Attempts have been made to define osteopathy throughout the forty years I have been associated with this profession. They have failed because finally the conclusion was reached that osteopathy cannot be defined; it can only be described. To define means to place limits on. In attempting to define the scope of osteopathic practice, is the GOsC trying to create and place a priori limitations upon the applications of osteopathy? If so, that would limit patient choice.
A definition should be attempted only in the wider context of care. It is invidious to try to define osteopathy without a definition of medicine. If medicine is defined then perhaps a definition of osteopathy could be achieved. Osteopathy is not an “alternative” to medicine. It was not Dr Still’s intention to found a new profession. He wished to reform the existing system (Korr 1995). After a slow start in the UK with the challenges of the war and the formation of the NHS free at the point of delivery, osteopathy is now beginning to take its rightful place in the delivery of health care to the nation. In the early days, osteopaths had no choice but to restrict practice to neuromusculoskeletal conditions. There were far too few osteopaths even to attempt treating conditions beyond this narrow range. Not surprisingly, the profession developed a name for this, not because it summarised osteopathic care but because neuromusculoskeletal conditions are so extremely common and are poorly served by allopathic medicine. However, to restrict osteopathy to this narrow practice now, poorly serves public choice.
The osteopathic concept can be described simply. Dr Still recognised in the 19th century that the body is a self-healing, self-regulating, self-adjusting organism. This is conventional wisdom today. In disease, therefore, should the issue be to control the disease or should it be to find out what has impaired or compromised the self-healing, self-regulating and self-adjusting mechanisms (the health) to have allowed the disease to occur in the first place and not to have resolved on its own? There are two clear differences in philosophy here. Allopathic medicine is concerned with the control of disease, while osteopathic medicine is concerned with that which has compromised the health. Dr Still himself said “To find health should be the object of the osteopath. Anyone can find disease”.
This may be achieved many different ways. The osteopath will do what is necessary to assist the health mechanisms to resolve the disease naturally. It is not technique centred, neither is it restricted to a system of the body, a part of the body, a group of conditions, nor an age group.
The model proposed in the Consultative Document is technique centred and divisive. Osteopathy is not technique centred. What sound evidence is there for the claim that there is a typically encountered practice? This is described in Clause 35 as “the features of the typical experience most likely to be had by patients when seeing the majority of osteopaths”.
Which patients see the “the majority of osteopaths”?
How many patients are there who see “the majority of osteopaths”?
The typically encountered osteopathic practice is that which is typically performed in each individual practice. My patients and many other osteopaths’ patients would be highly alarmed if they were given the “typical approach” as described in Clause 39.
This GOsC Consultative Document should be scrapped and consultations begun not just with the BOA and Regional Societies, but with some of the groups who are driving this profession forward, such as the Foundation for Paediatric Osteopathy, the Osteopathic Sports Care Association, the visceral osteopaths, veterinary osteopaths, the Sutherland Society and the Sutherland Cranial College. There is no “lack of clarity around what constitutes osteopathic practice” (GOsC p2). The philosophical basis of osteopathy is clear.
Nicholas Handoll, DO
April 2009
This proposal is endorsed by Stuart Korth D.O., on behalf of the Foundation for Paediatric Osteopathy, Peter Armitage D.O. on behalf of the Sutherland Cranial College, Nicholas Woodhead D.O. on behalf of Post Graduate Cranial Faculty, Stephen Sandler, Ph.D., D.O. on behalf of Post Graduate Obstetric Training, and Christian Sullivan D.O. on behalf of the Sutherland Society.
Please take the time to engage the consultation process as fully as possible.
Dear Nick,
I whole-heartedly agree with your comments on the re-validation process. Rather than writing something similar but separately, I wonder if there is any way in which we, who feel very strongly about the potential demise of true osteopathy and our ability to practice it, could ‘stand up and be counted’, by adding our names to a list or petition.
Dr. Still was extremely reluctant to teach technique – he thought it led to ‘blind routinism’. After a few years in practice it becomes clear why. Osteopathy is remarkably effective, largely because each treatment is ‘bespoke’; it is tailored to the presenting condition of the patient ad hoc, based on our knowledge of anatomy, physiology, pathology etc. and our varied experience.
The GOsC appears to be ignorant of an Osteopathy’s most important diagnostic and treatment asset, which is the unique palpatory library and the perceptual skills that the Osteopath has acquired over years of earnest observation and personal development, regardless of the myriad techniques that can be employed to re-enable the body’s self-healing, self-correcting eco-system to flourish. The patient’s ‘condition’ occurs in the context of his bio-psycho-social context, which uniquely determines the treatment approach. Patients with apparently similar conditions are not necessarily treated in the same way, as all Osteopaths know.
An approach to Osteopathic practice that specifies for condition A, we use approved techniques B, C, D and if it fails, then try E, F & G, will serve neither patient nor Osteopath. But it would suit the Lawyers and Insurance companies very well.
In response to Christine Comoy, The Prime Minister can be petitioned online here if anyone wants to set up a petition:
http://petitions.number10.gov.uk/
If there are more than 500 signatories, the petition will be responded to by 10 Downing Street.
It may be a little early to be petitioning the government about the content of the GOsC’s consultation documents. They are just drafts and the GOsC are saying quite emphatically at their consultation meetings that they are open to changing them (especially the Practice Framework).
They claim to be intent on using the consultation process to listen to the profession’s concerns and to work with us to find solutions that are workable in practice. Perhaps we should try to work with them to change things before we start going over their heads.
I too am not convinced by the GOsC claim that the practice framework does ‘not seek to prescribe the scope of practice’. These are dangerous times for the profession most importantly in the area of agreeing such scope – which includes not only which groups of patients we treat (which personally I believe should be all groups) but also what we treat (which is not just the neuromusculoskeletal system but the ‘whole’). Osteopathy is by its very nature inclusive and not exclusive in these regards.
The ‘potency of self-regulation’ is indeed primary for our patients but as far as it applies to the profession it should be a process which engenders health in it and not disease. We are being challenged to clearly and effectively communicate what we do without limiting our scope of practice through political correctness. Politics changes. Principles remain.
However Osteopathy is described it must be in language that embraces the full scope and potential of Osteopathic practice if it is to be at all useful and constructive. Health involves freedom of expression and for the profession this includes freedom of diversity in practice which in turn includes ‘flexibilty’ and ‘individuality’. Perhaps without realising it, we have already lost the right to ‘self regulate’ and regulation has in this respect been ‘insidious’. Perhaps Osteopathy should be given back to the Osteopaths? If it is not the subtly harmful process of regulation will continue under a guise of public protection until Osteopathy has to go by another name as practice scope is gradually limited.
Evidence of competence and continuing development is fair enough, though the latter should not be mandatory in my opinion, but any restrictive ‘practice framework’ is unacceptable and unhelpful.
As for ‘potency of self-regulation’ applied in the care of our patients, it could be argued that any intervention which promotes or restores the self regulatory system is Osteopathic in principle even if it is not a manual technique being employed. It is more a question of which interventions are (in the words of Littlejohn) ‘nearest the normal’ in appealing to what is ‘innate’ than what is actually done in the name of Osteopathy.
Most Osteopaths I know are naturally reflective, explorative and conscientious with respect to their practice, which evolves and unfolds naturally as a result. Some are inspired! Limiting the scope of practice will only harm the profession and may drive from it some of its most gifted exponents?
Dear All,
I am an Osteopath, I have patients who are pregnant, who are children, those with sporting injuries and others who have work related problems. However I certainly am not ‘the majority of osteopaths’.
As noted by Christain Sullivan in the latest copy of Osteopath Today, I am not ‘typical, ‘less typical’ or ‘least typical’, I am simply an Osteopath. As stated above each individual consultation is just that, individual to that patient and that osteopath. I work in the interest of the health of those who consult me, I practise using osteopathic principles which guide me to use the techniques I employ. Some of these taught at undergraduate level, others through post graduate and CPD courses.
As a Osteopath in my first year of practice I am alarmed by all of the documents being fed through my mail-box. I am alarmed mostly by the scope of practice document. I concur with Nicolas Handoll and his co-signees, to define is to constrict, however I feel this is a double edged sword and that in order to be accepted by the general public there should be an understanding of osteopathy, its scope and practice. To define it as a treatment for musculoskelatal disorders is doing the profession a profound injustice.
I will be making my concerns known to the GOsC and attending the consultation days. I would urge all my colleques to do the same, we must as a profession ensure that osteopathy is not ‘dumbed down’ and the richness and scope of its practice and practitioners is preserved.
I would wholeheartedly agree—otherwise we are heading for the medicalisation of osteopathy, and rendering a a shadow of its true self.
Dear Colleagues,
I feel the same, a great worry in terms of restriction that can be done by defining.
Nevertheless, I would like you to consider more on the following points, I have posted these ideas elsewhere, and they are very basic and pragmatic, and am not trying to find out the “sex of the angels” ie. setting up something different, simply are the means to reach the CORRECT Osteopathic way, I believe to the best of my understanding – always thinking and applying everything under the Osteopathic essence – the UK profession certainly will fulfill this for MANKIND with the best way of practice and best choices for Patients:
1.Dr.A.T.Still was the founder of Osteopathy.
2.He wrote a set of values that, if not scientifically taken/put down, must be followed.
3.Why the actual Osteopathy way of teaching and practice is in the USA and the UK in a parallel position? Though, synchronous in some way, but definetelly, by the looks, moving apart from each other?
4. Is not this a major problem to put the International House in Order?
5. How many “Osteopathies” do exist Worldwide? I shall answer, – as many as countries exist – how ridiculous! You look around and find out, if I am wrong!
6.Why not letting each single properly qualified and registered Osteopathic practitioner to expand in the best way he / she sees best for Patients in terms of unlimited / full scope of practice, obviously, always using the Osteopathic Principles and as such (having to be all the time) being FULLY proficient at that.
7. For so much, generally, the actual British Osteopathy / Osteopathic Medicine teaching system should exist as it is, and Osteopaths only could engage in more practice rights after for instance having practised as it occurs now in the UK. for at least 5 years full time in Osteopathy.
8.The Colleagues that want to remain practising as they are now they shall be able, to do so, but we cannot seclude the profession nor its Practitioners and even less the FUTURE. (By the way I might be – or not be – one of those, that wants to remain as it is, simply I have to take a political view for this Great Profession and Colleagues best interests and for the future of Mankind.
Note: other professions are on the move, and Sociologically this is most interesting to see and interpret…
9. No one can impose and / or restrict on the future.
Including Patients freedom of Choice.
Does one have to go the USA or the UK or elsewhere to be treated in a certain Osteopathic way?
10.This is NOT a Profession that was born restricted in terms of practice rights, actually, always fought for full practice rights under FULL Osteopathic practice, reasoning and principles, that it is a unique way of thinking and clinical application, so, why is it like that now?
I am sure we all will agree, the Founder’s views,
it only can be used under scientific reasoning and appraisal, and
obviously adapted to our times under proper scrutiny, please see next
Dr.A. T. Still Quotations.
Not following that, if the principles are not incorrect, which they
are not, the fact is that, it will be obvious then, one is not
following the Founder’s views!
Dr.Andrew Taylor Still agreed with -
Use of Drugs:
In all cases of snake-bite, after that, I always used ammonia as an
antidote, and if it was not handy I would use soda or some other
alkali with equal success…Autobiography, p. 45
We love every man, woman, and child of our race; so much so that we
have enlisted and placed our lives in front of the enemy for their
good and the good of all coming generation, and ask the Lord…to please
aid and assist by all honorable means in stopping the useless butchery
of our mothers, wives, sisters, and daughters; to teach our people
better sense than to use any drug which would cause gall-stones,
bladder stones, diseased liver, heart, and lung troubles, fibroid
tumors, piles, appendicitis, or any other disease or habit which may
be traced directly to the unphilosophical use of drugs…Autobiography,
p. 316
We recognize the necessity for bandages, lint, splints, stays and
anesthetics, because they have proven their beneficial use…But when
should the knife be used? Never, until all nerves, veins, and
arteries have failed to restore a healthy condition of the body in all
its parts and functions. The great failing of many who enter surgical
work is their too frequent use of the knife and the anesthetic. Where
chloroform is used a hundred times, ninety-nine times it could have
been avoided with beneficial results to the patient…Autobiography, pp
324-325.
Scientific and Medical Foundation and Osteopathic Integrity:
I have learned that if a student is allowed to go into the clinics and
operating rooms before he masters anatomy, he gets cures mixed with an
imperfect knowledge of the machine he tries to adjust…This limited
knowledge created a desire on their part to go out into the world as
“cure-alls and know-alls,” wanting to say and write all and much more
than is Osteopathy…Autobiography, p. 131-132.
Article III, Constitution of the American School of Osteopathy,
Kirksville, MO, 1894 – The object of this corporation is to establish
a College of Osteopathy, the design of which is to improve our present
system of surgery, obstetrics, and treatment of diseases generally,
and place the same on a more rational and scientific basis, and to
impart information to the medical profession, and to grant and confer
such honors and degrees as are usually granted and conferred by
reputable medical colleges….Autobiography, pp142-144
Article V, Constitution of the American School of Osteopathy,
Kirksville, MO, 1894 – That the said board of trustees and their
successors, for a period of fifty years, shall have full power and
authority to appoint a faculty to teach such sciences and arts as are
usually taught in medical colleges, and in addition thereto, the
science of Osteopathy. …Autobiography, p. 144.
To be qualified for a profession you must have a complete training
from persons who understand the science thoroughly, and know how to
teach it…Autobiography, p. 152
Some heads are not governed with the milestones of reason. When you
see one of those fellows, with little heads that know it all, claiming
in a week or ten days to be a great Osteopath, remember what I tell
you: That child was weaned [too early]…and he is ready to go into the
world and make a boast that he is an Osteopath, and that he
comprehends all of the science, and more, too. He is ready to go
before the world, and make false statements enough to get more money
than he thinks he can get by straightforward, honest dealing before
his fellowmen… Autobiography, p. 261.
One objection to Osteopathy is that it may make thieves and
scoundrels. Some men come here for a little while and go away and
say, “I have been in Kirksville; I am an Osteopath,” and so on.
Autobiography p267-268.
Another dangerous point I want you to guard against is, that as soon
as our students begins to know a little something of Osteopathy, some
one will come and offer to pay their expense to foreign parts if they
will go. They propose to pay them well if they will go and practice
Osteopathy, when they are no more fit than a donkey is to go in a
jewelry-shop. Men come and ask me what to do for a sore throat, and so
on, and say they will pay so much for it…Autobiography, p. 268.
Some people think Osteopathy is a system of “massage,” others that it
is a “faith cure.” I have no “faith” myself, I only want the truth
to stand on. Another class think it is a king of magnetic pow-wow.
It is none of these, but it is based upon a scientific
principle…Autobiography, pp 274-275
At the beginning of your Osteopathic duties you have the satisfaction
of knowing that you are about to enter the practice of a science. By
a systemic adherence to its never-failing laws, you will prove an
honor to yourself and a benefactor to mankind. You should ever
remember that Osteopathy is confined to the immutable laws of nature.
…Autobiography, p.295.
If Osteopathy is not complete within itself, it is nothing. It walks
hand in hand with nothing but nature’s laws, and for this reason alone
it marks the most significant progress in the history of scientific
research. …Autobiography, p. 298.
This is a war not for conquest, popularity, or power. It is an
aggressive campaign for love, truth, and humanity…Autobiography,
pp315-316.
The advocate of Osteopathy has the highest respect for the science of
surgery, which has been recognized as a science in all ages.
…Autobiography, p. 324.
As has been before stated, the object of Osteopathy is to improve upon
the present systems of surgery, midwifery, and treatment of general
diseases; it is a system of healing which reaches both internal and
external diseases by manual operations and without drugs…We accept
that part of surgery also as being of great use and benefit to
mankind. …Autobiography, p. 324.
It has been the object of myself and also of my teaches to direct and
be guided by the compass that points to nothing but demonstrative
truth…Give me anything but a theory that you cannot demonstrate.
….Autobiography, p. 399
Best regards,
Augusto Henriques