Defining the scope of osteopathic practice need not necessarily involve limiting our freedom to practise. I believe that a well-constructed Practice Framework document could actually safeguard us against any future attempt to limit osteopathic practice by those outside the profession who do not understand the philosophy our approach is based on. The Practice Framework is the best opportunity we are likely to get to safeguard our future.
The Practice Framework should protect our freedom to pratcise
A framework that clearly explains the underlying philosophy and principles common to all osteopaths and the reasons why these preclude the possibility of prescribing a limited scope of practice or establishing guidelines that determine which treatment approaches should be used in particular “conditions” would protect our freedom to practice, no matter what our individual approach may be. The current draft has some problems (as others have identified elsewhere) and these clearly need to be worked out, but there is much in there that would seem to meet these criteria. For example, the document states in section 11 that osteopathy is characterised by
“The intention to enhance the intrinsic health-maintaining and health-restoring capabilities of the individual person. This involves the consideration of a broad range of factors to identify and resolve the causes of impaired health”
and that osteopaths achieve these aims using
“Individually tailored intervention and advice encompassing a range of specific technical treatment techniques and approaches.”
This is as inclusive a statement of the common framework that underlies the many diverse approaches to osteopathy as is possible. Surely even those of us whose practice is furthest from the mythical “norm” should be content that this fairly represents us and supports our freedom to work towards the common osteopathic goal of promoting health in whichever ways we personally believe to be most effective.
Section 30 ensures this freedom further by stating that
“The treatment and management of a patient’s health problem will depend on the needs of that particular individual. There are many treatment approaches in osteopathy and there might be some variation according to the training and experience of the particular osteopath providing treatment. It is not appropriate to prescribe specific treatments for specific conditions as this is contrary to the principle of tailoring osteopathic care to individual need. It is also not helpful to dictate a limited scope of practice for osteopaths as they will practise according to their training and competence using their clinical judgement and skills.”
Statements like these, if included in a document that formally describes osteopathic practice, would protect us from the possibility that the GOsC or other outside forces might try to limit our freedom to judge for ourselves as trained professionals which patients we are competent to treat, what the extent of our ability to contribute to their care might be and which approaches we ought to use to these ends. Can we really afford to miss this opportunity to safeguard our future in this way?
There are many issues with the draft practice framework that still need to be addressed if this document is to fairly represent us all but to throw it out altogether would be to miss the best opportunity we are likely to get to ensure our freedom to continue to practice in the way we each believe to be in our patients’ best interests; whatever that might be.
Ben Katz
Agreed – we have a chance to attempt to communicate a little more about the nature of Osteopathy – my attempt follows:
Definition
Osteopathy cannot be easily defined nor its potential easily realised.
Principles
Its principles are clear.
There is no alternative Medicine – only Medicine. True Medicine is the art and science of healing.
Healing
Healing is anything that promotes or restores ‘health’ and the organism’s own ability to maintain this state.
Health is not merely the absence of disease but a state of harmony and balance both within the organism, between its various aspects and in its relationship to its environment and societal context.
Wholeness
Health is a state of the whole being and when there is a movement away from it the whole being must be involved in the restoration of this state of health. The whole includes various aspects of the ‘self’ including the psyche, soul and spirit as well as the soma. Any one aspect influences and is influenced by the others.
‘Nothing can be meaningfully considered in isolation’ (BOA)
Manual medicine
Osteopathy is a branch of healing that does not use drugs but rather employs manual methods to appeal to the organism’s innate self regulatory mechanisms in restoring function, integration, homeostasis and health. Mobility and motility is an important expression of health in the body and Osteopathy helps restore both.
Disease
Disease is an expression of an effort to restore health. Disease is not a permanent, negative or unchanging state.
Self Regulation
There is an innate ‘intelligence’ and potency- a ‘vital force’- within the organism that endows the body with a great inner potential for healing and change and a tendency towards health. The powers (or as Sutherland described them, the ‘forces’) within the body to overcome disease are considerable and not to be underestimated. Osteopathy ‘re-empowers’ the body to maintain the state of health.
Structure and function
These cannot be divorced one from the other. Structure determines function and function determines form.
Rule of artery and expression of vitality
The free circulation of blood, fluids and energy is both an expression of the health and vitality of the organism as well as a crucial factor in the maintenance of its health.
Individuality
Just as each individual is unique, so is the expression of their vital energy, fluids and inner forces making up the ‘pattern’ or web of life that can be palpated and ‘engaged’ in treatment. As each patient and each Osteopath are unique and as this pattern changes with time in both patient and Osteopath, each treatment is unique and can never be repeated. There is therefore no ‘typical’ or predictable experience of Osteopathy for either the Osteopath or the patient. Each patient practitioner interaction and relationship is in itself unique. Osteopathic treatment is not a one-way process and as the patient heals, the practitioner is also changed by the interaction.
Scope of practice
Osteopathy is applicable to patients of any age from newborns to the elderly and to the treatment of all systems of the body. Its limits are unknown and what ‘constitutes’ Osteopathy is indefinable.
The focus of Osteopathy is not on the technique nor on the ‘labelled’ condition but rather on the health, expression and function of the whole.
Osteopathic diagnosis is not only based upon ‘critical reasoning’ but also on intuition, perception skills and palpation – it is based upon listening to both what the patient has to say as well as to what their tissues have to say.