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You want your patients to feel welcome in your practice regardless of who they are. If patients feel excluded it not only impacts how they feel about their experience but can also impact their outcomes. Of course, you wouldn’t exclude certain groups of patients on purpose, but there are certain things you might do that can inadvertently make people feel excluded. 

The six tips below will help you ensure your practice is more inclusive to all patients. 

1. Take a Look at Your Intake Forms 

When a patient enters your practice, the first thing they encounter is your intake forms, and some of the sections on an average intake form can feel othering. 

There are some adjustments you can make so your intake forms are more inclusive. For example, include a space for preferred name in addition to legal name. That way you will call your patients what they prefer to be called. You should also include space for pronouns on your intake form and ensure you use the pronouns your patients indicate.

When you put sex on a form, only putting male or female can make people who don’t identify with either feel excluded. Patients’ sex assigned at birth can be different than their gender identity.

You can ask for sex assigned at birth and gender identity, offering male and female as options but also many other options. This should not be a mandatory section. Don’t label your options beyond male and female “other” because that can make people feel excluded. 

Some parts of your intake form, such as those relating to pregnancy or gynecological issues may be unnecessarily gendered e.g. some RMTs will label these sections “for women”. However, there are people who do not identify as women who can become pregnant, so you shouldn’t use those gendered labels.

2. Help People Feel They Fit into Your Practice 

If you want diverse groups of patients to feel welcome, your marketing materials should reflect this. Your images should reflect a variety of different races, ages, gender expressions and backgrounds. When using images of families, show images of families with various compositions including grandparents, same-sex parents, or single parents. 

Consider introducing yourself to all patients with the pronouns you use. With images of human bodies or anatomy, for example when asking patients to indicate where they feel pain, try to use gender neutral images. Consider providing gender neutral washrooms wherever possible, including clear signage. People won’t see themselves fitting into your practice if it’s not somewhere they feel comfortable using the washroom.  

You can also be a bit more deliberate about the media you consume and seeking out media created by and centered around people of different races and ethnicities, LGBT+ people, fat activists, or other diverse creators creating content about their lived experiences. You can look up blogs from health care professionals from marginalized groups, as well as articles from people in marginalized groups sharing their experiences in healthcare. This can help you understand how to be more representative in your own marketing.

3. Tackle Digital Inclusion

There are certain aspects of your website that can make you less accessible to certain populations. If you’re working with a website developer, you can ask them to keep accessibility in mind, but there are also a lot of simple things you can do.

You can use headings to properly organize your content, which makes it easier for anyone to follow but can also make it easier for people who use assistive technology like screen readers. Descriptive alt text for images and descriptive names for your links can also help. E.g., Instead of saying “Click here to read about my clinic” with the words “click here” as the link, try something like “To learn more about my clinic read About Me”, with the words “About Me” being the link. Colour blindness is common so you shouldn’t use colours to indicate required fields (try asterisks or question marks instead).

Some of your patients will prefer online appointment booking and are more comfortable online. Some patients, including many older patients, are not comfortable with or don’t have access to technology. Therefore, you should make digital options available but provide alternatives. You can offer appointment booking by online booking system, email, phone, or even in person. You can use email, text, or phone calls for appointment reminders, depending on what your patient prefers. You can take as many different types of payments as possible including cash, cheques, credit cards, direct billing or even e-transfers.

You should not assume that your patients have access to the same digital tools or experiences, regardless of their demographics. 

4. Take Steps to Become More Culturally Competent 

Cultural competence is keeping in mind how cultural differences may impact healthcare. There are many barriers to health care that can come from cultural differences including language, cultural traditions, cultural understanding of healthcare, and cultural assumptions the healthcare practitioner may make. 

To become more culturally competent, you should first avoid making assumptions. If you’re not sure about something, ask. Many people will happily answer your questions. However, be sure you’re asking because there’s a reason to know, not just because you’re curious – you don’t want people to feel as if you’re prying. You can also try to learn from reputable sources about the different cultures you’ve encountered in your practice and community. 

If there’s a language barrier, encourage your patient to bring someone to help translate. If they have someone translating, be sure to look at the patient while speaking as if no translator existed. Body language and eye contact become even more important with a language barrier. So does patience – this can be frustrating for the patient. You can use translation technologies to help enhance communication. Ensure you’re practicing active listening by reassuring your patients that you’ve heard them and validate what they’re saying. Let your patients know that it’s ok to take their time to communicate. You can repeat back what you understood in your own words, to reassure patients you’ve understood. Keep your explanations simple and use commonly understood language – this can help with all patients. 

Once you can clearly communicate your understanding of the patient’s condition and your preferred treatment approach, you should respect that your patient has different preferences that might be informed by their cultural understanding. You should listen to what those preferences are without judgement and do your best to incorporate them into treatment (assuming it’s within the scope of practice of massage therapy). By listening to and respecting a patient’s cultural understanding of healthcare, you will build trust which can improve the patient-provider relationship.

5. Think About Your Physical Space

The physical environment of your clinic can exclude people with certain bodies in ways you might not anticipate. To ensure your practice is inclusive to plus-sized people, ensure they’re able to fit into your treatment space. Consider investing in a solid, wide massage table with a high weight capacity, with arm extenders to widen it if needed. Consider larger sheets so your patients can feel fully covered and secure. Consider armless chairs in your waiting room so that no one has trouble fitting.

There are modifications you can consider for people with physical disabilities, depending on your control of your space. You can ensure there is adequate open space in your clinic for patients who use mobility devices. You should ensure things like credit card terminals are mobile enough that they can be lowered for someone in a wheelchair. Wider doorways in washrooms and treatment rooms and more room for mobility devices in those spaces, as well as lower counters also help with accessibility. Consider emailing receipts to patients to aid in accessibility in reading them, but also consider offering to print receipts with larger print.

If you can’t accommodate a patient with physical disabilities, be prepared to refer them to another RMT in the area who can. This could be an RMT who works in an accessible clinic, or who does home visits. You can do this using the RMTFind Advanced search and either selecting Outcalls (in home visits), or Wheelchair accessible (where applicable).

If a patient has physical or other disabilities and you determine them capable of consent, talk to them directly about their needs rather than any support person they bring. Treat them the same as any other patient and don’t make assumptions about their needs, capabilities or competence.

6. Don’t Make Assumptions 

It’s important not to assume that all patients will be comfortable with your treatments. There may be a variety of reasons based on culture, ethnic background or beliefs that people may not be comfortable with certain parts of their bodies being touched or may not be comfortable with certain products you may use. They may have cultural expectations about what safe touching is. 

You should not assume that people from the same demographic have the same preferences. Although certain things may be more common in certain demographics, no group is a monolith, and everyone should be treated as an individual. Consider factors like culture when interacting with patients, but it shouldn’t be the only thing you consider and shouldn’t come before what the individual patient tells you. You also shouldn’t assume that certain groups of patients will have problems with the same things. 

Don’t make any assumptions about a patient’s culture, background, religion, sexual orientation, or anything else based on how the patient looks. However, if you do have confirmation that your patient belongs to a certain demographic don’t ask them any question you have about that group. It’s not your patient’s responsibility to educate you on any group they belong to. If you don’t have a professional reason to know, and are just curious or trying to make conversation, consider not asking your question. 

Encouraging diversity and making your practice more inclusive is not just a single action, or one-time event. It is a continuous process of growth and starts with keeping an open mind and committing to listening and learning. You won’t have all the answers and may be uncertain about the best way to move forward. If you don’t make assumptions about how your patients will feel or react, and if you seek out diverse voices to learn from their experiences, you can continue to work on making your practice more welcoming to and inclusive of all patients. 


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