The Ontario regulator – College of Massage Therapists of Ontario – has released draft health history guidelines, as an exercise in examining the “over collection of personal health information”. A discussion on the structure and relevance of conducting a health history is long overdue. I appreciate the framework the guidelines provide re: principles, inquiries not relevant/sometimes relevant and always relevant, with a focus on allowing the patient to control the amount of disclosure.

I have three arguments on how to improve the guidance document:
1) Quality-of-life questions re: regular exercise, sense of vitality, sleep quality and social engagement would be a helpful addition. Questions regarding occupation, recreation and social interaction provide a fuller context to the subject’s perception of their health and well-being. Without these, I argue, we are guilty of merely addressing the person as a physical/bio-mechanical entity.

2) Differential assessment questions deepen the inquiry and reduce risk of harm or adverse reaction to massage therapy care. We might consider a framework of identifying yellow or red flags, as outlined in Petty & Moore’s excellent text Neuromuscular Examination and Assessment.

For example, “How is your general health? Are you experiencing any feelings of general malaise or fatigue, fever, nausea or vomiting, stress, anxiety or depression?” Feeling unwell or tired is a common symptom with neoplastic disease, while malaise and depression can associate with rheumatoid arthritis.

“Have you or has anyone in your family been diagnosed with Rheumatoid Arthritis?” Collagen necrosis of the cervical vertebral ligaments is a concern in spinal mobilization, or other joints during the acute inflammatory stage. Care should be taken with movement of the neck.

“Have you received X-rays or other medical tests?” X-rays are ordered to diagnose fractures, arthritis and serious bone pathology such as osteoporosis or tumour, and to determine the extent of the injury following trauma. Other imaging includes CT scans, MRIs, myelography and bone scans. Considering the individual is undergoing such tests is a yellow-flag to be cautious in approach.

While I understand the scope of the CMTO’s exercise is to identify relevant and appropriate lines of RMT inquiry in the health history, and to position consent and disclosure squarely with the patient, I believe the regulator is facilitating an excellent opportunity for RMTs to build on their discernment and critical thinking when considering the risks of adverse reactions to massage therapy care, and that this opportunity should be seized to advance our discipline. See Dr. Donelda Gowan’s instructive thesis, Exploring Patient Safety Issues in Massage Therapy, and Understanding Patient Safety Incidents (Adverse Events).

3) There’s an opportunity to collect more qualitative data from our patient engagements while at the same time creating secure, comfortable boundaries for them. In Pam Fitch’s comprehensive Talking Body, Listening Hands: A Guide to Professionalism, Communication and the Therapeutic Relationship, she provides a simple graphic (chapter 7) for patients to indicate gradient levels of comfort with touch. The patient is encouraged over time to resubmit the graphic, observing how openness to touch and care changes positively over time. I suggest the CMTO’s draft health history guidance falls short in addressing such contextual issues and biopsychosocial frameworks in structuring the proper conduction of a health history.

Thank you for the opportunity to comment on this important exercise.