Palliative and Hospice Massage in a Death Avoidant Culture with Ashley Brzezicki

In this episode I have a great conversation with Ashley Brzezicki, an RMT and death doula, whose personal narrative and cultural insights bridge the gap between massage therapy and end-of-life care. Exploring this tender intersection, we shine a light on the human touch in healthcare—a touch that offers solace to those grappling with terminal illnesses and envelops their loved ones in the warm embrace of empathy and understanding. 

Ashley's tapestry of narratives threads through our conversation, from confronting the cultural discomfort around death to the art of finding meaning amidst life's final chapter. We delve into the vital role of hospice care, a misunderstood haven offering more than just comfort in dying—it's about living each moment to the fullest, with dignity. Our discourse challenges the medical community's preoccupation with cure over care, advocating for a holistic approach where every healthcare provider, from the massage therapist to the hospice nurse, becomes a guide in the patient's odyssey of self-discovery and acceptance.

This episode calls out some of the noticeable absences in healthcare education, and we advocate for massage therapy to become a university-level degree. We dissect the ethical implications of outdated teachings and the significance of evidence-based practice, as well as the challenges practitioners face in the evolving landscape of Continuing Education. Our exchange extends beyond academia to the essence of patient-centered care, weighing the merits of various modalities against the need for genuine relief. Join us, as we unfurl the importance of compassionate healthcare and the enduring impact of a simple human touch in the profound journey of life's sunset.

Transcript

Speaker 1: 0:08

Hello and welcome to another episode of Purvis Versus. My name is Eric Purvis. I'm a massage therapist, course creator, continuing education provider, curriculum advisor and advocate for evidence-based massage therapy. In this episode, we welcome Ashley Brzezki, who is an RMT and death doula at New Brunswick. Ashley has an interesting background in anthropology and she uses this education area of interest to educate RMTs on working in a death-avoidant culture.

Speaker 1: 0:32

In this episode, we discuss the importance of holding space with compassion for those who are terminally ill, living with a degenerative health care condition or are experiencing grief and loss. Our conversation moves on evidence-based practice and the problems we feel the stakeholders have with adopting this into their curriculum and practice standards. My key takeaway from our discussion was to remember we need to focus on treating the person and not their disease. If you enjoyed this episode, please rate it and share it on your favorite social media platforms. You can also support my podcast by making a donation by visiting buymeacoffeecom. Purvis Versus can also be found on YouTube, so please check us out there and subscribe. So thanks for being here and I hope you enjoy this episode.

Speaker 1: 1:17

Hello everybody, and welcome to another episode of Purvis Versus. Today we have Ashley Brzezki here, coming from New Brunswick. I'm excited to have her to talk about her journey as a CE provider as well as her experiences being an RMT in the province of New Brunswick. She's got some new content new course hopefully coming out soon. I know she presented recently at a massage therapy conference in Halifax. So thanks, ashley, for being here. Tell us a little bit more about yourself and about what you're all about.

Speaker 2: 1:51

Thanks so much for having me. I'm so excited to talk. I feel like we've been waiting for a minute to have this conversation, so I'm glad to finally be here. My focus is on creating content that will help massage therapists be more comfortable catering to a client demographic where they might be facing terminal illness, their own mortality or really any degenerative condition where they suddenly have to consider these big existential questions their own mortality. I find that that is in terms of content.

Speaker 2: 2:32

I find that lacking in massage therapy programs when you're learning to become a licensed massage therapist. So that is and that comes from a place where I've had my own personal experiences navigating my own death avoidance and recognizing at a point that I can't provide the kind of quality care that I want to provide to people if I'm a death avoidant healthcare provider Because you never know who's going to walk in through the door, right, you might be treating someone for four years and all of a sudden they've got terminal cancer and having a space where you already have a certain level of self-awareness with your own hangups with mortality, so that you can hold space for another person and not say anything that might trigger them to feel isolated or defeated or like you don't want to listen to their story. I think that's incredibly valuable, and there's just not enough out there yet, so that's what I'm looking to provide Lovely.

Speaker 1: 3:33

Is that an interesting niche. It's so unique Like I would say that you're probably the only massage therapist I've ever heard of that is interested or passionate about this thing. And, of course, death avoidant happens to all of us, happens to everything, so why not talk about it? I think that's really something that's necessary. Do you want to share at all where this came from for you? Why did you decide to tackle this Absolutely?

Speaker 2: 4:05

Yeah, absolutely. I find that to you know. Now, on the other side of the story, it's been 20 years. On the other side of the story, I can recognize this as a bittersweet gem in my life that has opened up a level of self-awareness and compassion that I initially I wouldn't have identified. This I'm going to call it a trauma because that's what it was. I didn't identify it as the gem that it was, as the gift that it was. At the time I had to make meaning out of that experience and build an identity for myself around it. And now I'm in a place where I'm leaving it into my clinical practice. So the story goes.

Speaker 2: 4:51

I'm raised first of all in a death avoidant culture. So in the West we have a deeply death avoidant culture. We don't like to talk about death. We don't like to think about our own death. On some level we're neurobiologically wired to avoid death. But there is a difference between it just creates a lot of unnecessary suffering when we avoid it, when we avoid it to such a degree right, because now all of a sudden, a death is coming either way and when you're facing it at the end of your life and you haven't been in a supportive place in a supportive culture that dares to look at it, then you're struggling with a lot of existential questions on your own. So death avoidance is a cultural failing it's not an individual failing and I think it's way too big a burden for people to be tasked with dealing with these big questions on their own, and that is actually what I found myself doing when I was younger. So this thing that set a new trajectory, a new path for myself, happened in high school.

Speaker 2: 5:58

Like I said, I was raised by a death avoidant culture, but also my parents were incredibly death avoidant and kind of still are. So my parents are Polish. I come from an immigrant family. My parents were raised by people that went through the Second World War and I think as a generational trauma kind of thing, they probably were raised by the people who probably didn't get to focus on loss and death and grief to a degree where maybe it would have been helpful for them not to completely avoid it. So I was raised by the product of that. There was another overlapping thing. So when this specific moment happened in my life, I really didn't have a chance to look at death to begin with anyways. I mean, even the family dog was still alive, like I had no healthcare concerns in the family, all of my friends and their families were intact, like it was literally something I never had to face. I was healthy, vital, youthful.

Speaker 2: 7:00

In high school I decided to get a volunteer position at the hospital in my city and there was this one day where I was walking through the hallway go back in time three or so months and he told me that our next door neighbor was diagnosed with terminal cancer and then he wouldn't be coming home. And because I was raised death avoidant, I didn't know what to do with that. So I just kind of did the protective thing, tucked it into a box in my mind and threw it out the window and I just never looked at it again. And then all of a sudden I find myself at the hospital and I've pretty well all but forgotten about my neighbor and I look over and the only thing that I could recognize on his body were his eyes, because he had just declined so much in his health. And in that moment, because I went from zero to 60, I went from not looking at death whatsoever, not wanting to consider it, to suddenly being smacked upside the head with it. I did something reflexive and self protective.

Speaker 2: 8:10

And now, in hindsight, I recognize that I did the best that I could with what I had at the time. But I sacrificed human connection for my own sense of safety. So I just walked on. I carried the trauma of that and the shame of that for such a long time. I really felt like it was a failure of my humanity. Because I recognized I feel this is my perception that I feel I recognized a kind of pleading in his eyes that I was too afraid to show up for, I was too afraid of having, you know, holding space for him. And I remember the feeling of just almost leaving my body in that moment. And then my legs felt like they started moving without me and all of a sudden I'm walking down the hallway thinking to myself on my head like, oh no, what have I just done? Like I just completely abandoned him in his moment of need. So yeah, that was the moment that led me down this path of like just having this horrible existential dread for years.

Speaker 2: 9:17

And it wasn't until I entered more advanced courses in anthropology in my undergraduate degree and in my masters that I really recognized, because anthropology is the scientific study of humankind across time and culture, and it wasn't until we started looking at the way, the differences between Western traditions and Eastern traditions that I really started recognizing. I'm sure I'm death avoidant by nurturing at home, but also culturally we're not. We're not holding space well for death and dying and our own mortality here. And that was when I started healing. I didn't know that I was healing at the time, but that's when I started deconstructing my own biases and beliefs about death and dying.

Speaker 2: 10:08

And now I'm at the point where I feel like I've done enough work around, that I have a. I can hold it much more gently with myself than I used to be able to, and you know your journey throughout your own mortality. There's always going to be different layers of the onion to unpack. So it's not like the, it's not like you ever reach a destination and being okay with dying, but to a degree you definitely lessen your own suffering and potentially the suffering of other people, specifically if you're a healthcare provider, right. So that's, that's kind of where I come from. That's the history behind it, and, yeah, Wow, so that's very powerful Actually.

Speaker 1: 10:52

So thanks, thanks for sharing that. It's funny. I never really think about it before. About the, you said you know we are raised in a death avoid culture, which is so true because it's like death. Is this, this one thing that we don't really want to talk about? Just one thing that you know it's obviously extremely sad when we lose people that are close to us, but it's not talked about very much until we get older. Like you hear about it and you know our parents and grandparents and then elderly people we know they talk about it.

Speaker 2: 11:24

But people our age.

Speaker 1: 11:25

We're young ish. Yeah, we should be. We should have many years left. Yeah, it's, it's. It's something you just, you just ignore.

Speaker 1: 11:34

Yes, and I think that I've never really thought about that until you said this right now that I could see. I can see where you're coming from and how shameful that can be. I think the words you used were you said you were self protective and you kind of walked on and you kind of since felt shame afterwards. And that's probably the same with a lot of us. And if I think of my early experiences with people dying and my first memory of knowing someone that passed away was a neighbor of ours, who's very lovely old man that my dad used to go golfing with and he just died in golf course one day at a heart attack, and I remember going to his funeral and and and feeling like not sure what to do, how to deal with these emotions, like I didn't. I knew him but I was like 1314 years old but I didn't really know how to feel or what to feel, and it was because I never talked about it before.

Speaker 2: 12:30

Yeah, absolutely. You know, what's interesting about that is that this I kind of, I kind of lied in a sense. This was a moment that stood out for me as a big trauma moment, but actually my first, and this is the way that it goes for so many people, right, this is all cultural, societal training. When we're kids, we know that kids start wrapping their head around the fact that you know, if you step on an ant and it's not moving anymore, something's changed and you're the reason why, right, and you start developing your sense of empathy and you start wrapping your head around the fact that, oh, like things can die. I was taken without permission by my godmother to awake, so my parents didn't provide yes, so big move, big move. And what I remember from that? Because I do remember the moment that and it was the first time I'd ever gone to a ceremony where someone had deceased I remember the moment that I saw this woman in the casket and I remember thinking like, oh, she doesn't really look alive, like that, doesn't. You know? And I'm a young, I'm a fairly young person, I'm probably six, seven, eight years old, max and I just kind of carried on. It wasn't this traumatic thing that people would expect it to be. But it wasn't until I got home and my mother yelled at my. I remember that there are being a very this was a very big deal, right, a very big deal. And I remember just the feeling of like, okay, I wasn't scared. But now clearly something's wrong, because they're very upset about this and I, you know, I get it to a degree.

Speaker 2: 14:23

But the point of that story is the way that society responds to death when it happens, the way that parents respond to their kids. Having natural questions about death is also social, cultural conditioning, right. So we kind of we were raised in a death avoiding culture. Those natural questions are kind of beaten out of us because we have them when we have them when we're kids. But then we learn that it's inappropriate to discuss this sort of thing.

Speaker 2: 14:55

And then you find yourself, you know, dealing with an acute situation of you know a terminal diagnosis, or you know your best friend dies or something like that, and all of a sudden this thing that you were never allowed to discuss is suddenly overflowing your plate and you don't know how to handle it, because we're not taught how to handle it. So the moment that sticks out for me isn't when I saw death for the first time as a child. It's when it's the many years between that moment and the moment where I was a teenager, in high school, where I was taught a lot of times, unconsciously, that death is this dirty thing that we're not allowed to talk about it. It's inappropriate, and if you bring it up, you know you're going to be socially disconnected because people will turn away from you instead of leaning in.

Speaker 1: 15:46

I feel that these are things that we are all like. Everything you're saying, I'm like yeah, I totally agree with, like you're so spot on with that, but we don't have these conversations. People don't have those conversations, and I'm assuming that's why you're doing. What you're doing is because you're like we need to teach, we need to learn the tools, we need to have these awareness or at least to have people to have conversations around these topics, because this happens. This is life. Death is part of life. It's just I know a bit of a cliche, but you know it's, it's so. I'm really, I'm really excited to that. You're doing this because no one else is.

Speaker 2: 16:28

Thank you. Yes, I feel like I've kind of found my where, my my own personal interests and experience and the needs of that I recognize in in culture and in humanity and in our society. I feel like those two things are kind of converging and I'm really excited about what's coming. So thanks for having me, that's great.

Speaker 1: 16:48

My what you you mentioned, to the difference between kind of the western and eastern cultures. I mean, I don't know enough about enough of the eastern kind of religious or beliefs, but I do have a very rudimentary understanding of Buddhism, because I've always thought Buddhism was really cool. As a kid my dad had a good friend and she was. She was Buddhist. I remember going to like the temples and stuff and as a kid in you know, old Vancouver, chinatown, and and she was, you know, taught me about all. You know I was like I was a young kid but I was always really neat, but that was the one thing that was. That was they talked to. A lot was about about, about death, it was, it was, it was, it was part of everything that they, that they did, because death, for them, though, wasn't a permanence, it was more of just a transition to a different. I can't remember the right word, but enlightenment, I guess, was the, I think was the, was the and maybe reincarnation.

Speaker 1: 17:48

So I always thought that kind of belief system always resonated more with me as a young person. But that means that's a way better way to think about life.

Speaker 2: 17:57

Yeah.

Speaker 1: 17:58

About death.

Speaker 2: 17:59

Yeah.

Speaker 1: 18:00

And we do in our Western culture.

Speaker 2: 18:02

Right, two sides of the same coin, right, I think, for me, if you wanted to. I mean this is an extreme generalization, but for the sake of starting somewhere in the conversation, I kind of look at what we do in the West as focusing on what we're looking at, whereas Eastern or traditional knowledge system it's almost as if they teach you how to look at things differently. So there's, there's an aspect to traditional knowledge systems that is much more philosophical in nature, and over here we like quantifiable things, you know, and that's where, that's where I see the paradox and everything related to this conversation around providing care in in death care spaces, is that the curative treatments that we have here in the West, which exists only because we focused on disease and focused on science and focused on finding new treatments, new ways of doing things, at some point those things fail because death is way more persistent than all of our technology, and when it does, we're probably going to lean on those more traditional knowledge system aspects of our you know of, of your, your whole person, the way that you philosophize your interactions with the world, or you know what, what is all this, what is this all mean? Right? Those things naturally come up, at the very least at the end of your life. If you're in a good position where you're ready to consider your own mortality, you can look at those things in advance. Which is partially what I'm so passionate about telling people is that you can actually live a better life If you consider your death, if you consider your mortality. There's a level of gratitude that you're able to access when you know that this universe doesn't owe you anything. That carries through to the rest of your existence.

Speaker 2: 20:08

Here and I do find that in those Eastern traditions, I think perhaps and this is just me, you know, wondering about it but perhaps because they lacked curative treatments, they had no other choice except for leaning on. How do I look at this? I can either be completely devastated and suffer or I can create an ideology that will help me, that will help me wrestle with my own mortality Right, considering that everything's a balance, energies, you know the whole reincarnation aspect of Buddhism, those things. If you can lean into that as a possibility, there is something that feels a little bit more softer for you when you consider your mortality Right, and that's kind of where the gem in Eastern traditions is, in my opinion, and that's I mean I have a deep appreciation for it because I do. That is my bias. I do have a background in anthropology, but I'm seeing especially now that you know, since I took my death to a little course I'm seeing that it has a place. It has a place for us when we're looking at the suffering of human beings.

Speaker 2: 21:30

One of the things that you run into when you're looking at palliative or hospice care is a sense of isolation that they can't talk to anybody about it. Every other healthcare provider is focused on their disease. They're not focused on the person and a lot of times people end up having to have these natural conversations that come up at the end of their life, where they will start asking you if you're available for sitting down and talking about it. They'll start asking you about how you see the world, how you see mortality, how you see death. Is there anything after this?

Speaker 2: 22:04

And the notion that we would all struggle with that, isolated by ourselves, because our healthcare providers don't know how to hold space for that conversation. I'm just, I'm just morally not okay with that. You know, I find that it's a. It's a turning away from humanity that I'm not comfortable with. It's exactly the failure that I had when I walked away from my neighbor, mr Fisher. It's an echo of that, I don't you know. Ever since, I've been spending all this time trying to find a way to right a wrong from my past, and this is kind of my way of probably in some ways manifesting my own healing but also showing up for the needs of human beings in a biomedical, disease focused healthcare system that ignores the spiritual aspect spiritual aspects of a person's health.

Speaker 1: 23:02

I'm so glad you brought that up, ashley, because you know you mentioned, you know that the, you know, in palliative and end of life care, really the person centered care is the thing that is kind of the term that it's, it's building, it's been used for a long time. We start seeing more and more and all types of healthcare. You know, in our world, the MSK care, everything should be person centered, which is focusing on the individual and their needs. You know, rather than just disease management or just, you know, fixing a problem, and whether that's treating a low back or neck pain or whether that's being supportive for somebody at the end of life, the same principles applies like how can you hold that space for that person to help them the best way that they need or they want at that time?

Speaker 1: 23:52

And it's, it's so true that in end of life care, yeah, like people are, they go to hospice and they're just like they go to there to die, just to live out their last days, and they're, you know, given drugs and or they're trying to be, their life tries to be prolonged. But the humans miss right that that human connection is often missing. We sit in all healthcare because the biomedical approach has a place, but you know it's not treating the human. Is treating the, the bit of the human and the disease, right, rather than the illness, which is like the behaviors and how the disease is impacting the person, right. So that's right, that's right?

Speaker 2: 24:35

Yeah, I do. I suppose I should probably distinguish between, because I use both terms, palliative and hospice care, and they are actually different. So palliative care comes from the root word, which I think comes from Greek might have to fact check that for me but it comes from it's to cloak, so you're cloaking pain. The whole concept is just pain management. In palliative care you're ideally working in interdisciplinary, everyone's collaborative, and you're supporting the person in bio cycle, social ways. Hospice care for people in hospice care, they're in palliative care, but the difference is that you know they have and generally depends hospice center to hospice center, but generally they have about six months left to live and I I think I would be much more afraid to exist on this planet if we didn't have hospice care, because in hospice care the care team is specifically trained and how to approach the hard questions of death, of mortality, how to support people at the end of their life, how to support the family members around the person at the end of their life at the other end of the person's life, I should say, because there's a lot of grief and bereavement that happens after they die and hospice care sets up the family to have grief care after the death of the person who dies.

Speaker 2: 26:08

So I don't want people to think that hospice care is like this place where people get tucked away to die, you know, over, medicated and quietly as easily as it is on the health care team. It's actually kind of the opposite. You have suddenly, when you enter hospice care, you suddenly have access to resources that you didn't have before, because hospice care centers have just the resources allocated by the government are different for those care families. So it's it really is. I mean, I I can understand how people who are death avoid and afraid of death almost see it as like the last benchmark before they die. In some ways I suppose that's true. But also, the longer you prolong your access to those resources, the longer, in a sense, you potentially suffer. So hospice care is comfort care and I wish there was more conversation around that because people don't seem to know People are afraid of entering hospice care because they think it's quote-unquote, giving up Right, it's not really, it's not really.

Speaker 1: 27:17

No, thanks for clarifying that.

Speaker 2: 27:18

That's good, that's something that's good yeah, for sure.

Speaker 1: 27:20

Those are terms that we kind of throw around, but we don't. A lot of us don't even know.

Speaker 2: 27:24

Well, they're used interchangeably. Yeah, and I don't blame people for not knowing the difference. Nobody really knows the difference unless you've taken courses.

Speaker 1: 27:32

Yeah, yeah. I have a client, a long standing client, who is a hospice nurse and she loves her job because of being there for people at the end of the last stages of their life and she finds it very rewarding, I guess you have the person to be able to do that. But over the years 12 plus years she's been a client she's. You know, I think. How do you do that? She's like I love it yeah.

Speaker 2: 28:03

Good for you. The world needs more of you, yeah.

Speaker 1: 28:07

So you know, I find that.

Speaker 2: 28:07

I hear that a lot. Yeah, I hear that a lot too. Usually I might put a little bit of a spotlight here right now with what I'm about to say next, but usually when people say that to me, when they're like I don't understand how you can do that In a split second. I know way more than they realize about how comfortable they are with their own death. Sure, yeah, yeah, yeah, yeah, because it's. I mean, I think the thing that people don't realize about hospice care as well is that, and palliative care, to a pretty significant degree, is that because the emphasis in those contexts is addressing total suffering of the person, so not just addressing the biological markers for the reason they have pain, but also whether or not they're socially isolated, whether or not they have a failing relationship with their parents. You know, like all of these things, spiritual questions you know I haven't been a believer my whole life and now what happens when I die? You know those big, big things.

Speaker 2: 29:19

Palliative and hospice care is more adequately prepared for dealing with those situations and, as an important component of that, the health care providers are given training in how to, they're given training in boundaries, they're given training in compassion. You know they have an understanding that they are there for human connection, right. And I do not feel that that is emphasized in the biomedical model. A lot of times health care providers are expected to behave like robots. You know, onto the next one, onto the next one, they're for the disease, no time for human connection. That's depleting. That is depleting for the health care provider. That leads to burnout, right? And I think the thing that I wish everyone could see a little bit more clearly is that when the emphasis is placed on alleviating human suffering, you have no choice but to connect with that person on a human level and you, as a health care provider, get a lot back from that, because it's a mutual connection and there's something about it that's replenishing. So when she talks about how rewarding that is, I know exactly what she's talking about.

Speaker 1: 30:43

Yeah.

Speaker 2: 30:44

Yeah.

Speaker 1: 30:45

Yeah, and then you do. I know the guy I'm like. If I think of my own mortality, it makes me feel very uncomfortable.

Speaker 2: 30:53

Yeah.

Speaker 1: 30:54

Yeah, I'll admit that no too many things to do, right I? Don't want to think about death, but you know, as you get older you start to realize that well into my 40s now, you know life's probably at least half over, you know, and so you're like, but you're like I still have half left. There's lots more to do, right. But yeah, it is something, and you're right, in our culture and just kind of in my bringing as well, it wasn't really talked about in death. It was a scary thing.

Speaker 2: 31:22

Yeah, and I don't want to place myself above you at all, and I don't feel that way, Okay good, because I you know, to be honest, I also have, like I said before it's you're peeling back layers of an onion. There's always going to be the next thing that kind of freaks you out about mortality or about declining in your health, and I just kind of peel those layers back as gently and as self-compassionately as I can, but I'm on that same path. There's things that I'm uncomfortable with too.

Speaker 1: 31:51

Let's. This has been great. I feel like we could talk about this forever. I want forever Forever. I know Maybe we'll have to do like a four part episode or something, but I wanted to ask you more. I was kind of just we'll leave that there behind and I want to ask you more about kind of some of your like, maybe the content you are presenting or the course that you want to teach it, and kind of what's that going to look like for RMT? It's like what kind of things would people expect if they're like I'm taking a course from Ashley?

Speaker 2: 32:18

Yeah, so the focus will definitely not be on modalities you base yeah, I mean there's just it really comes down to more so about there's the science of medicine and its application, and then there is the art of medicine and its application, and I think that extends to massage therapy as well. And you know, being able to hold space for people who are dying takes a certain level of finesse when you're thinking about communicating that way, and it's the kind of training that we don't get at our baseline level of education when we become certified. So, gosh, I mean I want to talk about all kinds of things. I want to draw on my experience as an anthropologist and I want to teach people like hey, look, this isn't, this isn't like a cut and dry thing. There are different ways that you can look at death and dying. These things are culturally mediated. Cultural training is the kind of thing where all of our brains are like open source code, like our brains are open for training that we receive, that we end up like through society and through culture that we end up. We end up running these programs on a near unconscious level. And it isn't until you draw attention to the fact that you're running this unconscious program that you can kind of start rewiring your perspective on things, your approach to things, and I mean we know that we can only show up for people to our own level of comfort with a certain subject Right, and because our culture creates death avoidant people, those people end up taking classes that are probably also death avoidant in nature, like even healthcare providers, even doctors, and we just I just think that we, we need better. We need better because, at the end of the day, I feel like everyone I'm over here talking about it as a teacher, but I need society to buy into this because we need to care about this on a social level, like we have to improve the level of care that we're providing to people.

Speaker 2: 34:53

So I'm like I told you, I've got my own hangups with mortality as well. I am not with the way that things are right now. I am not comfortable being a patient with the way that things are, and I need to put my money where my mouth is and I need to start. I mean, this isn't going to be fixed by itself. We need as many people out there are educating on this stuff so that we can get people to know about this stuff, so that meaningful change starts to happen, and I agree with you like meaningful changes starting to happen. There is a lot more conversation about biopsychosocial factors and I'm very, very happy about that.

Speaker 2: 35:29

But at a foundational level, what I don't think there is enough emphasis on is the fact that we have built a biomedical system, a biomedical model of healthcare, and I think there's this assumption out there that if you go to the hospital you're going to get compassionate care as it concerns mortality, and that is not true. That's not true. I actually have a quote here. It's a quote that I keep around because it kind of helps me keep pushing. So this quote is from Jared Rubinstein, who's a medical doctor in palliative pediatric care, and he says this is from his own social media account. One of the great failures of modern medical education is that a doctor can go through all of med school and residency and receive almost no education and normal natural dying or training and how to support someone at that stage of life. Is that not one of the craziest things you've ever heard?

Speaker 1: 36:36

Yeah, that almost seems so illogical.

Speaker 2: 36:39

Yeah, and because we're not going to be able to change the way that doctors are taught right off the hop, but as allied healthcare providers, as massage therapists what a beautiful thing it is to be one of the few kinds of providers out there that at least have that level of education and the fact that we are in an industry where we don't have 15 minutes with a client we've got. I mean, it depends on the way that you run your practice, but I myself I run my treatment 60 minutes at a time generally.

Speaker 1: 37:20

That same year.

Speaker 2: 37:21

Yeah, 60 minutes with a client Are you kidding? That's gold. And if you can provide them with education or with a gentle space where they can experience what it's like to have someone who quietly supports them or not quietly if you're having a conversation but at least you know that they have the appropriate education around death care so that they're not completely alone, so that when their doctor comes in and you know, says something, doesn't even bother looking them in the eyes or just reading and chart and they leave right away. And I'm not saying that happens in palliative or hospice care necessarily, but a lot of people on oncological units, for example. I've heard a lot of stories in my own practice because now my clients know that I'm a death care provider and they tell me all kinds of stuff that would make your skin crawl.

Speaker 2: 38:12

It's just there's, yeah, there's not enough, there's not enough human connection.

Speaker 1: 38:16

Yeah, it's the biomedical model.

Speaker 2: 38:17

That's the problem.

Speaker 1: 38:19

Yeah, and that's, and the biomedical model model is in this state. I mean, it is a bit of a travesty, isn't it? Travesty to humanity, I guess would be a good way to put it, whereas it's like the human connection isn't there. And it's so interesting listening to you talk about this, with the death care and of life stuff, because a lot of the language you're using is the same things that I always talk about when in like dealing with chronic pain, because that's my area of interest and like to about like creating that we have 60 minutes to create that meaningful connection with somebody. Or if someone's living with some debilitating or some chronic pain condition, we're not going to fix it, we can't change it, but we can make their journey through life hopefully a better place.

Speaker 1: 39:03

And we have the gift of time, which nobody else has, and we have the gift of that, holding that safe space and, obviously using touch as a way to communicate and to feel good with somebody, as well as verbal communication. It's so powerful and that's the beauty of our profession that I don't think this is all anecdotal. I don't think enough RMT's realize the power of holding that safe space and having that connection with people, for whether it's, you know, like you said, talking about the end of life care, or whether it's chronic pain or any other kind of persistent or long term health condition People don't need to be fixed, they just need to be believed, they need to be feel safe and feel comfortable with you and guaranteed. Physios, chiro, osteopaths, you know, medical doctors doesn't matter who it is, who it is, he or she is. I don't think that any of them have the ability to do that as well as us because of the gift of time.

Speaker 2: 40:07

That's it, absolutely. Yep, absolutely, yeah, healing can still exist where curative treatments have failed. So there's a difference between curing and healing, and I think that even when a person gets to the point where they know they're going to die, there's still healing that can take place. It's just about showing up and not being afraid and not turning away.

Speaker 1: 40:34

Yeah, and then just, yeah, I just think to reemphasize the similarities and kind of our little different populations, but how things are very different but the same right. And I like how you use the word curing and healing and often times, like we talk about in the chronic pain world, about you know, healing being this you know, oh, you're going to heal from your injury. Well, yes, your injury can heal, but your disability or experience with pain you can heal. In terms of meaning, I'm putting an air quotes I know I can't see that Put an air quotes in terms of healing, in terms of like, accepting or learning ways to live best with what you have, with your current situation, and that's something that I really want people to understand and, regardless of who you're treating or who you're working with, and regardless of what their concern is, is healing doesn't always have to be a tissue fix. It could be supporting that person to live better, live more meaningful lives.

Speaker 2: 41:41

Yeah, absolutely 100% I am. I really like Andrew Solomon's work. He teaches clinical psychology in the States at an Ivy League school and he has this really popular TED Talk where he talks about how people overcome difficult circumstances. And we as human beings, we're meant to be storytellers. We can make sense of our individual traumas or these difficult circumstances by. What he says is forging meaning and building identity. And I hear what you're saying about the chronic pain thing, because at some point you know, if a person recognizes that their situation isn't changing, they're going to have to spin gold out of that in some way if they want to alleviate their suffering. And that's when people start forging meaning and building identity. Who am I now? What does this all mean? And it's all you know. How am I going to live my life now? Right. And it's all applicable to the end of your life as well, when you're looking at terminal illness. Oh God, what does this mean? Like, how am I going to live my life now? Or whatever life I have left, right? Very applicable.

Speaker 1: 43:01

Yeah, yeah, and that's why I brought up that, just because it's there's so much overlap and similarities, and that's because it's treating the human, not treating the condition.

Speaker 2: 43:12

That's it, that's it, and that's what I care about. That's where I want my reach to be. Yeah, for sure.

Speaker 1: 43:17

Yeah, yeah, and like that's. I mean that's why people like yourself and myself and others are out there. You know a lot of us will. We want to be involved in teaching courses or content because we want better for people. We want people to receive, hopefully, better care or the very least, you know, not making people feel worse.

Speaker 2: 43:42

Yeah, that's it Absolutely, and that's where. That's where just having the training and communication and also understanding that I mean you can't if you want to make someone not feel worse, you're going to have to find a way for you not to get triggered by your own existential dread when they're talking about theirs. Right, like, if you haven't overcome a level of that, then you run the risk of sincerely hurting somebody, and a lot of times they don't even tell you. They just write you off as a healthcare provider, right, like, if you know, like, what are they going to do? Spend their precious time trying to teach you how to overcome your stuff.

Speaker 1: 44:23

They just won't come back.

Speaker 2: 44:25

No, they just won't come back. Yeah, yeah, yeah.

Speaker 1: 44:30

That's. That's an important thing too for us to understand as a massage therapist is that we as a profession I find this from conversations and experiences of how people over the years is that when someone doesn't come back you know we don't we just tend to dismiss it rather than thinking what did I do that maybe triggered them or push them to not come back. But a lot of us are busy and we're like, oh, we just focus on all the positive. But I think it's really for us it's been such a surface or any healthcare profession, but we're RMT, so we can talk about us. We should always question why the person not coming.

Speaker 1: 45:06

Like did they come back because they didn't need to? Okay, that's great, but maybe they did need to. Maybe they're seeking care from somebody else because I did something, or I didn't do something that they needed or wanted. Those are the questions we should be asking. You know what? How do I get this person to come back again and again, and again? If I were to look how successful I am, Okay, great. But what about the people that didn't show up? Why didn't ask the questions? Why are they not coming back?

Speaker 2: 45:31

I actually I can tell you a story related to that. I had this pivotal moment in my own practice and it was actually because of this that I decided to take in part because that I decided to take a death dual course just to wrap my head around such things a little bit more deeply. But I had an initial assessment just coming in for standard treatment, nothing specific, nothing really MSK. They just wanted to relax or feeling stressed, and I noticed when they were walking in that they had this beautiful curly hair. And I should have known better because I had been paying attention to you know the idea that you shouldn't comment on someone's body. Regardless of whether or not it's a good thing Someone's losing weight, still don't say, oh wow, you look great. You know, because you have no idea what the context is. They might be struggling with a needing disorder, so just don't comment on a person's body. So I, you know, I thought I had ingrained that, but I think at the time maybe I thought that hair was innocuous and it wouldn't be a problem. So I complimented this person on their curls, on their curly hair, and I could tell as soon as it left my mouth they became it shifted. It shifted the tone. I took them into my room, we sat down and I was like, oh boy, you know how do we address this Cause.

Speaker 2: 47:05

Now the tone's changed and it's an initial assessment. It's not the best way to start with the therapeutic relationship and, to this person's credit, they told me what I had done wrong. So they told me that their hair isn't naturally curly, that chemo had changed it, that a lot of people now it's called chemo curls, that a lot of people compliment their hair, but they don't know that really all they're achieving in that moment is she gets a reminder that she could have died. Wow, yeah, hair right. You think it's innocuous and I just I mean, I thanked her up and down for being, you know, daring to be that honest with me, cause that's a level of honesty that you're just not going to get at a lot of people, cause most of them will just rate you off. But she chose to be honest and I, you know I owe a lot of thanks to her cause.

Speaker 2: 48:02

Now I've kind of like elevated myself and understood in a split second that I was not doing enough and that I could be doing better, and I think I'm not saying this to toot my own horn whatsoever. It's just a philosophy I have. But if you're not willing to be, if you're not willing to not take things personally, if you're not willing to do the kind of self reflection you were talking about just now, then your practice will plateau. It's, you know, it's the difference between a clinician who wants to provide superior care and superior support and someone who doesn't want to look back at an embarrassing moment. You know that's, that's the difference. Or to, you know, I have to get that client back because money or whatever other reason, ego, whatever, you know, you have to, you have to be humble and try to elevate yourself.

Speaker 1: 48:54

Yeah, and that's the sign of a top notch clinician, I think, is when you can be humble and you can have a humility and be like, yeah, I screwed up.

Speaker 2: 49:03

Yeah, yeah, yeah, even in conversations where we're talking about like evidence-based things, because that's the, I mean, that's what I believe foundational. I believe in that that is, in order to push this profession forward. We need to focus on evidence-based things. Yes, the paradox that I exist in is that when people are facing their death, they're much more likely to reach towards spiritual means of feeling better. And a lot of times people you know practicing embodiment through their spirituality, receiving something like a Reiki treatment right For some people, they would find that really supportive if the curative treatments have failed, if there was no other recourse, and you know they can be happening at the same time.

Speaker 2: 49:57

But you know a palliative care doctor or a hospice care doctor will have a level of patience for that. That's someone like an ICU doctor potentially wouldn't right Cause that's not in their frame of relevance. You know they're focused on disease. These guys are focused on human suffering and I worry that there's some massage therapists out there that are driving for evidence-based practice so strongly that they're willing to throw the baby out with the bathwater and not having patience for things. Like you know, they're client requesting a referral for a Reiki provider. You don't have to provide one but you know, don't be offensive towards the person and say that they're a full poop. Yeah, no, poop, yeah.

Speaker 1: 50:49

Full of shit, exactly, yeah, yeah, that is a. I'm glad you brought that up, actually, because that is a huge thing. That is like, okay, I agree, 100%. Evidence-based practice is where we should be going.

Speaker 2: 51:03

Yes.

Speaker 1: 51:04

Otherwise we're just make-believe based practice 100%.

Speaker 1: 51:08

But the key with evidence-based practice, though, is and this is where there's the misrepresentation is yes, it's relevant research evidence. Relevant research evidence plus your own clinical expertise, plus what the person wants in the context of the individual. So there is definitely. You see these extremes right? You see these people like well, there's no research evidence for it, therefore it's garbage and it's useless and we shouldn't do it. But what if there's not? Maybe not research for a specific thing let's use Reiki, for an example. But you know the person really wants this. You know, maybe, that they've had experiences before that has worked for them. Or maybe they you know they found a practitioner that's done it. That's like yeah, you know this might help you in your healing or might help with your experience. Then why would we take that away from somebody? As long as we're not, as long as it's not being sold as this falsehood, yes, this Reiki treatment is going to prolong your life?

Speaker 1: 52:11

Well, no, it's not. Yeah, but maybe it's gonna make your experience a little bit better. Personally for me, I wouldn't do Reiki. I wouldn't recommend it. But if someone came to me and said you know, whatever I've been recommended, I go see this person, what do you think I'd be like?

Speaker 2: 52:27

You, do you.

Speaker 1: 52:28

You do you Like. I mean, as long as you're aware of the limitations and the pros and cons of it, then I don't see a problem, as long as you're not just wasting money on false promises.

Speaker 2: 52:41

That's it, yeah, and that's a big thing, that's right fine, big thing Go ahead, sorry.

Speaker 1: 52:45

No, no, sorry, I was just gonna say that that's a big thing where I see our profession, whereas there's a group of us and more of us I would like to say there's more of us, but there's a bunch of people on profession. Yeah, one evidence base, but we know there's not a lot of very strong evidence for any type of manual intervention. We know that what we can do at most is symptom management, pain management, a little bit of functional stuff with touch and movement, blah, blah, blah. But really what it comes down to is it's we have to have that realization that we aren't fixing people. But there is also part of evidence is your clinical experience and what does the person want? And there's gotta be some middle ground there. But there is a danger, though, with evidence-based practice. There's a danger where people will use it to explain anything.

Speaker 2: 53:42

Yeah.

Speaker 1: 53:43

Oh well yeah, I know there's no evidence, but I've been doing this for 20 years and I know it works.

Speaker 2: 53:47

Right, absolutely yeah.

Speaker 1: 53:49

It's not evidence-based practice, because you need to have some type of evidence there you can provide person-centered care. And the absence of evidence-based practice. So let's use a rake example. You could say, okay, this would be person-centered care, and if we're giving this person something that they want, we know there's no evidence for it, that's fine. They're getting something that they want that's not gonna cause them harm. Go ahead as long as you're aware of that. But I think we do have a danger of some people and I see this, that's why I bring it up is that people will tend to use their anecdotal experiences and their clinical experiences as being gold-staffed evidence. Yes, that's part of the evidence-based thing, but it's the mechanisms or claims you're making are not supported.

Speaker 2: 54:32

That's right. That's right. Yeah, that's strong. Yeah, absolutely. I kind of wish that our programs were a little bit stronger and explaining how research works, for exactly that reason. Yeah, it laughs at me. I think guys are like yeah, I know, that's a good bias alert and there's not right.

Speaker 1: 54:57

There's not. It says in the competency documents that all the regulated provinces have and even the unregulated provinces are supposed to follow that inter-jurisdictional competency document. That's a hard word to say, sounds like I've been drinking. I haven't been, but hard to say. But it says in there you know, armies must follow or you utilize evidence-based practice. I can guarantee you, I have interviewed and spoken with schools and instructors all across the country and I have never once encountered one place where evidence-based practice is taught adequately.

Speaker 2: 55:36

Right, I agree.

Speaker 1: 55:39

And most exposure that RMTs get to evidence in school is they do like a research methods course where they learn like. This is the abstract, this is the introduction and I know someone's probably gonna send me a message that's listening to this and be like no, my school, you're wrong, I'm like again, I'm not all of them, but I'm saying majority right, it's not enough, because if you wanna be a healthcare provider, I have to understand evidence. Yes, absolutely Can't follow a recipe from a textbook.

Speaker 2: 56:05

Yes, absolutely yeah. Yeah, I struggled with how to manage that when I was teaching in a school in the East. So I did try teaching at the college level up and coming massage therapists and I knew going in that it would be something that I would struggle with. I just didn't know how much of a weight it would be on me and ultimately it was a major contributor to me deciding to focus on CE courses, because there I feel like I have much more control. And to give credit to the college where I taught, I mean we talked about this.

Speaker 2: 56:52

I talked about this issue with the directors before I started teaching and their stance on it was basically yeah, we know it's a really big problem. We actually reached out to the college of massage therapists of New Brunswick to tell them that we need better standards here in our education and, from what I understand, the CMTNB is just very slow to do a change up. I don't know the reason why. I mean I can toss out ideas that I have as to the reason why I mean surely it would take a lot of effort to kind of revamp one of the major textbooks that they construct the board exam from.

Speaker 2: 57:46

But at the end of the day what I found that I was doing when I was trying to provide evidence-based, toss some evidence-based stuff in there, and while I teach and just highlight that it's importance and where it comes from, and, da-da-da, I was just frustrating students. They were just getting frustrated. You know, they're already in a position where they have to cram so much material into their brains. They're focused on step one, getting a license, and I'm over here trying to teach them complicated, complicated concepts about all kinds of things. And I just got tired. It just felt like an insurmountable task and I just decided to, you know, exit when I could and just focus on CE. That's what I'm gonna do. I think that's where I can create the biggest change, instead of being a cog in the wheel of a system that is resistant to change.

Speaker 1: 58:45

Oh, I love that you said that and that's the whole reason why I got into CE2 was to influence, get a groundswell of support of people just kind of speak in the same language or thinking similarly.

Speaker 1: 58:56

You know we don't have one to be the same right, but to get the information out there, because trying to change the stakeholders was impossible. Yeah, that's all right. The schools I have found across the country and it's like I said, I've spoken to so many of them, I would say all but one of them that I've spoke to they don't want to change because they don't really know what to do and they point the fingers at the college and I think that is the weakest excuse you could ever use, because you can change. You can still teach the stuff that they need to pass to board exams, but you can also add in evidence-based content. It's not like an all or nothing. You can blend it and you can combine both and I know from my experience because I work with the school in Alberta where we're doing exactly that, and I know it is possible.

Speaker 1: 59:50

But there's the reluctance from the schools, like they'll all say, oh yeah, we know, but they don't do anything about it. They're like, well, they point the finger at the college and the colleges, for whatever reason, to the regulatory colleges. I don't really understand why they don't want to do anything either, because their mandate is safe, effective, ethical care.

Speaker 2: 1:00:09

Thank you for saying that.

Speaker 1: 1:00:10

Yes, and they don't realize for some reason they won't realize that you are licensing, educating people out there that are not necessarily giving safe, effective and ethical care.

Speaker 1: 1:00:21

Now safe okay are RMTs hurting people? Probably not. But how do you define safety? Do you define safety of maybe inferring problems that don't exist? Are you maybe increasing some pain-related disability or some functional disability Right, effective? We know that a lot of these patho-anatomical, tissue-based claims have no evidence to support them, but that's what's taught, because that's what's in those textbooks, particularly the green textbook that most of us used for the last 30 years, and the thing is that I find is that the biggest problem is the ethics of it.

Speaker 2: 1:01:01

Yeah.

Speaker 1: 1:01:02

You should not be. If you are ethical care, one of them is non-malificence, which is do no harm. The other one is informed consent. So if you are a college and you're saying we're gonna examine people on this content that is not supported by any evidence, and then RMTs are going and they're passing that exam, and they're going and they're relaying those messages or they're following these treatment protocols as outlined, what they're supposed to do, and they're telling clients like, oh yeah, you have back pain because you've got a short this and a long that and a rotated this or this is unbalanced this week Twisted pelvis.

Speaker 1: 1:01:45

Yeah, whatever it is, like you can just throw anything in there, right? Yeah, when there's no evidence to support that. And then you get, and they're giving that information to people and like, do you want? And they're giving you consent to treat, it's actually they're not giving you informed consent because they're giving you consent based on falsehoods. It's not supported, so the ethical component is completely gone. Now some people might listen to and I say this all the time and I'm glad you brought it up so it gives me another time to say this. So, thank you, ashley. Is that like well, what harm are they doing? You know, like most people aren't, aren't negatively affected by that, and I would say yes most people aren't.

Speaker 1: 1:02:20

Most people don't care if they're they have a twisted pelvis or up, slip or down, slip or rotation or, like most people, like my back hurts and then you do the thing and they feel fine. But what about that for that percentage of the population where they hold on to that and they it impacts their behavior in a negative way Absolutely and they stop doing things or stop engaging in life, or maybe that, maybe that fear and anxiety about that pain starts to amplify and maybe that sensitizes their nociceptive system and maybe they start to feel their pain becomes worse because of the things that we that someone well-meaning said did.

Speaker 2: 1:02:55

Absolutely.

Speaker 1: 1:02:56

Yeah, that is the thing that the colleges and the schools and the regulatory colleges and the schools and the associations really need to understand, and I've had many conversations with them and I just don't think they do. I just don't think they see that, they see that as a problem. So, but if we don't have these conversations, you know one's gonna listen, maybe somebody will eventually listen.

Speaker 2: 1:03:15

I'm seeing a parallel right now between our culture raising our death avoidant culture, raising death avoidant healthcare providers and also schooling that is outdated, raising leadership in those schools that still believe in outdated stuff, 100%.

Speaker 2: 1:03:32

And you know yeah, and then, and then that being resistant to change. I mean I know that at my particular college, when we opened up this conversation you're right they did say you know it's up to the CMTMB to pick a different textbook, let's go. And they did tell me that each individual instructor please go ahead and weave in evidence-based protocols. And so I know that I did. I think there needs to be a bigger conversation around it than that was a three-on-one conversation and I think I would have felt better about what I was instructing if it was supported by the other instructors who are also instructing. Do you know what I mean? Like, if there was like a let's get the entire teaching crew together and have a conversation around evidence-based protocols, then I would have felt, honestly, more confident. And I mean I knew that I was teaching in a way that ethically sat right with me, but the discomfort that I had in teaching was not knowing whether or not I was budding up against another instructor's teaching in a different class, and that itself was quite uncomfortable.

Speaker 1: 1:04:55

For sure. Because, then what's the student has to believe? Somebody who do I believe, right, you know who? Which person's making a more compelling argument? Which person do I like the best? And rather than getting consistent messages, it creates inconsistent messaging, like you said, and students would be frustrated.

Speaker 2: 1:05:13

Right, yeah.

Speaker 1: 1:05:14

And that's a problem and that's what I've seen kind of throughout, at least in BC, where you know I know a lot of people in a lot of the schools is there might be there's some great instructors, but then everybody else is just kind of just going through the motions and so that creates that inconsistency. I do know, from when we look talking about evidence-based, we look at the research. The biggest influence on RMT is long-term education, like how are they going to practice, how are they going to critically think, how are they going to be as clinicians? That's formed with what you learn in school.

Speaker 1: 1:05:46

If you learn these hard and fast rules in school. This is how things are. And then you go out into work and you take a CE course or you read some information online or you go to visit some social media page and it challenges your initial education and you haven't been taught about kind of some of the scientific process or haven't been taught about like evidence, changes and what you're learning in school. That's. This is not the hard and fast rule. It's going to change and maybe today you're learning both fashion and now you're like, oh, we don't have to worry too much about fashion. It's a thing, but we don't have to worry about fixing it on people. If you're not taught that kind of level of to think or to be challenged, you're not going to. Most people aren't, and the data suggests that 60% of people, when presented with information that challenges what they learned in school, won't accept it.

Speaker 2: 1:06:46

That's painful.

Speaker 1: 1:06:47

And that's across all healthcare professions. So, massage therapy data on massage specific, but as well as physiotherapy, chiropractic, medical doctors, occupational therapists so that baseline education is also so important and, like we started off with this conversation, we are in such a great place as a profession to provide really good quality care for any type of whether it's death or any type of MSK thing but we need to be educated better on many of these basic principles in order to do that most effectively, because some of us, like yourself, will come into this in your career and you'll realize, oh, I want to change because this doesn't make sense to me and this is a better way. A lot of people won't. They feel very resistant to it, which is-.

Speaker 2: 1:07:42

I remember, yeah, yeah, I remember in my own experience, when I was freshly graduated. I was, I kept up, I was prepared for my boards and I jeez, I'll never forget the ego death that happened because I was. I think I was on a Reddit board somewhere and on some sort of a massage therapy board and somewhere in there someone called into question whether or not trigger points actually exist, and I remember being like what, that's what? What did I learn then? Like, why wasn't there more emphasis placed on here is a thing, here is a theory, here is the weaknesses behind the theory. You pick your philosophy behind it, at least right. And so when I read that headline, I mean to your point about, you know, 60% of people don't want to change the way that they're thinking.

Speaker 2: 1:08:39

After their college education, I remember one of the first things I thought in that acute moment of like, the stress involved in like oh shoot. Like I thought I was taught something very real, very tangible. I thought what exactly did I pay for? You know, and I think for some people, when you're looking at the amount of financial investment involved in going to massage therapy college because it's not a small investment you think that you're. I mean, I thought that I was getting. I thought I was getting something different is what I'm trying to say.

Speaker 2: 1:09:16

And the thought of spending that much money on something that was suddenly called into question by some random person on an internet board. You know, that was a hard. I thought about that one for a few days. Oh yeah, you know how much? Okay, because then it's like, oh my God, how much do I have to unlearn so much and relearn so much, so much, and so, yeah, it's just one of those things where I mean, am I surprised that the statistic is 60% of people? Frankly, yes, I would think that it would be lower than that, but you know, people have a hard time changing their minds when they feel like their worthiness is in question.

Speaker 1: 1:10:01

For sure. I think it's both a sunk cost fallacy. It may be a maybe that's what it is when you've paid a lot of money into something, and yeah, I think that's the right term.

Speaker 2: 1:10:09

I think that's the right term. 100%.

Speaker 1: 1:10:11

Yeah, and I like yeah because I don't know what it is in New Brunswick, but I mean when I went to school here in 2003, it was like $30,000 for tuition alone. I mean, I think when I finished from our school after it was a three year program then, or two and a half year program, then it was like I think I probably owed $60,000.

Speaker 2: 1:10:31

Oh man, I said oh yeah, we got to do better than that, guys.

Speaker 1: 1:10:35

Yeah and then you realize, and at the time and I just, I like same as you, like I went and I learned all the stuff in school and I was like, okay, well, this some of the stuff you know, but like didn't really make sense. But you kind of just you're like, well, they're teaching, this has got to be true and there must be evidence out there somewhere. And I feel dumb sometimes, but I'll admit it that I, you know, I had a university degree. I had a science degree from the University of Victoria and we talked a lot about research and stuff. But in the program we were just kind of just fed this information and it's kind of like you teach the anatomy and the physiology and the kinesiology, which is like, okay, that's science, we know these things exist.

Speaker 1: 1:11:21

But then when you're spun the, the manual therapy, the hands-on stuff, they kind of blend it nicely into this sciencey sounding stuff. So they kind of you know, I hate to admit it, but like I was tricked, like where a lot of us are tricked, because you're like, oh, yeah, that's right, that makes sense. Yeah, there's fascia, I know. Yeah, there's nerves, I know, there's arteries, I know there's things and this is what we're doing to them Without really thinking or questioning. Is that what we're doing to them?

Speaker 2: 1:11:51

Mm-hmm. Yeah, well, because think of how much effort it would take for your brain to wrap its head around. At every turning point you're gonna question where the instructive material is coming from, like no, you've already have so much stuff to learn on your plate. It would just be. I mean, it would turn it into a four-year program instead of a two-year program over here, if you were doing it adequately, you know.

Speaker 1: 1:12:14

Yeah, it should be a four-year program.

Speaker 2: 1:12:16

I agree.

Speaker 1: 1:12:17

Some people argue against that. I think it should be a degree program. Personally, but, like you and I both been to university and I think we see the value in that kind of that different type of learning environment.

Speaker 1: 1:12:32

I was at a conference in Winnipeg in March, april this year, may April or May this year, and that topic came up about education and I had said in this panel discussion that I thought it was a good idea for university education. A lot of people really didn't like that because they're like well, that way there's so many fantastic massage therapists out there that they would find university is just a barrier and think well, is it a barrier, like if it's just an? Undergraduate degree, you would apply and you would get in.

Speaker 1: 1:13:01

As a mature student you could get in. I think it's usually 23,. They don't really care about your undergrad or your high school stuff anymore and a lot of people in the RMT profession don't are mature like they go in after they, when they're in their 20s or 30s. Right, not everybody, but a lot of people do, and I thought that's just a weak argument, like you could just go in and you would you get education, but you'd have maybe a little bit more education.

Speaker 2: 1:13:25

Right.

Speaker 1: 1:13:26

When I look at the you know and when you look at the cost, it was a cost to go to university. It's still cheaper than you, than most universities are cheaper than massage school tuition-wise.

Speaker 2: 1:13:37

Wow, we're pretty close right. Like I was just looking here.

Speaker 1: 1:13:39

I had a conversation with somebody recently about this and I was like, well, let me take a look and see what's the tuition at UVic, you know, and it's like I don't know what it was like $4,000, $4,500 a semester and so okay, so times that you know it's what's that, say $8,000 or $9,000 a year times four years you're looking at that $30,000 to $40,000.

Speaker 2: 1:14:02

Yeah.

Speaker 1: 1:14:03

And that's a degree where you could do something else if you wanted to later on, absolutely. You can spend a very similar amount as a massage therapist.

Speaker 2: 1:14:13

Yeah.

Speaker 1: 1:14:14

As a massage therapist. It's full-time school, so you're probably not working part-time A lot of people don't Whereas if you went to university you'd have your summers off or you know your schedule is kind of you could get a part-time job in there if you needed to. It's kind of a similar price cost With a massage therapy. Unfortunately, your degree isn't transferable. It's kind of like a dead end. You're a massage therapist and you can do things around massage therapy but say you want to be a nurse or you want to be an occupational therapist or a physical therapist. You want to do something completely different. You kind of have to go back to do a lot of your education because it's not transferable.

Speaker 2: 1:14:44

Right, yeah, yeah.

Speaker 1: 1:14:48

I think that we need more education, but yeah, I completely agree with you.

Speaker 2: 1:14:53

I mean, it is where it's definitely goes back to again, like trying to find a way to elevate this profession, and I mean we're going to have to find a way to be flexible if we want to achieve that. Yeah, that's what it's going to take, and if 60% of us don't want to be flexible, how long is it going to take for us to elevate? That's the question.

Speaker 1: 1:15:17

Yeah, yeah, it's probably going to be when you and I are retired. We're tired of it because then we'll kind of be like, well, we've tried to do something, you know Right.

Speaker 2: 1:15:28

We did our best. We did our best.

Speaker 1: 1:15:30

You know, someone's got to do something else to pick it up behind us. You know, and Well, just like the stuff that I'm doing with my, I do my course creators Mastermind Group right is just trying to get more evidence-based educators out there so that there's more people presenting better quality supported content to the profession, so we can create wide spread kind of systemic change and that will hopefully put pressure on the colleges, on the massage schools, on the various stakeholders, the professional associations, when they start to say, oh people, want to learn more about this stuff.

Speaker 2: 1:16:05

Mm-hmm. Yeah, I think that's brilliant. I think that's brilliant, yeah, yeah. The reason why it's so brilliant is one of the reasons is because if you go to Again, this goes back to you don't get the research focus unless you go to university, right? So if you're trying, if you're a massage therapist who wants to create CE content or courses, it is stressful to consider how you're going to elevate it, to agree where you would be comfortable rolling it out to the general public, especially where the rhetoric is let's elevate this, right. If you don't have the background and research, then how are you going to do that comfortably or confidently? So if you're providing a place where there is discourse about it, there is support around it, you know peer mentorship and that sort of thing, I mean I think that's brilliant because it's a stumbling block For people that I know, that I graduated with, who are thinking of creating their own CE courses. That is a stumbling block. How do I make this good? What is good? Yeah, what is the standard? Now?

Speaker 1: 1:17:19

How do I define good? Yeah, and I see it all the time and I have definitely. I feel like I've calmed down a lot. I used to get very upset over seeing crap online and things people were saying and I used to want to argue, but I just figured it just got my blood pressure up and it wasn't good for me. I'd rather bring people together than push them apart, so I just kind of leave things be as much as I can and just try and do things like these podcasts and other stuff that I'm involved in, just to say, hey, here's the messages. This is all positive. Just because maybe you're doing something that I don't agree with doesn't mean I don't like you, but I think you can do better.

Speaker 2: 1:17:56

Yeah, you know how you're not going to elevate. This profession is where we create and fighting between groups, where we just stagnate because we're all busy yelling at each other and being keyboard warriors, not being brave enough to say the same thing to their actual face.

Speaker 1: 1:18:12

Oh yeah, I hate that stuff, the keyboard warrior.

Speaker 2: 1:18:14

Yeah, yeah. I've seen people take screenshots of individual providers, the menu, the things that they provide in clinic and oh, they do cranial sacral therapy, like. Let's all point and laugh that kind of vibe Bullying. It is bullying and it's a conversation where, first of all, it's not happening in good faith and, secondly, if you're hoping to elevate this profession, you're going to have to get those people on your side and that's not going to happen. If you're trying to publicly humiliate them, they're not going to bite. If anything, they'll get more defensive and dig a deeper hole and be more resistant to change. So yeah, I'm with you. I just I don't. I think there is enough anger online for it. I just I keep my head down. I teach the way that I want to teach Evidence-based gentle. I have to be gentle with people that think in a different way, because it's through patient conversation that we can kind of come together a little bit better. Yeah.

Speaker 1: 1:19:20

Yeah, gentle is key. Some people like to be pushed, but some people they just push back harder. Yeah, but just to further emphasize the point you made about. So a barrier like research right, is the barrier is and the danger. What we have and this is something that I see all the time is we see people out there teaching C's that have the best of intentions, but they're basing the premises of their course on not good research or based on some anatomical principle or some piece of anatomy, and then they're making wild claims about it.

Speaker 1: 1:19:59

I see that all right, like just because something exists doesn't mean you can change, or it doesn't mean you have to change if further symptoms to get better and we see a lot of that like let's use the SOAS.

Speaker 1: 1:20:10

For example, there's a lot of people out there that will teach courses like the SOAS and back pain and there's actually not one piece of evidence I've ever seen that says the SOAS has any relation to back pain. But then people are like but I treat the SOAS all the time. I'm like there's a lot of really good explanations for why that treatment can help the low back. It's not because you're addressing the SOAS Right, but when you're looking at but people will base these I'm just picking on SOAS. So I'm sorry if anyone's listening.

Speaker 1: 1:20:35

Actually I'm not sorry if you're offended by SOAS, but there's a lot of research out there that says, yeah, this is what the SOAS does, this is where it exists and this is how it moves. And then there's these big inferences made that it's somehow related to pain or somehow related to pain. The only paper I've ever seen and I've done a deep dive into the SOAS research is there's a very rare cancer that can infect that. The SOAS in that area.

Speaker 2: 1:21:07

OK.

Speaker 1: 1:21:07

That's pretty darn rare. That's it. Low back pain is not related to it. Now people are going to say, ok, well, what about? You know, but I do the thing, I push in there, I do the crosshands or whatever I do, and people feel better. I'm like, yeah, if you understand the evidence of how manual therapy works, you realize you're impacting an entire system and you can create an analgesic response from treating kind of anywhere and that could still impact the person's low back pain in a positive way. But people don't. That's stuff, like we said, that's just not presented and it's very fundamental knowledge that is missed and that's my long way of saying is that using evidence the wrong way can be, at the worst, dangerous or at least less, never helpful.

Speaker 2: 1:21:55

Absolutely. I do have a theory why there's so much emphasis on like modalities and anatomy-specific courses. I'm kind of thinking, and maybe this is just like one way of looking at it, but I just feel like people think there's something sexy about it. It's just something that it's marketable. Oh look, I do cupping now. And now, all of a sudden, the general public's like, oh my gosh, she does cupping now. Or like, oh, she took this other piece of you know, and it's just so marketable. And there is a lot of like oh my god, look, real change.

Speaker 2: 1:22:31

And I'm doing like the error quotations Real change, like, look, I have like deep dark circles on my back because they put a cup on, so it must have done something right. And I feel like that's dangerous too, because again, it's the idea that you're kind of leading people to stray as to. You know, don't mistake theory for actual truth, the theory of how something works versus how it actually works or a best understanding of it. Those two things are not the same thing and often they're marketed as truth and I do find that problematic. Yeah.

Speaker 1: 1:23:06

Yeah, I agree, the modality and kind of quick fix and the acronyms out there are very predatory. And you know, people, I don't care what people do Like, I don't care how you practice, whether you use cups or not, I don't use them. We're not allowed to use them in BC. But even if we were, I wouldn't Because like what's the point.

Speaker 1: 1:23:29

You know like I don't see the point purposely, but they are often marketed as this fix it thing and it sells, right. It sells to RMTs who want to take courses and get certified and that stuff. I am not convinced that the public really cares how many acronyms you've been trained in. I'm not convinced that the public really cares if you do cupping or needling or whether you do. You know e-stem, or whether you do barefoot or something I don't think the public really cares.

Speaker 1: 1:24:05

That's my personal opinion, because on my website for years now I sold my practice in 2022 and my shares of the clinic and I just have a small practice out in my house, but in our clinic and we had a big clinic Physios Chiro's Massage Acupuncture and we had about 15, 16 people there. We never once listed on our website what we did. I'm a massage therapist, I'm a chiropractor, I'm a physio. These are some of the populations I like to work with.

Speaker 2: 1:24:33

Right. That's definitely yeah, that's against the grain of what most people, most clinics do. Yeah, 100%.

Speaker 1: 1:24:40

And you know what? I never once and I was owner of that clinic for 12, 13 years, maybe we never once had somebody come in who asks like, oh, do you do this? They didn't, they just wanted to. They're like I want to see somebody that's going to make me feel better, I like to have my back cracked, I like to do exercise, I like to get massage, I like to get used, whatever it was they would choose. People don't ask, but I think in our profession and yeah, what you said you look at clinics and they list all the things I do this, this, this and this thing. I'm like people don't care.

Speaker 2: 1:25:10

Yeah, I could be wrong.

Speaker 1: 1:25:12

But in my experience, which I know is a dangerous thing to say, I never, ever had anybody ask me do you do this thing?

Speaker 2: 1:25:20

Right, yeah, I did have one person. I remember the moment that a person that I had treated that I hadn't seen in a while, that eventually came back because the other massage therapist that they had switched to clearly show that they did cupping. I decided to take that availability offline and I just thought like if somebody wants it, I'll just provide it. Then you know whatever what's the big deal. And then they came back and they're like oh well, I saw that you took it off, so I just assumed that you didn't do it anymore and I thought, well, shoot, ok, rats, ok.

Speaker 2: 1:26:02

Well, I feel like I'm constantly this is something that I struggle with myself, because I see the dangers involved in listing everything out like a menu, at the same time that I'm recognizing that for some people, they will bother to look through that entire menu.

Speaker 2: 1:26:28

And also there is a level of self-consciousness. I get uncomfortable when I think about OK, well, I'm pointing myself towards this evidence-based, let's all elevate the practice. Da, da, da, da. And there's a level of self-consciousness that comes along with that, because I do offer things like cupping and I do offer things like cranial, sacral, and I feel like I'm here on this podcast talking about evidence-based stuff and if a person wanted to do the keyboard warrior thing, they would just pop onto the menu, grab a screenshot, post it onto Facebook and say look, she's full of shit.

Speaker 2: 1:27:07

But the reason why I provide some of those things, like you said before, is that people, if it's patient-centered care or person-centered care and they ask for it, ok, I'll offer it. Whether or not I believe in the theory of what, for example, cranial sacral teaches I mean, I personally don't I think there's other drivers but I have found the benefits of doing cranial sacral holds on people because it's not as stimulating as massage. It's a static hold and for some people that just really need to decompress don't do anything stimulating, even if it is effleraage. I treat some people that are sensitive to those People with like aledinian stuff like that.

Speaker 2: 1:27:55

Yeah, you know they'd rather be held.

Speaker 1: 1:27:58

Yeah, yeah, for sure.

Speaker 2: 1:28:00

Yeah.

Speaker 1: 1:28:01

And that's such a it's an important point you make there too, ashley, is that the thing is, is we name these things? We name these things cranial, sacral, we name them myofascial, we name them effleraage, we're just like. I think we should just name it all just manual therapy, manual therapy.

Speaker 1: 1:28:17

And so, yeah, you're like, yeah, maybe I'm doing what's or people are going to call it cranial hold. But I know what I'm doing is I'm just holding this person in a place that makes me feel comfortable and maybe I'm just putting my hands on it, Maybe I'm doing a little push, pull, twist the skin here, maybe a little tilt whatever it might be that makes it feel better, but that doesn't have to be cranial, sacral, that could just be a manual approach that works for that person.

Speaker 1: 1:28:40

So we can simplify, because I do the same thing too, like I, you know, with people that come in and I will, you know, use a variety of different techniques.

Speaker 1: 1:28:49

Sometimes it's Swedish, sometimes it's. You know the way I always like to joke about it is. I'm like do you like the swimmy technique? Take the slow, stretchy skin technique. Do you like the one the me to hold you technique? Do you want? Like, do you want an oscillation, like, do you want the pokey, do you? Want a broad pokey, or the fingertip pokey you know, and then I mean, I do kind of.

Speaker 1: 1:29:07

I know that some people might think that doesn't sound professional, but I don't know. I have my own way of interacting with my clients and they're like, oh, I like it when you do the. Can you just do the broad, like sweeping thing? I'm like, yeah, I'll focus on that and we'll focus on this area and we'll blend in a couple other things.

Speaker 2: 1:29:22

Great you know, and that's so, that way we're not naming it, I'm just.

Speaker 1: 1:29:26

but they're describing the kind of touch and whether that works best for them. And if they don't know, then we'll just try a few different things to see what feels good, and sometimes that might be, say, it's cranial, maybe they've got, you know, terrible headache and maybe I'm just gonna like hold their skull for half an hour.

Speaker 2: 1:29:44

Yeah, that's it.

Speaker 1: 1:29:46

Yeah, it doesn't have to be cranial sacral.

Speaker 2: 1:29:48

Mm-hmm.

Speaker 1: 1:29:50

That's the way I like to think of it.

Speaker 2: 1:29:51

I totally agree Simplify it right.

Speaker 1: 1:29:53

We can. I think we can throw it all into the same bucket of manual and just call it manual therapy.

Speaker 2: 1:30:00

Yep, I agree.

Speaker 1: 1:30:03

Yeah, well, this has been wonderful. I feel like we could just chat forever. I'm gonna have to do another one of these. Yeah, yeah, especially when we had the half hour of stuff we didn't record beforehand.

Speaker 2: 1:30:13

Yes, that would have been a good conversation too. Absolutely yeah, yeah, we'll, yeah, we'll get. I'm sure we'll have more chances to get together again. Oh, for sure, I appreciate it. That was a great chat.

Speaker 1: 1:30:23

yeah, yeah, thank you. So for people, do you want to? Do you want to just provide any information for people to get ahold of you if they have any questions? Maybe people are interested in your course. I know it's not launched as a book or thing, but I know you are planning on launching it sometime in the future. Maybe just give some people how to get ahold of you.

Speaker 2: 1:30:40

For sure you can find me on social media, so I do have a LinkedIn. Just search my name. It's Ashley A-S-H-L-E-Y, brazicky, I'll slow down. It's BRZ, e-z-i, c-k-i, so I'm on LinkedIn. I'm on Instagram I think my handle is ashrmtdeathdula, so you can find me there. I do also have a Facebook, but I'm less active there just because I find it a pretty noxious place, so I don't love to spend my time there. But those are probably the easiest ways of getting ahold of me on social media. I do have an email, ashrmtmentorgmailcom, and I do have a website that's being worked on as we speak, so that will go live sometime soon and I'll be providing lots of resources there as well, and I'll post onto my socials when it's active. So that's coming course is coming one step at a time, and, yeah, I'm so looking forward to interacting with other massage therapists about this topic. It's something I'm really excited to do, so hopefully people see as much value in it as I see in it.

Speaker 1: 1:31:54

No, I think it'll be great, ashley, I think your passion comes through, definitely, and how you talk about the topic and talk about what it is you want to offer. So I look forward to seeing great things from you. So thank you.

Speaker 2: 1:32:05

Awesome. Thank you so much for having me.

Speaker 1: 1:32:07

Thank you for listening to Purvis Versus. If you enjoyed this episode, please give it a five star rating and share it on all your favorite social media platforms. You can follow me on Instagram or Facebook by searching at ericpurvisrmt, and please head over to my website, ericpurviscom to see a full listing of all my live courses, webinars and self-directed course options. Until next time, have a great day and thanks for listening.