In February of this year, 2015, a team of researchers published a report into osteopathic regulation. You can sound knowledgeable by simply mentioning it as the “McGivern research”. They specifically wanted to find out how they could help us to practise in accordance with the OPS (Osteopathic Practice Standards). It’s quite a lengthy report, and I would encourage a skimming approach to reading it, but what it reveals quite clearly is that the previously wide gulf in understanding, between the GOsC and the thousands of osteopaths it regulates, is narrowing. The Council now possesses what seems, in large part, a fairly accurate snapshot of our current thoughts, attitudes and feelings towards regulation. Did they read our minds? No. They read a lot of relevant literature and documentation, and they asked us what we thought. Do you remember some time ago a very long questionnaire was sent to us, with questions such as “Q14 Regulation has had a positive effect on how I practise as an osteopath”. There were 68 questions, some divided into sub-questions, and I, along with 808 other osteopaths (17% of the profession), dutifully sent mine off. 37 osteopaths and a number of other people involved in regulation were also interviewed. Then they crunched the numbers, applied the statistical tests, and came up with some very useful information and recommendations.
Before I go on, I emphasize that all distortions, mistakes, prejudices and misunderstandings are my own and I apologise. Please base nothing securely on what you read here. All I present here is what I personally understood and found interesting about it. I recommend you look at the paper itself. It is especially interesting to download Appendix 4, if you are a visual sort of person, like me, who enjoys looking at graphs and seeing, for example, that 14% of the osteopaths in the survey have had a complaint that did not escalate to the GOsC.
Click Here to see the McGivern Research on the GOsC website
Here are some of the things they know, along with some of their recommendations:
They broadly describe us as using a variety of techniques underpinned by osteopathic principles. They identify four distinct, informal sub-disciplines
- structural (OMT applied to the neurmusculoskeletal system)
- visceral (OMT applied to the internal organs)
- cranial (OMT applied to the skull) !
- classical (a treatment model developed by Littlejohn and, later, John Wernham)
Quite how that definition of cranial osteopathy slipped through the net I don’t know. I suppose it is something to do with the misleading name, the textbooks (I’m thinking Magoun), and the opacity of the cranial world. But it is a bit of a surprise to find that even in such a learned and highly researched report there is such a misunderstanding of what cranial osteopaths are doing.
We are insecure because of the lack of evidence underpinning osteopathy, and we worry about our own practice standards
Yes it’s very difficult to be told how important consent is, but not exactly how to comply. It’s scary to know that our notes might be deemed to fall short, yet not have any examples to show us what is acceptable and what is not. It’s very undermining to be told we have to explain the risk and benefits of techniques, when there is inadequate information about the risks and benefits. Yes, by being rational and conscientious human beings, expected to do something that is not easy or even maybe possible, while the sword of Damocles hangs over our livelihoods, we are thrown into a state of insecurity and doubt. Not surprising, really. I am pleased that NUMBER ONE RECOMMENDATION of the report is to develop more evidence relating to the benefits and risks of osteopathy. And the second is to provide better training for us in consent, explaining risks, note keeping and protecting patient dignity and modesty. There are mixed messages coming from GOsC and the iO at the moment. I attended a talk on consent recently where I was shocked to discover that I should have been leaving the room every single time a patient got undressed. I hardly ever do this. However according to this report, I have probably been complying with the spirit of the standards, which do not have a black and white attitude to the undressing issue. Bring on the improved communication and training, is all I can say. Click here to read more about consent
The report suggests we have “formative spaces” where we can safely reflect and discuss our practice. Now I had to look up formative, and my computer came up with this.“serving to form something, especially having a profound and lasting influence on a person’s development.” It sounds rather womb-like. A safe, protected confidential space where we can be our unformed selves, supported and nourished, while we develop into the fully grown practitioner that is still a work in progress. This is what is behind the new Peer Discussion Review in the new CPD scheme.
We have a low opinion of each other
Wow, this was a shock to me. 28% of us have had concerns about other colleagues’ practice and behaviour. Just as well Stalin’s not in charge. We could fill a whole gulag with osteopaths. Or maybe there are just a few very prolific offenders, know to many. I suppose we shouldn’t be too worried, as we don’t know what sort of concerns we’re talking about. (Now wouldn’t that be an interesting piece of research). I’m guessing we’re not talking Jimmy Savile or Harold Shipman; maybe it’s just someone who we think manipulates a bit too much, or shouldn’t be wearing jeans to work, or is treating people by invoking power animals. The report recommends using the language of Red Flags (for concerns needing to be reported) and, mixing metaphors with gay abandon, “Yellow cards,” for issues better addressed personally or during Peer Discussion Reviews. They say that the GOsC need to communicate this clearly to us.
We often comply with the regulator’s standards out of fear, especially if we are newly graduated
Most of us don’t feel we comply with the OPS and half of us do it so we don’t get sued or into trouble with GOsC (ie fear based compliance). More recent graduates do this particularly. I don’t remember complaints being mentioned much when I was at college, but I heard a recent graduate say that the phrase “No notes, no defence” is repeated like a mantra these days. However the report does also describe new graduates as “safe, if not always effective”. Arguably this is better than “effective, if not always safe”. There is a bit of a worry expressed in the report that we are being flung in at the deep end, sometimes working alone with no support, and lacking the experience to deal with complex patients and communication issues. There is a warning to the colleges not to focus on safety at the expense of interpersonal skills.
We think the GOsC is getting better
We feel that the GOsC is better than it used to be, and has made an effort to engage with osteopaths. To say that the early years of regulation were a bit rocky is an understatement. Madeleine Craggs once told me that GOsC staff had received hate mail, and she looked quite sad remembering it, and many years on that traumatic period is still being referred to quite significantly in this report. Let’s try to put it down to a personality clash, misunderstandings on both sides, communication problems, regard it as water under the bridge, draw a line beneath it and move on. Apparently we are still in the process of getting over it, but getting over it we are. We’re still just a little bit suspicious, and are still swayed by negative things we hear about GOsC from colleagues, and still affected by the tone of their communication. The report recommends that GOsC continue to engage and improve relations with osteopaths.
We’re scared of ending up in front of a Fitness to Practice Committee because of a complaint
I am old enough to remember a story which might have been an urban myth: An osteopath was consulted by a patient who had a mental health disorder (paranoid schizophrenia or something similar). He phoned the GOsC to ask for advice on how to deal with it, and ended up being investigated himself. Now that was ages ago, and possibly not true, but that is the kind of thing that seems still to be affecting us. We hear Chinese whispers, and it knocks our confidence in the fairness of the committees. But even those with first hand experience report problems. Two osteopaths and one patient who had been through a complaints process were interviewed for this research. All of them found the process distressing; the osteopaths thought it lasted too long and that they should never have ended up before the committee, and even the patient was dissatisfied as the hearing ended up being about something other than they had complained about. After the event the osteopaths had lost faith in the fairness of the regulator and had become “disengaged.” The report recommends that the number of Fitness to Practice hearings be kept to a minimum (I think we’d all agree with that). They suggest firstly prevention, or in the case of lesser serious complaints, the iO’s mediation service.
This was an interesting paper and the recommendations all appear highly pertinent to me. There’s plenty more of interest in the original text though so click here for the report.
PS: Some interesting nuggets contained in the text
Did you know that quite a serious attempt was made at legal recognition in the 1930s, but failed due to the inability to define osteopathy, the substandard education, and internal struggles. (No comment!).
Did you know that by the time the McGivern Research was published this year there were 11 colleges offering osteopathy? I had no idea there were so many. When I applied, there were three, with distinct identities, and one other one for doctors.
Did you know that the research says that some osteopaths practice forms of therapy akin to esoteric healing. Yes, you might have thought that your ability to channel violet lights and reverse chakra spins was all a bit secret from the powers that be, but they know that some of us do some of that kind of thing and there is no judgement expressed about it here.
Did you know American Osteopathic Physicians only use hands-on techniques on 5% of their patients? The rest get drugs or surgery. Either they’re getting different patients from us through, or they just don’t like manual technique as much as we do.
Well, that’s quite enough for now, See you next week.