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.

Massage Therapy, One Million Acts of Green and Father’s Day

A lot of stuff to cover today, a bit of a mish-mash, but here it goes …

I recently jumped on the One Million Acts of Green website, and actually recorded my acts of green – I am so amazed that some very simple things that I do daily can have such a large, cumulative effect on the planet. And what is even more amazing to me is that my conversion has been all very painless and very simple. Who would have thought?

I have thought a lot about massage therapy practice and the environmental impact since my post on Earth Day, and I have always been conscious of how human activity affects the environment and our health. I realize that some people feel that whatever they do won’t make a difference anyway, so why bother? Or, some people think that the environmental impact of our activities is blown out of proportion, and they continue to do as they please with little regard for future generations. But, I am happy to report that bringing even very simple things to the attention of others can be a catalyst for positive, sustainable change. Small changes really do add up, and I am living proof, as my carbon footprint has been reduced by over 280,000 kg/year.

I really do encourage as many people as possible to get on the above website and see not only what they are doing that has made a positive impact, but also what can be done to help out the environment. Check out Green Nexxus – One Million Acts of Green to learn more about what you can do, every day, to help mitigate the impact of human activity on the planet.

And, on a lighter note, since Father’s Day is fast approaching, why don’t you go green when thinking of the men in your life? I don’t know many men who pass up gadgets, so why not make a “gadgety” gift as eco-friendly as possible? I’m talking hemp wallets, solar barbeques – you know he wants it! (or maybe you want it? It’s all good) The products at Exclusively Green are environmentally friendly and sustainable, how great is that?

So, massage therapists and clients, give Dad a green gift, and check out what you can do at the same time to lighten the load on the planet.

Massage Therapy – Health Profession or Customer Service? part 1

Nine years ago when I graduated from my Massage Therapy Diploma program, I was so excited to start practicing – after all, I had toiled for 2 years to earn not only my diploma, but also to earn my Registered Massage Therapist designation through the College of Massage Therapists of Ontario, which I did 4 weeks after graduating.

For those not familiar with massage therapy regulation in Canada, Ontario is one of 3 provinces in which massage therapy is a Regulated Health Profession, and a massage therapist must have passed College of Massage Therapists of Ontario (CMTO) Board exams. The purpose of the professional college is the protection of the public and maintenance of the integrity of professionals by establishing standards and quality assurance guidelines. By being a member of this professional college, I take great care to uphold the standards of the college and do my best to serve my clients in a responsible and ethical way. This however, can sometimes be easier said than done.

What I quickly found out after graduating is that no amount of instruction or coaching can replace real-life
experience, and I’m sure that is true of everything in life. For those of us who do have some customer service experience, we quickly found out that that massage therapists hold a unique position in an industry which has one foot in service, and the other in health care.

People outside of the profession may wonder why this “foot in both worlds” makes a difference to the practice of massage therapy. After 9 years of practice, I have learned that it all boils down to this: being a health-care practitioner obliges us to caring for client health first and foremost, with the customer service aspect falling a distant second, even if it means potentially losing the almighty (and necessary) business dollar.

In this industry, is the client “always right”?

No, absolutely not. And before customer service gurus go crazy at this statement, let me tell you why.

The ultimate responsibility of a massage therapist is to improve or enhance the health and functionality of a client within a therapeutic relationship of mutual trust and respect. Add to that privacy and confidentiality issues, and one can understand the depth of this responsibility. Since most clients coming in to see massage therapists have little to no knowledge of human anatomy and physiology, and even less of how massage therapy can affect the human body, they often don’t have the level of discernment necessary to dictate to a therapist what is needed.

How many times has a client asked me “Why are you looking at my neck, the pain I have is in my elbow?” Questions such as this are very valid, and give the massage therapy community the perfect opportunity to educate our clients one-on-one about the profession and about their own bodies. How else would a client know that irritated nerves in the cervical spine can affect sensory or motor function of the upper limb? The only way many clients ever learn anything is by spending time with a health professional who takes the time to educate them. Massage therapists are in the position of privilege and should take advantage of the opportunity to educate their clients.

Does this mean that every therapist takes the time to educate their clients? No, and sometimes it may not be necessary. What I would like to instill in new therapists is that while clients might not actually care why or how a certain symptom comes about, this lack of knowledge or caring doesn’t give a client by default the right to dictate to a therapist what needs to be done.

Case in point: I recall on one occasion when speaking with a potential client on the phone, she became very belligerent when she said she would refuse to fill out a health history form, and I then had to tell her that I would not be able to treat her. She proceeded to tell me that “it is absolutely none of your business what my health issues are or have been”, to which I replied “It is my business, as there may be an issue which may adversely affect your health if I treat you without being aware of it.”

Let’s just say that that conversation did end with my losing a potential client, and that was perfectly fine. I
had the confidence at that point to place the responsibility I had as a therapist above her desire to dictate how I perform my job. I can also tell you this – I would not want to be in a defendant’s chair in a lawsuit where I treated a client without adequate knowledge of her health, and she ended up getting hurt. If such were the case, and I lost the suit, not only could I end up paying a lot of money, I could lose my profession.

Part 2 to follow: Massage therapy – is the customer always right?

For a great read on the practice and business of massage therapy, check out Business Mastery by Cherie Sohnen-Moe.

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

Massage Therapy and Anatomy – Arthrology Definition

Arthrology is the study of joints.

Joints occur where the surfaces of 2 or more bones meet. An articulation is another term which refers to a “joint”

Why is arthrology important to massage therapy?

Massage therapists work with the musculoskeletal system. Clients may present with symptoms which may be confusing – it is necessary for a therapist to assess a client’s presentation and form a clinical impression – meaning, his or her opinion on the cause of the symptoms. (remember, massage therapists are not permitted to provide a diagnosis).

Muscles cross joints to produce movement, and any joint dysfunction may lead to muscular imbalance and pain. Muscle tone which doesn’t support a joint (hypotonic – meaning not enough tone), or restricts movement too much (hypertonic – meaning excessive tone), may cause pain in the joint itself.

For a therapist to successfully treat the underlying cause of any symptom, he or she must understand the relationship between muscles and the joints which they cross, as well as the anatomy of the joint itself.

Massage Therapy Launched into CyberSpace – PRWeb Press Release

WhyMassageTherapy(.com) provides resources and in depth information concerning the massage therapy profession.

Nova Scotia, Canada (PRWEB) April 26, 2009 — Where do industry knowledge and experience meet to create the most unique and relevant massage therapy website in cyberspace?

Why Massage Therapy? (.com) is an information portal for all things concerning massage therapy, and was developed by Jodi Forsythe (RMT) in response to her desire to find information online that was professional, relevant and accurate.

“In the 9 years I have been a practicing massage therapist and a massage therapy educator, I have seen a huge need for public education about the profession.” stated Jodi Forsythe, creator of WhyMassageTherapy. “There are so many misconceptions about the profession that I want to provide information to the public not only about the benefits of therapeutic massage, but also about the practice and the business of massage. In this climate of economic uncertainty, the site also provides a perfect reality check for those going through a professional transition who might be considering a massage therapy career.

De-mystifying the practice and profession of massage therapy is meant to empower potential students, schools and massage therapy businesses by ensuring that people know what they are really getting into. “As a former educator in the profession, I definitely noticed that the more realistic vision a student had upon entering massage therapy school, and the more information they had before enrolling, the more likely he or she was to succeed, not only academically, but in business as well. With increased preparation comes increased student retention, it just makes sense. For me, it’s about attracting the best candidates to the profession, and then supporting them with resources to help them succeed throughout school and into their chosen career.”

The website is not just for benefit of newcomers to the profession, and members of the public, it is also meant provide moral support for therapists as well. “There is such an advantage to being able to bounce ideas off of other therapists and professionals. Everything from business and practice management to anatomy review, treatment techniques, products – you name it, it will be discussed on the blog.”

To learn more about what the massage therapy profession is all about, visit Why Massage Therapy?(.com), where knowledge and experience meet to provide the most industry relevant information on massage therapy.

Massage Therapy – Going Green on Earth Day

Happy Earth Day, everyone! Here in Halifax we are getting Mother Nature’s finest display of rain and wind I have seen for a while, but it’s all good. After all, every day is a bonus.

As a Massage Therapist, I have often contemplated the role the environment plays in my health and that of my clients. I have always been concerned about the environment, but have had a really hard time until recently a) finding accurate information which can help me live as eco-friendly as possible, and b) being taken seriously by skeptical folks (it’s getting better, but as we all know, there are some people who think global warming is a hoax).

Now, just let me clarify one thing – I am not a perfect, eco-friendly being. Yes, I have a car, but it is energy efficient, I take care of it in the most eco-friendly ways possible, and I really don’t drive that much. I do recycle a lot, have a stainless steel mug for my shade-grown coffee (for the most part), and lie awake at wondering at the plight of the whales, polar bears, honey bees and (sometimes) the human race.

When it comes to massage therapy as a profession, I chose to join an alternative health care industry out of my belief in a more holistic way of being and providing health care. I am sure that there are many others who share my beliefs, and at the very least, most massage therapists will acknowledge that what is applied to skin during treatment is absorbed into it and can affect the body. While there is a great deal of evidence which suggests that parabens found in many skin care and massage therapy products may be carcinogenic, how many of us are willing to absorb the extra cost of providing our clients with toxin-free mediums? Not only might we be exposing our clients to harmful chemicals, but we are literally elbow deep in the stuff for up to 5 or 6 hours a day.

For hygiene purposes, to prevent the spread of communicable disease, it is a generally accepted fact that linens be washed in hot water with chlorine bleach after each use – how environmentally friendly is that? I am 100% on board with washing anything that has touched bare skin of a client after its use, but I wonder if there are alternatives to performing our daily duties in a more sustainable way, so as to help preserve the environment? Perhaps washing a full load of linen in hot water with non-chlorine bleach followed by a cold rinse would suffice? Also, how about using a laundry detergent that is not only scent-free, for our clients and colleagues with environmental sensitivity, but also is absent of ingredients such as phosphates, dyes and perfumes? While we’re at it, why don’t we ban the dryer sheets and ensure that our appliances are working as efficiently as possible? Not only is this approach good for the environment, it is great for the pocket book.

The clinic itself is often an area where a multitude of environmental sins takes place. From massage table cleaner to floor, rug and bathroom cleaner, hygiene doesn’t have to equal toxic but it often does. There are several suitable alternatives to toxic, commercial and household cleaning products if you take the time to seek them out (bear with me, I am trying to help my readers with just that issue).

The bottom line is this – in an alternative health care industry such as massage therapy, how can we stand idly by and ignore our own behaviours which are contributing (in a small but not insignificant way) to the growing crisis in the environment? Isn’t it our responsibility in teaching our clients about holistic health care to acknowledge that our lives depend on the very health of the planet? If we fail to at least make a minimal effort to “green” our practices, then we are not only failing our clients and ourselves, we are failing the planet and future generations.

We don’t have to be perfect, a little effort can go a long way. Today, Earth Day, is the perfect opportunity to start thinking about how the massage therapy industry can have a positive impact on our clients, ourselves and our planet.

Anatomy and the Massage Therapist – know your stuff!

Let’s face it people, massage therapy just isn’t effective unless you have a good working knowledge of anatomy. I will be adding posts several times a week with “Test your anatomy knowledge” questions, and answering them in the subsequent post. You may have to dig a little bit to find the answers, but hey, cracking a book never killed anyone, and this could be a really great review and/or learning experience.

Today I’ll start with an easy one:

How many divisions, or sections, are there of the spine? Within each division, how many bones are there?

Good luck!

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