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.

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 Client Rights

Question: At my first massage therapy appointment, I asked the therapist some questions concerning the treatment. I found her to be evasive, and a little impatient with me. As a client, don’t I have right to know what is going to happen?

Yes, you certainly do. Here is a list of some of the rights you have as a massage therapy client.

1) Get some advice on how to find a licensed massage therapist – you have the right to know what qualifications your therapist holds. Ask where he or she went to school, to what professional association or college he or she belongs, and if they have any additional training. And remember, don’t discount a therapist just because he or she has recently graduated – there are some really fantastic new therapists who begin their careers every year.

2) You have the right to be informed about what to expect during and after a treatment. This is known as Informed Verbal Consent and is a set of statements designed to make the client aware of expectations concerning the treatment, as well as his or her rights as a client. Informed verbal consent goes above and beyond some typical quesitons, such as “do I have to take off all of my clothes” or “is it normal for the treatment to hurt?”. For any Canadian massage therapist who practices in compliance with the CMTO standards, informed verbal consent is mandatory before assessment or treatment begins and provides the client an opportunity to ask questions.

I have been disappointed to hear from clients who, when they’ve seen me for the first time, tell me that no
massage therapist has ever gone over informed consent with them. I cannot speak for students educated in the US, but Canadian massage therapists should really know better. We are obligated to advise clients what is going to happen. Period.

3) You have the right to receive treatment in a safe and hygienic setting. This is everything from the entryway of the clinic, to the bathroom and waiting facilities, and most certainly extends to the linens, towels etc that come into direct contact with the client. Linens should only be used with one client, and anything that comes into contact with the client’s skin needs to be washed after each use.

Equipment should also be safe, clean and in good repair, and there should be nothing on the floor on which a client could trip or lose footing. If the linen looks dirty, the equipment is wobbly or obviously broken or the
clinic is obviously unhygienic, you have every right to turn around and leave. (and I suggest you do)

4) You have the right to receive treatment from a massage therapist who is clean and hygienic herself. If there appears to be “hygiene” issues, you have the right to voice your concern and leave, you are not obligated to receive a treatment from someone who makes you uncomfortable or is unclean. I can pretty much guarantee that if a therapist doesn’t pay attention to his or her personal hygiene, that the linen and equipment will be lacking in this department as well.

5) You have the right to refuse treatment from a therapist who is ill. Your therapist should advise you in advance (preferably) or when you arrive if he or she isn’t feeling well or has a cold, and should not charge you if you decide to postpone treatment until he or she is feeling better.

6) You have the right to stop or modify the treatment at any time. If you are in a lot of pain, or for ANY reason you are uncomfortable, you do have the right to tell the therapist you want to stop. The therapist should respect your request and allow you to get off of the table and get dressed in privacy.

A massage therapists needs to receive informed verbal consent from you if he or she is going to be working in a “sensitive area” – for example, breast massage is not typically performed unless it is clinically indicated by your presentation or health history. Either way, it is always your choice whether or not to receive or refuse treatment.

If you feel that any inappropriate touching or remarks have been made, whether of a sexual nature or not, you have the right to report the therapist to his or her professional association. Please do so, as therapists who violate massage therapy professional standards and a position of trust do not deserve to call themselves massage therapists. In addition, therapists who engage in sexual misconduct commit a crime for which there should be repercussions.

7) You have the right to be advised of the massage treatment fees when you book your appointment. You also have the right to not be subjected to “upselling” or pressure sales tactics. The College of Massage Therapists of Ontario, and any provincial massage therapy association who follows their guidelines, require therapists and clinics to post their fees in a visible space for all clients to see. Anyone who doesn’t do this is in violation of the policy.

8 ) You have the right to know what products are being used on you. If you have a health issue such as an allergy, or an objection (for example) to products tested on animals, you need to ask this when you are booking your appointment. Remember, though, that a therapist also has the right to know of any issues in advance so he or she can be honest with you, whether or not he can accommodate your request.

9) You have the right to receive your treatment on time. Occasionally a therapist may run a little behind, for example, if the previous client was late; however, if this is habitual, then it shows an issue with your therapist’s time management. While the duration of the appointment will probably be reduced if YOU are late, if your therapist is late, you should receive your full treatment.

If the therapist is so late as to keep you from other commitments, you have the right to leave without incurring a charge. After all, you were ready at the agreed upon time.

The above points are some of your rights, but do realize that a therapeutic relationship between a massage therapist and client is based on mutual respect. If for any reason you don’t feel the situation is working out for you, please consider finding a therapist with whom you have a “good fit”.

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