Saddle up kids. This one is a long one.
Regarding the newest message from the CMTBC that goes into effect today, please enjoy this version I wrote for people like me who prefer things said in in plain accessible words, so I can understand what the crap it means.
Although this is representative of the new scope of practice standard, I wrote this for edutainment (education + entertainment) purposes only, and should not be taken seriously by anyone. This is my personal interpretation of what these things mean in a practical sense. In no way am I suggesting that I am any kind of authority on this. Also….if you’re offended by the use of so called foul language…this isn’t for you.
New Scope of Practice Standard of Practice and Evidence-Based Practice Standard of Practice go into effect today January 15, 2024The CMTBC Board approved some new shit regarding expectations of practice for an RMT. Keep in mind…this is an expectation, not a suggestion.
It’s regards to 3 things, and those things are: Scope of Practice standard, Evidence-Based Practice standard and Consent Standard of Practice.
This all goes into effect today. (January 15, 2024)
1: Scope of Practice Standard
“Standard” is another word for base minimum level of expectation.
- The Scope of Practice Standard clearly talks about shit we’re allowed to do and shit we’re not allowed to do because it’s bad for the public. We gotta stay in our lane yo. This includes understanding what the definition of Massage Therapy is…I know it’s borrig AF, but you can’t sell something you don’t know the definition of. For further clarity, check Massage Therapists Regulation and Notices to the Profession.
Scope of Practice expectation includes:
- A definition
- Eight minimum requirements
- A dictionary of terms
- Shit you gotta understand about how it works.
Evidence-Based Practice
When it comes to Evidence-Based Practice this is what you gotta know:
- The very definition of evidence-based practice. What the fuck does this mean?
- 4 basic rules of application
- A dictionary of definitions
More shit is coming by the end of Jan, so we can understand more about this important move.
Consent Standard of Practice
The Consent Standard of Practice sets clear expectations regarding how to do informed consent. If you’re shaking your head at this going…but why, I’m just fine…then we’re not here because of you. On the whole, we suck at this, which is evidenced by the shit list. Take a readthrough that bad boy and tell me we don’t deserve some pretty strict rules.
Research is supporting that we can’t be telling lies and bullshit in our practice…so we gotta get on the same page. If you believe bullshit…that’s not the worst thing…no one even blames you for it, well at least I don’t. However, even If something isn’t your fault because we were taught an outdated education, it’s still our responsibility. Fault and responsibility are different things…you feel me?
4.c. is about how we communicate with people:
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- You gotta ensure that you’re doing your best to communicate in a way that people understand what you’re saying. Pro-tip…asking them to paraphrase can really help. (See this part for more about “Application to Practice”)
- You gotta do your best to incorporate an evidence-based practice approach. The fact that this is an expectation is both amazing, and terrifying… I mean…we’re not taught EBP in school, and our professional association doesn’t stand behind evidence based material, so we are functioning in this profession which is taught, and incentivized by bullshit to never change. If this is making you uncomfortable that’s good…we ought to be uncomfortable.
If you think there’s loads of quality education out there appropriate for RMTs at the level of a HCP…you’re just not paying attention, and I would be happy to explain myself to you anytime…because that’s accountability…talk shit and you’re expected to explain yourself.
- You gotta ensure that you’re doing your best to communicate in a way that people understand what you’re saying. Pro-tip…asking them to paraphrase can really help. (See this part for more about “Application to Practice”)
Strategic Plan
We got a plan to make shit better…modernize…get with the times and shit.
For more information
If you got questions you can link here, or if you wanna talk to someone, you can check the CMTBC with your questions here.
Standards of Practice
Purpose
If you want your massage therapy to be safe, ethical, and competent this is the base level minimum expectation.
It’s time to level up yo. If you want someone to talk to about this…I have office hours on Mondays and Fridays. Just message me. I’m happy to chat with you anytime.
This expectation of getting our crap together drops today, homz.
2: Scope of Practice
Definition
What we’re allowed to do, and expected to do can be further viewed in the Massage Therapists Regulation
If you call yourself a Massage Therapist…this is what it means. You wanna wear the badge, this is the bare minimum. Not an option. Not an opinion.
If you want more freedom to do whatever you think is best, you can be a bodyworker and be unregulated. No disrespect! I know plenty of bodyworkers that are straight up better than a lot of RMTs in terms of hands on, rapport building, and consent practices. We have a lot of work to do, and if you’re not on board for this change, just tap out and say it’s not for you. No shame fam. I still love you, and I’m still here for you. You’re still my Massage Therapy family.
The legal definition of Massage Therapy is:
“for the purpose of developing, maintaining, rehabilitating, or augmenting physical function, or relieving pain or promoting health, the services of
- assessment of soft tissue and joints of the body, and
- treatment and prevention of physical dysfunction, injury, pain and disorders of soft tissue and joints of the body by manipulation, mobilization, and other manual methods.”
I don’t like this…because we know we can’t prevent shit…but whatever, I’ll take it for now.
There’s also a list of shit we’re specifically not allowed to do, including:
- prescribe or administer drugs or anaesthetics,
- treat a recent fracture of a bone,
- apply any form of medical electricity, or
- move a joint of the spine beyond the limits the body can voluntarily achieve using a high velocity, low amplitude thrust. (…by the way…I asked if this means we can do it in the periphery, and got a real big no).
This is a more specific list of shit we’re not allowed to do…guess they have to say that because people keep doin it. You can check it here in the Notices to the Profession
Massage is obviously up to your style…but you gotta colour within the lines if you want the title.
Requirements
- You gotta know your shit when it comes to scope of practice, actually read the emails sent out by the CMTBC, and understand this shit and what it means for your practice.
- You gotta actually not just know your shit, but you gotta do that shit. Stay in your lane, color in the lines, and walk that walk yo.
- When doing Massage Therapy at all, you gotta:
- Take care to practice within the shit we’re allowed to say and do; and
- Make sure your skill level is appropriate for the task.
- You can do exercise, theragun, scraping people or other shit we’re allowed to do that’s not actually massage therapy, but you best be also making Massage a part of the treatment or you’re gonna get got.
- Yo! Listen to me…I’m fuckin serious yo. STOP putting fingers inside of people! You’re hurting people, taking advantage of people, and you’re an embarrassment to the profession….sorry…that shit just makes us look bad….Sorry…that’s as nice as I could be about that.
- If you’re also another kind of practitioner, you gotta keep yo shit separate yo. Try:
- Clearly telling people that you can’t do both at the same time;
- Do only RMT shit when you’re billing as an RMT. Keep that shit separate yo.
- Keeping it separate means not just bills, but appointments, email communications and charts too.
- A couple of suggestions on how to keep it separate:
- Don’t even say on your website bio that you also provide something that isn’t specifically massage therapy like esthetics, aromatherapy or whatever…you wanna do that shit, you gotta have another space where people can see Jane or Joe the bodyworker versus seeing Jane or Joe the RMT who does completely different shit. Don’t confuse people or mislead them into believing they can double dip services…keeping that shit straight and making sure they understand it on you yo.
- This means all your shit has to be in line with that specific service…RMT intake, billing, homecare, charting is all specific to RMT. Like I said…you wanna provide some different shit…great, just make sure it’s all separate;
- Don’t even talk about that other shit you do when you’re providing RMT services.
- That also means don’t sell people on your RMT services when you’re providing that other shit you do, like aromatherapy or whatever.
- Keep all your bills and records separate.
- When you bill someone…that shit must include:
- Your registration number;
- Only call your-self an RMT on that bill…don’t put your other shit in there if you’re also a chiro, physio, counsellor, or acupuncturist. One bill at a time.
- The bill should only say it’s for Massage Therapy. If a patient also saw you for a back-to-back treatment as something else, you gotta bill that shit separately.
3: Evidence-Based Practice
Definition
Evidence-based practice in Massage Therapy will officially involve 4 parts, and it applies to everything we do in all sessions from intake to discharge. It includes:
- Evidence based on research for what you do. Don’t just talk about it…be about it.
- Do that shit while still being a Massage Therapist within the rules set out by Massage Therapists Regulation and CMTBC’s Scope of Practice Standard of Practice.
- Individualize your treatment molding it to your patient’s perspective. Include their values, experiences, preferences, expectations, and concerns. You gotta ask about that shit. How do you like Massage Therapy best? What works best for you in your experience? What are you hoping I can do for you today? What are you expecting out of your Massage Therapist?
Be open to the fact that what you believe may not mean shit.
Don’t be one of those assholes that won’t change their mind even when they’re wrong. No one is saying that’s easy! It’s hard AF. Just…be humble yo…understand that it’s a fact that you might be wrong, and when there’s no quality scientific evidence to support your belief, and there’s lots that says you’re wrong, no matter how hard that is…you gotta roll over and change your mind.
Trust me…I do it all the time. Being wrong is uncomfortable, but it’s nothing to be ashamed of…on the other hand not changing your mind when you really should is embarrassing. If you dig your heels in for a while…no shame friend…I got you and won’t talk shit when you come around. We’ll just be happy to have you on the right side of evidence.
When you collect new information and integrate that into practice, you gotta take the time to reflect on how you think it could affect your practice and patients.
Requirements
- Evidence based care, and a patient centred approach is no longer a suggestion it’s a standard including:
- researching evidence specific to the condition being treated or approach to treatment;
- practice context. This includes RMTs’ scope of practice as defined by all that legal shit here (Massage Therapists Regulation and CMTBC’s Scope of Practice Standard of Practice);
- patients’ values, experiences, preferences, expectations, and concerns; and
- yes, this also includes your own knowledge, skills and understanding. We’re not robots. That’s why they call it a practice. You down for the journey?
- We gotta up our game, and have good reasons for doing what we do in practice…can’t just speculate and talk shit anymore…it’s upon us to defend what we say with good quality information. That’s not longer a recommendation…it’s a standard.
- You gotta take “reasonable steps” to keep up to date on how to have an evidence based practice…I don’t know what they’re saying is “reasonable, but check this link if you want to check your fastest, easiest and most fun way to an evidence based practice. This is a 4 hour intensive that gets you there fast!
- An RMT engages in learning activities that:
- are informed by research evidence…which…man…if we don’t know how to sniff out the fakers, how are we supposed to know?! It’s hard. I know from lots of experience. Be skeptical about people selling you the anything ‘advanced’ or tells you the secret to unlocking your pain…these are the words of someone falsely claiming to have special knowledge or skill. Align yourself with people that are wrestling with uncertainty, and don’t really have satisfying answers…only dumbdumbs think they know what’s up.
- Whatever information you got, you gotta keep it in the boundaries of the Massage Therapists Regulation and Scope of Practice Standard of Practice; and
- I don’t think it’s fair to saddle us with the responsibility to be able to find the quality shit, when we’re not taught how to sniff out the fakers. On that note…if you wanna see who’s putting out legit shit, you can check Susan Shipton, Daniel Arbilla, Emily Walker, Connor Collins, Richard McIllmoyle, Jocelyn Kirton, Bronnie Thompson, Tristan Attenborough, Jamie Johnston, The Clinical Resilliancy series (coming soon), The Massage Therapy Network, and Monica Noy just to name a few that come to mind right now.
Align yourself with people who are wrestling with the discomfort of uncertainty, not people who come with simple comfortable answers because they’re usually wrong.
4: Consent
Definition
Consent is ongoing partnership…it’s not just given at the beginning and that’s that. You gotta make that shit an ongoing process, a la…hey…is this still working for you? Know what I mean? More below.
Informed consent means no surprises. Know what I’m sayin?
People can’t consent to something that they aren’t informed about. Everything is an invitation…not, I’m gonna…it’s more like, what I’d like to suggest is A, B, and C. A involves this, B involves that, and C involves this other thing. How does that sound so far? Do you have any questions?
I like to remind people that they can just change their mind if something isn’t working that great for them.
Check these for the specifics of what that shit legally means. No seriously…read that shit. The Health Care (Consent) and Care Facility (Admission) Act (the “Consent Act”) and The Infants Act.
The requirements below apply to all patients.
- The patient is in the driver’s seat. The RMT shows respect for this by:
- Making decisions together, not in a parental or prescriptive way. Stop thinking you know what’s best for people. You need to work collaboratively to make sure that they are making a treatment plan that is actually working best for them. They’re the expert on what is working.
- Creating an environment where the patient knows they are the boss. That’s on us. They are the expert on whether or not a treatment or treatment plan is working. Not you.
- Don’t bullshit or mislead people.
- An RMT must:
- Continue consent before and during all the parts of the session (including assessment, treatment and re-assessment);
- Customize the treatment based on what their goals are;
- Remember that consent isn’t just given at the beginning…it’s ongoing, and it’s on us to make sure people feel comfortable to change their minds at anytime…after all it’s their treatment.
- Stop immediately if people say no thank you. You’d think this would be obvious…but apparently it’s not. I’d recommend thanking people when they modify or change their mind about treatment…remember that this is a sign that they are advocating for themselves, and that’s a really good thing! Thank them for saying no, or that they would like to change their minds.
- RMTs have to inform the patient appropriately so that they can actually make decisions about their own health by:
- Telling them about what all the parts of the treatment include, including but not limited to:
- Intake process and case history,
- a treatment plan,
- assessment,
- Getting on the table
- massage therapy during a first session, and during the session. What does that include? What does it look like?
- massage therapy during a subsequent session, and/or
- home-care;
- providing information about:
- areas of the patient’s body where treatment will be delivered,
- the possible benefits and drawbacks of the treatment approach chosen,
- why we think the treatment plan may be helpful,
- options for disrobing, and
- options for draping during treatment; and
- communicating in a way that the patient can understand, considering factors such as age, language and cultural background. (See the guidance in the “application to practice” section of this standard.) Paraphrasing is really helpful here!
- Telling them about what all the parts of the treatment include, including but not limited to:
- On initial intake, an RMT has got to go through and have patient, guardian or substitute decision-maker) sign a consent form that describes the treatment and plan.
- After that…you have to offer the patient, guardian substitute decision-maker) a copy of the signed consent form, and keep the original for your files.
- During treatment the patient is in charge, and you gotta make sure that they feel comfortable that they know they can modify, stop, or change their mind about anything at anytime. It’s their massage. We 100% support their decisions here.
- Whether you’re getting verbal or non-verbal responses from the patient, you gotta ask about how their doing throughout the treatment, and make sure what you’re doing together is still working for them.
- Before a subsequent treatment, you refresh the patient’s memory about consent…how it’s all about them, and they can change their mind, ask to change something or stop treatment at anytime. Also check in to see if they think this plan that you chose together is still gonna work for them.
- You gotta renew consent when the treatment plan changes.
- You gotta document in your charting that consent procedures have been followed. (See the guidance in the “application to practice” section of this standard.)
- You gotta read and understand the Consent Act and the Infants Act. That’s the job, so do it.
- It’s our job to make sure people in our care are competent to give consent, or that we go through the substitute decision-maker. (See the guidance in the “application to practice” section of this standard.)
Hope that was useful and maybe even enjoyable.
Feel free to message me anytime at taylorjames.ca@gmail.com
Remember I keep office hours so I can hopefully be helpful to anyone that is looking for it.
With love,
