Too busy to read through the whole magazine looking for the juicy bits?  Not me.  Nothing speeds up a train journey like the latest edition of GOsC’s official organ.  You might not have the same luxury of a free hour to peruse the classifieds and read lengthy articles about ASA compliance before you pull into Clapham Junction, but if you still want to stay in the loop your problem is solved right here right now.  Here are some essential nutrients from vol 18 of the official GOsC magazine, as prejudicially selected by myself in accordance with my extremely partial interests and considerations.  Absorb them with ease.

What do the public think of us?

The main article presents some findings from an online survey of 1500+ members of the public to find out what they think of osteopaths.  The full survey is here.

They trust us

The good news:  people who have been to osteopaths have such a high level of confidence in us that we actually (just) pip doctors, pharmacists, dentists and physiotherapists to the post, with a 96% rating.  Amongst those who haven’t been to osteopaths, we lag significantly behind them, but are still placed just higher than chiropractors.  The order of confidence amongst all respondents, whether they had visited an osteopath or not, goes like this:-  doctors, pharmacists, dentists, physios, osteopaths, chiropractors, psychologists, counsellors, acupuncturists, and then poor old Chinese herbalists at the bottom.

They will trust us more if they know we are registered with a regulatory body

There might be a good reason to display GOsC registration in your literature or premises as it was revealed that many patients don’t realise we are regulated, but it has a big impact on levels of trust.  Lots of free resources are provided by GOsC for this very purpose.  There is an “I’m registered” Mark which shows your individual registration number, and a “We’re registered” mark for multiple practitioners.  Apply here.   Free posters also are available here.  A word of warning:  these registration marks are fairly new and have superseded the older ones.  As of now:

• Do not use the GOsC logo – it’s not for osteopaths, just for the GOsC itself
• Do not use the old Safe in our Hands certification mark.

Also you can stick with the traditional certificate on the wall which I personally think imbues your practice with the kind of old-fashioned certainty that’s hard to find in this transient, techno world.  For the nosy, it can also be interesting and sometimes entertaining to find out your osteopath’s middle name.

You are recommended to use your GOsC number on all your documentation:  letterheads, website, business cards and so on.  We don’t have to tattoo it into our skin just yet. I’m not sure how the number of complainers will be affected by this heightened regulatory awareness.  Will the increased level of trust from knowing you’re registered be offset by the knowledge that there is someone you can easily complain to?

People want to know which osteopath is best for their needs

Patients want to know what individual osteopaths specialize in: sports, children, migraines etc.   Bit of a controversial issue, I think, but the Osteopathic Development Group has a plan (known as the Advanced Clinical Practice project) to come up with something.  They need your input though and will be sending you an email with a  survey.  Keep your eyes peeled for that GOsC message in your inbox.  Or find it here. (Not ready today 3rd July but guess it will be coming soon.)

Advertising

If you don’t make sure your advertising is ASA compliant you run the risk of a complaint being made to the ASA (most probably by a committed sceptic from the Nightingale Collaboration or the Good Thinking Society.)   I think that what then happens is that no further action is taken if you agree to remove the offending non-evidence-based claim.  But if you don’t, and the ASA makes a ruling which you then fail to comply with, you would be in breach of the Osteopathic Practice Standards (and I guess the law?) and would be investigated.  Basically, it’s not worth it.  Bored, anti-alternative, science fanatics are sitting at home trawling through websites looking to find reasons to complain.  Here’s the list of things you can claim to treat according to the Committee of Advertising Practice

• generalized aches and pains
• joint pains (inc hip and knee pain from OA as an adjunct to core OA treatments and exercise)
• arthritic pain
• general acute and chronic back pain (not arising from injury or accident)
• Uncomplicated mechanical neck pain (as opposed to neck pain following injury i.e.whiplash)
• cervicogenic headache/migraine prevention
• frozen shoulder/shoulder and elbow pain/tennis elbow (lateral epicondylitis) arising from associated musculoskeletal conditions of the back and neck, but not isolated occurrences
• circulatory problems
• cramp
• digestion problems
• joint pains, lumbago
• sciatica
• muscle spasms
• neuralgia
• fibromyalgia
• inability to relax
• rheumatic pain
• minor sports injuries and tensions

A slightly curious list, but there you are.  What is lumbago anyway? I thought it was old-fashioned speak for low back pain. Sciatica can be caused by a number of things.  I am surprised to see digestion problems included.  And circulatory problems.  Does that mean we can claim to treat any dysfunction or malfunction of the entire cardiovascular and gastrointestinal systems, but not whiplash? Nor low back pain arising from an accident or injury, the thing we’re so good at?  We can’t claim to treat tennis elbow unless it is associated with back problems?  How many lay people would know or care about the distinction? How many clinicians could make the distinction?  Hey, let’s just include it in the category minor sports injuries instead.

Still, as we know, we treat the body not the condition, so this does not affect our treatment, just our advertising.  And this list is reasonably extensive.  Understandably twitchy about the law, CAP emphasises that the provision of this list does not constitute legal advice.  They have a page specifically about osteopathy on their website here.

Clinic Staff

Do also make sure your receptionist and staff know the limits of what they can say.  I once had a receptionist who had to be gently deterred from advising patients on a variety of treatments from icebaths for ME to olive oil drops for ear infections.

Testimonials

Patient testimonials and outcome studies are NOT considered robust enough to constitute evidence, and be careful that testimonials don’t mislead by including opinions or impressions from the patient that are “likely to be interpreted as factual”.  Also make sure that you have evidence that each testimonial is 1) from a real person and 2) you have been given permission to use it.

Free website check

An amazingly useful sounding (but again not legally binding) service is provided by ASA.  They will apparently check your website to make sure it is ASA compliant, free of charge, here.

Up to date research

But the buck stops with you, ultimately, and while sticking to the CAP list and being aware of what you can say means you are unlikely to attract any complaints, GOsC urge you to maintain up-to-date knowledge of research, most easily done through the excellent NCOR.  Where would we be without them?

Regulation can have negative consequences

Well done to the GOsC official magazine for including references to research into the pitfalls of regulation by Professor McGivern.  It shows a measure of self-awareness.  The problem is that regulation aimed at preventing bad practice may inadvertently get in the way of good practice.  Practitioners experience regulation and transparency as an attack, based on exaggerated risks and misunderstanding of the complexity of their practice.  They also get anxious and in turn defensive. They start spending more attention on covering themselves, covering up mistakes, and hiding any practice which is not standard fit, than on the actual care of patients.  Ring any bells with anyone?  If you have the inclination and the time to explore the University of Warwick paper in full you can find it here.

CPD – How to Record a Reading Activity

Be Specific

A reading activity has saved many an osteopath who has come to the end of their CPD year a few hours short of the 30. But what counts?  Well, not this.  I don’t think blogs or osteopathic magazines will do, unless a specific article responds to a specific need.  No, the reading has to be focussed, named and able to be located by the assessor.

Examples

The examples given by GOsC include two in which a specific clinical issue with an individual patient was mentioned, and the reading was directly in response to that  ie Mr Blogs came in with pain in this bit of him and some other strange symptoms such as this and this, I wasn’t sure if it was this condition or that condition so I looked this up in this book and then that book and decided he was more likely to have this condition and this enabled me to make a diagnosis and treatment plan.  I also made a table to help with  my differential diagnosis of this bit of the body in case it happens again.   OR, I read this book by this author about this slightly broader area/condition in order to enhance my understanding of what is going on with this particular group of patients’ physiology/psychology/anatomy when treating using such and such techniques.

Just “reading about consent” or “books and articles on functional technique to improve my range of treatment” probably wouldn’t be enough.

You also have to make some notes on your reading or evaluate the material (use GOsC’s own template on page 40 of CPD Guidelines).

Hurrah! The o zone is easier to update

The system has been upgraded.  You should be able to go from

My Registration

to

Update my details and

My practice details

and simply update.  This is excellent news.  As someone who once spent an hour and 2 telephone calls to GOsC trying and failing to make one small change, I feel quite buoyed up and am just about ready to get back into the water and try again.

Returning to practice after two or more years out – procedure not scary at all…

…according to GOsC and the people they quote.

I have never been quite sure if you are ever allowed back on the register once you leave, but it sounds like you are.  After 2 years or more away, or even with non-practising status, you go through a return-to-practice process as follows:

1. you are sent a self-evaluation form to reflect on where you are, what you might need, how you might go about meeting those needs
2. the form is reviewed by 2 experienced osteos from a GOsC pool
3. if they think you need it they will offer written guidance and a discussion (could be by phone) where they suggest what cpd you could do.  Often it will involve spending time with other osteopaths either in practice or through societies or institutions.
4. If you need it you will get ongoing support from them, mostly it seems about what cpd is appropriate

You have “good reason” to decline to treat a patient if they are any of the following

1. aggressive
2. lacking confidence in you or the care you are providing
3. inappropriately dependent on you

or any combination of the three!

Try to refer them to another osteopath.  Preferably one that can handle them.

Council Meeting May 2015

Most of this is double dutch to me, but there seems to be an interesting change to the practice of the Professional Conduct Committee ie where you end up if a complaint is taken seriously.  I think it is saying that osteopaths will have the opportunity to present evidence of good character in their defence more than they did before, in some way, by using good character witnesses or patients who can testify that you always explained consent well.  If you can speak legalese you might understand it. You can find it here.

Next Council Meeting

Thursday 16 July 10am Osteopathy House.  You have to book.  Call Marcia on 0207 357 6655 x246.

Be there or be square.

PILARS – Something go wrong at work, even potentially?  Report it anonymously and help to keep osteopathy safe.

You will be asked to identify what sort of incident it is, (there are 4 categories covering everything from patient confidentiality to equipment malfunctions) and whether it happened, nearly happened, or could happen.  You will find a user name and password on o zone here and then log into PILARS here

This is undoubtedly a good thing for us all and we should support it by using it.

BOOKSHELF

The Mulligan Concept of manual therapy: Textbook of Techniques

Wayne Hing, Toby Hall, Darren Rivett, Bill Vicenzino and Brian Mulligan

Reviewed by David Rodway DO

This book describes a new form of manipulation described as “mobilisations with movement” and “sustained natural apophyseal glides”.  Rodway says

“essentially, the practitioner applies a sustained passive accessory glide (translatory or rotational) to a limb or spinal joint and maintains this while the patient actively moves the joint in an otherwise painful or restricted direction.  The techniques should be pain free, immediately effective and longlasting.”

 A consideration of the cause of the symptoms is apparently absent.  Unfortunately if this is your bag, you won’t be able to attend the physio-only Mulligan practical courses (unless you are a physio), and despite many photos and descriptions of the techniques Rodway leaves us with the warning that we might not feel confident to try it solo.

Recognizing and Treating Breathing Disorders:  A Multidisciplinary Approach (2nd ed)

Leon Chaitow, Dinah Bradley, Christopher Gilbert

Reviewed by Amy Osland MOst

Osland likes this book, albeit a bit “wordy” for her personal taste, and thought it would be clinical useful.  It sounds like it covers a lot, from breathing disorders to the influence on breathing of sleep and diet to Pilates based exercises. Most of the main breathing techniques are muscle-energy techniques. She says

the idea that breathing is the most apparent relationship between structure and function is covered in detail

BIotensegrity: the structural basis of life

Graham Scarr CBiol, FSB, FLS, DO

In Backchat the only letter is one in which Scarr, an osteopath, responds to a review of his book (in the last edition of the osteopath) for the purpose of clarification.  Scarr produced this book after working with the originator of the concept of Biotensegrity who is called Stephen Levin: an orthopaedic surgeon who “recognised things at the operating table that could not be explained by conventional biomechanical theory”.  I’m getting interested.  I have seen the biotensegrity models, a bit like a complicated atomic structure which can compress then spring back out, but have never been familiar with the concept in any depth. Scarr notes that the orthodox “lever model” of the body still reigns supreme, even though this unproven (his italics) biomechanical hypothesis  “essentially asserts that living organisms follow rules that applied to man-made machines of the 17th century.”  He feels that biotensegrity is somewhat misunderstood due to clinicans’ interests in techniques rather than the scientific basis for biotensegrity, and also due to the amount of misinformation around.  He twice mentions the first 98 pages of his book, which promise to explain how the body might really work in terms of the structural design principles of biology.  I am quite inspired now to read this book, as I suspect there is profound sense and wisdom in it.  Here are some links he provides if you are interested

A wealth of interesting sounding papers

Videos showing you how to build tensegrity models

So there you go, a speed read of the osteopath; more interesting and useful than you thought.  See you next edition.