the osteopath Oct/Nov 2015 edition – speedread it here

We start with the subject that strikes so many osteopaths with fear and fascination:-

Complaints:  How many were there and what did people complain about in 2014?

Yes 2014 seems like a long time ago, doesn’t it.

NCOR have gathered information about “causes of concerns raised about osteopaths” from iO, GOsC and the insurers.  So most of these were not complaints that made it to the Investigating Committee.  They have divided them into 2 categories: complaints about conduct, and complaints about clinical care and adverse events.

Conduct – 109 concerns

The main problems as ever are communication and valid consent and I am imagining (hoping) only a few of sexual impropriety/relationship.

More about consent here

Clinical Care and Adverse Events – 139 concerns

Hmm…. Quite a few of these, and up from 86 in 2013.  This is a substantial increase.  Although bearing in mind there are about 30 000 osteopathic treatments a day across the country, it is a relatively small number.  I’m not sure why there’s an increase.  I suppose it could reflect a growing complaints culture, or growing numbers of patients being treated, because in my experience ostoepaths are becoming more and more careful, gentle and risk-averse in their techniques.  However, mostly the concerns were that the treatment was

  • inappropriate/unjustified
  • forceful
  • incompetently administered
  • responsible for increased pain or new injury – these account for 1 in 6 of ALL concerns.  Not sure how many of these were temporary soreness following treatment.

Advicde given here (they don’t mention the bleeding obvious – be careful with your patients, their bodies are in your hands..) is to allow and encourage the patient to complain to you directly.  If they go straight to GOsC I think you are more likely to end up with a formal complaint to deal with than if they go to you, iO or the insurer, even if it is fairly trivial or evidently unwarranted, simply because of different processes.  Bear this in mind if you advertise a complaints policy in your practice, and it says here that your complaints procedure should be clear and well-publicised.

If you need guidance on how to respond if a patient does complain, click here for NCOR’s advice on responding to concerns There’s an interesting paragraph there if you scroll down to what triggers negative feedback – it can be things you wouldn’t expect, like patients getting a shorter treatment than they are used to.

Alison White, Chair of Council

reappointed so back for a second 4 year stint

Do you have HIV, Hep B or Hep C?

You need to be careful not to carry out exposure-prone-procedures, but these do not include acupunture, or other needle techniques, vaginal or rectal examinations or techniques, or intraoral examinations or techniques.

Advertising

Simon Singh estimates that a third of osteopaths still don’t have ASA compliant advertising, and I have no doubt the Good Thinking Society (see their osteopathy page here) will  be working their way through the list, so save everyone a lot of time and get it done first.  I know it’s a bit of a chore.  I spent about two hours this week trying to figure out how to get a defunct website for a practice I don’t even work at any more taken down, because I couldn’t change the text myself, the web design company doesn’t exist any more and I don’t know the difference between a domain and a host.  But I’d rather do that than have to deal with an official complaint.  There is a well-organized efficient campaign running to ensure that osteopaths’ advertising is ASA compliant, and rest assured, you will have to sort it out at some point.

Click here to see what you can say on your advertising

What are GOsC doing with our money?

Well I went straight to the doughnut chart, showing how our £570 is allocated.

  • The largest expense (about £200 of it) is for Fitness to Practice ie standards, complaints, legal advice.
  • Next (about £108) is to keep GOsC up and running – admin and running costs
  • About £93 of your hard earned pounds go to communications, research and development ie NCOR, other research, website, communications etc
  • The remainder goes on educational standards, CPD, Council and committees, registration and IT infrastructure.

If you are really interested in all the details of GOsC’s work you will need to look in the magazine, but I have selected a few plum facts of interest:

  • 276 new applicants joined the register, and the number of osteopaths is now over 5000.
  • 56 applicants from overseas, or who were returning to practice after time off the register, were assessed.
  • The level of indemnity insurance osteopaths must have, has been increased to £5million.

The number of formal complaints is rising

42 formal complaints were made to the GOsC, seven more than the previous year.

The IC (Investigating Committee), considered 51 cases of which under half (22) were referred to the PCC. The median time for investigating a complaint was 2.5 months (not sure why they chose this rather than the mean) and the target is 4 months.

So the PCC (Professional Conduct Committee – where it gets serious) heard 22 cases, an increase of 6 over the previous year. 10 of the cases resulted in a finding against the osteopath.  The median time to do this was 11.75 months to conclude hearings.

Honesty is the best policy – and you now have a Duty of Candour

The Francis Report resulted from appalling fatal neglect at the Mid Staffs NHS Trust, and though it might seem a million miles from what we do, it does actually affect us regulated health professionals too.  We basically have a duty to be honest if something goes wrong, or causes harm or distress.

Read the full text of the statement here

At the moment GOsC is working through how to give us appropriate guidance.  I have long thought that if I cause a car crash the golden rule is not to admit liability for insurance reasons, however obvious it might be that you are at fault.  So applying the same principle, we’re obviously all a bit concerned that explicit admission of having done harm will end up with us up before the Fitness to Practice committees, or make our insurers liable for payouts, so the GOsC is in the process of figuring out how it works in practice.  Apparently the insurers support the prinicples of the Duty of Candour and say it should have no impact on an osteopath’s insurance, but contact them at the earliest opportunity in any case, for guidance.

If you’d like to be involved in working it out email candour@osteopathy.org.uk

CCTV

If you have CCTV as a security system, you need to be careful how you use it as any information recorded will be subject to the Data Protection Act.  The magazine has lots of good advice and a couple of useful links.

What do you do if you are concerned that a child is being abused?

Well, you need to communicate that concern, and first port of call is a social worker.  You can just tell them the details of the situation, mentioning no names, so that they can advise you whether the child should be identified and the matter taken further. Find a social worker by contacting your local authority who will find a duty social worker to talk to you.

If you like, you can ask the family’s permission to contact the GP for a “second opinion on clinical findings” and discuss your concerns with them, although this doesn’t sound as easy to me.

Andy Maddick has written an article for IJOM with further details.  You can find more in the magazine, and even more on the GOsC website where you can log into the o zone then go find the link to IJOM.

No Decision About Me Without Me

Shared decision making is a big topic these days, along with consent.  I believe that “No decision about me without me” has become a bit of an NHS mantra.  To get an idea of why it matters, have a think.  Do you like people making decisions about you without involving you?  Think how you like it if you’re talked into doing something without knowing all the facts; being asked to babysit a friend’s children without being told they have a ghastly tummy bug.  Or if someone throws away your favourite old jumper while you’re at work, because they think it’s scruffy.   Austin Plunkett of NCOR has here some good advice about shared decisionmaking and consent.

Key things to remember are to ensure that the patient feels comfortable, to ensure they trust you, that you are honest with them, that you try to understand where they’re coming from, and that you do inform them of benefits and risks of treatment. Don’t put them under pressure, allow them time to consider options, and don’t railroad them into things.  (I have just realised it would be a good idea to train up some of my more pushy friends and relatives in this too).

We are in a different age than when I graduated.  I remember when I was new in practice I heard osteopaths boast that they distracted patients before a thrust so they didn’t realise they were about to be manipulated!  The theory was that they wouldn’t tense up if they didn’t know what was coming.  Well, maybe not the first time.

NCOR have put together some good examples of conversations which show how you go about sharing decision making in practice, one of which is shown on page 15 of the magazine.  There is an excellent paragraph which I am tempted to learn parrot fashion on explaining the risk of serious adverse events. There are also examples of giving the patient the chance to change their mind and checking consent at subsequent appointments.  I know we’re all busy, but just practising a couple of these allowed in a solo role play might get it into your brain and rub off on you when you see patients.  A good resource for CPD.

PROMS – Good for you, good for your patients, good for osteopathy

Designed to record evidence on the outcomes of osteopathic treatment, it stands for Patient Reported Outcome Measures.  NCOR have developed an app for patients, who will be asked to complete 3 questionnaires over 6 weeks (they take about 6 minutes each).  All you need to do is ask your patient if they are willing to complete some questionnaires online. If they say yes, you give them an information sheet and a code.  That’s it.  It’s a cinch.  You will then get a summary of all the data sent to you.  The point is to just gather much more data about what is going on in treatment rooms round the country, but it also has the benefit to you of a kind of free feedback service, and potentially points for CPD.  Go to the NCOR PROMS info to get the postcards for patients, with your own personalized code sent to you. I think you just need to email Carol.  Not hard.

PREOS

This one stands for Patient Reported Experiences of Osteopathic Services and is for patients to submit a report on their experience of osteopathy on the PREOS website.  This one is REALLY easy for patients, and all you have to do is tell them about it and give them the web address.  It collects information about patients’ experiences and is totally anonymous.   You can find a leaflet on the PREOS website to print and give to patients, but just encouraging them to fill out their experiences and giving them the web address http://www.ncorpreos.org.uk would be a good start.  A sign in the waiting room, or a mention on an information sheet or website would be good.

Are you interested in Osteopathy and the Performing Arts?

If you are, contact Michael Mehta on 020 7638 3202 or at hermeshealthosteopathy@gmail.com.  It says by October 31st but maybe he’d still like to hear from you, as he is interested in maybe forming a special interest group.

New CPD Scheme – iO getting involved in offering courses

Yes it’s all going to change and you can find my unofficial description of the new CPD here.  There seems to be a positively huge groundswell of activity from just about every organization involved in osteopathy, offering new tailormade courses to help us in our upskilling and CPD compliance.  iO is also offering new workshops, include the consent and communication topics which are going to be compulsory.  It also publishes handy CPD articles in Osteopathy Today – there was a kind of test-yourself on neuropathic pain recently which was quite handy.

Book Reviews

Aches and Pains by Louis Gifford,  reviewed by Mark Andrews of Kemptown Osteopathy

Find a fuller version of the review here.

Mark loves this book which is written by an “early proponent of the biopsychosocial model”,  And if you don’t know what that is you need to read this.  Mark says that “If you use your hands to treat people in pain, in my opinion you cannot afford not to buy this book”.  I’d add my voice to Mark’s endorsement.  I’m on volume two and it would be number one on my list of books for any manual therapist.

Fascial Dysfunction:  Manual Therapy Approaches   edited by Leon Chaitow  reviewed by Simon Tolson

Simon doesn’t give this book the most glowing review, and from reading this it seems there is less evidence than I had thought for the treatment of fascia.  He does like a chapter on fascia in sport, and the section on barefoot running.  Apparently the chapter on Rolfing admits there is “no objective research”.  Simon is evidently a well read scholar of fascia, and concludes by recommending instead two other books The Fasciae by Serge Paoletti and Fascia by Schlep, FIndley, Chaitow and Huijing.

Backchat – A Letter Questioning Values-Based Practice

There is a letter here trying to clarify what the GOsC means by VBP – value-based practice . We’ve all got our heads around EBP (evidence based practice) as a concept, but VBP is new to me.  According to the Warwick Medical School website it is a “twin framework ” to EBP, and is

a clinical skills-based approach for working with complex and conflicting values in healthcare

Find out more about VBP here

The GOsC is currently soliciting osteopaths’ views on this. Theletter’s closing statement is that the real balancing task is between three things:  the Patient’s Agenda (what the patient wants to happen) the Practitioner’s judgement (what I think is best for the patient) and the Professions’ values (how the profession expects me to behave).

Short and to-the-point I hope, that was my speed read of another edition of the osteopath.  Please go to the magazine for the full version, remember I only pick out the bits I think are interesting – which are doubtless totally different to yours.

See you next time, by which time you should have sorted out your advertising…

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