The new CMTBC standard of practice on professional boundaries took effect on July 1, 2018. CMTBC has heard from some RMTs that they would like clarification on what section 10 of the standard means for the practice of accepting tips from patients, particularly in spa environments where the practice is more common. Section 10 of the boundaries standard states:

An RMT refrains from giving gifts to patients or receiving gifts (including tips) from patients, except where the RMT’s objectivity or ability to act in the patient’s best interests will not be compromised.

The standard does not mean that RMTs cannot accept tips under any circumstances. Rather, it means that an RMT must always exercise professional judgement in terms of reflecting on and assessing whether and how a tip or gift from a patient might affect the RMT’s professional relationship with that patient. A tip may be accepted where the RMT believes that it will not compromise his or her objectivity and ability to act in the patient’s best interests.

Many RMTs do not accept tips because they believe that it is inconsistent with delivery of massage therapy within a medical model. Some RMTs do accept tips. Both positions are acceptable under the new standard of practice, provided that the decision is based on a consideration of the RMT’s objectivity and the patient’s best interests.

If you, as an RMT, decide to refuse an offered tip in circumstances where it may constitute a boundary violation, and/or because your objectivity or ability to act in the patient’s best interests would be compromised, you may thank the patient for the gesture but politely decline. You may use the opportunity to explain why the tip is being refused, in a sensitive and gracious manner.

In exercising their professional discretion, RMTs should consider factors such as why the patient has offered the tip, and the value of the tip.