Patient Information

Gerry Carter

Thank you for choosing ‘Back in Brighton’ for your osteopathic care.

The purpose of this information is to explain what will happen during your consultation and potential examination and treatment and explains consent issues, as laid down by the General Osteopathic Council in the Osteopathic Practice Standards.

Please read carefully the content below, so that you are familiar with giving consent and the procedure of the consultation, examination and osteopathic treatment, before you arrive for your appointment.

The information below relates specifically to the service offered to patients by ‘Back in Brighton’ and does not necessarily reflect the same service offered by other osteopathic practices. This information relates to patients seeking an osteopathic consultation, treatment or advice in the UK ONLY.

The Initial Consultation

Your initial consultation will last approximately one hour and 30 minutes. If you have been to an osteopathic or chiropractic practice previously, you may be surprised that this session is so long. The initial, long first consultation will enable us to discuss your problem at length; enable me to listen carefully to your concerns; give you time to feel at ease, in what can be an anxious first visit; and examine and treat you in a manner, I believe, conducive to the best results for you.

To begin I will ask you questions relating to the condition you are experiencing, such as how and when the pain started, what you were doing at the time, and what situations aggravate or relieve your symptoms. In addition I will ask some questions relating to your medical history, such as what conditions you might suffer from, what medications you take, and whether you have had any recent accidents. It is important that we ask these questions because what may appear to be a musculoskeletal problem, in some cases can be a sign of a more serious illness or injury.

The Examination

Treatment

Following taking a detailed case history as outlined above, you will be invited to prepare for the examination. This usually involves a certain degree of undressing, relevant to the area to be examined. In the case of upper back, neck and shoulder conditions, the patient is required to remove upper body clothing; for the lower back, pelvis, hips and legs, the patient will need to remove lower body clothing. In some cases a patient will be asked to remove lower body clothing even when the pain or condition is deemed to be an upper body condition and vis versa, as it maybe necessary to observe other parts of the body during the examination, or in order to perform orthopaedic or neurological tests.

Patients are NEVER required to remove underwear. If you wish, you may also wear shorts, leggings or tights, of course relevant to the precise area to be examined and treated.

Sometimes when dealing with mid back issues it is necessary for the clasp of a bra strap to be undone, in order that the back muscles underneath the bra strap area can be effectively treated. This is only ever necessary when patients are laying on their front and permission will always be obtained before undoing a clasp. Patients may wish to do this themselves, or with their consent, I can perform this for them. It is recommended that you do not wear one-piece ‘sports bras’ particularly if you have a mid back problem.

For similar reasons, it is sometimes necessary to move the straps of underwear slightly, in order to properly treat the lower back and upper buttock muscles. Similarly with regard to the undoing of bra straps, permission will always be obtained before the moving of underwear straps. Patients may wish to do this themselves, or with consent, I can perform this for them, if they so wish.

If you have any concerns about the touching of, or the small movement of underwear or bra straps, please do not hesitate to let me know. It is extremely important to me that all my patients feel comfortable and at ease during both the examination and treatment, and therefore it’s vital that you let me know of any concerns you may have before or during these procedures. This will enable me to immediately remedy the issue causing you concern and make you feel more at ease.

Patients experienced in examination by some health care professionals may be used to being given a gown to wear. This is generally not appropriate for osteopathic examination, where full observation of the relevant body area is important for thorough examination and assessment of your condition. I provide patients with a towel to partially cover them during their treatment if they so wish.

Upon obtaining your consent, the examination will commence. The examination will usually begin with observation of your general posture when standing. You will then be asked to perform various movements to assess the function of the problem area. Osteopathic, orthopaedic and neurological tests may then be carried out to help ascertain your diagnosis.

Diagnosis and Treatment

The diagnosis will be explained to you with the help of anatomical charts, models, skeleton parts and computer soft-ware. We will then discuss the potential treatment approaches (including the possible alternatives, including treatment potentially carried out by other health care professionals, such as medical consultants and surgeons); the detail of what the treatment choices entail; and possible treatment risks that relate to the treatment proposed.

The Osteopathic Practice Standards set out by the General Osteopathic Council describe the osteopath and patient as a ‘partnership’ and so it’s extremely important that you explain your thoughts, concerns or fears about any course of action proposed by an osteopath. It maybe that you desire a different course of action from the treatment proposed or require further information in order to make your decision and so the patient’s input is essential to provide the best care, well being and service to the patient.

Upon obtaining your consent, treatment of your condition will commence. Osteopathic treatment can sometimes cause discomfort at the time of treatment but is rarely ever very painful. If you experience pain during your treatment, please do not hesitate to say, as treatment can usually be modified to make it more comfortable.

After the treatment

Following the treatment, we will talk at length about the way you need to protect yourself while your condition is settling. Sometimes patients do not do as well as they might, because they engage in poor posture in their home and work environments, or they further strain their condition by over-exercising, or in pursuit of their hobbies. Advice will be given to you on how to limit further strain of your condition with regard to your individual lifestyle and environment. Failure to pay attention to such issues is often a significant factor in causing a stubborn problem to be maintained.

Consent

Obtaining patients’ consent to examine and give any osteopathic treatment is vital, and is laid out clearly in British law and in the specific guidelines offered by the General Osteopathic Council in the Osteopathic Practice Standards, which all osteopaths must adhere to. You will be asked for your consent to examine and treat you from the onset. Consent is not on-going.

It is extremely important that you understand that you have the right at any time to withdraw consent and refuse further assessment or treatment.

If you suffer discomfort during treatment, or are in anyway unsure or uncomfortable about any part of your consultation, examination or treatment, please do not hesitate to immediately let me know.

All new patients will be asked to sign that they have read this ‘Advice for patients’ and specifically this section on consent.

Chaperones

It is quite normal for patients to feel nervous about seeing a practitioner for the first time, getting undressed in an environment that they are not familiar with, and particularly being examined by someone that they do not know. It is good practice to actively encourage patients to bring another person to accompany them during all aspects of any consultations, examination and treatment. It can sometimes be helpful to have someone else present, so that they can remind you later, of the detail of what was said during your consultation.

Please try to avoid bringing young children with you when you come for your consultation. Parents tend to be much less relaxed and observant when they have their young children with them. Treatment rooms can be unsettling for young children and this often has a detrimental effect on the examination and treatment of the parent, who may be trying to look after an anxious child.

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Examination or treatment of ‘Private areas’

It maybe necessary at times for osteopaths to examine or treat intimate or private areas of the body. These areas may include: the lower aspect of the buttocks and pelvic area, groin, breasts, or mouth.

What is deemed to be an intimate area may vary from person to person depending on their cultural or religious background. To ensure you feel safe, you will be asked if you want to have a chaperone present, and you will be asked to sign a written consent form provided to all osteopaths by the General Osteopathic Council. This will give a clear explanation and description of the examination or treatment being proposed.

It is important that you remember that you DO NOT have to consent to any procedure or examination and that you may change your mind at any time.

If you feel uncomfortable about any aspect of the examination or treatment, please do let me know immediately. If necessary, the examination or treatment can be postponed to give you a chance give some consideration to it and possibly return with someone of your choosing, to be your chaperone, on another day. It is also possible for me to refer you to another osteopath or medical provider (such as your doctor), who may be the same gender as yourself, if this is a concern.

Examination and Treatment of young persons

Young people under 16 years of age must be accompanied by their parent or legal guardian and NOT a friend (even if the friend is another adult). Young people aged 16 or 17 years old must be accompanied by another person who is themselves aged 17 years or older. Patients aged 18 years or older, may attend on their own or may bring someone with them if they so wish, to each and every appointment and any aspect of it.

Following your consultation

Sometimes patients experience some pain or soreness after their treatment and this is completely normal. Unfortunately, it is impossible to tell who will feel sore, or for exactly how long. Soreness or pain from treatment rarely lasts for longer than 3 days. If you are coming for a course of treatment, often the soreness levels reduce after each subsequent treatment session.

If you have soreness lasting longer than 3 days, or if you are concerned in any way about your symptoms, please do contact me immediately.

You may contact me by phone, text or email. I also provide patients with my private mobile phone number which may be used in an emergency to get in touch with me, such as after practice hours.

Soreness felt after treatment can depend on the type of condition that you presented with and for how long you have had it. Some patients naturally feel more pain or soreness than others. Sometimes activities patients engage in, both before and after the treatment session can make soreness more noticeable. If you are planning on traveling, exercising or engaging in anything strenuous or different to your normal lifestyle immediately following your consultation, please do mention it BEFORE your treatment commences.

After treatment try to find time to rest for a while as you may be a little more vulnerable to further strain. In addition, your muscles may be a little more reactive. Try to avoid excessive activity following your appointment.

Sometimes the application of heat (hot water bottles, blankets, baths, etc.) or cold (ice packs, packets of frozen peas, etc.) or indeed a mixture of both (contrast bathing) can be of benefit, but please follow the advice you were given during your consultation and if you are unsure about what to do, please do not hesitate to contact me.

Potential Treatment Risks

Osteopathy is generally regarded as a safe treatment by the NHS (see: https://www.nhs.uk/conditions/osteopathy/safety/). A study was commissioned by the National Council for Osteopathic Research to provide evidence of risk (adverse events) associated with osteopathic care (funded by the statutory regulator, the General Osteopathic Council) and carried out by the University of Brighton. The research on adverse events suggested that serious effects after osteopathic treatment are extremely rare: 1 in 500,000 or less frequent, while mild effects are common: up to 8 out of 10 patients. (see: https://www.brighton.ac.uk/research-and-enterprise/groups/healthcare-practice-and-rehabilitation/research-projects/complaints-and-claims-against-osteopaths.aspx)

As I have explained above, patients may experience varying degrees of these mild effects, which can include but are not limited to: soreness, tenderness, stiffness, tiredness, headache and nausea. However, these mild effects are usually very short lived.

Spinal manipulation is one of the treatment methods that osteopaths, chiropractors and physiotherapists often employ. Manipulation is generally considered safe. However, there are potentially serious ‘significant unwanted outcomes’ that can result from this form of treatment.

Patients should be aware that this treatment modality (as well as non-manipulatory forms of treatment) can cause the patients’ condition to worsen, and can include, but is not limited to: disc injury (or further disc damage), nerve injury, including ‘cauda equina syndrome’, spinal dislocation, fracture of a bone such as a vertebra or rib (especially when boney pathology is present, for example: osteoporosis), or further compromise to an underlying spinal anomaly that is not detectable by physical examination.

Neck manipulation carries with it special risks. There have been incidents of patients suffering hearing and vision loss, fatal blood vessel damage in the neck and cranium, and debilitating stroke following neck manipulations. However it’s important for patients to realise that these incidents are very rare.

The estimated level of risk of such outcome occurring from manipulation of the neck varies widely depending on the researcher, but it’s been estimated to be in the order of approximately one event for every 1 to 2 million manipulations, although this is only a rough estimate. Other research puts it in the range of 1 in 50,000 to 1 in 5 million manipulations, whilst other researchers put the figure at one in every 0.9 million treatment sessions.

In order to put the risk of neck manipulation in perspective, some researchers have compared this risk to the risk of serious complications or death resulting from the use of non-steroidal anti-inflammatory medications as being 100 to 400 times greater than for neck manipulation. It is also recognised that one of the causes of vessel damage and stroke described above can occur when simply having your hair washed in a hair salon! (‘beauty parlour syndrome’).

Remember, manipulation is just one of the types of treatment osteopaths offer. Before treatment commences, we will discuss your treatment options, and the potential benefits and risks of such treatment plan. Your consent will always be obtained before we progress to any proposed treatment.

Prescribed medications

Patients suffering from musculoskeletal conditions often suffer from pain, inflammation and muscle spasm. These symptoms will often be treated by doctors prescribing analgesics (such as paracetamol), non-steroidal anti-inflammatories (such as ibuprofen, naproxen or diclofenac sodium) and muscle relaxants (such as diazepam). If you have been prescribed these medications by your general practitioner or medical team and you choose to take them, please follow the instructions you were given. If you have any side-effects from taking these medicines you must seek urgent medical advice.

DO NOT take medicines prescribed for someone else. They may cause you to become suddenly ill and you may have a reaction to them that could be potentially very serious.

Over-the-counter medications

There are many analgesic and anti-inflammatory medications that can be purchased over-the-counter at pharmacists, supermarkets, confectionary shops, and even at petrol stations. As an osteopath working in the UK, I am not licensed to prescribe medicines and so I am unable to give patients specific advice to take any medication, including over-the-counter medicines.

However, I am able to give general information as to what medicines are available for treating various conditions, and in fact I often advise general practitioners on these medication matters. Nevertheless, you MUST first seek advice from your general practitioner or medical team, before taking any medication, to ensure that it is safe and appropriate for you to do so. Taking over-the-counter medicines can be contra-indicated in some cases. Individuals with other health problems, or who are taking other medications, may cause themselves serious harm by taking them.

If you are unable to speak with your general practitioner then you should either call ‘NHS Direct’ or speak with your local pharmacist in order to get more detailed advice.

DO NOT take ANY medication unless you have specific medical advice to do so.

Interruptions to treatment

As much as I try to keep interruptions to a minimum, please do keep in mind that on occasion I may be disturbed during a treatment session by someone at the door. Please also remember that I work without a receptionist or nurse. The person at the door may be my next patient who is early for their appointment. Experience has shown me that it is far less of a disturbance to attend someone at the door, than it is to ignore the person ringing the door bell over and over! Please accept my apologies for having to leave you for a very short while in these circumstances. Unfortunately, deliveries and postal services cannot be counted upon to occur at a definite time of day. I always endeavour to keep such interruptions to a minimum and to recommence treatment as soon as possible. Interruptions such as these are rarely longer than a minute or two.

Appointment arrivals

Please try to be on time for your appointment. I work to very strict appointment times and the practice rarely ever runs late. This policy benefits all patients because they can plan their sessions precisely around their work and other commitments knowing that they will not usually be kept waiting beyond their appointment time.

However, inevitably there will be times when I will run late, for some unforeseen circumstances. I ask that patients take this fact into consideration when booking their appointments.

Please try not to be too early for your appointment. Because I usually run back-to-back with appointments, when a patient arrives very early it can disrupt the treatment session of the patient currently being seen.

An important part of osteopathic duty of care is the writing of notes following a consultation, examination and treatment. If you are early for your appointment and I am completing notes on the previous patient, please remember that this is an extremely important part of the appointment and I am obliged by law and the rules set out by the General Osteopathic Council in the Osteopathic Practice Standards to complete these patient records. Keep in mind that it is a rare occurrence for me not to be finished by the time your appointment is due to begin.

Missed appointments and late cancellations

Please give a minimum of 24 hours notice if you need to cancel an appointment. This allows me sufficient time to offer that vacant appointment to someone else. It is not unusual for me to experience several no-shows or late cancellations in one day. This will often mean that I am unable to offer another patient an appointment because every appointment had been booked for that day.

The FULL FEE may be charged for these late cancellations or missed appointments.

Unhappy with the service

If for any reason you find that the service I provide falls below your expectations, please do not hesitate to bring it to my attention.

Patients are sometimes reluctant to talk through their concerns with their practitioner but I would value any comments you might have, as it may help me to improve the osteopathic care I provide. If you immediately raise a concern or complaint with me, I may be able to allay your concerns and deal with your complaint promptly and to your satisfaction. This is vital to ensure the patient’s comfort and peace of mind.

However, if you wish, you may raise a concern or complaint with another osteopath outside of my practice or with your general practitioner. You may also raise the concern or complaint with our governing body, the General Osteopathic Council at:

The General Osteopathic Council
Osteopathy House,
176 Tower Bridge Road,
London,
SE1 3LU
Tel: 020 7357 6655
email: www.osteopathy.org.uk/contact-us-cysylltu-ni/
website: www.osteopathy.org.uk