Monday, October 31, 2016

Report on the 2016 Inaugural Military and Civilian Health Care Provider Forum, Lakewood, WA


On Wednesday, October 26, I attended the 2016 Inaugural Military and Civilian Health Care Provider Forum at the Tacoma Golf & Country Club in Lakewood, Washington (very close to the city of Tacoma, as well as to Joint Base Lewis–McChord).


The event was intended to bring together individuals and organizations affiliated or interested in working with the military so tht we could learn from one another regarding services delivery, systems navigation and quality of care practices.


I was there representing the Veterans Therapeutic Massage Center (VTMC), Pacific Northwest College of Allied Health Sciences (PNCAHS), and the Project for Open Education in Massage (POEM). I was the only representative of the massage profession who attended the event.

The forum was intended to focus on joint collaboration on these mutually-beneficial objectives:
  • Enhancing collaboration between military & civilian health providers
  • Better understand services delivery
  • Learn more about systems navigation
  • Gain insight on quality of care practices
  • Initiate an action plan on joint objectives 
A number of presenters, military and civilian, laid out current programs, and what they would like to see more of.










There are many places where massage therapy could meaningfully fit in for the benefit of active-duty troops, their families and dependents, and veterans..



In the breakout session, we divided up into groups that brainstormed on one of several questions:
  1.  How do we encourage more civilian healthcare providers to schedule appointments for troops, their dependents, and veterans?
  2. How can we communicate/coordinate better in order to provide seamless care between settings for active-duty troops, their dependents, and veterans?
  3. How can civilian and military providers keep learning from and supporting each other?




Action items for POEM, PNCAHS, and VTMC from this meeting include the development of CE courses for beta testers in December, and attending the next meeting of the South Sound Military & Communities Partnership Health Care Working Group via teleconference. Report on those action items to follow as they are completed.




Friday, October 14, 2016

Looking for beta testers for continuing education program

I'm looking for beta testers for a 24-hour program of continuing education (CE), designed to meet the 2-year requirements for CE for massage license renewal in Washington state, as specified in WAC 246-830-475.

"Beta tester" just means that, since this is the first time the program is offered, you'll be asked to evaluate it especially closely, and you'll get a discount on the course price to recognize your evaluation efforts. You won't need to repeat the course based on any feedback; it is already valid Washington state massage CE. Your feedback will help me add value to the course, but you won't have to go to any additional effort for the full credit to count toward license renewal.

The program consists of:
  • 8 direct-contact hours supervised massage skills training in a real-life clinical environment;
  • 4 direct-contact hours in clinical applications of professional ethics, communication, and Washington state massage laws and regulations, including professional roles and boundaries;
  • 12 hours e-learning/online electives of your choice, including choosing among the following courses.
Adaptive Massage Therapy (2, 4, 6, 8, 10, or 12-hour options: courses must be taken in the order listed)
  1. Adapting Massage Therapy to Clients' Needs—Introduction, Legal Considerations and Scope of Practice (2 hours)
  2. Adapting Massage Therapy to Clients' Needs—Safety (2 hours)
  3. Adapting Massage Therapy to Clients' Needs—Cultural Considerations (2 hours)
  4. Adapting Massage Therapy to Clients' Needs—Transfer (2 hours)
  5. Adapting Massage Therapy to Clients' Needs—Dressing and Undressing (2 hours)
  6. Adapting Massage Therapy to Clients' Needs—Wheelchair and Bed Massage (2 hours)

Office and Clinical Operations for Mainstream Professional Healthcare Massage Therapy (2 hours)

Pain Science and Massage Therapy (2, 4, 6, 8, 10, or 12-hour options: courses must be taken in the order listed)
  1. Foundational Neuroscience for Pain-Science Literate Massage Therapy—Introduction (2 hours)
  2. Foundational Neuroscience for Pain-Science Literate Massage Therapy—How the Senses Work (2 hours)
  3. Foundational Neuroscience for Pain-Science Literate Massage Therapy—How Pain Works (2 hours)
  4. Foundational Neuroscience for Pain-Science Literate Massage Therapy—Adaptation to the Changing Environment, Professional and Personal (2 hours)
  5. Foundational Neuroscience for Pain-Science Literate Massage Therapy—Supporting What Massage Has to Offer Clients Living with Chronic Pain (2 hours)
  6. Foundational Neuroscience for Pain-Science Literate Massage Therapy—Trauma and Chronic Pain (2 hours)

Professionalization of Massage Therapy in the 21st century (2, 4, or 6-hour options: courses must be taken in the order listed)
  1. Introduction to Professionalization of Massage Therapy: The 5 Commitments of Client/Patient-Centered Healthcare Professionals (2 hours)
  2. Massage Therapy as an Interdisciplinary Healthcare Profession (2 hours)
  3. Interdisciplinary Professional Teamwork (2 hours)

Self-Care: A Professional Duty for Members of the Client/Patient-Centered Healthcare Team (2 hours)

Trauma-Aware Massage Therapy (2, 4, 6, 8, 10, or 12-hour options: courses must be taken in the order listed)
  1. Massage for Survivors of Military Sexual Trauma
  2. Massage for Survivors of War, Torture, and Genocide
  3. Massage for Clients Living with PTSD
  4. Massage for Clients Living with TBI (Traumatic Brain Injury)
  5. What Massage Therapists Need to Know About Gender, Culture, Trauma, and PTSD
  6. Recognizing Mental Health Emergencies: What Massage Therapists Need to Know About Suicide Prevention

Vulnerable/Underserved Populations and Massage Therapy (2, 4, 6, 8, 10, or 12-hour options: courses may be taken in any desired order)
  • Working with Diverse Communities in Seattle: Massage in Southeast Asian Cultures
  • Working with Diverse Communities in Seattle: Massage in East African Cultures
  • Cross-Cultural Responsiveness: Military Culture for Massage Therapists
  • Cross-Cultural Responsiveness: Refugee Experiences
  • Massage for Children Living with Cerebral Palsy
  • Massage for Children Living with Fetal Alcohol Syndrome


The first 30 qualified beta testers will complete 24 hours of massage CE tailored to meet the requirements of WAC 246-830-475 between October 2016 and December 2018 for $100.00.

To count as a "qualified" beta tester, you must have a valid and unencumbered Washington state LMP license, and current liability insurance through a reputable major carrier. Your license and insurance will be verified when you sign up as a beta tester, and it will be verified again before any contact with the public in any clinical direct massage skills class. You must be able to attend 12 hours of clinical classes and ethics classes in the Seattle metro area in person sometime between October 2016 and December 2018. If this sounds like an opportunity that you would like to act on, email me at raven.massage.ce@gmail.com, and let's start the discussion.

Details of massage continuing education beta tester program

Potential blockers to consider before signing up:

If you need all 24 hours CE to renew your license by, say, November 1, 2016, then we can't turn this around fast enough, and you shouldn't sign up for that purpose. You are still welcome to participate in the program to fulfill your licensing requirements for the period after that one.

There will be one 8-hour clinical in November, and one 8-hour clinical in December. Beginning in January 2017, there will be options to choose among more than one clinical per month.

The exception to that rule about multiple clinicals per month in 2017 is June, July, and August 2017, where there will be no clinicals in WA or anywhere in the US, as I am planning to be in Southeast Asia then.

Clinical experiences in Burma, Cambodia, Haiti, and Vietnam are not included in the beta tester program.

Sign-up (through October 31, 2016)

All of the action items are required for every beta tester.
 

Beta tester action items
  1. Provide valid and unencumbered WA state license (can't do clinicals without it) ("unencumbered" means you must have no current disciplinary actions attached to it, nor any restrictions from any past disciplinary actions)
  2. Provide proof of current professional insurance against liability and malpractice
  3. Provide license renewal date for planning 
  4. Promise that you can be in the Seattle area for 12 hours of in-person direct-contact CE (clinicals and ethics training) between October 2016 and December 2018 
  5. Promise that you have the computer equipment and Internet connection robust enough to participate in watching learning videos and participating in Skype or Google hangout discussions in real time. If you are unsure whether your setup is robust enough or not, I can provide you with information and materials to test it. 
  6. Pay $100.00 beta tester fee   

My action items

  1. Verify all information provided 
  2. Start student file, learning portfolio, and transcripts 
  3. Provide unique ID number for use in privacy protection for online discussion and polls 
  4. Propose a customized plan for meeting license renewal date with 24 hours of CE to each beta tester, and revise each plan as appropriate, based on beta testers' feedback and preferences, until plan is mutually satisfactory 
  5. Send out progress reminders (weekly or monthly, according to beta testers' individual preferences

Online courses contain knowledge that you need for application in the clinic, so many of the clinical courses will have online prerequisites that you need to complete first. These prerequisites will be spelled out clearly in the description of the clinical. In addition, every month (except June, July, and August 2017, when I will be out of the country), there will be at least one clinical offered that does not require any online prerequisites, and those clinicals can be signed up for, independent of the online courses.


First beta-tester task: Organize the order of production of online courses

All tasks are work that I am providing the classes at such a steep discount for, so participation is required in all tasks, in order to remain in the beta tester program.

My action items

  • Send out a reminder on October 31, 2016 that voting for the order of courses offered begins November 1 at 12:01 AM PT and closes November 8 at 11:59 PM PT. Include a link to survey for voting.

Beta tester action items

  • Using your unique ID provided at registration, vote for the order in which you'd like to see the courses developed and offered online.


Second beta-tester task: Work the plan we agree on for your CE progress

Life happens, and I expect that we will make changes to the plan as we work it, and as things become necessary to change or move around. However, the plan ends in December, 2018, and so even modified plans must be completed by December 31.

I'll verify your license and insurance information again before every clinical, to be sure that nothing's changed since registration before you perform clinical work on the public. You must have insurance and a valid, unencumbered license to perform a public clinic; there can be no exceptions to this rule.

Final beta-tester task: Complete a detailed evaluation of your assessment of how the program went for you.

I'll use your feedback to make changes and improvements to the program, which will then be offered at full price to future students.

I've tried to think of everything that might come up, but I'm sure that I've probably left things out. For any further information or clarification, please feel free to mail me at raven.massage.ce@gmail.com .

I'll look forward to hearing from you!

Thursday, October 6, 2016

Interdisciplinary connections: Kate Starbird on the importance of empathy in research

Kate Starbird is a computer science and engineering professor at the University of Washington. She studies digital volunteerism in social media after crises, such as an earthquake or the Boston Marathon bombing.

There are many caring people around the world who want to actively help when disaster hits. Although they are too far away to directly perform first aid, deliver supplies, and carry out other crucial tasks on the ground, they are perfectly situated for organizing information for rescuers who are there, like classifying messages in individual tweets to make those  messages easier to distribute where it's needed.

Just as we aspire to promote resilience and self-efficacy in our individual clients, she works to facilitate those aspects in communities.

With Hurricane Michael's destruction in Haiti in the news, her observation on the importance of empathy in conducting research is especially timely right now.

"I think empathy is really important for doing research—especially qualitative research—on disaster events. We really have to approach each study with recognition that the events we are studying had (in many cases) catastrophic effects on people’s lives. Even though we tend to focus on the more positive aspects of disaster, i.e. people working together to survive and thrive afterwards, the context of this work is always quite sad. At every point in the study—data collection (especially interviews), data analysis, writing up papers, and giving presentations—we have to balance our enthusiasm for the research with the weight of the event and its impacts. So being able to empathize with those who are affected, even with folks who were not directly affected but who spent considerable time trying to help and are therefore emotionally impacted, is extremely important."

"

Wednesday, October 5, 2016

We are not alone: The role of research as other healthcare professions also find their way to advanced practice




There's a dialogue going on in the radiation therapy literature that's very relevant to our growth and development as a healthcare profession. I'm including the full text of the final response here, because it's short, very clear, illustrates issues that we have in common, and serves as a model of discussing professional disagreements in constructive ways.

If you'd like to read the first article in the discussion, you can find it here, and the first response to the article can be found here.

We agree with the authors' conclusions that, despite the historical lack of an academic background in our professional development, "...omitting research as a core activity diminishes the value of the role, its contribution to high‐quality patient care and the status of the profession.".




J Med Radiat Sci. 2015 Dec; 62(4): 292–293.
Published online 2015 Dec 8. doi:  10.1002/jmrs.147
PMCID: PMC4968557

Letter in response to ‘The role of research for advanced practitioners’

Amanda Bolderston, DCR(T) (UK), RTT, MSc, FCAMRT, 1 Nicole Harnett, MR(T), BSc, Med, 2 , 3 Donna Lewis, MRT(T), BA, 4 and Marcia Smoke, MRT(T), RTT, ACT, MSc 5
Re: Sim J. Omission of research in the conceptual model of advanced practice. J Med Radiat Sci, doi:10.1002/jmrs.128 [PMC free article] [PubMed]
We have read with interest the correspondence between the authors of the article ‘Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions’1 and Associate Professor Jenny Sim regarding the role of research in advanced practice (AP) radiography roles.
We enjoyed the paper, and would like to commend the authors for their contribution to this important topic in our field. It is encouraging to observe discourse on the types of roles we would like to see, and the characteristics or competencies associated with them. It is to be expected that our national models will vary somewhat, given the differences in our professional jurisdictions, regulatory frameworks, associations and how the AP initiatives have evolved in each country. In Canada, our AP roles have developed in radiation therapy initially as a provincially funded, data‐driven (and evidence‐based) project in Ontario for over 10 years before a national framework was established.2 The concept is now expanded beyond Ontario and the national certification process is currently undergoing a pilot testing phase (http://www.camrt.ca/wp-content/uploads/2015/02/Advanced-Practice-in-Medical-Radiation-Technology-A-Canadian-Framework.pdf).
Our first step in Ontario involved a small group of practitioners working within a limited number of mainly large and urban centres. We positioned research as a core focus from the beginning, with the assumption that our advanced clinical experts would be the best positioned to build our professional‐specific knowledge base. The AP radiation therapist, as a politically astute clinical leader and expert clinician has the focus, skills and flexibility to see the evidence gaps and work towards filling them. Based on the collection of strong evidence showing the positive impact this new health care professional is having on the radiation therapy system,2, 3 Ontario's initiative has expanded to 25 advanced practice radiation therapists in nine of its 14 cancer centres. In 2014/15 alone, they combined for the production of 14 published manuscripts and 16 published abstracts for conference presentations and are engaged in a total of 52 research projects – a level of research‐related academic production that far exceeds the professional average in Canada. These activities integrate them deeply into the inter‐professional teams within which they work and make them a vital contributor to the creation of new knowledge in radiation therapy; an activity that is considered to be foundational to the definition of a ‘profession’.4, 5
While we also admire the Canadian‐based physician CanMeds framework – we would respectfully point out that radiographers (including those in an AP position) have a very different role, background and opportunities than the typical specialist physician. Traditionally our education did not include the same type of academic preparation assumed by the CanMeds framework,6 such that when they say ‘scholar’, it is automatically assumed that the physician will produce, consume and analyse research as well as use the scientific method to solve problems or questions. If we want to be equal contributors on the team, we need to overtly require this activity as this is not historically part of our professional identity. In addition, we have the opportunity to develop something unique to our profession and perhaps to move away from medically based criteria and models.
Thank you for the opportunity to engage in a discussion about the importance of research in AP roles. As stated, we feel omitting research as a core activity diminishes the value of the role, its contribution to high‐quality patient care and the status of the profession.

Notes

J Med Radiat Sci 62 (2015) 292–293

References

1. Smith T, Harris J, Woznitza N, Maresse S, Sale C. Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions. J Med Radiat Sci 2015; doi:10.1002/jmrs.115 [PMC free article] [PubMed]
2. Harnett N, Zychla L, Bak K, Lockhart E. The evidence‐based development and implementation of an advanced role: The Clinical Specialist Radiation Therapist. J Allied Health 2014; 43: 110–16. [PubMed]
3. Lockhart E, Gutierrez E, Warde P, et al. A new model of care: An advanced practice radiation therapy role. 2014 ASCO Quality Care Symposium. J Clin Oncol 2014; 32: (suppl 30; abstr 131).
4. Manning D, Bentley HB. The consultant radiographer and a doctorate degree. Radiography 2003; 9: 3–5.
5. Nixon S. Professionalism in radiography. Radiography 2001; 7: 31–5.
6. Harnett N, Palmer C, Bolderston A, Catton P. The scholarly radiation therapist part one: Charting the territory. J Radiother Pract 2008; 7: 99–104.


POEM commits explicitly to every one of the fundamental values and subvalues of The International Charter for Human Values in Healthcare

The International Charter for Human Values in Healthcare was published by a multi-year international collaborative initiative, to describe the core values that every client/patient should be able to reliably depend upon finding in every healthcare encounter that they are involved in.

This list of values and subvalues, reprinted from Table 1 in:

Rider EA, Kurtz S, Slade D, Longmaid HE 3rd, Ho MJ, Pun JK, Eggins S, Branch WT Jr. The International Charter for Human Values in Healthcare: an interprofessional global collaboration to enhance values and communication in healthcare. Patient Educ Couns. 2014 Sep;96(3):273-80. Free fulltext link

represents an explicit commitment by POEM to every single one of the values and subvalues listed.

The International Charter for Human Values in Healthcare: fundamental values and subvalues

Fundamental Value 1: Compassion

Compassion should be central to human relationships. Compassion means to understand the condition of others, and to commit oneself to the healing and caring necessary to enhance health and relieve suffering. These values underlie our efforts to be compassionate.
  • Capacity for caring
  • Capacity for empathy
  • Capacity for self-awareness
  • Motivation to help, heal
  • Capacity for kindness
  • Capacity for genuineness
  • Capacity for generosity
  • Capacity for flexibility and adaptability in relationships
  • Capacity for acceptance
  • Capacity for curiosity
  • Capacity for altruism
  • Capacity for mindfulness

Fundamental Value 2: Respect for Persons

Respect should form the basis of all of our relationships.
  • Respect for patient’s and their significant others’ viewpoints, opinions, wishes, beliefs
  • Respect for cultural, social, gender, class, spiritual, and linguistic differences
  • Respect for autonomy
  • Respect for privacy and confidentiality
  • Respect for all colleagues of the interprofessional team
  • Humility

Fundamental Value 3: Commitment to Integrity and Ethical Practice

The healing professions are built around integrity and ethical practice. These must underlie and permeate all actions in the health professions.
  • Commitment to honesty and trustworthiness
  • Commitment to reliability
  • Commitment to accountability and responsibility
  • Commitment to the patient’s well-being
  • Commitment to doing no harm
  • Capacity to acknowledge one’s limits and seek guidance; awareness of own limitations
  • Commitment to tolerance and non-judgmental care

Fundamental Value 4: Commitment to Excellence

We must dedicate ourselves to achieving excellence in all aspects of healthcare. Without excellence, no matter how well intentioned, our efforts to heal will fall short.
  • Commitment to providing the best, most effective care (scientifically and psychosocially)
  • Commitment to communication excellence
  • Commitment to relational excellence
  • Commitment to self-awareness and reflective practice
  • Commitment to life-long learning, expertise, and professional development
  • Commitment to serve the patient’s best interest

Fundamental Value 5: Justice in Healthcare

We believe that healthcare professionals should embrace the values of justice in healthcare, and commit themselves to advocating for and putting these values into action.
  • Right to healthcare (information, access, quality)
  • Right to equality
  • Commitment to advocating for the patient
  • Absence of discrimination and prejudice
  • Attention to social factors, constraints, and barriers to care
  • Commitment to social justice



Adapted from: The International Charter for Human Values in Healthcare. © 2013, 2014 International Research Centre for Communication in Healthcare. © 2011–2012 International Collaborative for Communication in Healthcare. All rights reserved.

Tuesday, October 4, 2016

Becoming a trustworthy professional partner

We talk a lot about massage therapy becoming a mainstream healthcare profession. How do we make that actually happen?

Two crucial components of trust are competence and integrity. Our potential clients and healthcare professional colleagues need two things from us: they have to be able to trust that we are able to deliver safe and effective healthcare competently, and they have to be able to trust that our words are true, and that they match our actions.

A great deal of the focus of this POEM reboot will be interprofessional education, because that's a huge need in the current massage education landscape. We'll talk about competence soon; here, we'll talk about integrity and caring about what our partners care about.

Being a good partner means genuinely caring about what our partners care about, and integrity means that we don't just give lip service to that caring--we care in reality, and our actions are consistent with that caring.

What do our partners care about? Mainstream healthcare professionals have identified areas where they consider interprofessional education to be especially important. (All of these organizations are in the US context, because that's what I am most familiar with--I welcome comparison and contrast in a discussion about how these issues are thought about on an international level.)

The Institute of Medicine has identified six areas of healthcare quality that a healthcare system should aim for:
  • Safe: Avoiding harm to patients from the care that is intended to help them. 
  • Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively). 
  • Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. 
  • Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care. 
  • Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and effort. 
  • Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. 

To support these aims, the IOM proposes the following interprofessional core competencies, spelled out in Health Professions Education: A Bridge to Quality.

Chapter 3 The Core Competencies Needed for Health Care Professionals 
All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics. 
To this end, the committee proposes a set of simple, core competencies that all health clinicians should possess, regardless of their discipline, to meet the needs of the 21st-century health care system: 
  • Provide patient-centered care—identify, respect, and care about patients’ differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health. 
  • Work in interdisciplinary teams—cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable. 
  • Employ evidence-based practice—integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible. 
  • Apply quality improvement—identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; design and test interventions to change processes and systems of care, with the objective of improving quality. 
  • Utilize informatics—communicate, manage knowledge, mitigate error, and support decision making using information technology.

Similarly, the Accreditation Council for Graduate Medical Education (ACGME) has identified six milestone-based competencies to evaluate physicians in training. Although they slice up the conceptual pie slightly differently than the IOM does, you can see how much the sets of competencies have in common with each other.
Patient Care 
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. 
Medical Knowledge 
Residents must be able to demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. 
Practice-Based Learning and Improvement 
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. 
Interpersonal and Communication Skills 
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, patients’ families, and professional associates. 
Professionalism 
Residents must be able to demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. 
Systems-Based Practice 
Residents must be able to demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

The professional partners whom we say we want to be teammates with have made it very clear what they care about, for the benefit of providing the best care possible for their patients.

Providing resources for building these interprofessional competencies inside MT is one focus here at POEM. To make it easier to navigate the resources, each of these competencies will have a label associated with it. You can click the appropriate label to bring up all the posts associated with a particular competency topic.

Genuinely caring about developing these interprofessional competencies, and making sure that we walk the talk with integrity--that's up to all of us, every day.

Monday, October 3, 2016

Weaving the future of massage therapy as a modern medical-science-based healthcare profession

Rear view of the shed on a four-harness table loom. Photo by Aranel, September 28, 2004.

attribution share alike
This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

As any weaver knows, the elegance of a fabric lies in the yarns, not the threads. The whole is lots more than the sum of its parts. In health services, the threads are the diagnoses on which interventions are based. How these threads are spun into yarn (the underlying biodynamic of the tapestry of health) is poorly understood, to the detriment of efforts to understand the genesis of health problems and the interventions associated with them. Part of the problem is the imperative to “sell” diagnoses in order to market the interventions associated with them. Those who make their living by focusing on diseases resist understanding that health is a pattern. Without grasping the pattern, management is at best an approximation of adequate care...Understanding the tapestry of morbidity and the contributions of health services depends on the yarns woven from the threads that constitute diagnoses. The high prevalence of comorbid and multimorbid conditions and their impact on both responsiveness to interventions and the occurrence of adverse effects demand that views of health be changed from its current narrow focus on diseases to a much broader view of various aspects of health and their interactions in patients and populations. -- Barbara Starfield, MD, MPH, "Threads and Yarns: Weaving the Tapestry of Comorbidity", Annals of Family Medicine, March 1, 2006: vol. 4 no. 2, 101-103.

In an elegant metaphorical image, Barbara Starfield sums up brilliantly why it's so important for us to really understand how the natural world actually works.

First of all, it puts our clients and their best interests--instead of our own favored personal beliefs--rightfully at the very center of our practice.

Additionally, it makes patterns in the world around us make sense. If you accept the body of validated chemistry knowledge carefully gathered and curated across centuries and across countries and cultures as the best way of knowing about chemical reactions in life, then you can draw an unbroken line from:
Henry Vandyke Carter [Public domain], via Wikimedia Commons


how digestion works, to

By Quadell (Own work) [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons


why you can safely preserve high-acid fruits (but not vegetables, meat, or fish) in boiling-water baths, to

Martin Pot (Martybugs at en.wikipedia) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons


why respiratory and metabolic acid-base imbalances are such urgent situations to the mainstream healthcare professionals who are our potential colleagues and teammates.

Matter, and its property of acidity or alkalinity, behaves reliably in the same universal and coherent way through all of those scenarios, and our natural world is--to some degree--a reliable and understandable place.

If you reject chemistry, however--whether practicing flat-out systematic chemistry denialism, such as believing in homeopathy, or just believing isolated junk pseudoscience like drinking lemon juice so that the citric acid will somehow raise the alkalinity of your blood--then nothing makes sense. It's random lurching from validated chemical and physiology science to the very opposite, of those facts, depending on what you need to argue in the moment: for example, if you want to pass a reputable licensing exam, you'd say, correctly, that only the urinary system and respiratory system can make meaningful changes in blood pH.  Then, to defend the alkaline diet, you have to contradict those facts, and claim that, somehow, more citric acid survives the hydrochloric acid in the stomach to make it intact into the blood to have a meaningful paradoxical effect there of making it less acidic.

It's exhausting to keep all those stories straight, and there's really no reason to do it, when our clients are best served by seeing patterns as they are in reality. If we accept the reality of the natural world, and we do the work to understand how it actually functions, then we can better grasp the threads of the tapestry of the complex conditions that our clients are living with, and we will have so much more high-quality, meaningful, and relevant care to offer them.

Cheers to Maureen Johnson, who introduced me to the writing of Barbara Starfield!

POEM's temporary home

Hi, everyone--

While I straighten out the situation with the POEM domain, this site will be the temporary home for POEM blog posts.

I'm looking forward to a happy and productive time of service outreach and learning with you here!

Don't worry about the different author name "thalarctos" ("polar bear"); that's just my nym here in Blogger. When we go back to the real poem-massage.org domain, it won't follow us back there.

In any case, it's just me.

thalarctos, aka Ravensara Travillian