For me the worst thing about a complaint would be the feeling that someone was aggrieved or felt injured or upset by something I’d done, but going through the Fitness to Practise process would come a close second, and some osteopaths are truly hollowed out by the experience. It is something to avoid as much as we ever can. The notion that we could achieve a risk-free state in which we don’t have to worry about the dreaded letter dropping through the front door is fanciful – you can never totally eliminate risk – but you can try to minimise it. I recently had occasion to do a bit of research on the nerve-jangling subject of complaints, and treated it as a useful way to reduce my own risk. By seeing just what people had complained about, maybe I could avoid making the same mistakes or be alert to potential trouble spots.
I looked at some recent GOsC decisions, some from other regulators, and also the NCOR annual report which interestingly shows a much higher number of concerns or complaints than the ones that make it to the final GOsC committee. (I guess these are concerns that are found to be groundless at an earlier stage, or ones that have gone to insurance claims but not the official regulator). My reaction to most of the complaints fell into one of three rough categories:
- There but for the Grace of God go I,
- Well, I wouldn’t do that in a million years so there’s nothing to worry about,
- I must check my insurance renewal date.
Here are a few tips from what I read.
Renew your insurance
I think there were about 11 complaints this year that osteopaths were practising without insurance. Eleven! Eleven fully staffed hearings. Sorry to be Penny Pincher but that was paid for out of our subs!
I had no idea that being late to renew insurance, even if you haven’t actually treated anyone in that time, would trigger the full FtoP process, but now I know. It’s not like forgetting to renew your buildings insurance, where you thank your lucky stars the house didn’t burn down, briefly curse yourself for being such an absent-minded dimwit, and get onto moneysupermarket.com pronto, no harm done. You’re just simply not allowed to be an osteopath without it. Can you imagine going to a dentist, or having an operation, if you knew they weren’t insured for things going wrong? So if you’re moving house, or going through an acrimonious split, number one priority should not be subscribing to Elle Decoration, or making that Relate appointment; number one priority should be circling your insurance renewal date in your diary, and making sure your insurer has your contact details. I have my renewal date, August 24th, etched in my brain now, and circled in red on my calendar. I feel a bit nervous about the fact it’s in the busy Summer holidays, and almost tempted to ask Balens to set up a lifelong direct debit, just to be sure.
Be sensitive to patients, especially when it comes to touching them and looking at them in their underwear
Did anyone hear Mickey Flanagan describing his visit to an osteopath recently? He viewed it as a thinly veiled, potential sexual encounter, while knowing that it wasn’t really. Men, eh? Well, just bear it in mind that we’re used to touching people and seeing them undress, but it’s out of the norm for most people, who associate being in a room with one other person and taking their clothes off with something entirely different.
A moderately shy friend once confided to me, in a hushed, confidential voice, that an osteopath she had seen had stood behind her, put his hands on her hips and made her bend over while he looked at her bottom. I did try to explain that he was just checking her movements, but you can see where issues of miscommunication can cause problems. Yes, one person’s standard motion testing is another’s inappropriate and pervy intrusion. Apparently we are getting better at these issues of “dignity”, but do try to be chatty and put people at ease and explain what you’re doing so they don’t get the wrong idea and think you’re a bit seedy.
Don’t go out with your patients
It’s not a trivial thing for a member of the public to make a complaint to the Council, especially when you consider there is no financial recompense involved. The motivation has to be pretty strong. But we’ve all heard the phrase “all is fair in love and war”, not to mention “hell hath no fury like a man confronted”. Yes that cute, uncomplicated ex-patient that you are having such fun with, giggling over coffee and sandwiches at the local cafe, or sending flirty texts to, could easily turn into a scorned or bitter ex-lover determined to seek revenge. Regulators are extremely hard-line on this, and even having a platonic fling AFTER you’ve discharged someone as a patient was recently deemed to be unprofessional by one regulator; accepting a Facebook friend request speedily was even flagged as problematic! My advice would be to completely and absolutely rule patients and ex-patients out as potential partners or date material, however I say this in the full knowledge that 1) I’m not currently out there looking for Mr Right, and 2) there are very happily married people who first locked eyes across a treatment table.
I’d say this is the issue of the moment. And I am going to devote yet another blog to it soon, because I don’t think it can be over-egged. Recently a group of osteopaths exclaimed surprise when I said that I noted consent at every treatment. As a geeky veteran of many consent courses, all I can say is that I reflected back their astonishment. I was amazed that they didn’t note consent at every treatment.
I feel that consent is a kind of state, rather than just an act, and I try to create an atmosphere in which patients feel that they are equal partners in the treatment, and can stop me or ask me questions at any point. But I also take certain formal steps, and what I do is 1) make sure I tell the patient what I plan to do, 2) ensure they have agreed OUT LOUD, 3) tell them they might be sore or tired after, (or detail specific risks for certain interventions, or if I think they are a high risk patient), and 4) write an acronym in my notes. In my case it’s CORBE for Consent Obtained, Risks and Benefits Explained.
But personalize your consent process to whatever works for you. Just made sure you DO it and NOTE it.
And so in my quest to learn what I can from other people’s experiences, this is just the beginning……more to come….thanks for reading, now, go and check your insurance renewal date.