From the off it was very evident that practitioners and regulators approach the subject from very different angles.  The osteopaths’ tone was established with a graphic, real life portrayal of every practitioner’s nightmare.  Badrul Huda recounted how his livelihood and reputation had been virtually razed to the ground following a complaint from a consultant psychiatrist. Not even a patient!  Despite Huda pointing out that the complaint was easy to refute, and was indeed eventually found to be groundless 2 years later, it had nevertheless justified suspension from practice: a practice still yet to recover to anything like its previous thriving level.  Unfortunately, as this was a specific case, it could not be discussed, so we have no idea if this is something that could just happen to any one of us.  The first of numerous questions arose in my mind.  If someone makes a serious complaint about us (e.g. sexual impropriety or dangerous practice), is it incumbent on the GOsC to suspend us pending investigation even though there is no actual evidence against us, seeing as it’s one person’s word against another?  In the light of Kavanaugh vs Blasey Ford, it is apparent that in many situations only the people involved are able to know exactly what has happened, and unless they are existing in a state of absolute truth and clear sight, even they will perceive the same event completely differently, according to whatever tint or distortion applies to the lens through which they view the world. But let’s not get philosophical, and back to the nuts and bolts of the thing.

Speaking for the regulators

What is the process if a complaint is made against you?

I am relatively familiar with this, but for those of you who don’t know, you can think of it as basically 3 different stages:

1.  A complaint to GOsC is passed to the screeners, who decide if there is anything to investigate.  Some complaints are thrown out (including, we are assured, “vexatious complaints”), and you might never know that the complaint had even happened, but the majority do get passed on to the
2. IC or Investigating Committee.  At this point you will be sent a (registered?) letter from the GOsC, and the complaint will be further investigated.
3. If the IC decide that you might be guilty of “unprofessional conduct” it will be referred to the PCC, or Professional Conduct Committee, and a kind of court case will ensue, with lawyers and arguments and hearings and, eventually, a decision.

For everyone’s peace of mind, there is a fourth stage, which is a review of EVERY SINGLE CASE by the PSA, who is the uber-regulator who sits above them all.  This is a kind of quality control and ensures that the GOsC doesn’t go off at a strange tangent.

Next question:  Can we not be informed about any complaint even if thrown out at stage 1, as it might alert us to a problematic individual or issue which we could use to minimise our future risk of complaints?

Representing the practitioners:  Berni Martin says some chiropractors approaching retirement are deregistering rather than face the stress and worry of the complaints process

Reasons to be Reassured #1:  The risk of a complaint is low

While not quite turning into the “Jeremy Kyle Show”, as was bantered about a lot behind the scenes, Tim Walker clearly wanted to dial down the emotion and stop it being the “how can poor, innocent osteopaths protect themselves from the emotional and career devastation wreaked by these malicious complainers, and the cold, impersonal workings of the creakingly slow regulatory process?” show.  As Steven Bruce, speaking on behalf of the osteopaths, brought attention to the suffering endured, the mention of “suicide” caused our outgoing regulatory chief to intervene and try to change tack a bit by getting things into perspective.  He pointed out that we should not live in fear as the risk of a complaint is very low. Unfortunately, I noted, he didn’t say “extremely” low, or “vanishingly” low.  So, risk not being something that people evaluate rationally, “very low” translated immediately in my head to “quite high”.  While the risk might be “very low”, it is clearly far, far more probable than the likelihood of me dying in a plane crash or winning the lottery,  two things which I strongly believe will happen to me on a fairly regular basis. So the key here is not to focus on the fear, but to try to keep a rational perspective and reduce the risk as much as you can.

Reasons to Be Reassured #2:  Removal from the register is rare – 14 osteopaths in 6 years

Different things can happen to you after the PCC meet and make their decision, on a sliding scale from nothing to admonishment to removal from the register, but removal is rare, and some of those removed seem to have chosen that course of action.  You have to break the criminal (or moral) law in a significant way, (e.g. molest a patient, commit fraud), or stubbornly pursue a self-destructive and defiant course of action which you know will end in removal but which you believe is worth it for a matter of principle.  Or, you might decide you will just not be an osteopath any more and can’t be bothered with the FtoP process at all and so not turn up for any hearings.  If you really want to give them no choice, you might even send the GOsC abusive mail containing colourful phrases like “please inform the GOSC that there is a greater chance of a monkey flying out of my bottom than there is of me [doing as they ask]” – true story, it’s on the website.  But if you haven’t done anything too transgressive or dangerous, and you cooperate, admit to and address your failings honestly, you will almost certainly remain on the register.

David Balen says the same problems have been recurring for 25 years:   “things made worse, causing people pain, lack of proper consent”

Another question: how stressful is the process of having a claim made against your insurance, compared to a GOsC complaint?

2 ways to think about complaints:  Risk management and Incident Management

Now, there are 2 ways to think about complaints, as David Balen, of the insurance company, helpfully pointed out.  There is “risk management”, and there is “incident management”.  What we were mostly talking about on this “surviving the process” broadcast was incident management, i.e. what to do if you are the subject of a complaint, but what he, and probably the GOsC, are most interested in, is risk management, i.e. avoiding a complaint in the first place.

Jonathan Goldring, barrister who has represented many an osteopath, and is clearly influenced by witnessing osteopaths and chiropractors going through the the dark night of the Fitness to Practise process, did point out that it is impossible to reduce the risk of a complaint to zero.  And yes, he’s right.  But we can reduce it a bit.  I have my own personal list of things I’ve done to reduce my risk, and will probably share it on the blog soon, maybe after I’ve rejigged it following a word or two with the highly experienced David Balen, who says he has been lecturing to osteopaths about this for years, and the same problems keep coming up.  Clearly as a profession, we are not learning the lessons.

Another question:  can we not be advised of what has gone wrong for other osteopaths?  For example, when there’s a plane crash, all airlines immediately learn and share what went wrong in that case in order that the whole industry becomes safer.  Tantalizingly, I glimpsed on David Balen’s notes a list: something like “5 rib fractures, 2 cauda equina (suspected), 12 inappropriate treatment.”  They probably referred to complaints that have come to the insurer, not the GOsC.  People have got hurt or feel that their treatment was “wrong” and have gone down the recompense route.  Is it only me that wants to know every single detail of the circumstances of every one of these, to make sure I don’t make whatever mistakes those people made?

Maurice Cheng and Georgina Leelodharry:  The iO offers support, including COSSET, an out-of-hours helpline staffed by Samaritan-trained osteopaths

Things you might not know #1:  There is no obligation to treat people – you can turn them away

One of my top new ways of protecting myself:  turn away patients who I think will react badly to treatment.  You know the ones;  you can just smell trouble. They’re terrified of being treated, or they have a long list of previous practitioners who all made them worse.  You can’t understand why none of their previous therapists has been able to help what seems to be a straightforward problem, or how a foot massage 7 years ago directly caused their chronic cluster headache problem, as they claim. Well, one useful thing I learnt:  Tim Walker explicitly stated that you are not obliged to treat anyone.  You can’t turn people away because of things like religion, sexuality, age or race, (broadly falling under the title “protected characteristics”), but you can turn someone away because you think a course of treatment will end up making them worse, for whatever reason, and I would imagine most patients given that opinion would gladly go on their way.

Things you might not know #2: This is not a dispute resolution process

This is an interesting point to be clarified.  Presumably many osteopaths and complainants think the process is about resolving their dispute.  Well it’s not.  The GOsC looks at the complaint more as an alert that there might be a practitioner out there who is guilty of unprofessional conduct (UPC), and the complaint needs to be investigated to shed light on that.  This might be why research a few years ago showed that not only osteopaths but complainants were dissatisfied with the outcome of the process – the reason being that the thing they specifically complained about was not addressed.  e.g. they were angry that the osteopath was dismissive and rude to them and tried to sell them overpriced herbal products.  After a long process the osteopath was found not to have been rude or profiteering but was admonished because they didn’t gain adequate consent and had inadequate notes.  Patient feels aggrieved because their specific complaint was not upheld.

Another question:   These people who complain –  why do they do it?  What are they hoping to get out of it?  There’s no money in a complaint to the GOsC. Obviously it’s tempting for us to write them off as problem individuals compelled to fill their empty lives and take out their bitterness on a hapless and innocent  therapist.  But as the GOsC reps reminded us, it’s not a pleasant process for them either.  An alternative view would be that they are innocent victims, whose trust has been betrayed by incompetent or immoral therapists, and who have then done the courageous and responsible thing and alerted the regulatory body to registrants who should probably be investigated just in case other members of the public are at risk.  But I’d love to read a few interviews, maybe find where they’re coming from, and whether we can find out exactly what they did want to achieve, and how that can be fulfilled without this protracted and often lose-lose process.

Things you might not know #3: Unfortunately, you can’t avoid the process by leaving GOsC

The GOsC is not a kind of club that you’re a member of.  So you can’t avoid being subject to its rules and regulations just by leaving.  Only in a few special cases might you be able to do this (aka “voluntary removal”), and it won’t be up to you, but other parties involved.  And I don’t think you’ll be able to do this if you then intend to simply carry on business as usual while calling yourself a spinal therapist.

Well, all this might seem a little bleak.  And Bleak House, Dickens’s famous satire of the interminably slow workings of the legal system, came to mind more than once as Steven Bruce persistently asked “but why does it take so long”?  Well, it turns out, for rules to be changed to make things quicker is in itself a prohibitively costly and involved formal process, and there are also just the mundane matters of everyone involved in a case looking at their diaries and trying to find the next date they can all convene, and then none of them falling ill on that day.

Some reasons to be positive

1. Everyone, including the regulators and even the Department of Health in their recent consultation document, agrees that reform would be a good thing.  They would all like a quicker process and there is lots of discussion at Council meetings about the amount of time it takes to process complaints.
2. Everyone also agrees that it is too adversarial a process.  However, a bit like RCTs, we all know it’s a blunt instrument for dealing with the complexities involved, but currently it’s the best way that we have.  Chances are that a more inquisitorial and less adversarial process might evolve in the future.
3. At discussions like this one, hosted by the Academy of Physical Medicine, more sharing and understanding will hopefully help all sides to understand each other and share ideas about improving things.
4. As the new CPD scheme kicks in, osteopaths might become better trained and equipped in dealing with consent and communication issues, which lie at the basis of many of these complaints.
5. Remember, our fears of the process are largely disproportionate to the risk.

Thanks for reading and hoping this helps us all.

P.S.  More blogs in the pipeline, just thought this was topical.  N.B. I haven’t forgotten the 2nd day of the SCCO Conference or the one on motivational interviewing. Bye for now, and enjoy the lovely Autumn days.