Managing patient response to osteopathy treatment

Osteopathy, as with all areas of healthcare, carries complexity and risk. Despite the best of intentions of osteopaths, sometimes the outcomes experienced by the patient isn’t as expected or intended. Osteopaths need to be sure they’ve thought through not just what could go wrong during treatment, but what they would do if this was to occur. Considering in advance how you and the clinic will respond in a situation will assist you to stay calm and focused.

Unfortunately, Guild Insurance has seen cases where a patient has had a poor response to treatment and the practitioner hasn’t dealt with this in the most appropriate manner. An example of this is allowing a clearly unwell patient, who is experiencing dizziness and is vomiting, to go home alone rather than calling an ambulance. This may result in the patient’s situation deteriorating while at home as well as allegations of professional negligence against the osteopath.

What to say and do

Health professionals will usually not want to alarm their patients unnecessarily. However, this needs to be balanced with erring on the side of caution. If you have concerns about a patient’s health following treatment which they don’t share, this requires a conversation where you clearly detail what it is that’s concerning you. You also need to be sure they understand what the possible consequences for them may be if they don’t follow your advice.

The first step to determining how the patient has responded to treatment is to ask them while still in the consulting room. You need to be sure you allow enough time to do this genuinely, not asking as the patient is getting ready to leave the room. This question should also be asked after the patient has re-dressed; this will make them more comfortable to have the conversation. When asking the patient questions, as with all communications, avoid using clinical terms the patient is unlikely to understand. Also, asking closed questions such as “are you feeling ok?” is likely to just provide a response of “yes”. To really understand how they’re feeling, ask them more specific questions to describe how they’re feeling, such as “How are you feeling now compared to when you arrived?” or “Is this how you normally feel after an adjustment?”. And don’t forget that this conversation needs to be noted in the patient’s record.

You might also look for nonverbal cues to understand of how the patient is feeling. You may be able to tell from the way they’re sitting or holding themselves if they’re experiencing discomfort. You may also be able to tell from the look on or colour of their face if they’re unwell or in pain. While it’s difficult to form any conclusions just by looking at a patient, these clues should prompt you to ask them about how they’re feeling.

When the patient insists they’re fine

If you, as the treating osteopath, have concerns about the patient’s wellbeing after treatment, you need to act on this. Patient’s will at times play down how they’ll feeling as they may not want to bother you and they may not realise how unwell they are. Some patients may feel they’d prefer to just go home and rest, thinking that’ll make them feel good again. However, if you have concerns it may be wiser to ask the patient to stay within the clinic for a little while after treatment so they can be observed. And If you believe that patient needs urgent medical attention, this must be stressed to them. While you can’t force a person to seek medical assistance, you must be sure you’ve been very clear when explaining why you think it’s necessary.

If you have a patient who insists on going home, you should consider having a conversation with them about how they’re getting home. Rather than travelling home alone, it would be worth suggesting they have someone pick them up or catch a taxi home. You should also ask the patient if they’ll be home alone. If there’s no one at home with them, it would be ideal for them to stay at the clinic for a bit longer to be observed.

If a patient has left your practice feeling unwell, it’s recommended you contact them soon after to check in on them. This goes a long way towards maintaining the treating relationship, as well as allowing you to provide further clinical advice if they’re still unwell. Once again, this conversation needs to be recorded in their clinical record.

In summary…

Ignoring problems doesn’t make them go away, even though we have all been guilty of hoping it would. If you have serious concerns about a patient, you need to act on this and not hope for the best. It’s better to call an ambulance that turns out to not be needed, rather than not call one when it is. Poorly managed incidents will possibly escalate and become more serious.

Finally, even if you don’t think the patient is likely to complain or seek compensation following feeling unwell after treatment, you should contact your professional indemnity insurer. Guild Insurance requires all professionals insured with them to notify them when there has been an incident which may potentially lead to a claim for compensation. Notifying Guild of this early means they can start to gather details of the incident while it is still fresh in everyone’s mind. If it doesn’t develop into an insurance claim, then the matter is simply closed.

Patient response to osteopathy treatment

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