S2E5: The Need for Touch Never Goes Away

Episode 5

May 1, 2021

Jill Cole joins the podcast this week to talk about truly advanced clinical practice, elevating patient care, and building interdisciplinary care. It's not about your hands, it's about what your brain tells your hands to do.

Image for S2E5: The Need for Touch Never Goes Away


Jill Cole joins the podcast this week to talk about truly advanced clinical practice, elevating patient care, and building interdisciplinary care. It's not about your hands, it's about what your brain tells your hands to do.

Continue the conversation in the Healwell Community: community.healwell.org

Support your favorite interdisciplinary nerds! Join us on Patreon for early access and special bonus materials: patreon.com/interdisciplinary

About Our Guest:

Jill Cole is a 1998 graduate of the Boulder College of Massage Therapy, in Boulder, Colorado, and has worked in the field of massage therapy as a clinician, educator, presenter, and researcher ever since. Having worked closely with physicians, nurses, physical therapists, acupuncturists, chiropractors, talk therapists, and other allied health professionals, Jill brings a comprehensive approach to hospital-based massage therapy and patient care. Jill has served on professional boards for the American Massage Therapy Association-KY, and currently sits on the National Board of Directors for the Society for Oncology Massage. Jill Cole is also the former Director of Clinical Education and Director of Education for the Lexington Healing Arts Academy, in Lexington, KY. Additionally, Jill is licensed by the KY Board of Massage Therapy, Board Certified by the National Certification Board of Therapeutic Massage and Bodywork, and holds a Master of Arts in Higher Education Leadership, from Siena Heights University. Jill works at UKHC Integrative Medicine and Health, where she is the Massage Therapy Coordinator.


Cal Cates 0:10

Hello, I'm Cal Cates

Cathy Ryan 0:12

and I am Cathy Ryan.

Cal Cates 0:14

Welcome to another episode of Interdisciplinary. In this podcast, massage therapy educators, practitioners, and positive deviants, Cathy Ryan and me, Cal Cates. We use research, science, experience, and humor to explore the broad landscape of healthcare and humanity, really, through an interdisciplinary lens because isn't our experience interdisciplinary as humans? You'll always learn something, you'll always laugh, and you'll always come away better informed and with real things you can do in your own community and practice to create a more compassionate and collaborative system of care for all humans. I want to make sure to invite you all to our private Interdisciplinary community at community.healwell.org. You can join for a month, you can join for a year, you can dip your toe in, you can dive all the way in. But if you enjoy the conversations we have here on the podcast, we're having even more conversations like this in the community and it's a great place to learn from and with your fellow practitioners across disciplines. Make sure that you share the podcast and link and do all the things so that all the people in your world and life know to come and listen, leave us a review, give us some stars, all the things. So now, the moment you've all been waiting for - today's pun. I actually had kind of a hard time deciding. I'm glad this is a weekly situation, so I know we don't have to wait that long for the also incredible pun that I didn't pick today. You guys might actually know this one. Did you know why koalas aren't bears?

Cathy Ryan 1:39


Cal Cates 1:40

They don't meet the koala-fications.

Cathy Ryan 1:41


Cal Cates 1:48

That's right. So, Cathy, what is happening in British Columbia, aside from laughing at really good koala puns?

Cathy Ryan 1:58

COVID is happening, it's still happening. Vaccine rollout has had some issues here in Canada. People are getting vaccinated. It's slow, for a variety of reasons. And I'm still encouraging everybody to wear masks, and be smart, and keep your distance. And most recently here in BC, there was a travel ban that was issued within the province itself. So we have, I think it's five health districts in our province. It's a very, as I've mentioned before in the podcast, BC is a very large province, somewhere between the size of Texas and Alaska. So it's a big province. So we have five different districts. So now our health officials, our public health officials are asking everybody to stay within their own health district and not travel about in the province to try to get things tempered here. That's where we're at. How about you, my friend?

Cal Cates 2:59

Well, I think I would say, we're still in denial in a lot of ways. We're seeing a relatively steady plateau, but we're not seeing like a decrease that would really, in incidence or death rates, that would say that the restrictions that are being lifted are well informed. I think we just see a lot of policy makers and decision makers sort of caving to the pressure that is mounting from people to just, quote, go back to normal. So I think, I do think that the vaccination rate is getting to a level where, hopefully, these changes and restrictions will extend the plateau rather than support another spike but I don't think we really know until we know, and I wish that people would just keep their masks on and keep being safe. But I don't know that that's going to happen, so we'll just keep watching it and doing what we can to educate and advocate.

Cathy Ryan 3:53

Same here.

Cal Cates 3:54

Yeah. So I bet that COVID will come up a bit as we talk with today's guest, our chum and colleague, Jill Cole. Jill, I'm not even going to try to say what your new fancy title is. I'm just going to tell the people that we're really glad you're here, and let you tell us where you are and what you're doing and why do we care about all the things you're going to tell us?

Jill Cole 4:17

Well, thanks, Cal, thanks, Cathy, for having me on on the show today. I'm Jill Cole and my official title is the Massage Therapy Coordinator at Integrative Medicine and Health. It's a part of University of Kentucky Healthcare and we're located in the Markey Cancer Center. But our goal is to be able to provide integrated medicine services throughout the enterprise and we're getting there, slowly but surely. I'm a massage therapist, I've been in the field for, I think this is my 23rd year, since 1998. So I've just, I'm just really stoked to be here. I have a background in massage education and research, I have a master's in higher education leadership. And, yeah, viewers can't see me but I actually have my mask on. Talking about COVID, I'm actually in the hospital, in the clinic today. And, you know, I think it's one of the things while, one of the things that just came out while you all were talking, is I've been getting hit with a lot of questions from other massage therapists now that we're all, you know...can, you know, if I'm vaccinated and my client's vaccinated, I'm thinking, I think we can take our masks off in the treatment room, I think it's perfectly fine to, you know, to move forward. And in Kentucky, particularly, the governor, we have a mandate, which supports, boosts our efforts that we remain masked and have eye covering and, in the hospital, we're, we're masked, eye covered, gloves, you know, anyway, the only, two things that are evident during COVID that weren't pre-COVID really are the masks and the eye covering all time, you know, so, which I'm very grateful for as well. I get off easy because I have Infectious Disease kind of at my fingertips. If I have any questions, we just call Infectious Disease, part of the hospital, you know, and they have been just our allies. We were shut down just for a short time last year. IMH, Integrated Medicine and Health, opened up, back up, our massage services once the governor gave us the go ahead that, yes, you can treat. Another, unfortunately there's another hospital system in Lexington that that didn't happen. And that, to me, that's very sad that they, and they're still not treating patients in the hospital. So I'm just very fortunate that our administration really sees the value of what we do and why. And we're still inpatient treating, and we're outpatient as well. So, yeah, that's a little bit about me.

Cal Cates 7:08

That's awesome. So you guys are the Integrated Medicine and Health program. It sounds like you are everywhere on the hospital campus, you're inpatient, outpatient. Tell us all the environments where therapists are working and how many, like what's the shape of the program? How many massage therapists, what other disciplines are, are all together there?

Jill Cole 7:27

Yeah, that's a great question. So I initially jumped on the steering committee in 2015. I was in my former job at Lexington Healing Arts Academy. I was the Director of Education at that time, and that's a local career training school that trains massage therapists and so forth. So, from that steering committee, we initially started out just in Markey, just, you know, just treating cancer patients. Now we have expanded. UK has three infusion centers so we're in three infusion centers. In inpatient, we are in cardiac rehabilitation, and also the oncology floor. One of the really cool things that has just developed is that we have Kentucky Children's Hospital here. And we're able, we're going to be able to provide 16 hours a week, it's the start, of inpatient services to the kids. The Director of Palliative Care, the physician there, is a huge champion and I'm just really, I'm just, I get giddy, I get really excited. And so that's another place that we're getting ready to expand in terms of inpatient. Additionally, we have chair massage services, it kind of got halted with COVID, but we have provided chair massages to like the campus and faculty, other healthcare providers, staff, and we're getting ready to launch an initiative to treat the frontline workers with COVID. So UK, the 10th floor and Emergency Department really are where the the big crux of handling patients with COVID and you know, definitely a lot of caregiver fatigue, a lot of burnout. So, starting May 17, there's myself right now and two other massage therapists I'm onboarding for PRN massage therapists to work on the caregivers. We had just a huge gift from one of the Board of Trustees. And we're going to be able to, probably, I think with, we crunched the numbers, we're able to get give about 250 free 30-minute massages. So it's a start.

Cal Cates 9:40


Jill Cole 9:42

Yeah, additionally, we have, we've got an acupuncturist on staff. Right now the UK HMO covers that we have Narrative Therapy, we have that goes in patient. We have a team of creative arts therapists that include, we have about six to seven music therapists. So the coolest thing I've experienced thus far being here, is giving a massage while the music therapist is in the room. So with the patient, we were giving foot massage to the patient while the music therapist was playing and the patient just went out, it was, it was really cool. The patient was good at risk. He's on the heart transplant list. So we were able to really help his anxiety. So. Animal-assisted therapy, the dogs just came back on campus last week, they're all vaccinated. So I know, you know, it's dog dominated y'all. We don't have any animal-assisted cats yet. So...

Cal Cates 10:41

I think that's a good choice.

Jill Cole 10:44

Yeah. Yeah, for sure, for sure. So that's, that's going on, which is was really exciting. We've also been able to do Telemed throughout throughout this with guided meditation, self-guided massage, yoga self-guided, some lymph drainage, and so forth. So we've been really trying to kind of broaden, kind of what we do and how we reach people.

Cathy Ryan 11:11

Jill, correct me if I'm wrong, but I think I have seen research out of the University of Kentucky around massage therapy, is that correct? I think I've seen like posters at conferences and, and so forth. Are you, are you directly involved in any of that?

Jill Cole 11:28

Um, I am involved in some and, Cathy, that's a great question because, before massage became a part of our application at UK, initially, they were a part of research, massage therapy was a part of research. We have a long partnership with different providers in doing research, there was a pretty extensive low back pain study that came out of UK. Nikki Monk is a graduate of University of Kentucky, she got her PhD here in gerontology. And so I'm, I'm actually I have an alignment with the College of Rehabilitative Science in the College of Health Science and in terms of a couple of research projects that are going on. And and yeah, I'm, I'm super excited. We've got some champions over there, I'm going to be starting a postbaccalaureate class, Lord help me in the fall. And which would hopefully, kind of help me to get through to my PhD. So I'm looking at a PhD in Rehabilitative Science with this focus on massage. So I don't know, I will..we'll see.

Cal Cates 12:41

Well, you definitely have a good friend in Nikki Monk along that path. So...

Jill Cole 12:45

Absolutely, absolutely, for sure. For sure..

Cal Cates 12:49

It's interesting, Cathy, you asked about research and I was curious, when you said that you were going to be able to provide all of these massages for caregivers and for, you know, frontline providers, are you planning to collect any basic data about that? I feel like this is a place that we have tried to crack into for years and that COVID has sort of finally helped administrators see that providers need this as much as patients need it. But I feel like once, sort of COVID dies down, everybody's going to go, you know, that's fine, we don't need this anymore. And I wonder, you know, whenever we have those opportunities, what can we measure to show like, this is just the thing that should keep happening?

Jill Cole 13:25

Right? Right. So that's a great question, because what's been on my mind is the caregiver fatigue. And there's, there's, there's been so much energy and movement around caregiver fatigue, and, and where what goes, what I'm really interested in, is coming from a perspective... I gave a talk to a group of doctors a couple of weeks ago, and the data that I gathered around self care, talked about how it is also an issue of ethics. Because if I'm not taking care of myself, my ability to do my job, my competency in my, in my best practices are compromised. And I think that, you know, from my perspective, I'm really, that's really an area of interest for me, in particular, of how can I best serve my clients? And if if I am not 100%? Or if I'm not, if I'm burnt out, so to speak, you know, that that term burned out? So looking at, you know, what, where I'm interested in doing is looking at, you know, what can we do to help our competencies? If we come from that perspective, help our ability to do our job, and that it becomes an ethical issue, and therein it becomes our responsibility to take care of ourselves just as much as it does to take care of the patient. And so the two are core, they're, they're, they're not mutually exclusive. And so, you know, I think that we have a, you're right, Cal, we there's an interesting moment that we can really say to the administration, to other providers around us, this is important and we need this. And I feel like, that is a huge area of interest for me and I don't know how it's gonna look collecting data? When we start, we're supposed to go live May 17. So, I don't know how that's gonna look. But I think it's an important question to ask, and it's an ethical question, it becomes a huge ethical consideration for all of us. You know, you think about us in massage therapy, we've known this for a long time, right? Because we're, we come from an education that's more embodied and holistic. But, you know, we go through life not just with our heads, with our whole self.

Cal Cates 15:55

Yeah, well, I think you, you make a good point that, you know, massage therapists, we know this with our brains but how many massage therapists do we know that also are fatigued as caregivers and who, you know, see more clients than might be healthy and work in environments where they don't have the kind of support they need? And so just because our brains know, it doesn't mean that we're even doing the best job of taking care of ourselves, and what does that really look like? I think we talk so much about self care, and the ways that it's not necessarily a vacation, what are the day-to-day things you can do to care for yourself and to create an environment in your work, in your home, where you feel supported? And I feel like that's one of the things that has been happening through COVID is people are finding a hard time finding support. There's commiseration but, like true support and resiliency, I think has been hard to come by.

Jill Cole 16:45

Definitely, I totally agree, totally. And I look at my, you know, from my personal perspective, I look at myself and I noticed just, you know, my energy level, that's where I really have noticed a decrease, you know. It's that, you know, that hard mental lifting that we're all doing and really trying to move through this, this time in our lives. And, you know, full disclosure, I'm fully vaccinated. You know, a lot of the patients that I see are fully vaccinated, but there is still, you know, that diligent piece of, you know, there is still in my mind, what if, you know, there's still a danger, you know, and best, what are best practices there? So, you know, I'm also guilty of not taking time for myself, for sure. For sure.

Cal Cates 17:39

Well, I think COVID has also, it's created this myth that this is why caregivers are fatigued. It's another layer, for sure, but caregivers weren't starting with a full tank. The environment of providing care, particularly in clinical spaces, I feel like is, it is not uncommon for people to feel fatigue and burnout and the various words that we use to describe just being tired, like you said, just feeling like oh, I don't have all the resources that I wish I had. And I hope that we can keep the conversation about the toll caregiving takes on caregivers, front and center, even as more people get vaccinated, and sort of the specter of COVID around every corner is less present. It's not going to sort of become less stressful to be a caregiver, that has always been something that's, that's challenging and that requires real mindfulness to take care of oneself.

Jill Cole 18:42

Absolutely. Another hospital system in the Midwest, that they have developed a particular, in their nursing program. I'm kind of paraphrasing, but it's an essentially a self care competency checklist. And they start like, the integration during the nursing program. And then, when they onboard nurses in their system, they also implement so if, say, for example, if it was a nurse that didn't go through that system, they onboard the self care training. And they have really tracked data around that and, you know, well being, you know, employee attendance, employee engagement, and so forth. And they've seen some really positive results, and this happened in pre-COVID. Because when you think about nursing, just the the level of burnout that can happen in that profession and especially for new nurses, you know, supporting new nurses, and, you know, I think it, I think it goes across the board for any other allied health professional, you know, massage therapists, and so forth. But, you know, I think, you know, the longer I'm kind of around on the planet, I will learn a little, like, I'm looking at my pinky, I'll learn a little bit more. For sure, for sure. So, you know, I just, you know, when I start to ignore or when I get on autopilot and not take care of myself, then I'm like, then I'm curious like, well, why do I feel bad you know, or I get this back pain that I'm so surprised, oh my gosh, my back has gone out, you know, kind of thing. So when, in reality, it's just having that awareness of what I need to do and how, you know, if I put it in my schedule, it is work. It's not like you say, Cal, it's not a vacation. It's work. It's part of my overall health, it's part of what we do in our active daily living, rather than a little fluffy vacation with a little fruity drink with an umbrella, you know,

Cal Cates 20:53

Which is not to say that those are not also good.

Jill Cole 20:56

Yes, those are good. Those are very good.

Cathy Ryan 20:59

When not in a pandemic.

Cal Cates 21:00

I am not anti-fruity drink. What did you say, Cathy?

When we can travel safely, we're not in a pandemic, otherwise, you can have your fruity umbrella drinks at home, for now.

Jill Cole 21:11

Definitely, definitely.

Cal Cates 21:15

So in this role, Jill, do you, do you have - I want to figure out how to phrase this - what are your dreams for the program, and are they things you can make actionable? Does that make.. I mean?

Jill Cole 21:28

Yeah, absolutely. You know, I've been thinking a lot about this. My dream for the program is to, you know, is to, for us as as as a clinic, to have just this robust outpatient clinic. And where, you know, we quickly or, yeah, well, we quickly need more space, and we're able to have satellite outpatient clinics. We're all already talking about having a space in the Kentucky Children's Hospital. That's a shared space. So identifying areas in the hospital that we can share space to be outpatient to reach family members, caregivers, of the patient, to reach staff, to reach the patient. And then my huge dream, additionally, is to create an educational program, integrative medicine educational program, and expand that, that we have curriculum in all of our, in the Medical School, in the College of Nursing, all the other allied health trainings at University of Kentucky, that they have exposure, that that would be another dream. And then the third one is really to have a vibrant research arm of IMH, where we're, you know, expanding, strengthening our partners here, or we're looking at different areas of interest from, from my staff, different, you know, questions that people really might want to, like, really discover and look into and contribute in positive ways to research because that helps with placement, with solid placement, it helps with patient outcomes, and so on and so forth. So, you know, that's really kind of my big dream, so to speak, just to take over the world wealth.

Cal Cates 23:19

Yes. with kindness and compassion.

Jill Cole 23:21

Yes, definitely.

Cathy Ryan 23:24

So, I mean, I love this conversation, and it makes me want to weep. You know, as a Canadian-trained RMT, oftentimes, when I, you know, I'm having conversations with colleagues around the world, there's always this oh, the Canadian massage therapy education and training, it's so much more than what we have, you know, wherever, blah, blah, blah. And I'm like, yes, we have a really good program in the regulated provinces, we have good national standards, but we are, we are still very much in a silo up here. You know, you all are, like lightyears ahead of us in terms of integrative care. We're just not seeing that happen in Canada, and that's kind of been one of my pet peeves. It's like, it's great that we have this education and training, but you know, we're just not getting out there, you know, to change the culture and do what we can. So you know, when I, when I hear Jill, you talk about your program, I'm like, super excited, and I'm like, oh, man, we need to get our crap together up here.

Cal Cates 24:35

Well, and I wonder, Cathy, when I've spoken with folks, and because we did some work with RMTBC and talked about, sort of, like how come you know massage. I know that one of the conversations was around nursing unions and sort of the, again, sort of, I think the misunderstanding of how we fit and how massage doesn't actually replace or challenge any existing interventions. But the sense from physical therapists and nurses and some other sort of providers that are already in the system saying like, you know, we've got this covered. And I know that we've, we've had, we still have some turf, turf enough, 'turfiness' here in the States around that, but yeah, so I don't know if there's a question in there, but I know that it's never an easy answer.

Cathy Ryan 25:24

Yeah, there is a certain amount of territorial turf war stuff. And, you know, I'm hoping that perhaps COVID - yeah, I think COVID is shining a light on a lot of areas of deficit. I know, in Ontario, their Premier, who is akin to a Governor, in the early days of COVID, came out and said, you know, just the absolute devastation that was happening in long term care homes and just how little direct care patients were getting. So the Premier in Ontario said, look, we've got to figure out a way that every patient has at least X amount of hours of direct care every single day. Because that just wasn't happening, you know, they were getting like 10 minutes in the morning to get their meds and someone drop off the food and 10 minutes in the evening to get their meds kind of thing. So and I'm like, that is a perfect opportunity for massage therapists to work in those environments and help to fulfill that mandate, should it happen and it should happen. And similarly, you know, in hospital settings, too, there are so many times when a patient is you know, being cared for in a good way with the nursing staff, but you know, times that they're just hanging out in their hospital room because the staff is overburdened and particularly right now. So it would really help ease some of the burden on some of the other staff so that they can focus on, you know, what, what they need to do, and then rmts can help to fill some of those gaps.

Cal Cates 26:59

Yeah, it makes me wonder, Jill, I don't know if you've been there long enough to be able to comment on this, but that we're in this role. But we talk a lot about the difference between multidisciplinary care and interdisciplinary care and, as I'm listening to Cathy talk, I feel like the future of good health care, of effective community-based health care is interdisciplinary and that part of how we help each other understand that the competition is pain, the competition is discomfort, it's not each other is to learn and practice actually together. And I wonder what you're observing there in terms of, you know, it's one thing to be aware that massage is a thing, it's another thing for me to be another practitioner of another discipline and actually call on the massage therapist to say, I have a patient who's dealing with this, what do you think and for us to actively collaborate in better care for this patient?

Jill Cole 27:52

You know, that's, that's a great question. I definitely think that that is, the stage is set here at UK for that and it's starting to happen. You know, what I've noticed, you know, I've been brought in, I'm starting to kind of set in on some different committees around non-pharm with adults, you know, and with pediatrics and some different committees there. And one of the things that myself and my boss talk about is how can we really, how can we broaden and get our message out to other providers within, you know, within the healthcare system? That, you know, and I think, I think it is coming? You know, it is, you're right, it's not into this big competition, you know, one of the things that I really am trying to do right now is reach out to our partners and physical therapy and occupational therapy, and really, you know, talk to them, especially the lymphedema specialist, you know, to really talk to them about what they're doing and what we can, what we, how we can partner together to treat, to treat the patient. You know, and then the whole, one of the things that I have been thinking about lately is I'm actually developing a presentation right now for providers, for family members or patients and also, you know, for their loved ones, as well as like considerations. What are some considerations for oncology massage, because, you know, educating the oncologist to say, you know, I had a referral for a patient who had a double mastectomy and she has a lot of just tension sometimes and pain where she had her implants put in. And so just, you know, that, you know, that whole pressure, you could do, could do a whole series about pressure adjustments and why. So, it's education. You know, it's like, what, what we what can we do for your patient and I feel like... we're actually getting ready to launch a new EMR June 5. We're going, we're transitioning to Epic. So right now we have a different one for outpatient, a different one for inpatient, a different one for scheduling, and my brain is like whoa! And so that is going to make it so much easier to just call for a consult for massage or any of our integrated medicine services. Right now, it's a little wonky. But the future of medicine has, is I feel like that is a huge part of the future of medicine is that it's interdisciplinary. It's not just, it's not, you don't just compartmentalize a person in their specialties, you have to think about how is this disease process affecting them as a whole, right? And so I just I think it's huge. I think it's huge, and you, we miss so much when we don't include the whole self. We miss so much of what if, you know, this person had an opportunity to write out what happened to them, what they're feeling? What if they had an opportunity to listen to some music when they're experiencing pain, when they're experiencing anxiety? You know what, the what ifs, you know what if they had that "healthy touch" while they're getting, you know, their first chemotherapy or their, or while that child is in the sedation unit? You know, what if we're working on the kid that's getting sedation for the first time, you know, or for the 10th time, you know, so it's just those kinds of things. And I think I'm just very lucky and grateful that this is happening now. You know it, I go back, I went to the Boulder College of Massage Therapy, graduated in 1998. And we were actually, I had an internship at Boulder Community Hospital and I was working on patients' bedsides - this was, this was quite a few years ago. And that really connected, started to spark in me. And when I moved back to Lexington in the late 90s, early 2000s, because I'm from here, I tried, you know I kind of had been trying over the years and it just wasn't time then. And I'm just, it's just really cool to see the, see the champions that we have now. But there, we're still a lot of work to do. Still lots of work to do.

Cal Cates 32:27

Definitely. So Jill, as you were talking about how things are emerging, and how exciting it is that this is happening now, I wonder about how we, you know, part of creating interdisciplinary care is being advocates in our own right and really actively pursuing and creating interdisciplinary care. And we see a lot of massage therapists in our training programs, and even sort of newer folks that we hire, tend to be unproductively deferential to other disciplines in a way that doesn't create an interdisciplinary environment. And when you're looking at, when we're training therapists, what we train them in has very little to do with their hands, and helping them understand that you may be an excellent practitioner of the manual therapy and, to bring a value added contribution in this environment, there are lots of other things that you need to understand and be able to do. And I wonder, how do you, how do you cultivate that and therapists in your program? What do you look for when you're hiring people? How did you get where you are?

Jill Cole 33:32

Right, this is another great question. And my first response, and I'll explain myself is...

Cal Cates 33:40

Explain yourself!

Jill Cole 33:41

Yeah, my first response is don't ask permission. And what I mean is that don't ask permission for you to do your job as a massage therapist. We are licensed, we are well trained, we have, we go through our own education to become licensed. If you take it a step further, we can also become board certified, that's a big C, you know, that's, that is a process that brings what we do even to a different level of perhaps recognition, so on and so forth. So my first thing is, don't ask permission, we have value. And this is something that I've struggled with, you know, if I'm being quite honest, you know, I have struggled with, you know, and I've, and I think it's something that we all need to, if we do struggle with it and examine it, first is to examine where we may have, you know, vulnerability or insecurities in what we do. You know, our worth, you know, we are, you know, I would say don't ask permission, we are worth what we're doing. We bring a value, and this is why. And I think, I feel like I've been driven, I've been, I've had a lot of different experiences with the field of massage therapy - over the years. Some have been incredibly, incredibly positive. Some have been incredibly, incredibly negative. But, you know, once you make that commitment, and you dive in, and you're there, you know, it for me, I, I feel like it's, I just have always felt that push and that call, maybe not in that order of, you know, get my hands on somebody. I was 22, I think, when I first had a massage, and the physiological and emotional experience that I felt was so profound, that it's still with me today at 47. And I hope that I have been able to, if it, if it's that I've been able to facilitate that, if that is there for that other client or patient, I've been able to meet that patient where they are. To me, I feel strongly that we need a seat at the table in interdisciplinary healthcare, I feel strongly that we fit in with patient care and patient health outcomes. And that we can we are, and we will continue to make a positive difference. But I just, when we're working with other healthcare professionals, we don't need to ask permission for what we do. We know what we do, you know, we're the, we are the subject matter experts in all things massage therapy and we have to help inform, educate, keep the bus going. Keep the train moving.

Cathy Ryan 36:48

Oh, oh, oh, I want to have this conversation. Yes, please, please. You know, and this just came up recently, because I presented at a couple of conferences on the weekend, people asking about how do I get certified in, let's say scar tissue work? Because that's one of the things that I chat on about as a massage therapist. And I'm like, don't look to me for that, you know, and, you know, kind of touches in on, Cal, what, what you were talking about, too, in that, you know, I think one of our gaps in massage therapy is some kind of standardized process for advanced clinical practice. So we don't often work, here in Canada, we don't work with an institution that will provide that kind of education and training for us, and I think there are various organized organizations, like Healwell, who've done a really great job of creating coursework that helps exactly, you know, get people there. What I would like to see is something really standardized in whilst having this conversation with someone, they're like, oh, what techniques would you include in that? And I said, zero, zip, none, no techniques. A technique is not an advanced clinical practice. Understanding the intricacy and the complexities of certain aspects of what a patient is going through, that is advanced clinical practice. So you know, I've said before, I could teach an entire weekend of scar tissue management and not teach one technique. I mean, I do include that because massage therapists are massage therapists, and they like to see the hands moving.

Cal Cates 38:33

Yeah, right.

Cathy Ryan 38:35

But you know, I could cover that topic matter, I think, effectively without ever demonstrating one technique. And I think people could come away with something that would help support them in delivering good care to their patients.

Cal Cates 38:52

Well, I feel like what you, what you just said, Cathy, makes a lot of sense. I'm seeing a woman next week, who is in her 90s and has advanced Alzheimer's, and her daughter contacted us because they had brought in another therapist a few months ago, this woman has a lot of contractures. And this therapist snapped a tendon on this woman's body. And, you know, I, my brain goes to "aarrrgg", you know, like, stupid, blah, blah, blah. And I, I think, you know, I bet that person is a perfectly competent therapist with a, quote, healthy body. But when you have contractures that are connected to neurological disease and when you have like, not understanding, it wasn't what that person did with their hands, it was what their brain told their hands to do because of their limited understanding of what was happening in the body. And I think that, you know, which leads me to my question to you, Jill, because you - we've been active, I'll just say, detractors of board certification, not because of the concept of it, but because of how it actually exists in our country - and what would you like to see to, I don't think that board certification, as it exists presently through the National Certification Board, is valuable. It is a, it is a piece of paper that speaks the same language as medicine and so, in that way, and I think that that's kind of where the hat has been hung is like, we have to be able to say the same things they say, but people who are board certified, aren't necessarily being held to a higher rigor or something that really does connect these dots and says to hospitals, consumers, this is an advanced practitioner. And what would you say, like if you were going to write a little love letter to NCB and say like, I would love it if this was part of board certification? Or maybe that's not a letter you would ever write and, you can hear my question under the question, about what do we need to do?

Jill Cole 40:47

Right? And, and absolutely, I do, I do hear you. You know, my background, you know, graduating from Boulder College, I graduated with about 1200 hours of actual classroom hours, another 1000 of practical hours. And, at the time, they were developing an associate's of occupational science. And, sadly, my school is not around anymore, but it was from that, you know, I, you know, I didn't know any better. I always knew that, you know, from my perspective, I had a really wonderful entry level training program. And as such, it, you know, it was expected of all of us to go through, and this was in the late 90s, and take the tests and so forth. And it was expected. But now I've, you know, having been in massage therapy education, in administration, and also instructing, you know, I definitely have seen how we've addressed some of the gaps of entry level learning through ELAP, we still have more to go. If I were talking to NCBTMB, I would, I would say, you know, what if we could really address advanced practitioner competencies across the board, you know, let's look at you know, let's look at how maybe neuropathology, let's look at, you know, a lot of different pieces in pharmacology. And I think, I think really, just how can we look at that, and I'm coming from that Boulder perspective of, kind of had it set the stage for me, and I know that that's not the norm. So that's what I would like to see, is can we identify as a, as a profession? What are some advanced practice competencies that we need to have, in order to have board certification? I think that would carry more weight. You know, and I do, I understand and see a lot of the specialty certifications that are, have come out, I've been actually helped to write the some of the test questions for oncology and so forth. But going deeper, what are the foundational competencies other than, rather than having to take the test rather than being in practice for so long, and so forth? So, so, I do agree, I think it's, I think it's more I could teach you all day about techniques, like you said, but if you know, you know, what do you, what if you go into a patient's room, and they're on the Hospice floor, and you actually know them? Right, you know, how do you deal with that situation?

Cal Cates 43:37


Jill Cole 43:39

You know.

Cathy Ryan 43:40

Yeah, I mean, that's not to totally slam techniques. I am a massage therapist, I'm still a clinician, I still move my hands around, and I love the techniquey stuff. But you know, I think that's such an important point is that, you know, I feel like our entry to practice education and training here in Canada, we've gotten to a place where it's pretty solid. There's, it's a living, breathing thing. It's going to change and evolve over the years. But I think we've I think we've done a pretty good job here in Canada of creating good national standards. But what next? You know, and particularly in the regulated provinces and some of the associations in the non-regulated provinces have a requirement for quality assurance or ongoing evolution of the therapist. And there's some tools that the regulators use to kind of, you know, ensure, you know, the CE thing is part of some of the regulators' quality assurance packages. Some of them just says you do have to do this, but we're not accrediting certain courses or we're not telling you how many hours, you just have to do this, it goes in your portfolio, we're gonna check your portfolio from time to time. But what I would like to see is that next step of having actual competency standards around advanced care for these very complex issues like neurological, like oncology, like post surgical, like mental health. You know, there's a, there's a number of these issues that are written right into our, what's called our interjurisdictional competency document, which is the framework for the national standards here in Canada. So it has these complex care areas identified, so it's already expected of us, but we have no actual framework for that, or standardization for training for that. So that's something that I am presently poking the bear. I'm hoping we'll see some forward movement. I was speaking with a colleague, and I said, I'm hoping this is my legacy piece as a massage therapist. So y'all might get emails from me, just warning you. Because I think, I think it would be great to see it as an international thing, you know, essentially, and not just a Canadian thing. So I would like to hear voices from other places, really knowledgeable, fabulous people like yourselves, I have some input on this.

Jill Cole 46:16

Definitely, I think for, in order for us to survive as a profession, we have to think about how can we evolve? You know, we had such a boom of massage therapy training, you know, 15, 20 years ago, even 10 years ago. And now, you know, we've seen the slowing, slowing of people getting into the field, there's more demand than there is supply. So it's like, we have to really look at, like you said, what is the legacy of massage therapy? How can we make it more sustainable? You know, when we look at, you know, kind of the forecasting of jobs in terms of tech, in terms of how our jobs are going to change, as you know, in the next 20, 30, 40, 50 years, the thing that has not gone away is the need for touch, the need for human contact for people. And so we have to figure out, how can we, you know, how can we stay, you know, go, you know, stay in the game. And and this is a huge piece of how we do it.

Cathy Ryan 47:30

And that's such an important point, Jill. You know, it's not like we have to reinvent the wheel because, if we take a look at every single health care profession, they've done this and they're doing this.

Cal Cates 47:43

Yeah. Yeah. And I think I appreciate you saying really clearly that, you know, I think we look at the Bureau of Labor Statistics predictions and AMTA telling us always that massage is one of the fastest growing professions and, you know, we also see an incredible, I guess, dropout rate, you would call it from, you know, within five years, a very large percentage of people, who've gone through massage training, leave the profession. And so, but I think we see those statistics, and we think, and we think about what you both just very smartly said that the need for touch will never go away. And we become complacent and we say, well, people are always going to want rubs, right? People are always gonna want to be touched, and so we don't have to worry about it. And we are, I mean, I feel like we're now able to get our whole foot in the door in environments like where you are, Jill, but we don't have our shoulder in the door, the door isn't open, you know, and it could close. It's all about what we do now in this moment, how much further the door opens and how long, and if it just stays open permanently? Or if we're, you know, 30 years from now, people are having these same conversations and wondering when, when are we going to make it?

Jill Cole 48:49


Cal Cates 48:50


Cathy Ryan 48:51

Well, and you know, for me, I think the driving force in anything that I do is the, is the care, providing the care for patients, otherwise I wouldn't still be at this after 31 years. So you know, that's my motivating factor, I think, is that there are many massage therapists that have no, zero interest of working in some kind of institutional setting. And certainly that is your prerogative and there's lots of work for them to do. But we can certainly see that the patient need is there and the value for the patient, I think, that should be enough to motivate us and say, hey, there's a whole area here of patients who are being missed, who could benefit from this care. Let's get there and provide that for them.

Cal Cates 49:43

Absolutely. Any parting words of wisdom, Jill, you've already spent many of your wise words with us, but.

Jill Cole 49:53

Well, I think I talked about my koala-fications very well - kind of circle back to the pun in the initial part.

Cal Cates 50:01

We hardly scratch the surface, it's true.

Jill Cole 50:04

I'm just teasing. You know, I think, parting words would be, continue to find if we can continue to find our passion. If we continue to define what, what is needed from us, where we are needed, how can we express our need, then we can start to, you know, enter foot, maybe get our leg in the door, you know, keep the door.. maybe walking through that door, that threshold, you know How can how can we get ourselves through the threshold? And what does it look like on the other side? That's what I'm kind of envisioning. You know, I'm here and I'm envisioning, what does it look like another side of the door?

Cal Cates 50:49

Yeah, yeah. When I can step fully through.

Jill Cole 50:52

Definitely. Definitely.

Cal Cates 50:56

Awesome. Well, I'm excited about so many things now.

Jill Cole 51:01

Yeah, me too.

Cal Cates 51:02

Yeah. Thank you so much for being with us, Jill, and for being with all the people you're with there in Kentucky and everything that you're doing. I think we'll, we'll be getting into some good trouble coming up here. So thanks very much. And Cathy, as always, thanks for bringing the Canadian perspective and just your general charm and humanity.

Cathy Ryan 51:21

Thanks my friend, Rebecca, too.

Jill Cole 51:23

And to you both.

Cal Cates 51:25

If you want to keep it going, come and check us out at community.healwell.org. I assure you, it will be well worth it, including live conversations every Tuesday night where we talk about all kinds of stuff, and always learn from and with each other. So stick with us at Interdisciplinary, we've got some, we've got "Healthcare for the Homeless" coming up. Stick with us, we've got some great guests coming up for the rest of season two and go give us some likes and reviews and all the things, and we'll see you next week. Thanks.

Rebecca Sturgeon 52:01

Interdisciplinary is produced by Healwell. Our theme music is by Harry Pickens. You can send us feedback at info@healwell.org. That's info@healwell.org. New episodes will be posted weekly, via Apple podcasts, Spotify, and our Facebook page. Thank you.

Transcribed by https://otter.ai