Q: I’m writing to you because I believe my employer is engaging in behavior that is unethical, illegal or both. My employer has recently implemented a policy where the front desk personnel talk to clients upon their first visit, asking them questions about where their pain is and what they do in their daily lives. They are asking these questions either at the front desk in the lobby, or in the waiting area. Neither of these areas offers privacy, so confidentiality cannot be preserved if other people are in earshot
I was taught that these questions are part of the therapist’s intake, and I think it’s inappropriate for the reception staff to be asking the clients such personal questions. The company is a franchise, and a massage therapist at another location told me that the receptionists at her site are going so far as to ask questions about medical conditions and medications.
Reception employees are not licensed massage therapists and have no influence on a client’s care. I need to ask my own questions to determine the best treatment plan for my clients and to be aware of precautions or contraindications.
So, clients often wonder why I am repeating the questions they’ve already answered because in their minds, they have already gone through the intake process.
I am very upset that my company is having the reception staff be involved in finding out about a client’s pain and medical information. I feel that it is my responsibility to ask such questions, and I’m not sure what to do about it. Is my employer acting illegally or unethically? Do you have any suggestions on how I can approach them to stop this practice?
A: Based on the information you provide, I assume that your employer is having the front desk staff do the medical intake so that you, and other practitioners, don’t have to. It doesn’t make sense that they would want the intake to be done twice, so perhaps your employer isn’t aware that you need to do the intake regardless of what anyone else does.
In and of itself, the practice of having reception employees ask for medical information isn’t necessarily unusual, nor is it illegal or unethical. In many medical office settings, it is common practice for the receptionist to ask the client/patient to fill out the medical history forms, but they don’t typically get involved in fleshing out what the client writes on the form. If they do ask questions, it’s typically in the treatment room, in private, before the doctor comes in. Behind closed doors, nurses or medical office employees often ask the patient, “What brings you here today?” so the doctor has a succinct idea of what to expect when he goes into the treatment room.
The questions are designed to assist the practitioner, not replace the practitioner’s evaluation methods. But your situation seems different. It sounds like the information is not being communicated to the practitioners, so it must be obtained again. Furthermore, it sounds like you would not find it helpful even if the reception staff did communicate it to you.
So, if your clients are being asked personal questions by people who are not doing it for useful reasons, their privacy is jeopardized. This is where ethical practice can be compromised. Additionally, if personal questions are being asked in a public area, a client’s rights to privacy and confidentiality are not being upheld. In certain settings, HIPAA regulations would be violated if confidential information about a client is shared publicly or without the client’s consent. (For a summary of HIPPA privacy rules, visit www.hhs.gov.)
I recommend you set up a meeting with the manager who supervises you. Explain that because massage therapists must develop a treatment plan based on their own assessment of a client, it’s best that they evaluate and do the entire intake themselves. Express appreciation for the intention to help by having the receptionists assist in the process, but emphasize that it is truly not helpful and becomes a source of confusion for the client.
Further, explain that because the receptionist’s involvement is unnecessary, the client’s privacy may be breached, as the receptionist is now privy to confidential information.
Add that if the questions are asked in a public area, the privacy of the client is further violated.
Q: I went to massage school two and a half years ago because I wanted to change professions. My job satisfaction as a phlebotomist had diminished over my 11-year career, so my plan was to build my massage practice as I phased out of phlebotomy.
The problem that I am facing is that because I lack assertion skills, I can’t get clients to rebook before they leave my office. Hence, it is taking me a very long time to build a steady clientele. I get new client referrals by word-of-mouth, but I don’t know how to get them to come back without sounding like a salesperson. If half the clients I have seen over the past two and a half years had rebooked, I’d be able to survive solely on my massage income.
When my client is getting their checkbook out, I’ll say things like, “Would you like to schedule your next appointment?” Most of the time, they say they’ll call me, and some eventually do, but often months later. Am I supposed to push the issue?
My clients typically tell me how much better they feel after the massage—their backache is better or their neck is easier to turn—but I find it very awkward to tell them to make another appointment so the improvement lasts.
Should I call them in a week or two to see if they want to reschedule? We did some role plays in school with assertiveness and communication, but we really didn’t cover how to get clients to rebook. I could use some guidance with this, since I know this is standing in the way of my business growth potential.
A: It’s true that a massage practice can’t be successful without clients, and it’s important that we know how to get our clients to rebook. It’s commendable that you are able to recognize the areas where you need to grow and hone your skills. When our career goals don’t turn out the way we plan, it’s very easy to blame circumstances and not look to ourselves to see where we could be contributing to the problem. So you are already ahead of the game in that you know your discomfort with assertion is standing in your way.
If you wait until the client is ready to leave to address the rebooking issue, you may be limited with what you can say and do to encourage them to reschedule. At that point, asking them outright could put them on the spot and cause an uncomfortable situation for both of you. I propose an entirely different approach.
Instead of viewing this issue from the standpoint of getting a client to rebook before he leaves, you might try introducing the concept of multi-appointment treatment planning during the client’s very first assessment. One of the ways we can truly help our clients is to educate them about how regular massage therapy helps maintain the benefits they feel after the initial massage, whether it’s the relaxation and stress relief, or decreased pain and increased range of motion.
Remind clients, too, that their aches and painful areas don’t develop in one day—or even one week or one year—but are more often the result of lifelong postural or movement habits. It’s unrealistic for either the practitioner or the client to expect that one massage will provide lasting relief or remedy.
Adopting a new policy or approach tends to be easier with a new client, so I suggest you try this approach the next time a new client comes to see you for massage.
A perfect time to explain the benefits of ongoing massage, or a massage treatment plan, is during the intake interview when you’re asking questions about their injury history and the reason they are seeking massage. Let’s suppose the client tells you they are there for relaxation and that they have chronic neck or low back pain. The perfect time to educate the client about the benefits of ongoing massage therapy is while you are assessing their posture and range of motion
As you explain your treatment plan for the session, you might add: “Since you tell me that your tension areas are chronic and likely from habitual activity, it’s important that you understand that today’s massage might offer a period of relief, but it may take one or two more visits to work out the tight, restricted tissues if you want long-lasting improvement.” Then, at the end of the treatment, you can invite them to schedule follow-up appointments.
Assessing range of motion and the pain or limitation that accompanies their movement is important to do both pre- and post-treatment. Improved range of motion and decreased discomfort during the post-treatment assessment are objective evidence that the massage was helpful. At that point, when the client is experiencing and enjoying the positive effects of massage, recommend follow-up treatment by saying, “I recommend that you return for follow-up treatment within two weeks to ensure that these improvements are maintained.”
There are other marketing strategies that foster client retention and return, such as package plans and referral rewards. For example, you could offer five massages for the price of four, or offer clients a free massage if they refer three clients who book appointments.
Another recommendation is that you attend your state’s AMTA Chapter meetings and talk to other massage therapists to get ideas on how they manage client retention and rescheduling. Because we often work in isolated settings without regular opportunity to network with our peers, these meetings are a great place to stay connected with our community so that we have a place to take questions such as this. You can find your chapter contact information by visiting www.amtamassage.org .
Dianne Polseno, LPN, LMT, is president of Cortiva Institute-Boston.
She is also the recipient of the 2006 Jerome Perlinski Teacher of the Year Award