The Therapist’s Guide to Build a Referral Base – Part II
By Dr. Ross Turchaninov, Phoenix, AZ
Part I of this article discussed the basic communication rules between therapists and local medical communities. Here is the link to Part I:
HOW TO COLLABORATE WITH THE LOCAL MEDICAL COMMUNITY
Now, it is time to discuss whom to approach in the medical field to create a healthy, productive referral base for patients who desperately need help. We finished Part I by defining the therapist’s primary target: family doctors or Primary Care Physicians (PCP).
Let’s put ourselves in the shoes of a PC physician whose office is unfortunately underpaid by medical insurance companies and overwhelmed with a large number of patients looking for answers to their pain and dysfunction. Medical insurance companies’ greed pushes the PCP office further to cut time for direct interaction with their patients. It is a widespread practice to give each patient 10 minutes of a PCP’s time.
Each PCP office has a number of patients with various types of somatic pain and dysfunction, and the doctor doesn’t have viable solutions anymore. Let’s say that a patient has suffered for months from shoulder or lower back pain. The PCP has already tried different medications and sent the patient to a physical therapist, a chiropractor, a rheumatologist, an orthopedic doctor, etc. Some of their patients have already used massage therapy, acupuncture, and even had surgery but are still in pain!
These patients form a ‘dark cloud’ in a PCP’s practice since all treatment options are exhausted, but the patients continue to visit the clinic, demanding help and answers. However, family doctors have used all available treatment options and have nothing more to offer. Seeing these patients on their schedule only triggers anxiety for the physician.
Medical Massage practitioners who are confident in their ability to deliver stable clinical results would like access to these patients. If a therapist is successful in treating patients from the ‘dark cloud,’ it will open bridges to the medical community and build a healthy MM practice.
Many therapists have tried to contact members of the medical community and have failed. We read about this in the comments under Part I of this article. Unfortunately, therapists are using incorrect methods to build referral relationships.
The three most common mistakes while trying to get in direct contact with the PCP office:
- Application of therapies that don’t have a solid scientific basis
- Attempt to impress the physician with personal credentials
- Justify professional expertise with endless soap notes
Doing those won’t work. It needs to be done more professionally and effectively. There are two paths to success: quick and slow.
Quick Path:
The quick path is straightforward and efficient. If the therapist decisively helps a doctor or family members with complex cases of somatic pain and dysfunction and is able to explain the goals of their therapy and treatment protocol, then the therapist will quickly establish referral relations with that medical office. Be sure to ask for the most complex somatic pain and dysfunction cases. Successful relations with one clinic will allow you to build bridges with the rest of the local medical community.
Slow Path:
The longer path may take some time, but it works very well. The therapist should have a physical location for their clinic. The first step is to list PCP clinics within neighboring zip codes. Create a file for each doctor, including their education and credentials.
Next, ask every new patient who comes to your clinic for the name of their PCP and match it with your records. Then, put the PCP information in the patient’s file and a copy of your patient’s notes in the PCP’s file.
If your therapy was successful and stable clinical results were achieved, ask the patient to inform their family physician about the effectiveness of your treatment. However, the most important part is direct communication with the PCP office. You should send a very short version of your notes to the doctor’s office. It should have only one goal: the professional courtesy to inform the physician what was done for the patient and the therapy results.
The medical assistant will scan and insert the information you sent into the patient’s file. In this manner, you are sharing the patient’s medical records from your clinic with the PCP office, the same way a gastroenterologist, for example, sends short notes about treatment progress to the patient’s PCP.
Information sent to the PCP office must be a very clean and sharp professional exchange without even a hint of you promoting yourself or your business. The therapist may fax (preferably) or mail notes to the office. Do not call or try to get in touch with the doctor yet! Here is an example of a letter to a PCP clinic that you will accompany with notes.
YOUR CLINIC TITLE
Contact Info
Subject: Medical Massage Therapy Report for [Patient Name]
Date
Dear [Provider’s Name],
I hope this message finds you well. I am reaching out to share important details regarding the medical massage therapy sessions I had the privilege of providing for your patient, [Patient Name]. A total of [Number] sessions were completed, and I am including information on the soft tissue evaluation and specific therapies utilized.
Please find the attached documentation outlining the treatment approach for your records and any potential insurance claims. If you have any questions or require further details, please don’t hesitate to contact our clinic.
Sincerely,
Since most clients/patients, therapists, and family doctors work within the same and neighboring zip codes, it is just a matter of time before encountering a second patient from the same PCP clinic. After solving each clinical case, ask that patient to inform their physician about the success of your therapy and fax/mail the letter with your notes. After you’ve helped three patients from a specific PCP office, it is time to set up an interaction.
Your previous communications with the office laid the foundation for future cooperation; now, the interaction will require your credentials and clinical expertise. Ask the office manager for a short lunch meeting with the doctor, bring lunch to the office employee, and ask about the most complicated cases of somatic pain and dysfunctions while talking with the physician. This is the moment of truth because you give the physician the option of a clinical solution that can be immediately passed on to the patients.
Let’s say the patient didn’t listen to the doctor’s recommendation and never contacted your clinic. We guarantee that when the patient returns to the PCP office with the same complaints, the doctor will ask if they contacted your clinic. Now, the ball is in the patient’s corner. With this simple act, you immediately give the family physician leverage to psychologically deal with the patients who demand help but refuse to cooperate. We witness similar situations weekly because some PCPs our clinic works with call us directly while having the patients in the examination room and insist that patients make an appointment to seek Medical Massage help.
Documentation to Send
The most important part of the data therapists should send to the PCP office is notes. While working with therapists undergoing SOMI’s Medical Massage Certification, we noticed common mistakes they make. They include detailed notes about patients, what they found, and every step of the treatment process to impress doctors. Nobody will read those pages; they will only trigger irritation. Instead, the notes sent to the PCP office must be short and clean with proper references. Here are the form and an example of notes the therapist should consider sending to the PCP office as a professional courtesy.
The evaluation of the soft tissue presented below summarizes SOMI’s training and reflects the clinical science of somatic rehabilitation. Therapists who are not familiar with this content may alter the evaluation. We will take as an example a patient from our clinic with the following diagnosis: Posttraumatic Rotator Cuff Injury / Early stages of Frozen Shoulder.
Form:
YOUR CLINIC TITLE
The patient allowed the sharing of info with a health provider.
Patient: <name>_________________________ _________________________________________
Primary Care Physician: <name____________________________________________________________________________
CHIEF COMPLAINTS
|
Pain in the right shoulder |
Tingling down to the forearm along C6-C7 dermatomes |
Active flexion – 70 degrees |
|
Intensity increases with ROM and at night |
Active abduction – 50 degrees |
Inner rotation – severely restricted |
INITIAL EVALUATION
|
SKIN |
Sensory Test – positive along C6-C7 dermatomes (radial nerve distribution) Dr. Kibler’s I Test – Thickening of the dermis on the posterior shoulder |
|
FASCIA |
Dr. Kibler’s II Test – Restrictions in superficial fascia over right Deltoid m. Lateral Shift Test– Restrictions in the deep fascia that separates Trapezius m. from Supraspinatus m. |
|
SKELETAL MUSCLES |
Active Trigger Points – Trapezius, Supraspinatus, Subscapularis, Pectoralis Major, and Minor mm. Myogelosis – Horizontal portion of the right Trapezius m |
|
PERIOSTEUM |
Periosteal Trigger Points – superior and anterior surfaces of the Acromioclavicular Joint
|
|
COMPRESSION and FUNCTIONAL TESTS |
Compression Test (CT) – CT on the pectoralis minor triggered numbness along C6-C7 dermatomes Functional Test – Hawkin’s Test and Drawban’s Sign are positive |
MEDICAL MASSAGE THERAPY
- Lymph-drainage Massage to decrease interstitial edema.
- Connective Tissue Massage and Mobile Cupping to decompress superficial fascia
- Lateral Shift Techniques to decompress deep fascia
- Re-lubrication of the fascia
- Trigger Point therapy in active TPs, a decrease of perifocal tension around a core of myogelosis in the trapezius m.
- Post-isometric Muscular Relaxation to reset muscle spindle receptors, eliminate their hyperirritability, and restore normal reflex relations with the patient’s motor cortex
- Periosteal Massage around the AC joint to eliminate periosteal trigger points
- Passive movements and regular homework stretching
CLINICAL OUTCOMES
Complete shoulder and arm pain elimination, full ROM restoration, and sensory deficit elimination along the radial nerve.
We hope these two articles will help therapists start productive professional relations with the medical community and help many patients with chronic somatic pains and dysfunctions.
LIST OF ORIGINAL REFERENCES
Chaitov, L. (1998). Soft tissue manipulations. Healing Arts Press.
Cyriax, J. (). Theory and practice of massage. In Textbook of orthopaedic medicine (Vol. 2, [page range]). 11th ed. Bailliere & Tindall. Toronto.
Glezer, O., & Dalicho, V. A. (1955). Segmentmassage. Leipzig.
Goats, C. G. (1991). Connective tissue massage. British Journal of Sports Medicine, 25(3), 131-133. https://doi.org.
Kurtz, I. (1990). Textbook of Dr. Vodder’s manual lymph drainage (Vol. 3). HAUG, Heidenberg.
Mezlack, R., & Wall, P. (1965). Pain Mechanism: A new theory. Science, 150 (Nov), 971-979.
Mitchell, F. L. (1995). The muscle energy techniques manual. MET Press, East Lansing.
Pratt, R. L. (2021). Hyaluronan and the fascial frontier. International Journal of Molecular Science, 22(13), 6845. https://doi.org.
Roman, M., et al. (2013). Mathematical analysis of the flow of hyaluronic acid around fascia during manual therapy motions. Journal of the American Osteopathic Association, 113, 600–610. https://doi.org.
Travell, J. G., & Simons, D. G. (1983). Myofascial pain and dysfunction: The trigger points manual. Williams & Wilkins, Baltimore.
Turchaninov, R. (1998). Medical massage (Vol. I). Aesculapius Books, Phoenix.
Turchaninov, R. (2002). Medical massage (Vol. II). Aesculapius Books, Phoenix.
Vogler, P., & Krauss, H. (1975). Periostbehandlung, Kolonbehandlung. Leipzig.
ABOUT THE AUTHOR
Please click here to read Dr. Ross Turchaninov’s bio: https://www.scienceofmassage.com/editorial-board/
Category: Medical Massage
Tags: 2025 Issue #1