Looks like I keep finding your groups Ariana! :)

Ditto to what Nate said...

I have to chuckle when I see how all the other groups have so many members and so much posted and here just a few.

Therapeutic relationships. Yes,....

Yesterday I asked some fellow massage therapists, "How many use massage as a bartering tool? What cool experiences will you share with us?"

In less than a day there were over sixty replies, most of which were simple explanations of what therapists bartered for.

There were a couple who don't barter for one reason or another.

What interested me were the personal messages from therapists who were a bit leary of 'going against the flow,' and making a public statement against the grain in regards to bartering and ethics, as the majority agreed that bartering one's professional massage services was a-ok.

Ethics: A system of moral principles: the ethics of a culture.

Is there mention of bartering in the National exams or is this a state by state, school by school 'ethics' discussion? (It's been so long ago that I took the National test and studied for it, I can't recall.)

How do your, "Moral principles or culture" relate to mine? Is there a standard that all massage therapists should observe?

Is this a personal issue from therapist to therapist, between them and their clients?

Personally, I don't have an issue with bartering, although I've done very little of it.

Thoughts?

Kris

I do have issues about using bartering in a massage therapy practice. Bartering creates a dual relationship: that means having a client/ therapist relationship as well as a second relationship based on the bartering. If the barter does not work out well for some reason, the client/therapist relationship will suffer.
Bartering on a one time trade carries minimal risk. If the trade does not work out, the therapist is only out the time they spent doing one massage. If the agreement is for a long-term trade, there are increased risks.
Books on professional ethics counsel against dual relationships. There are many horror stories of bartering deal which did not work out well.

A friend of mine started a company called "Barter Pays" a long time ago.
Since it was set up very professional and with an awesome system in tack it worked very well.

Individuals could schedule a service or buy a product and use their barter bucks.
It didn't mean if they came to me for massage I had to use their service etc. We had a "pool" of business' to choose from.

I agree with Lee Bartering one on one can cause some conflicts, but a system like my friends works very well.

I was able to purchase tires for my cars, brochures for my business etc. An awesome concept when it is handled well.

For references regarding bartering, see the following texts on Professional Ethics.
The Educated Heart by Nina McIntosh (LLW) Chapter on Dual Relationsips (Wearing Many Hats)
Keeping the Professional Promise, Cidalia Paiva PHd (Mt Publishing) Brief mention in the chapter on Dual Relationships

A system like Gloria describes certainly lessens the risk. We must remember that dual relationships are all about risk - to both parties.
I can give horror stories about bartering gone wrong. Maybe later.

The reason for not bartering is Federal Income Taxes. Each service must be registered as income to the person. Do we barter anyway? Probably. But to declare in writing that you barter and then put it on the internet sets yourself up for tax evasion. I am not an expert on this but have listened to several accountants and lawyers who specialize in this warn against it.
Taya Countryman LMT

thanks
i dod not know that

Bartering is also using money. That is the coin that we save up to use for what we want and need. Its all just a big bartering system. It seems so much cleaner to just pay for what you want. Not that i don't do a trade with friends- I do. But when I want more sessions than they do, well I also pay them in between. Seems to work for me.

We cannot be sure how carefully the REvenue Dept follows these things or where they might get their information, but the law certainly does require that services are registered as income.
I agree with Nancy that it is cleaner to pay for what I want and what I buy. When I get a massage, I pay for it. That way I do not have an obligation hanging over me that I owe someone a massage, even if I am too tired or too busy to honour my commitment.

Yes, paying is easy and clean.
I only trade with very close friends and very rarely.
Good day to all

Where I live, the town thrives on trade. I barter/trade like crazy, but I am very explicit about the guidelines ahead of time. My sweetie and I do a lot of bartering with food (he's a caterer and we raise a lot of our own meat), but we make sure that the other person feels he's getting his/her "money's" worth. Three-way trades are also fine with us.

What would you do if a trade went wrong? Have you ever had a problem with the other person not living up to their side of the bargain? Or of one party being dissatisfied with the trade?

Absolutely. Honestly, the worst problems I've had involve trade with other MTs, including to one lying to me outright about her plans for the evening I was to receive.

Like I said, we do everything we can to provide good customer satisfaction. If the trade is our idea and it falls flat in our reception . . . well, we know not to trade with that person again. There are enough people around who are interested in trading that it doesn't much become an issue. We've gotten fairly picky, but trading our goods for someone else's goods/services seems to go pretty well.

I think that problems with trading or bartering can be controlled somewhat by limiting the trade to one for one. If you get into a longer term trade, it can become much more problematic.
For example, I know a therapist who traded with a contractor. She provided massage and he was to renovate one of her rooms. He was coming in regularly for massage, but the renovation project was going slowly. He gave first priority to his "paying" customers and meanwhile she was living in a half-completed mess of a room. It is deals like this that I think are very risky. If it is a one-for-one trade and it goes badly, you have lost only one hour of your time and work. If you get into a longer term trade, it can become very complicated.

So here's a question... Do you ask your clients about large/unusual scars that they didn't mention during the intake conversation? Obviously, it would be out of line to ask about tattoos, and I was thinking some scars can be similar, or maybe they have a tragic history behind them... Reason for asking, is I recently had a new client that had a long, deep scar around her upper arm--bicep/delts/tricep. I didn't ask what happened there, but only whether the area was sensitive or tender at all. It didn't look new, but definitely sparked my interest. She said that it was only tender/painful if it was pushed directly down to the bone. She didn't offer any other information about how she got it, and it looks like it would've been painful.

I teach that assessment is a combination of written, verbal, visual, palpation, & more and that all of these must be consistent. If a patient does not write on your intake form that they have had surgery or a serious accident then you must ask. If you saw a mole that was irregular in shape, which can be the first sign of skin cancer, as a therapist you must ask them about this and refer them to their physician especially if it is in an area that is not easily seen by them (like on their back). I am sure you would say something. I believe that being honest with your patient creates trust. So by asking about the scar it says, "I see it and I am asking because I care and I want to provide you with the most professional treatment." By the way, my new intake form is 5 pages long. The more I know the better my treatment plan even if they are here for a stress reduction or spa treatment. The class I teach is called: Assessment and Integration of SRT. www.StructuralReliefTherapy.com

I agree with Rachel. My health history form asks if there were any injuries or accidents (or surgeries), and the date. If the client did not answer this, and I see evidence of an injury, such as a scar, I would certainly ask what it was. I would say something to the effect of "You did not mention that you had an injury to your arm. What happened, and when was this? Does it affect the movement of your arm in any way? Does it cause you pain?"

I find that some clients misinterpret what we are asking on our intake. For example, if a client comes for massage treatment for a sore back, she may think that an injury to her arm is not relevant to the problem, and therefore doesn't mention it.
After you receive this information, you then need to update the health history form.

I would ask and do ask in my practice
After all, it is in front of my eyes. I cannot deny what I see.
Clients do forget as they see the scare everyday, they do not think about it anymore.

Reading the MBOK raises a number of ethical questions. In defining scope of practice a number of things under NOT our scope makes me wonder how other therapist view this. Many therapist sell products including supplements and herbs. This MBOK document states that recommending nutrition and herbs is out side of scope. Just having the product for sale is an endorsement, where do we draw the line.
The subject of tips is also on my mind. I have seen studies that relate touch to hormones that increase trust and generosity. Sales people, and other service staff (waiters, bellmen) and politicians have long known that shaking hands or touching the shoulder increases sales tips and votes.
As health care providers clients trust us and are vulnerable to suggestion after a massage. Is selling anything including things we consider good for them ethical.
What do you think?

These are very good points Kevin.
I don't know what the MBOK is, but certainly where I practice, recommending herbs and nutrition is out of our scope of practice. You are right - having the product for sale is an endorsement of that product. And because our clients trust us, they are more likely to buy. For that reason I would not sell these products. If people want information on nutrition (and they often do) I can refer them to articles from legitimate sources and they can make their own educated decisions.
I also do not accept tips. I know this is controversial as therapists in many areas rely on tips as part of their livlihood. However, as a heatlh care professional I do not expect tips any more than a doctor, nurse, chiropractor or any other health professional would expect tips.. There are many ethical issues around tips.
Does the person who tips well get a better massage? Will the person who tips well be favoured when they phone for an appointment and the therapist is busy?
If a person tips well, and wants a favour, such as a letter to their insurance company saying they need time off work - will the therapist comply more readily?

Lee, sorry for not spelling out the MBOK and I left out the T. Look to the group Massage Therapy Body of Knowledge for the draft. It is part of an effort to define what is and is not massage.
Tips and gifts are hard to turn down and many clients are upset if you refuse. A massage company here advertises a $39 dollar massage but tips are expected and added at 15%. The Therapist relies on the tips as do waiters and other service people. I am in agreement with you on this subject. I can only hope that the more we are healthcare the less we will see this as an issue.
As for products I see Chiros and others therapist selling and it sure would help cover the overhead, I just have not ever felt right about it even when I use and love the product. The exception is the music and oil we use.
More discussion and awareness all around should help. Thanks for the reply.

those places, usually do not treat their therapist very well, big turn over.

I practice in Ontario and our regulatory body, the CMTO, has the Core Competencies Document which details what a person must know in order to meet minimum standards and qualify for the Registration Exams. For Continuing Education, there is a list of modalities that are considered to be within our Scope of Practice and those that are outside of Scope and do not receive credit for continuing ed.
I believe that as long as massage therapists see themselves as Service providers, like waiters and hairdressers, they will not be accepted as Healthcare Providers. Most massage therapists say that they want to be acknowledged as professionals but that is not likely to happen until they conduct themselves as professionals.

I am offered tips occasionally, and I do turn them down - as politely as possible.

who has good online medical ethics for ceu's?

Looking for feedback/opinions here... I do insurance billing for clients who've been in a car accident, and am currently treating a 24 year old woman who has cancelled her appt the same day I think 4 times since she started seeing me less than a month ago (appts are 2x/wk). I do have a cancellation policy, but I'm not sure whether or how to enforce that with an insurance client..? Once cancellation was due to pain from ovarian cyst, one was picking dog up from vet hospital after being hit by a car, one was it was too cold/rainy and she didn't have a ride and didn't feel like walking (I live in Oregon...it rains a LOT this time of year!!), today, she had her fiancee cancel for her an hour and a half before her appt because she's not feeling good--thinks she might be getting sick, hasn't felt good since yesterday (both days have been absolutely GORGEOUS outside). I dunno. Yes, some of those seem like actual legitimate reasons to cancel, but I still kinda feel like she's walking all over me, and I do not want that to continue. So...do I enforce the cancellation policy? Mine is $25 if cancelled with less than 24 hours notice, or pay in full if appointment is missed with no notification.

In my experience with insurance companies, they are willing to pay for TREATMENTS so the client will recover from their injuries, they are not willing to pay for missed appointments. This client is probably expecting that the insurance company will just pay for all these missed appointments - and she is wrong! I suggest you speak to her in person and explain to her how it works. Her company will pay for treatment only - If she is not able to make the appointment your usual fee for missed appointments will apply. I would suggest to her that if the insurance company finds out she is not getting her treatments, they may cancell her coverage. You have to be careful how you word this - you don't want it to come over as a threat, but as a "heads-up" for her.

I didn't expect or mean to imply billing the insurance for her missed appointments, or even the cancellation fees. I guess I just need to toughen up and deal with the situation in person like you said. I will probably let these past ones go, and be very clear with her that if she cancels with less than 24 hours notice again, that it'll be coming from her pocket.

Rachel, I wasn't implying that YOU would bill the insurance company for the missed appointments, but the client may actually think this is what's happening, and that may be part of the reason why she is casual about keeping her appointments. Many people think that insurance companies have lots of money and can just pay and pay. Probably a tactful (and tough) way of explaining it to the client is to tell her that if she is really committed to making a good recovery from her injuries, she needs to commit to keeping her appointments. The insurance company will not pay for missed appointments, and you cannot keep making appointments for her if she doesn't keep them. I always point out to clients that someone else would have appreciated having that appointment time! And tell her that if she misses any further appointments you will have to charge her for them as you set out in your cancellation policy.
Yup, you do have to toughen up. Your professional time is valuable and should not be abused.

Thanks Lee. I get what you mean about clarifying it with her that the insurance doesn't pay whether she comes in or not. I know I haven't done that yet.

I guess I'm always reluctant to be tough with my clients, because the TACT is the part I have a hard time with! ;)

BTW, the good news for her cancelling today, is that I'm able to go do a trade with the acupuncturist that just moved her business across the street from me. Woohoo!

LOL - yes, the tact is the hard part! But if you think it through in advance and have something planned it will be easier. The fact is, that if a client doesn't respect your professional time, this may be a client who is not worth having. So if she is offended and decides to cancel out completely, it may be that she is not a great loss to your practice.
And good for you, to look at the positive side. Hope you have a good acupuncture treatment.

Hi Rachel. This kind of discussion with clients is always difficult particularly with needy clients. It is important to respect the client as well as establish reasonable policies for yourself. Here are some suggestions: Initiate a phone call specifically to talk about the cancelled apointments rather than wait until she either calls to schedule or shows up again. Start by expressing your concerns about the client. For instance that her injuries from the MVA need massage treatment based on a certain protocol for best results ( 2X per week.) Secondly you are concerned that she has some other health/personal issues that are preventing her from getting needed care (ovarian cyst, transportation issues, other health issues.) If you have a written cancellation policy - it is best practice to have each client sign a written cancellation agreement annually - go over it with her briefly. Explain that you have had loss of income due to her repeated cancellations and there is a balance due. Then you can ask her how she wants to proceed. Let her suggest ways to solve her problems with keeping her appointments. If she can't make a committment to be responsible for missed appointments, you may find that she is not the client for you. One possible suggestion is to offer that you can't tie up an appointment slot for her, but you will call her if you have last minute cancellations or openings to fill. That way you will not be abandoning her, nor losing income from late cancellations. Best of luck.

Thank you Nancy! These are great suggestions and show all of us that these situations can indeed be handled with great tact and respect for both the client and ourselves.

Thank you Nancy. I appreciate this groups' help. I don't regularly run into clients that cancel so much, and despite having a (signed) cancellation policy, I wasn't sure how best to handle this. I'm usually lenient with health/medical types of cancellations, and maybe let one non-emergency-cancellation slide, but she's given me all sorts of reasons, I was a little dumbfounded. She has an appointment on Monday already scheduled, and whether or not it holds, we'll be having ourselves a nice little chat.