He pulled me to the side and I was immediately uncomfortable.

It used to happen all the time. One of my friends dad when I was growing up was a bully.

He was REALLY old school and believed that he was always right. It didn’t matter if he was blatantly wrong.

The worst part was when he would force his opinion on you and expect you to respect whatever his opinion was. He would regularly use intimidating factors to push his way around, especially if you ever had the nerve to question him.

Then the day came that I had enough. 

When he pulled me aside that day, we were at a graduation party in a different town and he didn’t like the environment and the way other people were conducting themselves.

The reality is he just didn’t understand their culture so that made it wrong in his eyes.

However, he was going to enforce his opinion and demand this group of people change their behaviour and do what he thought was appropriate. The worst part was, he wanted me to go tell them to change, he didn’t want to do it himself.

I got my back up and wanted to go toe to toe with him (except he was way bigger and I don’t know how to fight). When I told him I wouldn’t have anything to do with it, he got angry and I mean really angry. He got in my face and looked at me saying “I’m a parent, not you, what I say goes”.

I had to put my foot down and tell him he could do whatever he wanted, but I would have no part of it.

A Balance Of Power

In this case there was a major imbalance of power.

This guy thought he had the right to impose his opinion on not only me, but every other person who was at this graduation party.

The problem is, he was blatantly wrong.

According to bullyingstatistics.com these type of people use their strength or position to harm, control and manipulate others, especially when those others have a difficult time defending themselves.

Do we consider this when we are dealing with our patients? Is there a balance of power there?

According to the College of Physical Therapists of BC “There is an inherent power imbalance in favour of the physical therapist, because the physical therapist has a disproportionate amount of knowledge compared to the patient, and the patient relies upon the therapist for care”

When we have a patient on our table we have to be careful of our communication and whether we are expressing opinions or fact. The two could be easily misinterpreted.

We must not impose our opinions on our patients.

It’s not only wrong, it’s against our ethics as Massage Therapists and healthcare professionals.

We see a variety of patients every day who walk into our clinics, some of us see a new person everyday, especially when we are trying to build our practice. Regardless of your background each one of the people who come to see you have a different background or come from a different culture that you may or may not be familiar with.

Whether we disagree with their lifestyle, religion, sexual orientation or anything else, we are medical professionals that must treat each person the same regardless of our opinion.

This also applies when speaking to them about other healthcare practitioners. We have to choose our words carefully. 

We have all wanted to look at a patient and say “well your doctor is an idiot” but again this would be expressing an opinion, which could be potentially damaging to not only our relationship with the patient, but the relationship they have with other practitioners.

Remember the patient relies on us for care, not our opinion. 

Applying Research

Staying up to date on research can be a difficult road to navigate.

Quite often it is going to challenge some long standing beliefs we’ve had, which can also change the way we treat and our relationship with a patient. 

However it is part of our responsibility as healthcare professionals.

I saw a quote on Facebook the other day where someone said they had lost the passion for their practice because research has proven a technique they loved wrong. This could be debilitating for some, especially when we are talking about some long standing beliefs.

It is important to understand that the technique hasn’t necessarily lost its effectiveness, but our explanation of what is happening has to change. If our understanding has changed and we don’t relay the information to our patient this could be considered a form of harm.

Our patients look to us to stay informed and assume that we are doing everything in our power to provide quality care.

With so much information readily available to us nowadays we should be able to find a few ways to incorporate research into our practice for the benefit of our patients.

Whether it’s via Facebook groups, blogs or just searching for research online we should be making this part of our regular practice.

Take some time and check out a couple of blogs and websites. A few that I like are painscience.com, the international journal of therapeutic massage and bodywork, pubmed.com and rmtedu.com which all have some great information on various areas of research and evidence based resources.

Photo by: Foundry

Communication Outside The Treatment Room

“If I wasn’t standing there, they would have had my daughter booked in once a week for the next two months!”

When I hear things like the statement above I think a little piece of me dies inside.

There is a drastic difference between a treatment plan and fear mongering.

Telling patients that they must come in for extended periods of time, without even knowing how a person will react to your treatment is a bullying tactic and it has to stop.

So does using terms like “well I only have one spot left, so you better take it before it’s gone”.

I get it, we all want a full practice but trying to tell someone you know how their body will be reacting two months down the road isn’t a treatment plan, it’s ego.

A proper treatment plan involves continual assessment and re-assessment to gauge progress.

As we move towards a patient centered healthcare system, these choices will more and more be the patients decision. Laying out a sound treatment plan and then incorporating the patient as part of the decision is how we will gain more respect in our medical community. 

A patient should never feel pressured in making their healthcare decisions. We have to remember, even though it may not seem like it, there is a balance of power between us and our patients. We have responsibilities not only with our treatment but also in the way we communicate. Using any kind of communication where a patient feels pressured to book back in is an abuse of that power differential. As we strive to be more a part of mainstream healthcare all of these factors come in to play. Staying on top of relevant research can be intimidating but it improves not only our relationship with patients but also with other healthcare practitioners. It is our duty to stay informed and keep our patients informed so they can make the best decision for their healthcare. Just make sure you’re never in a position where a patient has to put their foot down with you.

Communication is key with massage therapy patients.

New research is starting to show that in some cases, it may even be more important than the actual treatment.

But what about in the aspects of being a Massage Therapist outside of the treatment room?

Can the way we communicate on the phone, or even when re-booking make a difference?

It’s a skill that needs to be developed and can be the difference in not only hiring practices, but also the reputation of your clinic.

Develop The Habit of Providing “World-Class” Communication

Ok, you’ve worked your proverbial butt off to become a medical practitioner, you’ve invested time, money, blood, sweat and tears (no not the amazing 70’s music group), you dress for success and your patients love you!

You strive to ad value and content to your patients lives and you are passionate about helping someone  in pain have better quality of life.

The phone is ringing off the hook and you need to hire front-end staff and a receptionist.

Vitally aware that on average, front end staff can make up 65% of your outgoing costs after paying wages, income tax, benefits etc… how are you going to afford that?

You want to hire the best, but recognize their expected income is wayyy outside your financial comfort zone. Or it might be the case that you are cheap as chips!

Let’s think that you are the first example.

True story:

A friend of mine owns and operates his own medical clinic.

He hired therapists who are the best of the best, not hiring when he needed to make rent because the wrong people presented themselves, and in the end he has an amazing team around him… except for his front-end staff.

Don’t get me wrong, they are nice people, but they are not trained specifically for that position.

Lots of businesses hire well meaning people/staff based on the assumption that common sense will prevail and although they have no formal training in being the front line impression of the clinic, they are generally nice and this should come out over the phone or when in person.

The problem is, this rarely happens.

People have good intentions, but when stress levels increase as the business increases, people handle themselves with the attitudes and homegrown habits they already have. This may show as someone becoming a little short or curt over the phone, becoming less helpful to those requiring more assistance, becoming intolerant of uninformed potential patients and so on. 

Not quite what we are going for in representing your “World Class” clinic.

So what do you do when you start receiving comments from your patients saying that they love you, but hate dealing with your front end staff? 

They would rather book an appointment online or through you rather than through your front end staff.

Constant Reflection To Improve Your Massage Therapy Clinic

Remember that people emulate those that they look up to or perceive as being a leader.

How do you handle yourself in stressful situations, on the phone, in person with your patients?

Is it possible that your staff is mirroring you? 

Do you see yourself in the way they communicate with your patients?

It happens more often than you think. Maybe you need to develop or change some of your own habits first before asking someone to change or implement new habits themselves.

Rather than taking the time to role-play how your receptionist should communicate with patients, you must initiate the formation and implementation of good communication habits.

Instilling Belief

Remember, habits are more easily formed when there is a strong belief they are beneficial and positively impact you or someone’s life.

You must communicate to your staff your passions, your beliefs, and your purpose for helping people. More importantly, you must show this in everything you do.

Remember those mirroring neurons?

Remember that a leader lifts people up with him/her rather than pushing and prodding. Be the leader that pulls the best out of your staff, by encouraging them to perform to their highest potential.

It only creates an environment of success, caring and professionalism.

Photo by: geralt

Changing Massage Therapy Communication Habits

You need to determine specific scripts for what you want to be said when different scenarios present themselves.

First, think about the kind of experience you want when contacting a business. How do you like to be treated? Remember, you want to be known for providing “World Class” service right?

Sure you might think you are communicating appropriately, but have you actually listened to yourself as you communicate with someone?

Reflect on how you want your staff to communicate.

What do you want them to say? How do you want them to say it? What kinds of scenarios will your staff be in and what different ways of communicating do you want them to utilize in these scenarios? Think of questions you ask when you contact a healthcare professional.

What do you want said every time for each of the following?

Sit down and quietly write out the clinics introductory speech for phone calls, basically how do you want the phones initially answered?

• What do you want said when a new patient calls wanting information on your services?
• What do you want said when they are interested in booking an appointment?
• What do you want said when talking to returning patients over the phone?
• What do you want said when a lawyer calls looking for information for a patient?
• What do you want said when an insurance agent calls looking for reasons to provide coverage for a specific treatment?
• What do you want said when a patient calls in to complain or inform you that they are in more discomfort after your treatment?
• What do you want said when a patient has to cancel an appointment either within or outside your cancellation policy?
• What do you want said when contacting your cancellation list to offer appointment times to them?
• How do you describe your rates, your hours of operation, your location?
• What do you say when returning a phone call and have to leave a message?

Once written, you need to test them out on your existing patients.

Ask them what they like to have said to them when contacting a business. Fine-tune your scripts. Your patients want you to succeed and to represent professionalism just as much as you do.

Show your patients you care about their experience and the experience of those potential new patients  they refer to you.

Once you’ve got the scripts perfected, print each one out on their own individual pieces or paper.

Give them to ALL your staff, including those who rarely answer the phones. Everyone has to be on the same page as what is expected to be communicated and how.

Next take these papers and post them right in front of the receptionist. It’s easier to refer to them rather than try to remember exactly what to say.

Remember that forming or changing habits takes time. Research estimates that it takes a minimum of almost a month and a maximum of almost 2yrs to solidify a habit. Putting in this small amount of effort will have a dramatically positive effect on your practice.

As your staff get used to saying the same scripts over and over, it slowly becomes committed to memory and before you know it, it just becomes a habit of effective “World-Class” communication!

Communicating Massage Treatment Information

Concerning specific treatment and expected outcomes, you know  your staff is not expected to know the detail you do, but you can create scripts to provide general information.

When writing these scripts out, be as succinct as possible, limiting the info to just 2-3 sentences/modality. Your staff and the patient on the other end of the phone won’t remember more than that.

Make your list of techniques/treatments you provide.

In your first sentence, describe the technique.

In your second sentence describe why it can be used.

In your third and final sentence describe what the potential outcome expected.

Remember to keep communication clear, simple and succinct. Developing the Habit of “World-Class” communication doesn’t happen overnight.

It takes self-reflection, thought, dedication, belief and time.

Seems like almost daily, on one of my networks, someone will post the question of “what good is massage regulation really doing?”

They often throw up points like “prostitution still exists,” and of course it does and it always will.

Other complaints are about how much money the state revenue department, or the licensing board, or the Federation, or the testing company is making.Then we’ve got the complaints about taking CE to satisfy the law, and how that’s just a money-making racket.

As a CE provider, believe me when I say I’m not getting rich off of it, and very few are. But back to the question, what is the point?

The point of licensing in any profession is basically quality assurance for the public, for their own safety and protection. 

To get a license, you’re supposed to have x number of hours of education.

You’re supposed to pass an exam proving entry-level knowledge .

In most places, you’re supposed to get the continuing education in order to keep it. You’re supposed to agree to abide by a code of ethics and uphold standards of professional behavior. You’re supposed to first do no harm. You’re supposed to act in the best interests of the client.

There are now only a couple of states that are the last holdouts with no regulations in the works or already in effect…anyone may call themselves a massage therapist or any other derivative indicating massage, whether they actually know anything or not.

In reality, it’s hard to find out exactly how many members of the public have been harmed by massage therapy. 

The insurance companies and professional associations don’t like to release that information.

Many of the state massage board websites do have license verification online, and some do list disciplinary actions, but in most cases that will only show up if you already know the name of the therapist that has been found guilty of some infraction.

It must be said that not every single person who has been found guilty by a board is really guilty…there were times during my own five years of board service that I did not believe the accused person was guilty, but the majority voted that they were. 

It must be also be said that some therapists who are in fact guilty never ever get reported and thus keep preying on the public. There just aren’t any guarantees, just like with any other walk of life or profession.

There are people in every profession that are dishonest or predatory, and massage therapy is no different.

All things considered, I think licensing has been a valuable thing, and personally, I’d like to see it in every single state.

Yes, there are still people who will practice illegally. There are still prostitutes who will hide behind massage. But I think on the whole, licensing has brought a healthy amount of awareness and credibility to massage therapy.

I’m not resentful of having to get a criminal record check to get a massage license. If we were being singled out I’d be upset, but every other health care provider in our state has to do it.

Photo by: geralt

I’m not resentful of having to take continuing education…I love learning and I actually look forward to taking CE. However, I do think there comes a point in time when that should be optional.

Realistically, should someone who has been practicing for 20 years need to attend an ethics class the same as someone who has only been practicing for a year and may not have even faced any kind of ethical dilemma yet?

I’m not happy with the present state of the CE environment, anyway.

I think a person who is taking science-based classes or classes designed for public protection deserves more credit than people taking fantasy-based classes. With the long list of inappropriate classes that are currently approved, I really don’t see how attending a class in shape-shifting is doing anything to protect the public.

Some state boards are self-supporting. Some are at least partially subsidized by the state. Some try to educate the public. Some don’t. Some pursue illegal massage more than others.

Nothing’s perfect.

The point, to me, is that the majority of us, by paying for that license and jumping through the hoops, are proving that we have at a minimum, the entry-level knowledge to practice massage safely. The majority of us have taken the education, and passed the exam, and meet our CE requirements. The majority of us are practicing ethically. The majority of us are trying to keep massage and sex separated. The majority of us abide by the rules. The majority of us are just here to take care of our clients and do the best we can. There will always be some bad apples, but I think requiring licensing has weeded out a lot that might otherwise be here. Just my opinion.