Massage therapists – Stop Complaining and Participate in Your Associations.

To really affect change in the massage therapy industry, therapists must stop being so complacent and exercise their democratic rights as association members. Much the same as voting for the leadership in your country, if you don’t make yourself heard by attending industry meetings, you don’t have the right to complain.

Yesterday I went to the SAGM of the Massage Therapists’ Association of Nova Scotia (MTANS). I admit I hadn’t been for a while, since the last one I went to 3 years ago was poorly run, unorganized, and really turned out to be a fiasco. All in all, it was very frustrating and unproductive. However, a lot has changed since that time, and since there are winds of change brewing in our profession, I felt the need to get involved again.

The most unfortunate thing about yesterday’s meeting, other than the whole insurance fraud issue wasn’t on the agenda, was that there weren’t even enough members present to reach quorum. This is really disappointing, as many of us, including and especially Board and committee members, had taken time out of our weekends and away from our families to be present and vote on critical issues in our profession. As it turned out, it was a great social occasion, but it looks like we’ll have to attend another meeting on yet another Sunday.

As I left the meeting with one of my friends and colleagues, she made a really great point – some of the people we know who didn’t attend are always the ones to criticize the association. It happens every year, and while these same people spend lots of energy complaining and criticizing the association board, they can’t be bothered to show up at meetings or sign the proxy forms.

Hmmm … it reminds me of politics, because in reality, it is. One look at world history has demonstrated that a vote can change the course of history, for better or for worse. One vote could make the difference to your association, your industry and your future. So, the next time I hear a complaint about policy XYZ, let’s just hope you were at the meeting, because if you weren’t, I don’t want to hear it. You have lost the right to complain.

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

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.

How Often Should I Get a Massage – Frequency Guideline

Following my initial blog post on this subject How Often Should I Get a Massage, here is my treatment frequency guideline, for massage therapists and their clients.

Remember, this is just a very generic guide, and will have to be adapted for individual situations.

Here are my general guidelines for treatment frequency:

Relaxation – once a month for an hour, unless you want to come more often.

Acute injury – more frequent treatments of shorter duration should help – for example, 2 times a week for 30 – 45 minutes. This should help relieve pain and congestion in the area, then after a few weeks, switch to deeper, muscular work for longer periods of time. At this point your injury may have moved into a subacute or chronic stage of healing, depending on the severity of the injury, 1-2 times a week for an hour, over a period of 3-4 weeks should get you on the road to recovery.

Treatment for chronic conditions (i.e. headaches or back pain) – one hour twice a week for 4 treatments, then try once a week for 3 or 4 weeks, and try to decrease to 1x in 14 days for 2 treatments. You will then go into maintenance mode. Once again, very individual, and the longer the condition has been an issue for the client, the more treatments will usually be needed to make consistent gains.

Some more general guidelines:

Follow remedial exercise and homecare advice – passive treatments such as massage therapy can only take you so far, it is YOUR responsibility to be proactive in your own health care. This means follow exercise, stress management, nutrition and lifestyle advice. Record what you do and how you feel, try to make a correlation between various factors. If you have a team of health care providers who are willing to work together, use them!

Don’t go too long between treatments! Progress made during a treatment is building on the progress made in a prior treatment. This means that if I’ve treated a client for chronic back pain for a month and we’re seeing some results, if he stretches out the length of time between appointments to 8 weeks instead of my recommended 2 – 4 weeks, it may be like starting all over again. What a waste of money for the client!

Remember, though, that if you start to feel consistently better (and consistent is key), you have the right to say “I’d like to stretch out the time between treatments a few more days, can we try that?” Your therapist can only give you advice and guidance, you have to figure things out what works for your situation.

If the treatment is not helping – find another therapist! Sometimes people feel awkward about ditching their therapist, especially if you have a good relationship with him or her. BUT, it’s your time and money, and you should see results. Sometimes massage therapy is not the be-all-end-all of treatments, I personally find a combination of therapies to be the most effective.

Knowing your rights as a client will prevent you from getting expensive, unnecessary or ineffective treatments, and will enable you to receive treatment that suits your needs.

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

How often should I get a massage?

Without fail this is one of the most common questions I receive as a massage therapist. The truth is, though, how often you should get a massage treatment is very individual and doesn’t follow a set formula.

As a massage therapist, I am asked this question by every 9 clients out of 10.  There are several factors that I take into consideration, and these factors include, but aren’t limited to, the following:

1. Why are you coming for treatment?  For example, is this for a specific issue, or is it for relaxation?

-       treatments which focus on specific issues are usually more frequent, though I rarely have treated a client more than 2 times a week for more than 3 or 4 weeks.

-         for relaxation and general health purposes, more than once a month is not necessary unless you have the time and financial resources to get treated.

2. What is the tissue presentation?

-         if you have a chronic, long-standing issue, and the tissue is very “dense” or “hard”, then you may need several treatments over a few weeks to make progress. Once your tissue has loosened up a bit, you should start feeling better. After a few weeks, your therapist should see how you are progressing, and you should be given the option of reducing treatment frequency.

-         tissue that is inflamed from injury cannot be treated directly with massage therapy, however, surrounding and compensating structures can and should be addressed to prevent pain and muscle imbalance.

-         tissue that is inflamed from injury can be treated with Manual Lymph Drainage (also known as lymphatic drainage or mld). Frequent treatments of this nature are recommended as this therapy facilitates the removal of metabolic waste from the injury and relieves pain and congestion.

3. Keeping in mind that everyone is individual and responds differently to treatment, you may notice that the effects of the treatment last only a day or so after the first treatment, with longer periods of feeling better as you progress – this is when your therapist should reduce treatment frequency.  After all, how are you going to know that you’re feeling better if you are still getting treatments twice a week? Exactly …

4. After 3 treatments, how are you feeling?

-         Personally, even with chronic issues such as upper back pain and tension, I feel that a client should notice an improvement by the end of the 3^rd treatment. This is my guideline which tells me I am on the right track, and it keeps me focused on what the client needs. I’m not saying there should be a huge or remarkable improvement, but some progress should have been made.

-         And just a side note for clients – if you aren’t seeing some improvement such as decreased pain, increased mobility etc by the end of the 3^rd treatment, then your issues aren’t being addressed. At this point your therapist should go over the treatment plan again (sometimes we miss things), and perhaps revamp it a bit.

-         If no progress has been made by treatment #5, ask to be referred to another therapist.  Beware the therapist who insists that you continue to book, and don’t be shy to say that you’re not feeling any different, after all, massage therapy is your investment in health.

If you are unable to come for the recommended frequency due to financial concerns, talk to your therapist. If he or she is aware of your financial limitations, she might be able to adjust the treatment plan so that you can maximum benefit for your restricted budget, or recommend things you can try at home to enhance and prolong the effect of the treatment.

For more information on Massage Therapy Treatment Frequency Guideline …

© 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.

Massage Therapy Client Obligations and Responsibilities

Massage therapy is unique in that it is a profession with one foot in health care and another in the service industry. This bridging of worlds brings a certain set of responsibilities to not only massage therapists, but also to their clients.

In keeping with my previous postings concerning the therapeutic relationship, I have decided to enlighten massage therapy clients as to what constitutes behaviours which massage therapists appreciate and those which we don’t. A little give, take and understanding of what massage professionals go through on a daily basis might help you establish a better relationship with your therapist, putting you on the top of the pile for preferred days and times, as well as getting “squeezed in” on short notice.

Here are the top things you can do to establish a great relationship with your therapist:

1) Show up on time. Massage therapists really appreciate a client who arrives on time and ready for treatment. It helps our day go smoothly, ensuring we don’t get behind. It also demonstrates to us that you respect our time and profession, which we really appreciate.

2) If you are late, expect that you will pay the full fee even if your therapist can only treat you for the remaining time. And, some therapists will not treat clients at all who are more than 15 minutes late for the appointment.

3) Please call 24 hours in advance if you have to cancel. We understand that life happens, and if you don’t give 24 hours notice and this is an isolated incident, it’s not usually too big of a deal. However, do expect the cancellation policy to be enforced, and if you fail to pay the balance owing, you may be “discharged” from your therapists care.

4) Know your insurance policy, if you have one, before the treatment. There are many different plans which may or may not cover massage therapy treatments, sometimes even within one organization, such as the government. It is your responsibility, not ours, to know how much coverage you have, if a medical referral is required, if direct billing is allowed etc. A therapist, even if he or she does permit direct billing, has the right to ask for payment up front if you are not sure of what is covered or don’t have the appropriate information. A therapist may also only direct bill for certain insurance companies. While most therapists do their best to accommodate clients (within reason), It is our prerogative to decide how to run our business.

I advise calling your insurer well before your appointment and asking them things such as 1. to what association does my therapist need to belong for me to get reimbursed, 2. do I need a medical referral to get my treatments covered, 3. how much coverage do I have and how much will I get reimbursed per treatment, 4. is direct billing permitted, or do I have to pay up front and submit my receipts? If you do need to get a medical referral, do so before your treatment, as massage therapists and doctors cannot “fudge” treatment or referral dates so your treatment is reimbursed.

5) Comply with the treatment plan and recommendations, especially if you are going in for a specific reason, such as an injury. While massage therapists are not permitted to diagnose, and are only permitted to form a “clinical impression“, we usually have great suggestions for treatment plans and exercises to ensure the best possible outcome. Remember that as great as massage therapy is, it is a passive therapy and only part of the health management equation. If you suffer from tight hamstring muscles, but don’t do the recommended stretching between your bi-weekly appointments, then there is only so much your therapist can do to help.

In the case of a client who is receiving insurance coverage for a motor vehicle accident, he or she has to realize that massage therapists are obligated to report to the insurer if the client is “non-compliant” with treatment and home care recommendations. I have seen many people discharged for “non-compliance”, and I have discharged patients myself for this reason. In a rehabilitative setting it is our job to attain certain treatment goals which may not be reached if the client doesn’t hold up his or her end of the bargain. By discharging a patient, I am preventing insurance fraud and freeing up my time so someone else can benefit from treatment.

6) This may hit a nerve with some people, but I’m going to say it anyway – client hygiene is really important. I am not talking about someone who had a shower in the morning and goes to see their therapist after work needing to worry about hygiene. I’m talking about someone for whom hygiene is generally an issue. After all, if a therapist is obligated to maintain a certain level of hygiene to treat clients, the therapist should be able to expect that clients show up presenting a certain level of hygiene. Think about it like this, would you want to be in a small room in close proximity to, and touching, someone who hadn’t had a shower for a few days? I didn’t think so.

And a side note: refrain from using cologne or perfume or tons of hair and body products. It’s really hard to work in a closed spaced with someone who smells like they tried every perfume in the local drugstore. No scent is the best scent, and this ensures that your therapist doesn’t get a migraine or has a flare up of allergies.

7) This is a business, and for most of us, our livelihood. A lot of massage therapists have a hard time reconciling the business aspect of the profession with the “caring” and healing aspect of the profession. But, make no mistake, this is how we pay our mortgages and buy our groceries, not to mention everything else that we need to live.

Someone (I can’t remember who, but I thought she was brilliant) stated in a cartoon “the caring is free, but the service is ($80.00) per hour”. We may choose to do pro-bono work, or may offer reduced fees to long-time clients if there is sufficient reason, but these cases are exceptions that are made of our own volition. I have had potential clients argue and tell me how much I should be charging – the key word being “potential”, I refused to book them. I also won’t negotiate “deals” with people or give them bargains just to get them to be my client – this is devaluing my own professional worth and undercutting my colleagues. Kind of like buying groceries, the price is what it is, and payment is due when the transaction happens.

8 ) Be prepared to pay with the massage therapists preferred method of payment. Find out when you are booking your appointment what is accepted, and don’t expect to run a tab.

Massage Therapists also have obligations to their clients – please check out Massage Therapy Client Rights if you are unsure of anything.

Following these simple steps will ensure that you establish a great relationship with your therapist, and that you get the most out of your treatments.

© 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 Therapy – is the customer always right? (Part 2)

As a follow up to my post a few days ago – “Massage Therapy – Health Profession or Customer Service? “, I’m pretty sure that you know where I’m going with this.

At the forefront of my thoughts when talking about massage therapists and customer service (as in “is the customer always right?”) is that ultimately because the health and well-being of our clients is our responsibility during treatment, it supersedes the customer service aspect of the profession.

That being said, for the most part therapists will very seldom encounter situations where they have to pull out their “health professional first” hat and decline a customer request. Ultimately, if what you do as a massage therapist during treatment presents a risk of harm to the client, then you need to stick to your decision if you decide to refuse or alter a treatment. Cases where this might happen:

1) Your client refuses to fill out a health history form.

This is pretty basic – I won’t treat a client if I don’t know what is going on with his or her health. End of story. The client may say “my health is fine”, but really, what does fine mean? “Fine” is different between members of the general public and health professionals, and most people, as previously discussed, don’t have the knowledge to have any kind of discernment when it comes to therapeutic techniques. Can you imagine getting a severe diabetic client who wants scar tissue work done, or a client with a history of TIA (transient ischemic attack) or stroke who wants to “work the kinks out” of his or her neck. These are two conditions which require precaution when treating, and for which certain techniques are contraindicated.

How to approach this? Tell your client that there are often conditions which require a treatment to be modified, or that treatment may even be unsuitable. You as a therapist are unable to plan and deliver the best treatment possible without this health information. You can also remind them that the health history is fully confidential and their information will not be disclosed. If they are really sticky, you can quite simply say that you are not willing to be liable for any injury caused because you weren’t informed, and that you will not treat them. (

*Any time you have this type of conversation with a client, you need to keep an incident report of it, even if you didn’t end up treating them. This will cover all of your bases in the event that the client feels like accusing you of being unprofessional. (Personally, I haven’t ever heard of this, but it’s better to be safe than sorry))

2) Your (new) client is adamant about getting “really deep pressure”.

This is actually quite common, and I have had to finesse my way around this several times. John (or Jane) Doe may say “My therapist uses really deep pressure, it’s the only thing that works for me.” and you start treating and suddenly your client finds your moderate pressure too much. Why is this? It’s because everything is relative and subjective – what is deep to one person is too light for another, or too much. What feels good to one client may be excruciatingly painful to another. Your colleague’s pressure might be considered deep, but relative to whom? This is a situation where being creative and flexible really comes in handy.

The fact of the matter is that it is always better to use the first appointment as a trial run, so to speak. I’m not saying to just put oil or gel on your client and spread it around so that he or she gets no benefit – that would just be annoying and I can pretty much guarantee they wouldn’t rebook. What I’m suggesting is that you use moderate pressure (I love that word) and check in frequently – and don’t forget to advise your client that he or she may feel a bit sore the next day (informed verbal consent should have done even before getting them on the table anyway).

How to approach this? You can say to your client “Since I haven’t seen you before, I’m not sure how you are going to react to the treatment, or my pressure. What I usually do is use moderate but firm pressure during the first appointment, and then if you react well to the treatment, I’ll use more pressure next time. This is to prevent you from getting really sore in case I use too much pressure – you might not realize this until it’s too late, and you could be sore for days.” This is usually sufficient, but if the client argues further, I will say that I rarely have complaints about my pressure being too light, or my clients being too sore (but this my experience, you’ll have to figure out your own explanation )

3) Your client shows up with a bad cough, fever or chills

Many clients will show up when they are getting ill with acute bronchitis or flu-like symptoms because “everything hurts” and they think that a massage will make them feel better. At this point you should ask them if you can call a cab for them and rebook when they are feeling better. Don’t take “no” for an answer. Seriously.

It’s not just that treating someone with an acute or systemic infection will be really bad for them (after all, they body is already trying to fight off a virus or bacteria – increasing circulation won’t help them at this point) – you are also putting yourself, other clients and your clinic at risk of infection. Remember the SARS epidemic (Sudden Acute Respiratory Syndrome) in Ontario, Canada in 2003? It was absolute chaos for a while, and massage therapists all over Ontario received guidelines from the CMTO concerning protocol in preventing the spread of infection. The last thing you need is to be remembered as the therapist or clinic that was an incubator for infection – even if it wasn’t your fault.

What I would suggest that you say to a client in these or similar events is something like this “Since you are not feeling well, I believe that it is in your best interest to go home and rest until you get better, the massage won’t help you and may make you worse. Let your body deal with the infection, and then call me in a week or so to rebook.

The bottom line is this, a client will 99% of the time appreciate that you are making his or her health as a priority. If a client cannot see reason in your commitment to her health or well-being, then you may risk losing her business. But, in my experience, I would rather have 20 clients who respected my knowledge and professional judgement than 40 who did not.

For more information on building and maintaining a practice, check out a fantastic, tried and true resource – Business Mastery: A Guide for Creating a Fulfilling, Thriving Business and Keeping it Successful

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

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