Management Of The Osteopathic Patient
(December 2003)
by Mr. Marc Jones DO (UK), BSc(Hons)Ost, Osteopath (UK)
Ask 100 osteopaths, physicians or other healthcare professionals for a diagnosis and you are likely to receive 100 different responses. How is it possible to know who is right and who is wrong and that osteopathy is not just a form of "hocus-pocus"?
The answer is that they all probably have the right and wrong answers to some extent and all that the patient need hope for, is that the practitioner is doing everything for the right reason and not just working on "auto-pilot".
As a British trained osteopath, I have received a high level of osteopathic clinical training (without special courses in "hocus-pocus") and, as is the case with my fellow colleagues, I have to apply this knowledge to each and every individual patient that comes to see me.
After assessing the patient and forming a differential diagnosis that indicates osteopathic treatment as being safe and appropriate, I have 3 main areas of LOGICAL approach to every patient. These are:
1. The treatment itself: what can I do for this patient using osteopathic techniques during the consultation?
2. Exercise and self-treatment away from the clinic: the patient will probably only see me for 20-30 minutes during the consultation and I may not see them for another week. How can they maintain the treatment process and continue to improve until I need to see them again?
3. Cause and effect: If the patient does nothing to aggravate the injury or condition, they will probably get better far more quickly. What can I do to ensure that they create the ideal environment for recovery?
1. The treatment itself
If I use every technique that I possess and the patient improves (or fails to improve), how do I know which techniques to use the next time? It is good osteopathic practice to use a smaller selection of techniques initially and observe the response. If something is working as expected, then we keep it and if it is not, then we discard it (for the time being at least). If there is an unusual or unexpected response to treatment, we can assess this more easily. The treatment techniques are all based on the mechanics of human anatomy and its physiology.
2. Exercise and self-treatment away from the clinic
There are certain osteopathic principles that can be applied away from the clinic. For example, if a structure is "chronically stiff", then one treatment session is probably unlikely to free it off entirely. Why not ask patients to do some of the work at home? "Little and often" is a phrase used widely as it will either give quicker relief of pain or enable more specific techniques to be applied by the osteopath on the following visit if patients have been able to improve stubborn areas themselves.
3. Cause and effect
This part of the management program is not rocket science. Let us make this simple: if you do not put your hand in the fire, you will not burn your hand and this principle can be applied quite easily. For example, if your back hurts when you lift, do not lift! If you avoid causative factors, this will increase the chances of a fuller and speedier recovery.
Put all three of these factors together and this is how I can tailor the treatment for each and every individual patient. Some may choose to use the word 'holistic' as I look at the whole person including their environment.
One other principal that I always keep in my mind: "I could be wrong". It is arrogant to think that we do not make mistakes. There is nothing more frustrating for a patient than having to suffer the same repetitive treatments with no apparent improvement because the practitioner (physician, osteopath or whoever) cannot accept that their initial assessment needs to be re-evaluated. I re-assess each patient at the start of every consultation. If there is progress, we can continue and if there is not, then we need to work out why and what to do next.
I also find it good practice to try not to repeat the same techniques on consecutive visits if at all possible. Everything should be done for a reason and if there is no good reason, then it should not be done at all.
Osteopathy is only as difficult to understand as you want it to be ... and as for the "hocus-pocus", at no stage do my hands ever leave the ends of my wrists during treatment.
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Copyright © Marc Jones - Osteopath (UK), Osteopathy Vancouver 2003 onwards
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