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.

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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, Oncology Massage

Into the Rabbit Hole

I have a writing task.  A big one.  I am choosing to take the advice of The Little Book of Talent and keep the biggest plans secret.  It’s not important to know exactly what the task is, just that it is.

 

I have been a writer since second grade.  Our teacher told us to write a Halloween story, and I went to town.  I had elaborate costumes, a haunted house, multiple plots coming together, and a hero facing certain ruin by ghosts.  I also had what I later learned was a deus ex machina — an ending dropped from the sky where the hero of the story got to survive and get away all in one piece.

 

Okay, it was a ghost extinguisher.  I gave my hero a ghost extinguisher.

 

So, maybe plot-wise, it wasn’t my best effort.  But for sheer love of the process of writing, it was enough to keep me hooked for years.  I can still feel what it was like to sit at the dining room table and write that story.  How I could hardly move my pencil fast enough.

 

As many things do, writing became both easier and harder as I grew up.  I learned about plot and foreshadowing.  About the nuances of character and exposition.  I also started writing essays, nonfiction.  I practiced translating facts into a readable story.  I found that this worked best for me if I had piles of facts and supporting facts that I could pick and choose from in the process of writing.

 

I felt most comfortable drawing from a deep well.

 

close up of rabbit on field
Photo by Pixabay on Pexels.com

Which brings me to today —  my writing task, based in fact and research and looming large over my life for the next several months.  I am breaking it into smaller pieces, and finding that each piece comes with its own rabbit hole attached.  These pieces sit before me like tiny cyclones, and if I’m not careful I could get sucked into the vortex of each one, disappear for a while, and come back with not even a pair of ruby slippers to show for it.

 

Today I am perched on the edge of a rabbit hole, trying not to dive in.  If it weren’t so fascinating, if every piece of information didn’t lead to twelve others, if I could just write one crappy sentence —

 

There it is.  The thing I keep banging up against is the first sentence.  More precisely, allowing the first sentence to be crappy and moving forward anyway.  Because, as I used to tell my writing students, revision is more than half of the writing process.

 

It may help me to look at this craft the same way I look at the craft of a massage.  Prepare.  Deeply and thoroughly prepare.  Then, when the person is in front of me, empty my mind and trust that the training is there.  Right where I left it.  Just make contact and go.

 

Just write that crappy first sentence and go.  Forward.

Thoughts on the profession

The Imperfection of Sight

“It wigs people out when someone actually sees them.  And it wigs us out to fully see ourselves.”

I am fortunate to be able to teach in a number of different venues, and I love them all.  My favorite, though, is the almost overwhelming intensity of a short workshop. With a room of people who have chosen to spend their time and money in a very particular way.  I teach continuing education, and in the workshops we often take time to consider ourselves, and what version of ourselves we bring to our clients. 

A few days ago, we were talking about working with people who are seriously ill.  We were considering medical decisions, and what we might do if we are working with someone who makes a decision that is different from one we might make.  The question on the table was about a specific case; about our thoughts, resistances, and feelings.  It was about what we would do.

Everyone in the room took the time to think about the question.  They sat in their groups and talked animatedly with each other and when we came back together, they gave their thoughts in echoes. 

Of course we would work with this person. 

We are massage therapists.

It’s not our concern what decision someone makes.

And that was the end of it.  Or was it?

I agreed with and believed everything they said. We are compassionate professionals and we practice unconditional positive regard.  Everyone’s health care decisions are their own to make.

And yet.  After the work is done and the client feels better and we get home alone at night with our feelings and our truth, what is there? Is there only a practiced neutrality that never allows for any conflict or feeling of distress?  Are we that good?

We are not.  I know deep in my own being we are not.  Because we are human.  The thing we are good at is hiding the uncomfortable bits of ourselves.  Our fears.  Our prejudices.  Our anger and our hurt. 

There were only a few minutes of class left.  So, I took a deep breath and offered some homework.  Dig a little deeper, I said.  I told them the truth.  I had conflicted feeling about working with the person in our scenario.  I saw wasted resources in the decisions being made.  I have prejudices that are causing me tension around the whole situation. 

If we don’t take out our darkest feelings and consider them, how do we trust our light? 

Remember when you were a child and were scared of the monsters under the bed or in the closet? Remember that a swift antidote to those fears was to go and look.  Put on a light and see the places where your fears reside. 

ancient art artist artistic
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It wigs us out when we see ourselves.  Because when we do, we must acknowledge the parts of ourselves that are not kind, not loving, not full of unconditional positive regard.  In our oversimplified way, we might think this makes our kindness and love somehow invalid.  What is does, really, is give us the tools we need to make our kindness and love richer and more true.  It saves us from collapsing under the weight of our unacknowledged shadows.  It returns us to our wholeness. 

The students left with the homework.  I hope they went home and looked into their own hearts and saw everything, or a little closer to everything.  I know some of them did not.  But I believe some of them did, and that is enough.  It is imperfect and it is enough. 

Inner World, massage education, Massage Tales, Thoughts on the profession

How Did I Get Here: Part 1

Next year will be my ten-year anniversary as a massage therapist.  Massage therapy is about my fifth career so far.  I’m happy to walk you through the other four (or so), but not right now.  Today I’m thinking about how I got here, to this career, the one that has lasted the longest.

About a decade ago, I worked as a marketing assistant at a big, fancy retirement community.  My job involved supporting the sales team, helping with events, and sometimes helping new residents move in.  For some new residents, I went to their homes and helped them measure out their new apartment and what could fit into the space.  I bent down to count outlets and find the exact placement of cable jacks in their new space.  This all happened in between doing all the office and administrative support work that was part of my job.

My favorite parts of my job were these moments working directly with the new residents.  I remember one day, I stayed in a new resident’s apartment to direct the movers while she took care of things at her old home.  She had a beloved Turkish rug cleaned and delivered to the apartment first thing in the morning.  I pulled the rug into the apartment and unrolled it in her bedroom, delighted to find that it fit the room exactly.  While I straightened the rug and checked it, I called her to let her know it fit.  I heard her smile through the phone.

The rest of that afternoon, I sat at my desk running marketing reports and updating our database.  It was mind-numbing.  When I couldn’t take it anymore, I left the Sales Office to go take a walk around the community.  I pretended to check on all the common spaces since we had an event later in the week.  Near the large community room, I ran into Mrs. G, who I helped move in about a month before.

“I met some lovely women at lunch today,” she said.  “They were also your chickens.”  Mrs. G called herself, and everyone whose move I assisted, my “chickens.”  Slightly agitated, somewhat befuddled but carefully tended, and definitely well-loved.  The metaphor made me smile.

agriculture animal baby beak
Photo by Achim Bongard on Pexels.com

The job, I realized, as I walked down the hall, did not.  The best parts of my day were the moments were I got to work directly with the residents in some way, to be of service.  I wanted something that involved direct care.  I circled past the nurses’ office and considered becoming a nurse, then realized that the nurse had strict, short time constraints on most visits.

I wanted something where I could spend more time.  As I walked back towards the Sales Office I remembered an idea from a long time ago — massage therapy.  Direct care.  Lots of time.  Being of service.  It felt perfect.

So, that is how I first started looking into massage schools — 12 years after I first had the idea of becoming a massage therapist.  But that’s a story for another time.

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