When I share it in my continuing education classes, I hear massage therapists say, “Clients don’t want to fill out five pages of an intake form”; “My clients schedule online and this gives me all the information I need”; or “The business I work for has its own form, and they don’t give us time to go over it with the client.
Think back to when you visited a physician and filled out her paperwork. Did you ever feel like she never even looked at what you had written? Then you might have wondered, “Why did I even bother?
Diana L. Thompson, L.M.P., gives us the quintessential documents we need for any massage practice in Hands Heal: Communication, Documentation, and Insurance Billing for Manual Therapists.
From her book, we learn the legal reasons for intake forms during the intake process and find real examples of situations to help us relate and understand. We need to be compliant in our documentation to be legal and to communicate with other health care professions.
Over 38 years ago, I volunteered as a massage therapist in the physical therapy department of Providence Regional Medical Center in Everett, Washington, and was introduced to the world of the intake process: intake forms, chart notes and policy paperwork.
Later, as an independent contractor for the Everett Providence Hospital’s Pain Control Center, I discovered intake forms to help clients easily describe their symptoms. I tried to create a one-page intake, but I found it was missing important client health information.
I finally used a combination of forms to create my current intake, and I continue to update it with new medical conditions as needed.
A therapist asked why I need to know so much information. Years of learning from my clients has taught me the body uses symptoms to communicate.
These symptoms reveal the body’s secrets, and a detailed intake gives me a means to glean this information. It is the foundation to building trust with my client. Here are seven steps to help you do a thorough intake.
Whether your client is coming for stress, work or sports symptoms or injuries, or chronic pain, she is desperate to tell her story.
But listening to a client’s story can sometimes feel tedious. We just want to know what is going on with her so we can get on with the massage.
Lisa Sanders, M.D., author of Every Patient Tells a Story: Medical Mysteries and The Art of Diagnosis, writes, “Doctors frequently interrupt patients before they tell their full story. In one study doctors listened for an average of 16 seconds before breaking in; some interrupted after only three seconds.” Sanders also shares, “The patient’s story is often the best place to find that clue” to her symptoms.
Sandeep Jauhar, M.D., author of Doctored: The Disillusionment of an American Physician, writes about the pressures on physicians today.
In a 2014 interview on NPR, he said, “A patient comes in with low-back pain and you have eight minutes. Does this patient potentially have an abscess or a tumor, or is it just run-of-the-mill back pain? That takes time to evaluate, get a good history, and do an examination. It’s so much easier to order a test.
As massage therapists, we can make the time.
While a client is telling his story, look at his age and then look at him and ask yourself, “Does this person look his age? Does he look older, younger or his exact?” This can help you determine his general health.
People in poor health generally look older than they are. Listen to his voice. Does it change pitch during the story? Does he start using words or phrases that seem to come from someone else?
I leave space on my form to write additional descriptions of a client’s symptoms, and I will sometimes put quotes around a client’s descriptions. Taking notes helps me to stay engaged while I listen.
How a client describes her condition can reveal clues.
Pay attention, because her description will not always match her true condition. Use the Internet to look up conditions and medications in order to better educate yourself
I use the National Institutes of Health website, because it is the most accurate and least opinionated. Collect any and all details, but don’t try to make any judgments or conclusions until you finish your full assessments.
And remember, assessment is not the same as diagnosis. Massage therapists are not allowed by any scope of practice to diagnose, and must refer to qualified medical professionals when necessary.
As clients tell their stories, they remember more injuries. This can become confusing, so ask questions to clarify the sequence of events or injuries.
What a client thinks and says is only his version of his diagnosis. Remember, a diagnosis is often just a description of his symptoms, as is the case with thoracic outlet syndrome.
Clients can have an incomplete understanding of their diagnosis or condition. Ask them to bring a copy of their radiology report and read it. Again, research anything you don’t understand, to educate yourself.
4. Ask again.
The number-one complaint of clients is they didn’t get the massage they wanted.
Massage business-and-marketing expert Irene Diamond, R.T., says, “Many therapists never really think about why their client is coming in. Once you’ve nailed down the exact reason for their visit, you will have a much easier time advising them on the frequency and number of visits.”
A client might come in and say she wants deep tissue massage, so this is her expectation. But let’s say she also tells you her goal is to move her neck and shoulder more easily.
Shelene Taylor, author of Massage Business Success: How to Attract a Steady Stream of Clients and Create More Income, explains, “Clients don’t understand that when they ask for specific work on a particular area, they won’t get a full massage.” Explain that deep tissue for their whole body may not be the best treatment for their neck and shoulder.
Taylor suggests, “Today you want a whole-body massage with some focus on your left shoulder and neck during our one hour, is that correct?” And if available, “I have an extra half-hour, would you like to take advantage of it to receive a full-body treatment today?”
Usually the client will really want both. I suggest you fill her expectation first and end the massage in the area of complaint.
During the session, briefly share what your hands feel and end with how you would have liked to spend more time in this area. Follow up after the massage and explain how her neck and shoulder need special attention. Suggest she book a longer session or book an appointment to just focus on treatment needed for that area.
Clients have questions, so give them time to ask. Their questions give insight about their concerns and fears. Sometimes they are not sure what massage includes. Use this time to educate them about your professional scope of practice.
Looking is just that: looking. Don’t start analyzing what you see; this leads quickly to an intellectual conclusion. An example of a conclusion is, “Your right shoulder is elevated.”
Is his right shoulder elevated, or is the left shoulder depressed, or does he have a twist to his torso, making his shoulder appear elevated? What you are observing is his shoulders are uneven. Until you have done your complete assessment and gathered more data, stay neutral.
Ask your client to put his hand on the problem area, because what he refers to can be different from where he puts his hand. Have him stand and face all four directions, so you can observe him from each side.
Watch him walk and notice what does not move easily. Ask him to move his body to recreate his condition. You might have him walk, squat, balance on one foot, or move his affected area to recreate the condition.
The mind can be easily fooled, and can lead to faulty conclusions. This has been proven by the science of advertising creating urban myths about our health and body.
The body is honest in its communication. Remember, your own body understands your client’s body better than your intellectual mind.
Assessment is comparison: A comparison of what the client writes and says when telling her story; the answers to your questions; what you see; what you palpate with your hands; and how she responds to treatment.
Skip any of these comparisons, and you might find the massage you give is not as effective as your client wanted.
Assess an area of the client’s body, try some treatment massage, and take time to reassess the tissue to feel how it responded. After the treatment, ask her how she feels—and listen to the response.
I also ask clients to email me to let me know the effects of their massage. How they responded to the massage is part of your assessment. It gives you the information to adjust your pressure, try different technique, or suggest longer or shorter sessions.
Sometimes we forget we are a complete stranger to a new client. She has made an appointment based on a recommendation, internet review or the reputation of the clinic. I have even had clients look at my picture and “get a good feeling.”
However she got here, we want her to return.
Clients want to feel better after their massage. Feeling better means meeting their expectations and goals. What keeps clients coming back is a feeling of trust and connection. A comprehensive intake process that includes an intake form and assessment is the foundation for a relationship of trust.
Taya Countryman, L.M.P. has owned an active massage practice since 1977. She specializes in complex and chronic medical conditions, and is a Spontaneous Muscle Release continuing education instructor. She was awarded the American Massage Therapy Association Washington Chapter’s Service to the Profession 2003 award; the Service to the Chapter 2006 award; and the Chapter Meritorious 2010 award. She is a 2013 Massage Therapy Hall of Fame inductee.