This is a true story: an elderly woman appeared for an appointment at a massage school student clinic. She told her student therapist, “My doctor says I have blood clots in my legs. He wants me to receive massage, because he says it will help my circulation.”

The implications of this simple statement are staggering—all the more so because the client chose a student clinic for her care instead of a seasoned professional. What can this client possibly mean? Is she accurately relaying her physician’s suggestion, which is essentially a recipe for pulmonary embolism? Or has she misunderstood her doctor’s advice, which may have been to suggest massage as a preventive measure to reduce her risk of developing clots (a scenario that carries its own list of cautions and concerns)? Or maybe she self-diagnosed and put her doctor’s stamp of approval on it to strengthen her case. This situation demonstrates the critical role of communication between massage practitioners and primary care providers when clients have or report conditions that change the way we need to work.

Some of us come from a tradition where we talked about getting a doctor’s permission before working with people we saw as having risks for massage. That paradigm, thankfully, has substantially changed. While asking for medical clearance may put a doctor at risk for litigation if any harm occurs, it does not offer any legal protection to the therapist. The role of the physician in this relationship is more properly as one of several important members of the healthcare team. He or she is in a position to help the massage practitioner maximize benefits of bodywork while minimizing risks for the client. Truly, the only people who need to grant permission for a massage to take place are the practitioner and the client.

Goals for Communication

A massage therapist once described to me a correspondence she began with a client’s doctor this way: “Dr. Smith, Mrs. Jones would like to receive massage. Is that okay with you, and what do you think I should do?” Obviously, this is not a useful way to communicate with another care provider.

I suggest the following goals for communicating with other healthcare providers. These guidelines are targeted toward correspondence with primary care physicians, but they can certainly be extended to others, including physical and occupational therapists, chiropractors, osteopaths, surgeons, and other specialists. Of course, these communications only occur with the written consent of the client.

Gather and share information
The purpose of the communication we initiate is to inform other providers about the work we do and to gather information about possible risks and benefits. It is not to ask for permission or specific directions. 

Explain and describe the work Other healthcare providers have no responsibility to understand what we do or what various modalities entail. Many doctors may understand that a patient wants to receive myofascial release or craniosacral therapy, but have no clear idea of what that kind of work involves. Therefore any communications about bodywork must include detailed information about the client’s position on the table or chair; the location, depth, and direction of strokes; and the duration and frequency of sessions. Without this critical information, it is not possible to make an informed judgment about safety or potential problems.

State concerns clearly when appropriate

 If a client has a specific condition (like the woman who says she’s been diagnosed with blood clots in her leg), it is fair and appropriate to ask questions directly pertaining to this situation. But if your inquiry is meant to gather more general information about a client’s health and resilience, it is probably better not to submit a specific list of concerns. This allows more flexibility to discuss topics as they may arise.

Certainly it is safe to say that most healthcare providers are interested in the work we do, and generally they want to be informed when their patients are regularly receiving massage—especially their patients with chronic, long-term conditions. Unfortunately, this doesn’t always happen, as some patients are reluctant to volunteer this information to their doctors. But in the same way that starting a drug regimen or a new diet or exercise program is important information to go into a person’s health records, massage therapy and bodywork belong here, too.

Types of Correspondence

Discussions with various providers have manifested in a desire for three types of communication: the general information letter, the specific needs letter, and the patient update letter. (By the way, while I’m using the word letter here, e-mail is perfectly appropriate; but some kind of a written record—as opposed to purely verbal conversations—is a good idea to keep in client files.) Here are possible templates that can be adapted for these basic purposes.

It is important to bear in mind that different kinds of providers may be looking for different types of information. For instance, a chiropractor or osteopath may be more interested in the client’s position and duration of sessions than the renal specialist or cardiologist who is interested in circulatory impact. It is our job to try to anticipate which pieces of information are most pertinent to request or share and to be open and flexible to the communications we receive in return.

Every bodywork practitioner, no matter what the focus of his or her field, needs to be prepared to deal with clients who may have complicated, multilayered conditions. It is an ethical imperative to gather as much information as we can to maximize the benefits of the work we do and to minimize the risks. Fortunately, the vast majority of other healthcare providers are perfectly happy to help us accomplish that task. 

  Ruth Werner is a writer and educator who teaches several courses at the Myotherapy College of Utah and is approved by the NCTMB as a provider of continuing education. She wrote A Massage Therapist’s Guide to Pathology (Lippincott Williams & Wilkins, 2005), now in its third edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com.