There was something different about the way she said goodbye.

The lack of communication was strange as her typical six or seven text messages were never sent.

I pulled in the driveway and wondered why she hadn’t gotten home from work yet?

I walked to the top of the stairs and there it was stuck to the fridge, almost glowing because it stood out from everything around it.

That letter told me about the pain she was feeling that I wasn’t able to fix, but really just didn’t know how to. It wasn’t that I didn’t want to, I just didn’t have the ability or maybe the proper tools to.

The last few months had been tough and I guess something I had said, done, or possibly not done was the last straw.

To be honest, I really didn’t know how to deal with our issues and sometimes chose to ignore things because well…it was just easier.

The strong woman that she was had long before decided to move on, since I couldn’t be the man she needed. She put her interests first.

I walked through the house alone.

The relationship we had taken so much time to build up was now gone because I didn’t know how to deal with it.

Why Therapeutic Relationships Are More Important For Massage Therapists

Our careers are built on relationships. 

Patients can go to a Chiropractor, Physiotherapist or even their Doctor and sometimes get a total of 15min with them. When a patient comes to you they get you for anywhere from 30min – two hours, of direct contact.

That time is your opportunity, especially when it’s a first time patient. You could be the best therapist in the world but if you don’t take the time to cultivate a relationship with that person, your efforts will be in vain.

So what can we do to build a solid relationship with our patients?

1. Make a damn good first impression
2. Read your patient
3. Build a good foundation through assessment
4. Build trust

1. Make A Damn Good First Impression

Remember the old saying “you never get a second chance to make a first impression”?

It is quite frankly the start to any good relationship. Even the girl I spoke about at the beginning must have been impressed the first time we met, it turns out I just couldn’t sustain it.

Greet everyone with a big heartfelt smile, they can tell if you’re faking it. This can set the tone for the rest of the treatment.

It’s important to remember that when your patients come in, it’s all about them. They’re paying you and it is their time.

So, no matter what is going on in your life, it’s kind of irrelevant. 

The more we can do to set them at ease before the treatment even starts, the better. Your patients have a ton of things going on in their lives stressing them out, including whatever injury they’re coming in for. This is not a time for you to come across in any kind of a frustrated way because you’re not having the best day, remember they’re paying you to help.

I used to work with a guy who was constantly stressed out about home life. He would fly off the handle about anything and could only communicate if he was yelling. Everyone was scared to deal with him. But, if he smoked a joint (yes this was happening in an industrial mill) he was way more approachable and easier to deal with.

The only way you could tell?

You could see him grinning ear to ear from across the mill.

Now in no way am I suggesting that you should smoke a joint at the start of your day in the clinic. But, the only way we could tell if he was going to be easy to deal with (which set us at ease) was when we saw that big grin.

Your patients will read you the same way. Most of the time they are coming in to relieve some stress and deal with a variety of other issues.

Do your best to set them at ease right away. 

2. Read Your Patient

This starts to happen as soon as you greet your patient.

Are they in a good mood and happily walking into your room?

Are they slumped forward and feeling down?

Read their body language.

This makes a huge difference in your treatment. If they’re feeling down and in a bad mood, they may not be as happy with your treatment as when they come in with a better frame of mind.

The results of the treatment may reflect that.

Other than getting this massage and relieving some stress, what can be done to elevate their mood?

Change your music to something more upbeat. It doesn’t always have to be new age spa music (in fact if I played that all day in my treatment room, I’d have to jump out the window), throw some 80’s music or something else they like on and elevate the mood a bit.

Try telling them a story or a good (albeit clean) joke to bring their mood up. Recite your favourite part of a a Seinfeld episode to them.

Get them to tell you a story about something great happening in their lives right now. Get them to talk about their kids, another loved one, or some accomplishment they have had in the last while. People love to talk about themselves, so ask them to.

I’ve heard it said that “the only thing we should be talking to our patients about is their healthcare”.

If that was the only thing you ever talked to, or allowed your patient to talk about, I doubt you’d get too many repeat patients. While the conversation should always be kept professional, patients aren’t coming in to be treated by a robot.

Your personality is part of what keeps them coming back. 

3. Build A Good Foundation Through Assessment

I didn’t completely understand what my teachers were harping on me so much about when I was in college.

They would get after me about “make sure you do three different assessments with each patient”. Then I became one of those teachers harping on the students.

Assessment is your foundation. 

A good assessment isn’t just to give you an idea of what’s going on with your patient, to tell you what areas to treat.

It’s your proof.

It is your opportunity to prove that you know what you’re doing and that you did a good job, that you made a difference. When you can perform the same orthopaedic tests after their treatment and demonstrate the greater range of motion, decrease in pain or freedom of movement, it instills faith in you and what you do.

Even if you’re a little stumped on what assessment to do, make something up, figure something out. Then look up what test you could do while they are getting on the table. You can always do more tests during the treatment.

In fact, get them moving on the table, so that you both get feedback about how the treatment is going.

It’s amazing the difference it makes when part way through a treatment someone can only move a certain amount and it continues to get better as the treatment progresses because you continually assess.

4. Build Trust

This is one of those areas where we are pretty privileged.

There is an assumed trust before our patients event get there. They know coming in that they are going to be naked on a table. That’s a pretty huge thing for anyone to give to us. Think about it, even before meeting us, they have enough faith to take their clothes off and just lay there, assuming we will be professional and bring no harm to them.

It’s our job to in still that trust immediately.

For me as a male therapist this is huge. Not everyone is comfortable coming in to see me, and some do it reluctantly. There are times I have to put people at ease before even starting an assessment (although I think I have an advantage from dealing with people in emergency settings) and let them voice how they’re not overly comfortable being treated by a guy, but they just need treatment.

Fair enough.

Let them talk. This is a big opportunity to build trust. After the treatment, when they realize nothing bad happened or was going to happen, they’re usually happy to book in again. 

In a conversation with someone a couple of weeks ago, they told me that their spouse had asked:

“What is so wrong with you, that you have to go for a massage once a week?”

The response:

“It’s more than just a massage, It’s my therapy. I get to unload about life, I get a good belly laugh and I get to de-stress”

Sometimes people need a non-judgemental ear. Allowing them to unload about the stress of life can me more valuable than the actual treatment (while of course keeping our professional boundaries in check without offering advice or counselling).

When people know that what they say in the room stays in the room, (think of your room like Vegas, okay maybe not all of Vegas, but you get what I mean), it builds their trust in coming back to see you again. Especially when different family members come in and talk about home life. We definitely don’t want to cross a line and say something to another family member that was said to you in confidence.

If someone comes in with a condition or injury you’re not sure how to deal with, refer them to someone who can. It’s okay to admit you’re not sure how to deal with something, just get them to someone who does. Trust me they’ll respect you for it.

Use these four steps to build a therapeutic relationship with your patients. Although some of these suggestions may seem like common sense, sometimes it’s easy to become complacent in practice. Even though I named the fourth one building trust, using the first three steps are a good way to set up the foundation to build trust. Communicate effectively with your patients when they describe their pain to you, figure out how to deal with it. Refer out and collaborate if necessary. A patient can pick any Massage Therapist in their community to use for their healthcare, being engaged and building relationships with the people who come to see you is what will keep them coming back. Be the therapist they need so that you never get a “goodbye letter” from your patient. Now if someone could just tell me how to get the TV and the Netflix account back that would be awesome.

 

“Success is walking from failure to failure with no loss of enthusiasm.”

— Winston Churchill

“There are no secrets to success. It is the result of preparation, hard work, and learning from failure.”

— Colin Powell

I couldn’t wait to get out of school.

25 hours a week was all I was going to have to work to make a great living.

It would be so easy, this is why I spent two years in school.

Then I got my first job and went to work. I think I had three patients my first week. Why wasn’t everyone just lining up to get a massage?

I worked in a room adjacent to a gym. All these healthy people that were into fitness and taking care of themselves, why weren’t they booking in?

The following week wasn’t much better.

Why wasn’t it just happening instantly like I thought it would?

Because assuming it would just magically happen was my first mistake. Unfortunately I made other business mistakes along the way. Some big, some small but they were all mistakes that I was clearly not ready for.

Here’s 10 business mistakes I’ve made along the way.

I’m sure there’s a lot more, but these are the ones I can remember.

1. Taking The First Job Offer, Without Actually Looking

I couldn’t believe my luck. I bumped into my sport massage instructor one afternoon and asked about getting involved in sports.

As the conversation progressed, she asked if I had a job lined up after school was done.

I hadn’t yet.

She told me about a great opportunity at a local rec-center. I would have full access to the gym, steam room, equipment, pool, everything. I’d also be working with a kinesiologist who had been at the rec centre for 15 years and had a great client base.

He would also be more than happy to refer people to me.

This was awesome, I don’t even have to look for my first job.

I was set and couldn’t wait to get started.

Once I got out there and got all set up, I had to start networking with the employees. None of them knew who I was, what I was doing, or really knew anything about Massage Therapy. They were willing to put an ad about me in their newsletter that went out every quarter, so there I had a bit of advertising. A friend of mine who owns a decal company made me up a sign for the treatment room, to show people in the gym what was being offered.

Then I’d show up and wait.

And wait.

And wait.

Some days people would come in and ask questions, sometimes they’d book in for a massage. I ended up getting one or two regulars that would come in once a week. Some days I would get super excited that I’d have three people booked in.

Other days, there wouldn’t be anyone.

I worked there for about nine months before I had to move on. And it was MY fault. The kinesiologist was a great guy, who did his best to help, my former teacher did everything she could to help, it just wasn’t a good fit for someone fresh out of school with no business experience.

Or maybe it was for someone else, I just couldn’t make it work.

I was so excited to get that first job out of school, I just assumed it would come easily. I didn’t even bother to look for another job at another clinic. I didn’t look to see if maybe there were other places that would be a good fit, where I could be busy right off the bat. I just assumed it would be easy.

It isn’t.

2. Not Starting In A Busy Clinic To Actually Learn The Business Of Massage Therapy

Since starting in the clinic I work at now, it has been a constant learning experience.

Compared to that first job, I have gotten to learn more about the “business” of Massage Therapy as opposed to being a Massage Therapist.

Actually signing a contract with the clinic and realizing the importance of that for both parties involved.

Understanding the mix of personalities in a clinic and how that affects not only the running of the clinic, but also how different people book in.

Getting into billing insurance companies directly and realizing the convenience it brings to patients. And this one is huge. I have seen a significant increase in patients ever since we started doing this. When the patient realizes that they don’t have to pay anything out of pocket and you handle the billing, they will choose your clinic over one that doesn’t.

Taking the time to understand how rent, tax and other deductions are all calculated has been a steep learning curve since starting there.

All things I should have learned earlier in my career.

3. Being Timid About Re-booking Patients

I really struggled with this early in my career.

Then one day I had a conversation with a local Chiropractor who runs a very successful clinic and has Massage Therapists working there.

He told me that one of the biggest mistakes he sees Massage Therapists make is when they concern themselves with what a patient can afford. Our job as therapists is to lay out the best treatment plan possible for the patient. If you say they need to see you twice a week for the next three weeks and then tell you they can’t afford it, alter the plan.

He backed that up with a story about a patient that had gone to a specialty clinic for some specific work. When they layed out the treatment plan it was very sporadic. Once they found out the patient had insurance coverage, the treatment plan changed dramatically and the patient was given better care.

The patient was understandably confused and didn’t go back to that clinic again.

Our concern (especially in patient centred care) is what’s best for their health, so give them the best possible plan for their recovery.

All too often I would be concerned about the patient’s finances when considering re-booking them. I’d say things like “well if you can afford it, I’d like to have you come back next week”.

Little did I realize that by communicating like this, I was losing the patients confidence in me.

Remember, you are the therapist and the patient is coming to you for your skills and knowledge.

Only worry about their pocket book if they bring it up.

4. Listening To The “Myths” I Heard From Other Therapists

The myths in Massage Therapy aren’t just around the therapy end of things.

They are also around who to work with.

All too often I’ve heard about therapists who had bad experiences in dealing with insurance, lawyers and workers compensation companies.

While the stories are true and some therapists have been stung by not getting paid, it doesn’t mean this happens every time. I know some clinics around town who are very successful in dealing with some of these insurance companies and make a good living off of referrals coming in from them.

Early in my career I would avoid these type of things like the plague because of the stories I’d heard.

Last year for the first time I entered into a “Direction To Pay” agreement with a local lawyer. The agreement is between the lawyer and myself, not between me and the patient. When he has people come in who have been in a car accident, he refers them out to healthcare professionals that he uses exclusively.

When the patient comes in to see me, they sign a contract which is then signed by the lawyer. When their claim is settled, the lawyer (not the patient) pays me out of the settlement.

Most of the stories I heard where this goes bad is when the patient calls the therapist and wants to negotiate a reduction in pay after the settlement. In these cases it is usually the patient who has made the agreement with the therapist, not the lawyer.

While it does take time to get paid from these agreements, it has filled my practice and made me busier than ever before.

I truly wish I had started doing this right out of school. It would have brought me more patients and I would have a steady stream of recurring income from a consistent source.

5. Not Getting Proper Accounting Advice

I’m not good with money.

I find managing money, balance sheets and accounting software confusing and frustrating.

I’m five years into my career and am just now starting to look at how to properly budget to make sure my finances are completely taken care of. Back when I first started I would just take my books to an accountant once a year to get my taxes done.

I am ALWAYS shocked at how much I end up owing.

At the start it wasn’t quite as important because I wasn’t busy. It was simpler to just take things in at the end of the year and have someone deal with it.

It was a terrible approach. It never made me understand where money was going, or where money was coming in from and I was never prepared to pay that tax bill.

Using a proper accountant and book keeper has helped to change all that. Now I can delegate a lot of that work and the accountant keeps me up to date on when things are due. I get regular communication about when quarterly taxes coming, how much is due and what things are good to spend money on business wise.

I’m also fortunate as I can just email back and forth with the book keeper regarding business questions, email receipts and she doesn’t tear me a new one when I walk into her office with a pile of unorganized junk that she has to figure out.

Now that we are working on a proper budget it should keep me in better financial shape for the future.

Had I started doing this from day one, I would be in much better financial and business shape today.

6. Not Having Another Job To Make Ends Meet

This is especially important if you’re just starting out.

Things are going to be slow while you build your practice. Even if you start in a busy clinic, you’re not going to be booked solid right from the start. Plus you have the added stress of student loans and the fact that you probably haven’t made a dime while you were in school.

There is no shame in having another job to support you while you build your practice.

When I first started in that rec-centre half the time I had do idea where I was going to get the money to pay the bills for that month and even had to borrow money from my parents at the start (and I hated that).

Then an opportunity came and I got my job working in dispatch with the fire department.

You have no idea the relief that brought. I was working construction on the weekend, just to get enough money to pay bills for that month when I found out I got the job. It was like I had just hit the jackpot.

I could schedule my clinic hours to work both jobs and this way had some money coming in while my practice was building. Even after starting at the busier clinic I kept working the dispatch job. Fortunately my clinic owner was understanding and would help me work around those shifts.

On average I would work 36 hours a week in dispatch and about 30 in the clinic.

Every Friday for about two years I would work in the clinic from 11am – 5pm, then head straight to the dispatch job and work 6pm-6am. Then another two shifts in dispatch between the weekend or during the week.

It was a lot of work, but eventually I was able to back off the hours at the other job as my practice grew.

Now I just work the dispatch job one or two shifts a month, and more because it interests me, not because I have to.

Don’t be afraid to pick up extra work while your practice builds, it will make you appreciate things when you’re busy that much more.

7. Thinking “Giving Away Free Massages” Was Good Marketing

This may be one of the worst things I did when I started out.

I would put up posters around the rec-centre promoting coming in for half price massages and did a bunch of them for free. My thinking was that I just needed to get people through the door, no matter how much the treatment cost.

It was terrible.

While I thought it was a good marketing ploy, all it did was open the door to people who didn’t want to actually pay for anything. One man during the treatment asked how long my schooling was. When I told him it was two years, he said “my son went to school for four years to be a welder and only gets $30 an hour, how the hell do you think you’re worth $90 with only two years of school?”

Most of the people I treated at a discount, expected their next massage to be the same price or cheaper and refused to pay full price.

While I still donate some time to sports teams and am willing to give out gift certificates for fundraisers when requested, I won’t market myself by doing discount massage ever again.

I also believe I was just cheapening the profession by doing that.

8. Not Networking Properly

A friend of mine invited me to a networking breakfast that he went to every week to see if it could help drum up some business.

I went to my first BNI meeting. There was a cost for breakfast (and for membership if you sign up), but there was a large group of people there who met regularly to refer and create business for one another. I thought it was  a good enough idea, so I signed up for a year with a chapter closer to where I worked.

While I made some great friendships, it didn’t end up creating a lot of business for me (however I know several people who swear by it for their business).

I should have been trying to network with local healthcare professionals instead.

Reaching out to local Chiropractors, Physiotherapists and Doctors would have brought greater returns than what I was doing. Once I started dealing with other healthcare professionals and communicating with them effectively, I started having more patients referred to me.

Now when I say networking properly, this doesn’t just mean the initial introduction. It’s an on-going process. Following up on the referrals and reporting back what you found and what you did with each patient grows a stronger relationship with those other practitioners.

If one of them sends you a patient, send back a thanks along with a report of what you did.

When you start comparing notes back and forth, they will be more likely to keep referring to you.  

But make sure you return the favour.

If you get someone in who could use the help of a Chiro or Physio, make sure you refer back to them as well.

9. Not Asking For Referrals

This is something I still struggle with, but continue to work on.

The biggest marketing advice I was given in school was: “just give the best damn massage you can to every patient, you never know who they’re going to tell”.

While we live in a digital age now, word of mouth is still one of the best marketing tools out there.

Don’t be afraid to ask your current patients for referrals. If they start talking about a friend who’s injured, explain what you can do to help, tell them a story about how you helped someone else with the same issue.

If they’re a regular patient, they obviously have faith in you and what you can do. So let them tell their friends about you.

Usually people are only too happy to make the referral, sometimes they just need a little nudge to remember to do it.

10. Not Being Active On Social Media

I’ve been studying and reading a ton about this over the past couple of years.

Social media is probably the most cost-effective tool you can use to promote yourself and your business. The only real cost is time and when you’re just starting out, you have lots of it.

Social media platforms are a free place to do business.

Facebook is the place to start connecting with your patients, it allows them to communicate directly with you as a therapist. Every time they interact on your business page with shares and likes, it opens you up to be able to market to their friends when they see this interaction taking place.

You can also set up ads and messages to reach a target audience, which you can structure to appeal to certain demographics. So you can actually aim your marketing at specific groups that you would like to have as patients.

Twitter is a great way to start interacting with local businesses and potential customers. Be a curator of content and provide useful information about Massage Therapy to start building a following in your community.

Use Linkedin to start connecting with local professionals in your area. Use it to grow business to business associations. You can also use it to blog about your practice and grow awareness about it in the business community.

There is so much more to being a Massage Therapist than just giving a great massage. You have to be a business person, marketer, accountant, networker and social media personality. It is just as important to learn how to run a business and be a sole proprietor as it is to learn a new technique at your next continuing ed course. In fact, there should be some solid continuing ed courses just on being in business. I’ve made lots of mistakes in my career, but at least with every mistake there is also a learning opportunity. Take the time to track what you’re doing for marketing and make sure you’re getting a solid return, whether it’s attending networking functions, volunteering your time or working directly with insurance companies. And even if you have a busy practice, you should still continue to market yourself. Even McDonalds still has to advertise.

I have been fearing this day since I graduated college.

The envelope looked different than any other mail I’d ever gotten.

I opened up the registered letter and there it was, a cheque for $20 and a subpoena.

It read:

“TAKE NOTICE that you are required to attend and testify as a witness in the place, date, and time set out below. You are also required to bring with you all documents in your possession or control relating to the matters in question in this proceeding.”

What was I going to do?

I don’t want to go to court and testify!

At the end of the letter it clearly states:

“if a person, contrary to these Supreme Court Civil Rules and without lawful excuse, refuses or neglects to obey a subpoena or to attend at the time and place appointed for his or her examination, is guilty of contempt of court and subject to the court’s power to punish contempt of court.”

Looks like I have no choice.

I am not looking forward to this.

Compensation For Being A Massage Expert Witness

I really wasn’t sure what to do.

It was quite insulting that a lawyer would send a cheque for $20 (the requisite witness fee) to force you to be a professional witness in an insurance claim that was being fought in order to achieve a settlement for the claimant and themselves.

Not only would I have to take time off work and lose pay, but there is also prep work to be done.

Before I called the lawyer in question, I figured I would talk to our provincial association for some advice first.

The association had some good advice as far as what should be charged in cases like this.

• Testimony in court $700 per half day
• Court prep time $93/hour
• Production of records $100 or $.50 per page.

I had no idea if I was just supposed to demand this or if it was assumed. I was told just talk to the lawyer and explain what was recommended to me.

Calling their office, the lawyers assistant answered.

I laid out what I thought compensation should be.

She responded and said, “okay you can bill us for the $93/hour, but no judge is going to pay you $700, that’s the kind of money they give brain surgeons”.

As we chatted about what would happen, I told her this scared the crap out of me.

Her response set me at ease: “Don’t worry about it, it’s not like TV. You’re a good person, as long as you don’t rob a bank in the meantime you have nothing to worry about. All you have to do is just show up and be honest, they’re not going to try and trip you up.”

Now it’s time to prep.

Prepping A Massage Therapist For Court

The lawyer had me come in to the office for an hour to prep.

We went through all my notes to make sure he could understand them and of course to see what I could remember.

Scouring over the notes, he asked for explanations on what he was reading. Deciphering what different orthopedic tests meant and what I was testing for. Looking for explanations on why there were missed appointments, why would I work on one area one day and a different area on another.

Some of those treatments were three years ago!

Then it was time to tell me what to expect and what was expected of any Massage Therapist called in as a witness.

Just be honest. If you don’t remember something just be straight up about it.

While the opposing lawyer is working for the insurance company and wants to win, they will not cross examine you like you see on TV. They will ask you questions more to try and discredit the patient, not you as a therapist. Just be honest with them.

If you’re asked a question, you answer the judge. While it may be either lawyer asking, you look at and direct all answers to the judge.

Dress appropriately, wear a suit.

Show up early and look for directions as to which room the case will be argued in.

While you are scheduled to be there, you may not be called. It will depend on how the case goes. If the case is settled before hand, you’ll be informed that you don’t need to show up that day and although the case could go on all week, you will only be called for the scheduled day and time that we ask for.

We discussed compensation.

He confirmed that $700/ half day was more than would be given, he did agree that $100/hour for time spent was appropriate as long as I was fine with that.

Two days before the case went to court, they settled. I was fortunate to not have to go. Although I will admit there was some disappointment, I ended up really wanting to see what it was like. Overall it didn’t end up being as scary an experience as I thought (even though I didn’t have to go to court) and as the lawyer and I talked I thought he was fair. He paid the $100/hour for the hour I spent with him and for the hour to get any extra paperwork together, in addition to the bill I had given them months earlier for sending them my charts.

The experience also made me realize that my charting should be better than it was. The lawyer wasn’t totally sure if he’d be able to use them. Some treatment notes were more detailed than others and not all of them were specific enough. Make sure that if you’re ever working with patients who are involved with insurance companies that your note taking is top notch. This is another way for us to prove not only our worth as Massage Therapists, but also our professionalism as one.