take quite a while. It is interesting to note that many highly successful and wealthy entrepreneurs and business people were “C” students – proving that, in the end, a GPA of 4.0 has less to do with success than common sense, talent, hard work and practical experience.

Finally, massage therapy isn’t just about knowledge. Massage therapy is a gift of your hands and your heart that you share with your clients, and that is what people will take away from your treatments more so than anything else.

Now, stop making excuses and go study!

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

A Massage Therapy Career – What to Know or Do Before You Take the Plunge

Some points to consider before you embark on a Massage Therapy career.

Massage therapy is an interesting, rewarding and fun career. It is also growing considerably in North America – according to the United States Bureau of Labor Statistics, the profession is forecast to grow faster than average (20%!) between 2006 and 2016.

If you are interested in a massage therapy career, this is great news. I would suggest, however, that before you embark on a new career path and undertake the commitment necessary to become a massage therapist, you consider what the profession is really all about.

1. My first piece of advice is to get a massage!

It never ceases to amaze me how many people love the idea of becoming a massage therapist, yet have never had a massage treatment from a professional. Getting a either a relaxation or therapeutic massage is a great opportunity to know what it’s like to be a client, as well as to establish a rapport with a professional in the industry. I would advise that you go for a massage therapy treatment in the type of setting where you think you’d like to work …

2. Speak with several massage therapists currently in the industry.

You will find massage therapists in spas, sports facilities and medical clinics. You may also find them working out of their own home, or perhaps the massage therapist you know will have a mobile service, and go house to house visiting clients. Tell them that you are considering a career in Massage Therapy, and as them for the input. Also ask them to be honest, and discuss a “typical day”, as well as the pros and cons of the profession, everything from work environment to pay rates, and how they fit into the organizations in which they work. Once again, because everyone has a different experience of the profession, speak with several people to get a general idea of what life is like as a massage therapist.

3. Experience different types of massage

From relaxation and therapeutic massage to different modalities under the “massage therapy umbrella”, you have several excellent options, try as many as you can before you make your final decision on whether or not to pursue a massage therapy career. After your basic education is done, it is good to know that you have options where you can specialize as your experience grows.

4. Ask your new massage therapist friends where they went to school, and what their experience was like.

As professional therapists, they will be able to guide you where to go for the education you will require, as well as discuss the licensing requirements for the state or province where you want to practice and live. The massage therapy school you attend is your foundation and will set the stage for years to come, so choose wisely.

5. Don’t let the romance of massage therapy as a healing art mislead you!

To be successful in Massage Therapy, it must be treated like a business, albeit a caring one. You will have bills to pay, so don’t be misled by thinking that the money you charge per treatment is money that goes directly into your pocket. Once again, talk to massage therapists to get a reality check on the business aspect of the profession, it could save you a lot of heartache.

For more information on the realities of the profession, check out the main site, under Massage Therapy Careers. Taking the time to learn about the massage therapy profession before you commit your time, money and energy is effort well spent.

© Copyright 2008-2009
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.

Massage Therapy and Informed Verbal Consent

What is Informed (Verbal) Consent, and why is it necessary for a massage therapy assessment or treatment?

Ignorance is NOT bliss in the massage therapy profession.

I remember my first few weeks of massage therapy school – making new friends, touching people I didn’t know, and the overwhelming amount of information involved, not the least of which was trying to wrap my head around informed verbal consent.(also known as informed consent) I was more “fortunate” than most of my peers, because I had actually had an awful first experience with massage therapy which, as a student and later a therapist, instilled in me the need to advise my clients of what to expect during treatment.

I swear that the massage therapist who treated me for my very first treatment could have been the poster child for what NOT to do to a new client. He didn’t tell me what to expect, he used pressure so deep I wanted to cry, and he talked about how much he hated his ex girlfriend. Wow, did I ever feel vulnerable, and had I known I could discontinue the treatment I would have. With a first experience like that it’s amazing that I ever went to another massage therapist, let alone became one.

So basically, the definition of informed (verbal) consent is: obtaining client agreement to the impending treatment based on full disclosure by the therapist as to what the client should expect before, during and after the treatment. The client consents on the treatment with full knowledge of what’s going on.

Why is Informed Verbal Consent so important?

There are a few purposes to obtaining informed verbal consent, not the least of which is that the client has a right to know what is going to happen – this is not rocket science. Would you buy a car or a house without knowing the specifications? Probably not. And certainly where a client’s health is concerned, he or she must be presented with sufficient information to make an informed decision concerning the treatment, and then give you permission to do it. Informed consent is about empowering the client through knowledge and trust. This knowledge and empowerment protects the best interests of the client. After all, it shouldn’t take too much imagination to remember how it feels to be lying in a very vulnerable position, mostly undressed, in a closed off room with just you and a complete stranger.

Informed consent helps establish trust between the therapist and the client – which is the foundation of a productive therapeutic relationship. When you say to expect XYZ and the client receives XYZ, then he or she knows you are a person of your word. If a client feels pain during treatment, and you stop whatever you’re doing when you are asked, the client understands that you are there to look out for her best interest.

Informed verbal consent protects the therapist, too. When therapists take the time to advise a client on the various points of informed consent, he or she is ensuring that whatever happens will not alarm, scare or cause undue pain to a client. A therapist should document that he or she received permission to continue with the treatment for each treatment – a simple IVC next to the treatment date should suffice. And therapists should remember that any time any new area or body part is worked on, or different treatment modality is used, consent must be obtained from the client.

What should be included in basic Informed Verbal Consent?

1) The nature of the treatment – tell the client what body parts you’ll be working on, as well as how much pressure you’ll be using. I like to explain to my clients how the will be undraped (uncovered) and that the only part of the body that will be uncovered is the part that I am working on.

I also tell clients to undress to their comfort levels, though it is more effective if I work directly on the skin. If my new client looks unsure, I usually tell him he can leave their underwear on, and I will leave the room so he can undress and get on the table in privacy. I also make sure before I do leave the room that my client doesn’t need any assistance with either.

2) The benefits of treatment – If your client comes in for a relaxation treatment, then a benefit should be that she will be more relaxed and may sleep better. If a person comes in specifically for treatment of an injury, then the benefit of treatment should be the same as the treatment goals – i.e. decreased pain, increased mobility etc.

3) What are the risks and side effects of the treatment? A risk is generally more long term in nature, whereas a side effect is more immediate. For example, a side effect is that a client may be a little “woozy” when he or she gets off of the table, but a risk of a more vigourous treatment is that your client may be a little sore the next day.

4) Advise your client of alternatives to treatment. This is described in the context of massage therapy – for example, if a client presents with scar tissue, you can advise your client that you will be performing Frictions (aka friction massage therapy). In the event that this is too much for your client to tolerate, you should advise that an alternative is to do petrissage and deep kneading to the area.

5) What are the consequences of not having treatment? If a client doesn’t have treatment, then he or she can expect to NOT achieve the goals and aims of treatment and not improve. So, if a client presents with limited range of motion of the right shoulder, and opts out of treatment designed to increase the ROM, then a consequence of not getting the treatment would be no improvement of shoulder range of motion.

6) The client ALWAYS has the right to stop or modify the treatment. Period.

Sometimes clients look a little confused when I say this, so I tell them “if anything makes you uncomfortable in any way, please let me know and I’ll stop what I’m doing. If you feel that you have had enough of the treatment, then we can finish.”

7) Ask the client if she understands what you have told her AND if she has any questions. This presents her with the opportunity to speak up if she is unsure about anything.

8 ) Ask the client if you have her permission to proceed with the treatment as you have described it. This might seem obvious, but you don’t ever want to get caught on a technicality. This gives her the ability to “Yes” or “No” the treatment, enabling you to carry on with confidence.

This is basic informed consent that every therapist should use when treating a new client.

For those candidates preparing for the College of Massage Therapists’ of Ontario (CMTO) certification exams (i.e. the MCQ and OSCE exam), informed consent is a little more involved. (OSCE = Objectively Structured Clinical Evaluation).

Though informed verbal consent (aka informed consent) may seem tedious, once you establish your own way of doing it, it should become second nature to you. And remember, it serves both you and your clients, and builds the therapeutic relationship on a foundation of trust.

© Copyright 2008-2009
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.

Massage Therapy and Preventing Missed Appointments by Clients

A Massage Therapist’s point on view on preventing and dealing with clients who miss appointments.

It happens to the best of us. Our day is booked solid, and we are all set to go full throttle. At some point during the day, a client doesn’t show, doesn’t even call to say that he or she is going to miss the appointment. Then another one misses an appointment. What is going on here? Our day is ruined by missed appointments and the no show client, and instead of being productive, we are stuck reading the newspaper when we’d either rather be treating, or at the mall/beach/movies. You feel disrespected, and yes, possibly, a little abused.

Let me just start by saying that most of our clients don’t miss appointments on purpose, usually it is a case of life getting busy and they have forgotten about it. I have been on both sides of that fence, and I have some strategies that can help prevent and deal successfully with the dreaded “no show” or “dns” (meaning did not show).

1) To begin with, I suggest that you create and post a cancellation policy and use a standard script when booking a new client. If you use a receptionist instead of booking your own clients, I suggest that you make friends with him or her and encourage them to use it when booking for you. When booking a new client, I ALWAYS advise them of the cancellation policy – you can say something like this:

“Your appointment time is reserved just for you, and if you should need to cancel, I do require 24 hours notice. In the event that you fail to provide the required notice, there is a charge of (i.e. 50%) of the fee. And in the event that you arrive late for the appointment, you will be charged the full fee, even if I am not able to treat you for the full duration of the time you’ve booked.”

This way there are no surprises – your script will become like second nature to you, and it is better to be up
front about your expectations – this way the client can’t come back and say that he or she didn’t know.

2) How you approach this is also going to depend on the situation in which you work. If you are a contractor, then you should have complete control over your clients and how you interact with them, establishing your own policies (within reason, of course). If you are an employee, then the control you have over how you handle these sorts of things may be limited by the policy of your employer – and this may or may not work to your advantage.

The College of Massage Therapists’ of Ontario (CMTO) requires that massage therapists post treatment fees in their place of practice where they can be easily seen by incoming clients. I think this is a really great idea, as there will be no surprises and the expectations will be clear. Also, it is a great opportunity to post your cancellation policy along with your fees, though I did have one clinic owner who had a problem with this (apparently it was “aggressive and tacky”) – I did notice, however, that my clients were very clear and accepting of the policy, and as I was in compliance with CMTO standards, it didn’t really matter what this individual’s opinion was. Ultimately, I had to answer to the professional college first.

Under your posted fees, you can indicate your cancellation and late arrival policy – it can be something like:

Your appointment time is reserved just for you. I respectfully request 24 hours notice to cancel an appointment, or full payment will be required. Full payment is also required if you are late for your appointment, or fail to show for your scheduled booking. Thank-you for respecting my time.

3) You don’t have to be so rigid with this policy as to drive away clients. Find your balance between fairness (towards all of your clients) and firmness (you are running a business, and when you treat it like a business, clients will see it as a business). Without telling clients this, I usually give them one missed appointments grace. This is only fair, as sometimes life just happens – children (or the client) get sick, things are busy at work and it slips their mind, the car breaks down, they get stuck in traffic… you know what I mean. It did work for me, and here is how I let them know that the next time the policy would be enforced …

4) When you call your client to let them know they missed their appointment, you should make it as non-confrontational as possible, their reason for missing the appointment may really be very innocent and legitimate. You can say something like “I am calling to make sure you are OK, you had an appointment booked with me at 3:00 and you didn’t show. Can you just give me a call to let me know all is well, and then we can rebook you?” Usually they will call and be very apologetic, if they’re not, when you document the missed appointment in their file (and when you called them, if you left a message, what was said, etc), you need to note this as well.

When you do speak with him or her, what you can say is “I’m glad you’re OK, and I will waive the missed
appointment fee, as it is the first time this has happened. If you should miss any more appointments, you will be charged the missed appointment fee. When would you like to rebook?” They are usually happy with this, and have gotten the message loud and clear about the expectation the next time they miss an appointment.

5) Your policy enforcement will also depend on the relationship you have established with your client. Is the
client relatively new? Or has your client been loyal to you for a while? A loyal client who has a family member who is ill or has a special needs child, for example, may not show due to a family emergency. If you have already established a good relationship with this client and you know you are not being taken advantage of, then I would let an occasional missed appointment go.

6) The reminder call can work wonders, even though it is a little time consuming. For your own sanity, you may want to get into the habit of doing this the day before the appointment – it can go a long way in preventing a no show, and give you time to book someone else if your client can’t make it.

Another issue which is directly related to massage therapy is fraudulent billing for missed appointments, if you haven’t encountered it, you should read about it, it will be an issue at some point.

These are just some pointers in how to deal with no-show clients, please stay tuned for my upcoming post on Massage Therapy and How to End the Therapeutic Relationship, for those clients with whom you “just can’t seem to make it work.”

© Copyright 2008-2009
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.

Massage Students – How to Prepare for the NCBTMB Exam

You’ve come so far within the last year, and done everything right – you’ve picked the best massage therapy school for your needs, gone to class (I hope), studied hard and are getting ready to graduate. Congratulations, well done. But now there is one more thing you need to do, and your next big question to yourself is how to prepare for the NCBTMB exam in your state.

Wow, trust me, I know how you feel. It doesn’t matter how hard you’ve worked or studied, you always wonder if you’ve done enough to get you over this last hurdle so you can start your new profession in massage therapy. Well, my friends, there are strategies and tools you can use to help you prepare for the NCBTMB exam. Here’s a list of pointers, some resources and some advice that is realistic (and will hopefully help you lessen some of the stress that comes with this challenge)

1) It doesn’t matter how much you have prepared, it will always feel like it’s not enough.

This is an unfortunate truth in whatever you do. You may find yourself thinking “Maybe I shouldn’t have gone to the movie with my friends last Sunday afternoon” or “maybe I shouldn’t have gone home to visit my grandparents/Aunt Jo/Cousin Felix last weekend”. What I can tell you is this – life is short, and I think it’s better to spend time with people you love – it helps you connect with what is important in life. After all, isn’t that why you chose a profession like Massage Therapy?

2) If you’re still in school, ask the administration if a graduate who recently completed the NCBTMB exam can come in and speak to your class about his or her experience. This is a reasonable request, and most massage therapy colleges love to show off their success stories. If someone does come to speak to your class, don’t be shy, ask questions. Most graduates are more than happy to help out newbies.

3) Start early – let’s say a few months before your exam – and set a schedule.

You may have already done this if your final exams for school are coming up, and that’s great. Depending on the time frame, you need to set a realistic schedule and STICK TO IT. This will allow you some fun time, and it will also allow you some flexibility for unforeseen interruptions. Personally, I like tons of freedom within structure, so setting a schedule keeps me from being overwhelmed while allowing me to make tangible progress and have fun. (I’m all about the fun)

4) Make sure you have the right resources

Mosby’s has a great selection of books which, if you didn’t use them in school, will be a great resource in preparing for your NCBTMB exam and when you start working. Also, there are sample NCETMB, NCETM & MBLEx Practice Exams available which are a great investment, try them out. (Unfortunately, when I did the CMTO exams in Ontario, I didn’t have a tool like this, but it would have been really nice)

5) Study the hard or difficult stuff first.

Trust me on this one. The sooner you get to the tough stuff, the sooner you can identify any issues and address them (darn that Kreb’s cycle). Studying the easy stuff will be a reward, so break it up. If you are studying for 6 hours during the day, spend a couple of hours on the more difficult stuff, then “reward” yourself with subjects you enjoy. And then …

6) Get together with a study group and test each other…

Hopefully you will have found a study group or buddy who is supportive, structured and serious. (Note – it may not be a good idea to study with your friends, you may tend to socialize instead of studying). Get the sample questions for the NCBTMB to help you with this process. Realistically, if you haven’t understood something before, then hearing or seeing the question in a different way may be enough for the lightbulb to go on – trust me, 9 years after writing my exams, this still happens. And, one more thing, the best way to learn a subject is to teach it, so time spent helping someone else is never wasted.

7) Try to find a study partner whose strong points are your weak points.

My study partner in massage therapy school was really good at anatomy – he could memorize muscle origins and insertions like no one I’ve seen. My strength was physiology – I prefer to learn processes. He used to challenge me constantly, and while it was annoying at times, it really did help me remember.

8 ) Surround yourself with positive, proactive friends and study partners.

As a former instructor, there were always a few students who constantly (and I mean they were relentless) found fault with everything, and when they didn’t do well, it was ALWAYS someone else’s fault. I like to call this “swimming against the current”, and these folks wasted time and energy fighting the system when they should have been focusing on learning and taking advantage of instructor knowledge and availability. (side note: my aunt, who has her PhD and has been a teacher for years, calls this type of person a “crazy maker” – they are never happy unless they are stirring up crap, then they like to sit back and watch everyone else freak out. Don’t fall for it, please)

Incredible, really, but you have to choose how you want to live your life, and surround yourself with people who can get you there. So, get rid of the dead weight and the ‘crazy makers’ early on, you’re not responsible for anyone other than yourself. Make the choice to be with people who elevate you (mentally, spiritually and intellectually), not drag you down with them. Harsh, maybe, but so what? These “friends” won’t be paying your student loans, so you need to align yourself with people who have similar goals – which is to pass those exams and get working.

9) Take frequent breaks, completely get away from the books, and move your body. Adequate rest and sleep are really important as well.

My schedule used to go like this – study for 45 minutes, take a 15 minute break, repeat 2 times (that’s 3 hours) – then take an hour or two and step away from the books. Get outside, play with your dog, throw a baseball, get to the gym, do some yoga/pilates/weight training. It doesn’t matter. Reconnect with your body, it really does help.

10) Don’t o.d. on junk food – you will crash and burn mentally and physically.

Remember, junk in = junk out. You need to help your mind retain all of this information by giving your body good fuel – fruit, vegetables, protein, and yes, some fat. Get rid of the deep fried or packaged, sugary processed foods, and the soft drinks.

11) Sign up early so you can have your choice of exam times – you will know by this point when you are able to deliver peak performance, so schedule accordingly.

12) If you have to travel to take your exam, allow yourself time to get there in a stress free state. Stay someplace, or have access to, quiet so you can review before your exam, and where you can sleep well.

13) This is the hardest thing to do, but the night before your exam, don’t study.

Really. Take a break, go to a movie, go for a walk, have a nice dinner and a good sleep. Remember that alcohol can inhibit your sleep, and may make you “wonky” the next day, so you may want to forgo that beer or martini. Feel free to do whatever you want afterwards as a reward.

Best of luck on your exams, and welcome to our profession!

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