Osteopathy was sold to me, as a prospective undergraduate, as a holistic form of treatment, and as I was at BCNO, where we also took a diploma in naturopathy, the approach comprised the holy triad of nutrition, biomechanics, and the psyche.  We had inspiring lecturers, who taught us psychosomatics and psychology in dazzling fashion.  Who needed Ted Talks when we had them?  We learnt all about the yearning for the breast, Maslow’s hierarchy of needs, Jung’s archetypes.   The college was even just round the corner from Sigmund Freud’s home in London; a home so imbued with light, intelligence and Ancient Egyptian artifacts, that you feel better just walking round it.  Students and tutors alike acknowledged the importance of the psyche in theory, but when it came to clinic, nobody seemed to know how to apply it in practice.  It was all too easy to dismiss difficult patients, with poor mental health, as “nutters”, and even if we realised they needed psychological help, there was little specific expertise among our clinic tutors, and scarcely any training in exactly what to do or say.  So I was delighted to see this study in the latest IJOM (vol 28, June 2018):

Barriers to identifying mood disorders in clients by New Zealand osteopaths: Findings of a thematic analysis

Kesava Kovanur Sampath, Dianne E. Roy

The title presupposes that identifying mood disorders could be better (no argument there), and makes the point that osteopaths are (incredibly) well placed to identify and manage mood disorders. which are, after all, very common.  This would not only be good for the patient’s psyche, but might be related to their physical symptoms, thus improving those outcomes too.  But do we do it?  And if not, why not?

Sampath and Roy used an online questionnaire, which included nine open-ended questions, exploring the approach of osteopaths to patients with mood disorders.  The questionnaires were sent to 216 osteopaths; 62 returned them (quite a good return rate, there, of 29%).  The emergent themes were analysed and categorized into three main areas, which the authors described as:

1. competency requirements,
2. boundaries of practice, and
3. client barriers

I will paraphrase them as:

1. Osteopaths don’t feel competent to deal with mood disorders
2. Osteopaths don’t feel it is their place to deal with mood disorders
3. The patients can make it difficult

or, to para-paraphrase – “The reason I don’t identify and manage mood disorders is because”:

1. I don’t know how to, or who to refer to
2. I don’t know if I’m meant to be doing this, as an osteopath,
3. And to be honest I find these mood-disordered patients are quite tricky to deal with.

The authors regard the three themes as “interlocking gears” with the competency requirement issue as the “main driver” i.e. better training is the main thing that needs to change to result in a change in practice.

Many osteopaths have good natural counselling skills, but it might help to know where the limits are, and to have some kind of structure.  Maybe the first step is deciding just what our scope of practice is in this area, then equipping our undergraduates to deal with it.  This would somewhat resolve the tricky patient issues as well, and set limits so that we know just what we can and should deal with, and what we should refer on.

The study raises many questions

The study is quite confronting as it goes to the heart of some of osteopathy’s big questions – its definition, scope and future direction.   Is osteopathy about looking at patients’ psyches, and if so, why the nervousness about fully embracing this and adequately training our future practitioners?  But wait.  Is that what patients think they’re signing up to, in any case, when they come to see us?  Might it even put some people off?  Is that how we market ourselves as a profession?  Many osteopaths might not even be interested in addressing this aspect of their patients.  Many  in the study commented that mood disorder management was “outside of my scope of practice”, and presumably lots of them like it that way.  Is it viable to have such a broad-church profession in which some people do this and some don’t?

The authors’ recommendations include more CPD courses addressing this deficiency – they seem to think that even a weekend course would be a big help – and, as this seems to be the first study of its kind, more research in this hugely important area.

Thanks to IJOM for presenting this really enlightening piece of research.

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