March/April 2012 issue of the Massage Message

Competencies’: Enthusiasm: Risk Management

“Risk comes from not knowing what you’re doing.” Warren Buffett

If you were to answer which profession has low or no risk would you list Massage Therapy?

I just read an excellent electronic magazine article by an Australian Massage Therapist. Natalie Millan, “Massage therapy and general public expectations: assessing the risk”, mostlymassagezine.com A very valuable part of her article refers to the enthusiasm of using a new or special modality without prior discussion with a client or a failure to review all the possible consequences. Further discussion of scope of practice and potential harm are in an article by Keith Eric Grant in Massage Today, December 2011. “Learning from Harm”. “As noted by Cohen and Nelson (2011), the legal basis for the regulation of health care practices by the states is protection of the public from harms of incompetence and malfeasance. The latter is primarily a function of oversight and discipline. The first, ensuring competence within scope of practice has elements both of training and of monitoring for capacity to practice.”

You may understand the term “actuarial” table when referring to life insurance. That means the expectation of your life span including your risk factors such as smoking, alcohol usage, occupations such as pilot, police, fireman or other potentially hazardous conditions. Insurance companies also compile statistics on risk as it applies to enterprise. The practice of Massage Therapy is not a uniform list of everyone practicing in the same environment, with the same safety or even using the same tools. There are circumstances when we have a higher risk. We all hate the fine print that sometimes costs us a lot of money when we think we are covered and make a claim only to find out that certain exclusions apply.

If you look at the questions asked by our insurance provider (American Massage Council), you will be able to quickly see where the danger elements lie. The following are examples for heat related modalities such as hot stones and heat packs:

Are you using a specialized heating device?
Are you informing your patients about the danger of items being too hot?
Do you stay in the room while a client has heat applied?
Are you reading the client intake form closely enough to spot contraindications?

If you cannot answer these questions to the affirmative, you should not be using heat as a modality. You will also notice that in all of the classes (modalities which require an extra insurance rider) you are expected to have a higher level of training to be covered by insurance. This strategy is not entirely based on extracting more premiums. Sometimes the insurance company wants to inform you as to the risks you are assuming by practicing a modality and assure that you have been properly trained to assume the risks. It distributes the cost of potential claims among those practicing that modality. In truth, hot stones have the highest incidences of improper usage currently in the massage industry. These claims are so high that several insurance companies are no longer covering this modality. I personally use hot stones as tools and have had very good results with no complaints. My method does not vary much from the teachings of Bruce Baltz. I have certainly had patients who are not good candidates. I never use them on anyone who has open wounds, exceptionally tender skin, or other health problems that are contraindicated. If a client indicates that the stones are not comfortable for any reason they should not included in the massage session. I have seen the description of the improper use of hot stones that made the client feel as if they were on an ironing board. (http://spas.about.com/od/hotstonemassage/a/Hotstone.htm ). There are other modalities that are gaining a reputation as being risky. Some of those such as stretching techniques have to do with both the initial health of the client and also the sensitivity to harm that the massage therapist understands. Here it pays to be totally tuned to your client while they are in your care. If you are watching the time, listening to the music or worrying about lunch, you may miss an important clue.

Insurance companies will think of some modalities as an economic risk. We have to consider our risks as they apply to our professional wellbeing as well as an economic problem. Thus we should consider our risk of being subject to an insurance claim as a serious and personal problem rather than just saying “I pay for insurance, let them take care of the client claim of injury”.

As I said earlier, I enjoy using heat in by practice. I do not want the industry to lose the ability to use heat. Heat related modalities are important as soothing and healing in their own right. Hot Stones are my favorite modality I do not want to lose their use!

“If you can, help others; if you cannot do that, at least do not harm them”. -Dalai Lama