You want your patients to feel welcome in your practice regardless of their race, religion, gender identity, sexual orientation, body size, or any other factor. If patients feel excluded or discriminated against 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 routinely do that can inadvertently make people feel excluded.
The seven tips below will help you ensure your practice is more inclusive to all patients.
- Take a Look at Your Intake Forms
When a patient enters your practice, one of the first things they encounter is your intake forms, and some of the sections on an average intake form can feel othering for some people.
There are some small adjustments you can make so your intake forms are more inclusive. One option is to include a space for preferred name in addition to full legal name. That way you can ensure you call your patients what they prefer to be called. You should also add a space to include pronouns on your intake form and ensure you use the pronouns your patients indicate when you refer to them.
When you put sex on a form, if you only put male or female, it can make people who don’t feel comfortable with or identify with either of those categories feel excluded. In addition, patients’ sex assigned at birth can be different than their gender identity or presentation. Instead, you can ask for sex assigned at birth and gender identity, offering male and female as options but also as many other options as you can think of as well as a space patients can fill in themselves in case you missed something. This should not be a mandatory section. Don’t label your options beyond male and female as “other” because that can make people feel excluded. This inclusion resource from the Canadian AIDS Society provides some examples of the types of adjustments you can make to your intake forms.
In addition, 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 sorts of sections “for women”. However, there are people who do not identify as women who can become pregnant, so you should use gender neutral terms to label any sections.
- Help People Feel Like They Fit into Your Practice
If you want diverse groups of patients to feel welcome in your practice, your marketing materials should reflect this. Any images you use of people should reflect a variety of different races, ages, gender expressions and backgrounds. In addition, when using images of families, but sure to show images of families with various compositions including grandparents, same-sex parents, and single parents.
It's not just marketing that can help people see themselves in your practice. Consider introducing yourself to all patients with the pronouns you use either in person or on your bio, not just to patients you believe might be transgender or non-binary. If you use images of human bodies or anatomy, for example when asking patients to indicate where they feel pain, make an effort to use gender neutral images. Consider providing gender neutral washrooms wherever possible, including signage clearly indicating the washrooms are gender neutral. People won’t see themselves fitting into your practice if it’s not somewhere they feel comfortable using the washroom.
- 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 specific 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 to access your content. Descriptive alt text for images as well as using descriptive names for your links can also help with this. 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. Red/green colour blindness is common so you shouldn’t use colours to indicate required fields (try asterisks or question marks instead), but colours can be easier to understand for some people, so you can use both methods to denote required information.
Some of your patients will prefer options like online appointment booking and are more comfortable in a digital landscape. However, some patients, including many older patients, or lower income people, 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 identified as their preferences. You can try to 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.
- Take Steps to Become More Culturally Competent
Cultural competence is learning about how cultural differences may impact healthcare and keeping that in mind when offering patient care. 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, just ask. Many people will happily answer your questions, especially if your body language communicates openness and receptiveness. However, be sure you’re asking because there’s a reason for you 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, as well as patience – this can be a frustrating situation for the patient. You can also use translation technologies to help enhance your communication. Ensure you’re practicing active listening by reassuring your patient that you’ve heard them, and you validate what they’re saying, and let your patients know that it’s ok to take their time to communicate. You can repeat back what you understood the patient said in your own words, to reassure them that you’ve understood. Try to keep your explanations simple and use commonly understood language – this can help both with a language barrier and with all patients.
Once you are able to more clearly communicate your understanding of the patient’s condition and your preferred approach to treating it, you should also 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, even if it may be different than what you’re used to (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.
- Think About Your Physical Space
The physical environment of your clinic can exclude people with certain bodies in ways you might not have anticipated. To ensure your practice is inclusive to plus-sized people, you should ensure they’re able to fit into your treatment space. This includes investing in a solid, wide massage table with a high weight capacity, with the use of arm extenders to widen it if needed. Consider larger sheets so your patients can feel fully covered and secure. Also consider armless chairs in your waiting room so that no one has trouble fitting.
There are also some modifications you can consider for people with physical disabilities, though they might not all be in your control.
For example, you can ensure there is adequate open space in your clinic for patients who use mobility devices. Adequate floor space can help everyone get around, not just people in 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 or tables also help with accessibility. Consider emailing receipts to patients to aid in accessibility in reading them, but also consider offering to print with larger print option to all your patients.
If you can’t accommodate a patient with physical disabilities, you should 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 selection Outcalls (in home visits), or Wheelchair accessible (where applicable).
You should be sure that if a patient has physical or other disabilities and you determine them capable of consent, you talk to them directly about their needs rather than any support person they may bring. Be sure to treat them the same way you would any other patient and not make any assumptions about their needs, capabilities or competence.
- Don’t Make Assumptions
It’s important to not assume that a part of your treatment that is routine for you will be ok for all your patients. There may be a variety of reasons based on culture, ethnic background, beliefs or other factors, 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 or experiences. Although certain things may be more common in certain demographics, no group is a monolith, and everyone should be treated as an individual with their own needs and preferences. You can consider factors like culture when interacting with patients, but it shouldn’t be the only thing you consider and should never come before what the individual patient is telling you. Just like you shouldn’t assume something you do routinely would be fine for all patients, you shouldn’t assume that certain groups of patients will have problems with the same things.
You also shouldn’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 you don’t need to ask them any question you have about that group that pops into your head. It’s not your patient’s responsibility to educate you on all aspects of any group they belong to. Before you ask any question to any patient, ask yourself why you’re asking and whether you need to know. If you don’t have a professional reason to know, and are just curious or trying to make conversation, consider not asking.
- Access Diverse Content
The best way to learn about people who are different from you is to learn from them directly. This can mean being 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 learn more about the concerns of various groups, the type of language they use to describe their experiences, and their perspectives, all by consuming content from these groups. This can also help you get more familiar with the barriers to health care for various groups. 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 could also help you with your own marketing efforts, because by ensuring the content you consume is diverse, you will more naturally recognize and value diversity in the marketing images you select. It could also help you in communicating with your patients in a culturally competent and respectful way, and in avoiding making assumptions about them. This is because by consuming diverse content you will have already gotten a lot of the information you need, and you will be more aware of the lived experiences of the people around you, which can help you respect and appreciate those experiences.
Encouraging diversity and making your practice more inclusive is not just a single action you take, or a one-time event. It is a continuous process of growth and should start with keeping an open mind and committing to listening and learning. You won’t have all the answers, and at first you may be uncertain about the best way to move forward. But 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.