“There are no set scripts and no set patients”

Steven Bettles, GOsC Policy Manager, explains why effective communication with patients about risks is a clinical decision, rather than just a regulatory requirement.

There is a perception amongst some osteopaths that effective communication with patients is a regulatory requirement imposed by the GOsC, rather than a central part of effective clinical practice. OPS: Communication and patient partnership The Osteopathic Practice Standards (OPS) set out clear expectations around communication within the ‘Communication and patient partnership’ theme. For example:

• A3 – ‘Give patients the information they need in a way they can understand’ – supported by guidance which stipulates: ‘You should inform your patient of any material or significant risks associated with the treatment you are proposing’.
• A4 –‘You must receive valid consent before examination and treatment’, has extensive guidance, including: ‘The patient needs to understand the nature, purpose and risks of the examination or treatment proposed’. These standards provide a framework within which osteopaths should work. To a large extent, they should represent the types of behaviours common to all healthcare professionals, and they aren’t
  unique to osteopathy.

Communicating risk

We sometimes hear from osteopaths who are unsure about the standards relating to communication, particularly for the communication of risk. Some have told us that they feel that such standards are an unnecessary complication and an unreasonable burden with which they must reluctantly comply. I have heard from osteopaths who say that if the GOsC requires them to communicate risks of treatment to patients, then the regulator should make it clear exactly what osteopaths are expected to say, going as far as providing a standard script that can be used with all patients. The requirement to inform patients of the risks of treatment, and to provide the information that they need isn’t just a GOsC requirement – it’s a legal one, most recently spelled out in a 2015 16 the osteopath magazine Oct/Nov 2017 Supreme Court judgment known as the Montgomery case.

This isn’t just about risks, it’s about finding out what is important to patients and factoring this into decision-making about their care. The Montgomery case also effectively ended the notion that practitioners can make decisions on a patient’s behalf, without discussion. For example, ‘My patients won’t want to know that there’s a minimal risk of severe side effects following a cervical manipulation’, really wouldn’t be a justifiable reason for not having this discussion.

Why communicating is a clinical decision

How and what osteopaths communicate with their patients is a clinical decision, and will be influenced by a range of factors, including the available evidence, the osteopath’s skills and experience, and the patient’s own values, preferences and beliefs. It’s the osteopath’s responsibility to ensure that they are sufficiently informed to discuss treatment options openly and honestly with patients, so that patients can make informed choices about their care. It’s no more the GOsC’s responsibility to tell osteopaths exactly what to say to patients, or to quantify risks, than it would be to interfere with other clinical decisions. Standard C2, for example, states: ‘’You must be able to formulate and deliver a justifiable osteopathic treatment plan or an alternative course of action’, and this is supported by guidance as to what this means in practice. It’s not the job of the GOsC to prescribe which orthopaedic or neurological assessments you should be carrying out in particular circumstances, or to approve particular techniques. These are your clinical decisions, therefore the same applies to what you communicate to your patients.

Information to help with patient discussions

Evidence around risks in osteopathy has certainly expanded over the last decade, and there is plenty of information available to inform discussions with patients about this. We have supported osteopaths by commissioning research into adverse events in osteopathy and by making a range of publications available on the o zone, to help them keep up to date. The National Council for Osteopathic Research (NCOR) also provides resources to support osteopaths in communicating benefits and risks to patients. It can be challenging, of course, to talk to patients about what might go wrong, but then so can plenty of other aspects of osteopathic care.

Communicating effectively should be seen as something that osteopaths need to learn, practise, review, reflect on and develop in the same way as they do with other clinical skills. Remember, this isn’t just a regulatory compliance exercise – it’s about effectively meeting the needs of patients as 21st century healthcare practitioners. It’s about finding out what matters to patients, and giving them the information they need to reach informed choices about their health and care. There are no set scripts for this, in the same way that there are no set patients.

You will find more resources on consent here