Thoughts on the profession

The Other 40%

I recently got back home from the International Massage Therapy Research Conference in Alexandria. If you’re not familiar, basically this is a nerd conference where massage therapy nerds can nerd out together. It is exactly up my alley, and I left feeling mostly inspired, energized, and just a little bit smarter.

On the surface, most of the conference was about pain. Chronic pain, the opioid epidemic that grows from (mis)treatment of chronic pain, the efficacy of massage as a treatment for all kinds of pain. For me, however, one other theme emerged from the conference, and that theme was: Health Equity.

During the first panel, three presenters talked about integrating massage therapy as a way to address the opioid epidemic. The first presenter threw out a sentence or two about cost, and quickly moved on to other things. The second presenter talked about integrating massage therapy and other integrative practices into the VA healthcare system, and the positive results that followed.

Yay, massage, right?

But as I sat there, I grew more and more uncomfortable. What about people who didn’t have access to either money or the VA healthcare system? What about the many (many) people in chronic pain who don’t have the extra income to spend on massage therapy, or other integrative practices that are not included in health insurance? What about the many (many) people in chronic pain who have no health insurance?

I struggle with this at some level almost every day. I am a sole practitioner, trying to make my living with a private massage practice. I do not take insurance, for a number of reasons. My services are out of reach for some people. I have an uneasy compromise, in that I offer a sliding scale to anyone who tells me they need it. But still, just the location of my office puts me out of reach for some people who don’t have access to a care.

Photo by Inzmam Khan on Pexels.com

And, being a human, I do not want to suffer this dilemma alone. I want the entire massage therapy profession to spend more time thinking about equity, about creative ways to make our services available to more people.

Let me clear: I am not talking about volunteering. The truth is that we live in a world that often equates value with money. The things we value are the things we pay for, and in order for massage therapy to be valued, it needs to be paid for. We are healthcare professionals who should be compensated, just as a physician, physical therapist, or nurse practitioner would be compensated.

Later in the conference, one of the speakers put up a colorful pie chart which showed the factors that really influence health outcomes. In her chart (and others I have looked up since,) clinical care (doctor visits, etc.) accounts for only about 10% of health outcomes. The largest pieces of the pie chart were health/lifestyle behaviors (30%) and socioeconomic factors (40%.)

Socioeconomic factors. 40%.

The speaker completely ignored this part of the chart. It sat there on the giant slide projected over her shoulder, and she didn’t mention it. Instead, she spent about a third of her presentation talking about health behaviors, and the influence we could have on these behaviors.

I get it. It feels good, and doable, to talk about influencing smoking cessation or encouraging movement. We can wrap our heads around health behaviors.

Socioeconomic factors are big and tough and scary. To really look at these things, we have confront things like institutionalized racism, housing disparities, and a long American history of devaluing humans based on their perceived otherness. We may even have to confront our own unconscious biases and prejudices. It will get messy, and there will be no such thing as uncomplicated success.

But we ignore that 40% of the pie at our peril, and the peril of our fellow humans. As several of the speakers at the conference said, we don’t just have an opioid epidemic in this country. We have an epidemic of epidemics. Pain. Opioids. Dysfunction. So many ways that people are suffering, often needlessly.

I have been reviewing the Health Equity Report for Louisville. In most of the report, the maps for different diseases are darkest in areas of economic disparity. We can not, must not, ignore this. It is inspiring to talk about integrating massage into total care, to research the effects of integrated care, but if we do not also consider how to bring integrated care to those darkly shaded areas of the health equity map, we are just watching ourselves move around a mirrored funhouse.

I don’t have an answer. Right now, what I have is frustration and emerging awareness of my own blind spots. Also, a resolve to never unsee what I am seeing now. I am seeking to educate myself, to listen, to work even more with groups who are trying to address health inequity in my own city.

I have no answers, just open eyes and ears willing to listen. So, tell me, what do you think we can do to address health inequity in our neighborhood?

Inner World, Thoughts on the profession

Be the Weirdo

There are so many conversations I would like to have about massage therapy, and about health care in general. The one about equity and accessibility of care. The one about basic massage education and its preparation (or lack thereof) for a career. The one about how much to charge and when/if to raise your rates. The one about complementary and alternative and where does massage live.

That last one — the complementary/alternative one — has been on my mind lately. For myself, I’m pretty firmly decided that massage therapy is complementary in nature, and is most effective when used in concert and communication with other forms of care. What’s on my mind is how we think and talk about those other forms of care.

I am struck by how many people come through my office and will tell me about their doctors with an eye-roll or knowing wink. Some will straight out tell me that their doctors are scam artists who are just in it for the money. I am working on changing this kind of talk.

There are better and more productive conversations we can be having about healthcare right now. I’m working with some super-smart nerds at Healwell trying to have those conversations in public.  In my daily private work, it’s a little more challenging.

It all comes down to acknowledging the feeling behind the words, the hidden voice that speaks through the filter of disdain for traditional medical care. And to honor that, to hear it, I need to ask better questions. Questions like: where did you feel unheard? What calms your mind? What wakes you up at night? And, when I’m feeling a little combative, questions like: do you think doctors go to medical school because they want to hurt people? How would you handle a day scheduled around too little time with every one of your patients?

Questions that want to look directly into the heart of the heart, the deep and vulnerable truth that always comes out somehow. This is terrifying, for both me and my clients. I am not sure how to do it.

I am bolstered by a conversation I’ve been having with some of the people I traveled with last month. In the country we visited, the standard greeting was a warm, heart-to-heart hug, sometimes with a kiss on the cheek. People we met thought it was strange that we would wave and say “Hello” without reaching out to touch them. We got used to the hugs and the human connection.

As we got home, some of us joked about becoming the “weirdo hugger” in our workplaces. But at the same time, many of us noticed that the same people who thought it was weird when we hugged them, would linger a bit until they got their hug. Every day.

This makes me think that we really do want to connect with each other in some real way. We have just built some of the most elaborate defensive systems on the planet to protect ourselves. And sometimes all it takes to get through those defense systems is to become the weirdo. Hug the people. Ask the questions. Start the conversation.

It’s not always going to end well. I have had experience with that this week. I had a couple of honest conversations. The outcome was not ideal, but my comfort and peace in my own soul was off the charts.

Weirdo power.

massage education, Massage Tales, Modalities, Oncology Massage, Thoughts on the profession

Interdisciplinary

How about a quick peek into the emerging future of healthcare?

Interdisciplinary:  integrating knowledge and approaches from a variety of different approaches

Interdisciplinary Team: a group of professionals from multiple disciplines working together toward a common goal

I have been thinking and reading a lot about interdisciplinary teams in healthcare.  As the abstract “aging American population” becomes more concrete, both in my practice and my personal life, I am seeing humans who interact with multiple professionals, all for their individual care and keeping.  I am seeing this done very very well, and very very not-so-well.

What is clear to me is this:   the future of healthcare is interdisciplinary.  It is both necessary and desirable that humans have access to multiple professionals to address the multiple and complex needs of their healthcare.  Also:  the future requires us to communicate with one another.  While I know and massage and sometimes take care of people who are receiving interdisciplinary care, that does not always include great communication.

Take, for example, the cancer patient who also has hypertension*.  The oncologist and the nephrologist ask the patient for reports from other physician visits, but they are not asking to communicate directly with each other.  And neither of them wonders about the massage therapist who has been working with the patient since the cancer diagnosis.

In an ideal interdisciplinary world, patients could have access to a wide range of professionals and those professionals would speak to each other on a regular basis.  They might even, I don’t know, learn from each other and gain creative insights into sticky healthcare questions.

Unicorns!  Fairies! Rainbows!, you say?

This is not only possible, it is happening.  Wouldn’t you like to hear from a real interdisciplinary team about how they put it together, how they keep it going, and maybe even how the massage therapy profession can contribute?

You are in luck!

Starting this September, I will be hosting a monthly webinar series for Healwell where we explore these very questions.  We have secured some of the most interesting people working in healthcare today — the people who are asking the questions and creating the change.  Come and join us for the Interdisciplinary Clan of Mystery, where we explore how to deepen our service to the humans we care for, and broaden our perspective to invite collaborations, curiosity and plain old increased clinical knowledge.

We are going to have some fun, challenging, thoughtful, and (best of all) interactive conversations. Join me to take a peek at the disruptors, innovators, and smartest people working in healthcare today.

 

*–patients mentioned are composites or theories and do not represent actual humans