By Terrie Yardley-Nohr
[Ethics and Etiquette]

The word disclosure as used in the health-care professions refers to sharing information. Clients disclose personal information to MTs about their health, therapists disclose information to clients about the treatments and modalities they use, and therapists may also disclose information about a client to a third party, such as an insurance company.

Disclosure involves several ethical issues. Using a client’s information only in a safe and ethical manner is an important principle bodyworkers should safeguard and maintain. To practice ethically, it is equally essential to give correct information to clients about their treatment and the modalities to be used in a session.

Client Disclosure

When new or potential clients call to book an appointment, they generally do not think about the information they may need to share with the MT before receiving a massage. Clients typically are thinking of the benefits they will receive from the bodywork, such as relaxation or pain relief. But the benefits often depend on the MT having certain kinds of information about the client.

Bodyworkers ask complete strangers to disclose a great deal of personal information about their health history before a session begins. Most therapists have the client fill out a health history form that asks about medication, surgeries and injuries, their current and past state of health, and what complaints brought them to the session. Clients who regularly receive massage are familiar with an intake form and have come to know the importance of disclosing health information for effective treatment, but new clients may feel uncomfortable disclosing their personal health information. A therapist needs to explain and educate clients on the importance of this information for effective treatment.

Clients may not disclose information for several reasons: they aren’t comfortable sharing the information, they don’t think certain information is relevant, or they may simply forget to disclose the information. Clients may also refuse to disclose something because they feel the information is private. Personal issues may be involved, such as past abuse or disturbing emotional memories associated with a condition. Clients may also need time to develop trust in a therapist before disclosing personal information. This information may or may not affect the massage treatment being given. For example, a person being treated for depression may feel her massage therapist does not need to know.

Clients need to feel comfortable with disclosing information. A therapist can help this process by talking with a client before the session begins. Allowing extra time for a new client interview will help clients feel more at ease, too. During the interview process, subtle hints are usually given and the therapist can dig a bit deeper to gather information that could be useful for treatment. Medications are a frequent area that may not be fully disclosed. A client who discloses that she is using painkillers or blood thinners may need further evaluation before treatment begins or may need to be rescheduled for another time. Explaining the need and use of the information helps clients understand that it’s in their best interest for an effective treatment.

Another concern for clients may be that too many people will have access to their personal information. It is important for clients to know that their information will be kept confidential. Disclosure of medical information to other parties should only be done with the client’s written permission and for good cause, such as referral or insurance needs. Group practices can make this challenging when more than one therapist may be working on a client. It is important that a client give written permission for this information to be shared.

Privacy legislation has taken effect in recent years, and as health-care providers, MTs need to adhere to the same guidelines all other providers follow. The Health Insurance Portability and Accountability Act (HIPAA), which became effective in 2001, protects consumers’ rights to privacy of health-care coverage, and the rights of consumers regarding shared health information. All health-care professionals must follow these regulations. Detailed information about HIPAA regulations is available from the U.S. Department of Health and Human Services, Office for Civil Rights, on the Internet at www.hhs.gov/ocr/privacy. Clients need to trust you with their health information and to know that it will be shared only with their consent.

In addition to HIPAA, your state’s laws, rules, and regulations may dictate what information you must keep about each of your clients and how long records must be kept. Check your state laws and rules to assure that you are keeping all necessary information about your clients and know how it can be shared with other parties. You can customize your office forms to make this easier.

Educating Clients

Sometimes clients may not know the relevance of information they’re disclosing for effective treatment. In some situations, clients may not list a condition that would put them at risk when receiving bodywork. Therapists should learn the signs and symptoms that indicate something is wrong. Most therapists will run into a situation during their career where a client has not revealed a condition, and the therapist sees a sign that would lead him to further questioning and possibly stopping a session. For example, while working on a client, you notice a red streak running up the leg. When you bring it to the client’s attention, she tells you it has been sore for a couple of days. This would be the time to stop the session and refer the client to see a doctor. If the client asks you what is wrong, it would be best to tell her that this sign contraindicates her for a massage until further evaluation. The possibility of this being a blood clot is not worth the risk to the client.

Most therapists who have worked in the massage field have had a number of clients who fill out a health history form and leave many areas blank, yet, during the session, bits of information are slowly revealed. Past surgeries can come up, along with health issues or medications that could be contraindicated for massage. Many therapists have heard a client say she did not feel it was important or there is no need for that information to be revealed to receive a massage.

Educating clients is an integral part of being a massage therapist. Therapists should not assume that clients will instantly trust and understand the expectations we may have for them and disclose all of the information that will be needed for effective treatment. It is often necessary to carefully explain to clients that massage is contraindicated for certain conditions, so understanding all the health challenges the client is facing will ensure a safe and effective massage session. For example, if a client tells you that she has been experiencing shooting pains down her leg, that client should be evaluated by a medical profession before receiving a massage. The client may feel she just wants her leg worked on and the pain to go away. As a bodyworker, you need to know when the pain started, what may have caused the pain, and has the client been evaluated by a doctor. The treatment for many conditions such as this can dramatically change from the information that is received. The relevance is not always obvious to a client. A therapist should take on the responsibility to help clients understand the need for divulging this information.

Your health history form should include a paragraph that indicates that the client has disclosed all known health information. If a client chooses not to disclose, a therapist could perform a treatment that may put the client’s health at risk. Although this paragraph can help a client know the importance of disclosure, many therapists need to work beyond this written caveat and help clients understand why the health information is so important for their treatment and care.

Clients can also simply forget to list health information. A thorough and complete health history form can help clients provide all their pertinent information. Asking a client if they are currently under a doctor’s care is a rather open-ended question and many clients will answer no. Yet under medications, they may list medications for blood pressure, thyroid, or painkillers. They are under a doctor’s care to receive these medications, but a client may not see the connection. A thorough health history form will include all conditions, signs, and symptoms to be checked off that would indicate further questions and evaluation before receiving massage. This type of form can help jog a client’s memory and help a therapist get a full picture of the client’s health.

Helpful Hints to Ensure Disclosure

Here are some additional hints to ensure client disclosure:

• Add a brief paragraph on your health history form explaining the reasons for asking about a client’s health.

• Look for clues in the client’s answers, such as fever, fatigues, soreness, etc.

• When in doubt, ask the client questions during the oral interview.

• Watch for signs and symptoms that could mean the client has a condition that could contraindicate massage.

• Keep good notes and records of your session with clients. You may see patterns develop that need further investigation.

• Before beginning any session, ask clients for any new information about their health.

• Include a disclosure statement on your health history form. It should include wording that the client has disclosed all known health information. The client should sign and date this form.

• Always be honest in recording information you have learned. Clients have no argument with a professional who is honest.

Disclosure is an important part of bodywork and a therapist needs to decide what information is needed to effectively and safely treat clients. Communicating and educating your clients will help develop trust, along with an effective treatment plan, that will ensure your professionalism and your clients’ best interests.             

 Terrie Yardley-Nohr, LMT, has been a massage therapist for 18 years, working both in private practice and medical settings. She began teaching massage techniques and ethics 13 years ago and became program manager at Anthem College in St. Louis, Missouri, 10 years ago. She is the author of Ethics for Massage Therapists (Lippincott Williams & Wilkins, 2006). Contact her at tyardleynohr@anthem.edu.