'' The Professionalism of an Osteopath ''
Written by Gareth Milner BSc (Hons) Ost.
15 Minute Read
In this Blog post I will be looking at the personality traits of an Osteopath and how and why they can call themselves Professionals. Firstly let’s define Professionalism, and if you have a copy of my Book Sorry! We’re Closed, you will know I love a definition!
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Professionalism … the competence or skill expected of a professional.
That’s not a great one. This is better.
Conducting oneself with responsibility, integrity, accountability and excellence. It means communicating effectively and appropriately and always finding a way to be productive.
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I will be elaborating on those 4 words in bold later on in this post. I will also be introducing the Osteopathic Solutions Team of Occupational Osteopaths including London based Giovanni Bruno, Peterborough based Jonathan Simmonds, Manchester based Francis Connor, and Bristol based Paul Henaghan.
Firstly I am going to reminisce back to my Osteopathy degree at the European School of Osteopathy in Maidstone, Kent (pictured in the gallery to the left).
I will go back to the very first day. In the morning we had our first Physiology lecture. I remember thinking this is great. I am with like minded people who have started the long 4 year journey in being able to call themselves an Osteopath. In the afternoon, we had our first practical 3 hour class with Peter Blagrave (may God rest his soul).
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Tip 22 - Teach Yourself to be a Teacher ... from my Book Sorry! We're Closed
Here's an extract ...
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Then my University days at the European School of Osteopathy (ESO) in Maidstone, Kent starting in the year 2000. I recall the Head of the School at the time, Professor Renzo Molinari (www.renzomolinari.com). His Biomechanics lectures were extremely stimulating and motivational for me to become an Expert like him. He also taught with such a lovely charm. Some didn’t like his style. But you can’t please everyone in life, can you? And if I am mentioning the ESO, I cannot leave out Professor Peter Blagrave; may God bless his soul. Mr. Blagrave had exceptional attention to detail and expected the best from you, always. You had such high respect for him, and he set the bar. With this he had authority, and you knew you had to follow his lead. He was approachable but at the same time, you knew you would be properly bollocked if you let your standards drop.
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Purchase your paperback copy of Sorry! We're Closed from our Online Shop
Back to our first practical class. I was like ‘What Course have I joined here?’ as I was 19 years old and in front of me across the room were my fellow female student colleagues, most of who were in their underwear. This was great! 'What’s that?' ... ‘Gareth, you were meant to write about the Professionalism of an Osteopath.’
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‘Oh yeah, you are right. But I was an undergraduate then’.
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Back to the professionalism. The long road to becoming an Osteopath. It was long. It was mentally draining. Even physically. Was it worth it? For me, not particularly as my Osteopath career ended within 2 years from graduating after a serious neck disc injury following an accident. But I am sure for the majority of Osteopathy graduates, it is well worth it. But of course my Osteopathy degree gave me the opportunity to own and run this type of Business. Let’s look at what I studied over those four years.
Year 1. Anatomy, anatomy and some more anatomy. You name a part of the body and we had to know every part of it. Nerves, what they were called, where they came from, where they went, what they did. Muscles, what they were called, where they came from, where they went, what they did. Ligaments; you guessed it ... what they were called, where they came from, where they went, what they did. Discs, bursae, cartilage, viscera (organs), bones (every part of them) et cetera. At 41 years old now (as of writing this) I don’t think I would have the brain memory power to cope with all the facts I had to absorb back then. I loved it though.
After the Uni day I would do what all World Class Footballers do after training, and do a bit more. I would trot upstairs to the ESO Library where I would grab the Anatomy texts and the bones and soak up more. There were some of my colleagues who would be into the party life, being a first year student, maybe I was a bit of a nerd but I sacrificed a lot of this to make sure I passed all my Exams, both written and practical and progressed with no stress to the 2nd year.
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Within the first year, we had a broad range of study matter. Practical Osteopathic techniques to start to master. The more simple stuff first like soft tissue techniques (basically massage), joint articulation and traction techniques.
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We had to learn Physiology, Neurology, Biomechanics, Orthopaedics, Pathology … just like a 1st year Medical Student. I really enjoyed the first year at the ESO. I was proud to pass all my Written and Practical exams, and be top of my year in the results.
Tip 33 - Grow the Osteopathic Profession ... from Sorry! We're Closed
Here's an extract ...
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Osteopaths qualify through a 4 year BSc degree in Osteopathy and in the UK (only) are registered with the general osteopathic council (gosc). You can view many quality Videos on YouTube of Osteopaths and Chiropractors (remember these Professions are the same) perform manual techniques. I will briefly go into the types of techniques we use to encourage the body, via the musculoskeletal system, to heal itself.
Purchase your paperback copy of Sorry! We're Closed from our Online Shop
Year 2. The toughest year for the amount of knowledge intake. It was obscene. We started to learn High Velocity Thrust Techniques (HVTs). You can watch these techniques on the Osteopathy Explainer Video to the left where I clinically treat Emma.
I will be honest HVTs were difficult to get good at. It takes a couple of years in private practice until really you can say you have mastered the majority of them. These are the techniques that both Osteopaths and Chiropractors are famed for. The ‘showman’ techniques. Very effective in immediate realignment of bones to dramatically improve joint function and mobility. Perfectly safe in the right hands. An Osteopath’s hands. Oh ok, a Chiropractors too.
The 2nd year continued with all the same subjects we started in the 1st year and by the end of the year, during the tough exams, I had even started to smoke cigars. But again I was proud to have passed all my Written and Practical exams, followed by a much needed Summer rest before the start of the next year.
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3rd Year. This was the start of our Clinical training. We had learnt so much in the first 2 years, and it was time to start applying it in the ESO’s Clinic.
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My First Patient as a Student
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A terrifying experience for a 22 year old. So much knowledge but how do I apply it? How do I cope with the nerves? How do I cope with my colleagues and Teachers watching? My first patient wasn’t a great one to get. A middle aged man with an acute back injury. Ok you could have a person with a disorder that was possibly complex to diagnose, maybe with not much pain going on. But typical, my first patient was in agony. He was a Vicar, so maybe Jesus could lend his healing hands after the treatment? I remember examining him. Fairly simple stuff. Then I presented my findings with my rather acted confidence to my Tutor who came in, listened for a couple of minutes, said to me 'I concur Gareth' and left to my complete shock. I treated the Vicar with my developing Osteopathy skills, but I certainly couldn’t call myself an Osteopath.
Throughout the 3rd year we continued to learn Biomechanics, both on a theoretical level and on a Clinical application. This was a subject I really enjoyed as it was very scientific. And in its application in the Clinical environment, that’s where more of the art of Osteopathy was able to express itself. I was again proud that I passed all the 3rd Year exams first time and progressed into my final year.
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4th Year. The year started off during the summer of 2003 where we were in the ESO Student Clinic (pictured to the left) every day. This really pushed on my clinical skills and my application of Osteopathy and its range of manual techniques.
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The majority of the year was spent at the Clinic, but at the same time we continued to learn new Osteopathic techniques including Cranial Sacral Osteopathy which needed a higher level of hand palpation (feeling) skills.
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To be honest I was burnt out through the year. Looking back, I worked so hard during the 1st 2 years of the degree that I think that caught up with me. I felt I was certainly good enough to get a 1st, but due to my nerves getting to me during practical examinations (some 4 hours long), I had to settle for a solid 2.1 in my BSc (Hons) degree. In Sorry! We’re Closed, taken from my experiences in life, I have even written a Tip called Manage Your Mind.
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I graduated in July 2004 from the ESO. Over the 4 years I was the only member of my year to pass every exam, to which I still to this day feel really proud to have achieved. This was a reflection of the dedication I had to my studies, and the sacrifices I made over the 4 years. A few months after graduating I registered with the general osteopathic council.​
I loved my Osteopathy degree. It was a time when I personally had independence. It was a big challenge but was hugely rewarding in the end game achievement. It was a shame I had to ‘retire’ before I really started, but this can happen in life can’t it.
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Let’s now look at those 4 words we saw earlier that were part of the definition of Professionalism … Responsibility, Integrity, Accountability and Excellence.
First up ... Responsibility. Of course most people consult Osteopaths for fairly simple musculoskeletal disorders. However the following is a case where I had a huge responsibility. 'Mr. Jones', a 55 year old Lorry driver presented to me in 2005 whilst I was an Associate Osteopath at the Banstead Village Clinic. He complained of left sided neck and shoulder pain. He also complained of shortness of breath, which he attributed to asthma. He was well over his BMI recommended weight and hadn't exercised for many years. He was also experiencing left side chest pain, which he reported was worse for stress. I examined his neck and shoulder and his range of movement was pretty good for a man of his age. There were no obvious signs that his pain was coming from the neck and shoulder. I decided to take his blood pressure, assess his pulse and have a listen to this heart (as Osteopaths we are trained to recognise when a heartbeat is pathological). All were of concern. I recommended that he immediately got a taxi to the local Hospital A&E. A few days later I called 'Mr Jones' and he informed me he was kept in for a few nights due to the diagnosis of a heart attack. He was discharged and placed on medications to reduce his blood pressure. He thanked me for 'saving his life'.
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Regarding my responsibility in my Profession another case springs to mind. 'Miss Price', a 16 year College student presented to me with frontal headaches. She came to the Clinic with her Mother. She had been suffering from these debilitating headaches for over a year and had consulted Neurologists, with MRI scans finding no cause of her pain. In the Case History I asked her if she had a history of accidents. She detailed a fall from her horse 18 months prior. I performed a Cranial Nerve Examination and Osteopathic Assessment. The cause of her pain was simple to diagnose. Her pain was caused by mechanical dysfunction in the upper neck joints leading to cervicogenic headaches. This cause of headaches is not classically thought of by the Medical world. Over the course of 7 treatments in 5 weeks, she had a great response with a significant decrease in symptoms. I then had to 'retire' from the Osteopathic Profession due to my own neck injury. I hope she continued to seek Osteopathic treatment.
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2 different stories. 2 people. As an Osteopath, it isn't the responsibility to the Client. It is a responsibility to the Human Being.
Next up ... Integrity ... the quality of being honest and having strong moral principles.
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My first thoughts regard clinically treating a person in their underwear. An Osteopathic treatment isn't like a consultation with your GP, where generally you sit, fully clothed, and merely discuss your symptoms. Rarely will you be asked to undress down to your underwear. And even if you are it will be for a few minutes. An Osteopathy treatment involves (after the Case History) being in your underwear for at least 20 minutes.
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An Osteopath must exude professionalism to the highest degree in order to make the appointment as comfortable as it can be for the patient. Especially during initial consultations, the Osteopath must be clear about why the patient needs to be in their underwear. When contacting parts of the patient's body, a brief and clear explanation must always be given.
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Regarding a prognosis for a person's clinical presentation, the Osteopath has to be honest in the number of treatments that will be needed, and the chances for success, managing the patient's expectations. If Osteopathy is not the therapy needed for the person, then the Osteopath recognises this and gives them an honest, and direct evaluation.
Moving onto Accountability ... the obligation or willingness to accept responsibility for one's actions.
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So similar to responsibility but I will look at Accountability with another clinical example. The Osteopath's repertoire of manipulative techniques are overall, extremely safe. However like all clinical procedures, there are some patients and their presentations when certain techniques should not be performed. A few quick examples.
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High Velocity Thrust (HVT) to the neck immediately following significant trauma e.g. fall from a horse. A neck X-ray would be indicated.
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High Velocity Thrust to the L5/ S1 lower back joint with a presentation that mimicked a prolapsed disc.
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High Velocity Thrust to the neck on a patient with a history of stroke. A major no no.
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Looking at this, you are probably thinking 'Gareth, those High Velocity Thrusts, the ones where you crack the joint, they sound dangerous?!.'
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HVT techniques are safe in the right hands, either an Osteopath's or a Chiropractor's. From these types of examples, to which there are many more, the Osteopath is accountable to the patient for the clinical strategy. The Osteopath is also accountable to the regulatory body the gosc, regarding their clinical safety and conduct.
And last but not least ... Excellence.
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In my oh so short career as a practising Osteopath, I would judge myself on every single treatment. What were my focus levels? Did I perform the techniques as good as they can be done? Did I empathise well with the patient? What could I improve on? That drive for perfection was instilled in me, by myself, from the 1st day of my Degree. Within the Osteopathic Practice, the Osteopath strives for excellence in many factors including:
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The standard of the Clinic including equipment, furnishings, staff manners and professionalism, website, explainer videos, therapies available, hygiene et cetera.
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Their Clinical skills with a broad range of techniques and the Osteopathic philosophy started by Andrew Taylor Still.
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Their people and communication skills.
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Their physical presentation i.e. the wearing of a tunic or Workwear with the Business logo on it.
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After graduation the learning doesn't stop for Osteopaths. To maintain their registration each year Osteopaths have to complete and submit Continual Professional Development (CPD) to the gosc. Of course this isn't just to tick a box. It is there to better the Profession.
Meet our London based Occupational Osteopath Giovanni Bruno.
Giovanni ... What's it like to be an Osteopath?
Well Gareth, Osteopathy is a broad Profession that requires knowledge in almost all the medicine fields. As you know, Osteopaths are trained to screen the entirety of major musculoskeletal disorders and to guide the patient towards the right path to health treating them with Osteopathy or sending them to the appropriate specialist. Therefore an Osteopath has a high responsibility towards patients.
Being an Osteopath is certainly not an easy task and not a job for everyone out there. It requires you to change the patient awareness towards health. Osteopaths have the duty to inform and educate them. At the same time an Osteopath is a teacher, a medical professional, a guide, a coach and sometimes a trusted friend.
There are many traits that should belong to an Osteopath:
1. Empathy to understand and truly connect to the patient.
2. Must be curious like a child that had just started to explore the world.
3. Love for our Profession, for ourselves and patients.
4. Desire: a burning desire to keep improving Osteopathy as a Profession, ourselves as a practitioner and desire to overcome any obstacles between our patients and their wellbeing.
Giovanni is the Business Owner of his Private Osteopathy Practice MiTo Healthcare.
I concur wholeheartedly with Giovanni's comments. Especially concerning connecting with your patient and loving the Profession.
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So why an Osteopath to supply Manual Handling Risk Management Products & Services?
The Osteopathic Solutions Team understand the responsibility they have, not only for the Client, but also the Operatives, in regards to assessing Manual Handling tasks with honesty and integrity. At the same time, we have accountability both to our Client to protect their Business, and to their employees, protecting them against serious musculoskeletal injuries. Whether it is providing Onsite Courses, Risk Assessment Consultancy, Digital Products and Books, at Osteopathic Solutions our Head Office Team and National Team of Occupational Osteopaths always strive for excellence.
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And there we are with my Blog '' The Professionalism of an Osteopath ''. Below (only on computer viewed website) you will find interesting Clinical Blog Posts and my Podcast, recorded at a Podcast Studio '' When the Osteopath met the Chiropractor '' where I meet a Chiropractor discussing the similarities and differences (there are not many!) in the two Professions.
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Thanks for reading.
