Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Practice Policy (Gone Bad): The Sign
Every once in a while, you see something and think to yourself, That's a really bad idea. Case in point: I went to see my medical doctor the other day. Just after being "roomed," as they say, the nurse checked my vital signs. Then she left.
Dorsiflexion Dysfunction: Evaluation & Manipulation Techniques
Almost every condition from the foot to the hip can be attributed to the inability to dorsiflex the ankle mortice and other joints that participate in dorsiflexion. Let's start by understanding normal versus abnormal dorsiflexion.
A Chiropractor's Guide to Yoga
"Doctor, can I continue to do yoga while undergoing your care?" "Is it OK for me to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?"
More Chiropractors Required
An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
Change Lives by Supporting Chiropractic Research: Are You In?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fund-raising campaign to support chiropractic research.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
Fish Oil: A Key Component of Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
Patient-Centered Care vs. Payer Restrictions: Your Ethical Obligation
Do you have an ethical obligation to evaluate your patients, make a diagnosis and provide evidence-based, patient-centered health care, irrelevant to the payer restrictions?
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Harvard Health References Flawed AHA Position Paper
In its special health report, "Stroke: Diagnosing, Treating, and Recovering From a 'Brain Attack,'" Harvard Health Publications includes information from the American Heart Association's 2014 position statement on cervical manipulation and cervical dissection – a statement the American Chiropractic Association emphasized in a letter to Harvard Health mixes "scientific facts with half-truths."
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
News in Brief
Call for Abstracts Announced - Parker Las Vegas 2016; Logan Adds Doctorate Degree; New Role for Dr. James Edwards.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
Surprising Reasons for Orthotic Efficacy
Clinical outcome studies show orthotics are effective in the management of a wide range of injuries, including plantar fasciitis, Achilles tendinitis and patellofemoral pain syndrome.
What's Chiropractic Research Worth to You?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fundraising campaign to support chiropractic research.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
August, 2012, Vol. 12, Issue 08
Documentation in Hospice: What Do Employers Expect?
By Ann Catlin, LMT, NCTMB, OTR
Hospice organizations that hire or contract massage therapists expect professionalism. They expect sound documentation skills. Although there isn't a lot of consistency in how documentation is carried out, what IS consistent is the requirement to do it, and do it well.I once spoke with a hospice director who told me, "We use to have a massage therapist but it didn't work out." When I asked her what went wrong, she said one reason was that, "her documentation was poor quality." The take-away message here is: Sharpen your documentation skills and accept that it is an important part of the job if you want to work in any aspect of our health care system.
The main reason you became a massage therapist most likely wasn't because you were excited about doing paperwork or writing progress notes. Ask any nurse or physical therapist or physician and they will tell you it isn't their favorite thing, either. I've found if I re-frame my ideas about documentation, then an attitude adjustment is quick to follow. What follows are good reasons to pay close attention to your documentation skills.
Credibility: How you represent your work in progress notes reflects your degree of professionalism in the eyes of employers and coworkers.
Efficacy: Progress notes provide a means to track effectiveness of techniques or approaches in attaining desired goals.
Functional Outcomes: Your notes tell a story, over time, about the difference massage makes in your client's activities of daily living.
Improved relationship with colleagues: When your documentation provides valuable information for coworkers, your work is taken more seriously and you demonstrate that you are a team player.
Legal record: Documentation is your legal record of the services you provided.
Marketable skills: When applying for a position in hospice, highlight experience you have with healthcare documentation.
Don't just take my word for it. I did an online search for massage therapy jobs in hospice and in almost all notices job requirements referred to documentation skills. It's also worth noting that the number of job notices online is growing. Here are a few examples taken from postings that mention expectations with regards to documentation:
Keeping SOAP Notes Simple
For those of you whose eyes cross at the mention of progress notes, I want to offer a simple guide that is relevant to hospice. Since many use SOAP notes, it's likely you will be required to use this format. Think of a SOAP note as a picture of the session, showing the reader what you observed of your client; what you did, how your client responded and what you plan to do for future sessions.
S = Subjective information. In this section, record verbal comments your client makes about any of these things: their reason for and desired outcome of the session; a description of symptoms; the effect of symptoms on activities of daily living; and pain levels or other discomfort. It's common for the hospice care team to determine levels of pain using a pain scale the Wong-Baker Faces and Ruler Pain Rating Scale. You should also record any other relevant comments by the patient or family caregivers.
O= Objective observations. This section includes both observations of the client and what you did during the session. Describe just the facts about your observations — only what you can see, hear, touch or smell. Observations might include, but are not limited to special communication needs; breathing patterns; movement; muscle texture; functional mobility; body posture or position; skin condition; facial expression; sign of stress or agitation; interpersonal interaction; alertness; observation of confusion or memory loss; and non-verbal signs of pain.
The record of what you did should include information about site restrictions, precautions taken, the length of the session, bed or wheelchair positioning adaptations performed, massage or bodywork techniques that were utilized and which area of the body was addressed.
Descriptive language of the techniques used could include: focused touch, gentle compression, petrissage/kneading, effleurage/stroking, gentle stretching, holding, shared breathing, gentle rocking, moisturizing, abdominal massage, manual lymphatic drainage, energetic modality and caregiver instruction or support.
A= Assessment. Record the immediate results of the session including observed client responses and changes. Examples of observable responses might include signs of decreased pain; positive verbal comments; decreased agitated behaviors; fell asleep; increase in social interaction; appears more engaged; decreased muscle tension; relaxation response; deeper breathing; appears more alert; change in facial expression; improved movement; postural change; skin changes; returned touch; and improved ability to perform an activity of daily living.
P=Plan. This section includes information relevant to the treatment plan, including frequency of future sessions; additional client needs; treatment recommendations for future sessions and desired outcomes; client requests; and a need for caregiver instruction.
On the Job
I interviewed several massage therapists employed in hospice or long-term care about what documentation is required of them. As expected, it varies a great deal. Some organizations use electronic systems and more organizations are transitioning to electronic record keeping. Some organizations provide the therapist with documentation forms developed by the company. Other therapists must provide their own forms. Some use a structured SOAP note form with checklists, others write narrative notes or a combination of the two. Most organizations place the therapist's documentation in the medical record or other patient chart.
Valerie Stoughton Hartman is a Complementary Therapy Hospice and Palliative Care Nurse and Chairman of the National Hospice and Palliative Care Organization (NHPCO) Allied Therapy Section. She says that complementary therapies have taken a place in mainstream services provided by hospice programs in the United States. While many hospices appreciate and grow volunteer complementary therapy programs, others remain committed to hiring hospice prepared therapists.
When it comes to documentation, the industry is in the midst of figuring out best practices. As it stands right now, documentation standards are dictated by each individual hospice program. Administrators make executive decisions in order to assure accurate documentation reflects the purposeful use of a modality. Hired therapists have a responsibility in the referral process, interdisciplinary team communication, evaluation, assessment and provision of service. Volunteer expectations are often much less demanding. The NHPCO is a resource for program development if a massage therapist volunteers or is hired to work with a hospice program that is a member of the organization.
I agree with Valerie when she encourages massage therapists working in hospice to join the NCHPP Allied Therapy Section, which oversees allied therapy and complementary therapy use and integration in end of life care. We can all have a voice in establishing best practices in this rapidly growing field of massage.
Click here for more information about Ann Catlin, LMT, NCTMB, OTR.
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