Sunday 29 November 2015

Just to let everyone know that I'm now back from the UK, and the clinic is fully open again, for Osteopathy and Acupuncture treatment.  You can either phone 03 980 2425 for an appointment, or book online at: www.christchurch-osteopathy-acupuncture.co.nz

Thursday 12 November 2015

already registered for the so-called western medical acupuncture scope of practice. No worries. Conversations like this perhaps can also help safeguard both the Osteopathic and Acupuncture professions


Don't worry, I myself have now successfully registered in the so called Western Medical Acupuncture scope of practice (essentially to cover myself) and so have most of the other TCM trained acupucturist-osteopaths, or so I believe.

It's just that we osteopath-TCM acupuncturists have almost been coerced into doing so.  Not something that rests lightly with my egalitarian-liberal sentiments, and perhaps not something that the osteopathic profession (and the osteopathic council) should be proud of.

If we allowed this to happen to a relatively powerless minority of just a few of us - just think what might be in store for many more of you, my dear osteopath colleagues.

There are wheels slowly turning, if you haven't noticed  (I better not say the vice slightly closing - to strong a metaphor, I agree).  And as all of us osteopaths are only to keenly aware, there is still a lot in the pipeline with the pending paediatric specialism registration issue, if you haven't noticed.  Read the writing on the wall.  I hope its good, and I hope you like what it's going to say before it get's carved in stone.

I don't care, I don't treat children.  I and some of my TCM acupuncture-osteopath friends and colleagues have already been burned. A baptism of fire that we didn't necessarily want, and didn't see coming.

So what is the pebble pad professional osteopathic CPD portfolio forum for, or indeed any social networking including this Facebook page for - if not for exactly this kind of discussion?

Be grateful for this, as both S and our beloved osteopathic council have graced us with the wonderful social networking medium by forcing us to do our CPD online as a portfolio that can also create and share conversations like this.  Lucky us.  I hope we learn to use it wisely.  Perhaps the osteopathic pepple pad portfolio might after all be the saving grace of the osteopathic profession.  Let's hope so.

Any reflections, comments or suggestions would be most welcome.

Thanks for very helpful reply from the Osteopathic registrar.

Today, I received a reply to may earlier post from the Registrar of the Osteopathic NZ,  which was actually very helpful. 

Reflecting on this - networking and exchange of views and information like this, is a powerful and effective method to protect ourselves, our osteopathic profession here in NZ, and also the Acupuncture profession, which deserves our respect also.

Forgive me if I was being a little excessive or melodramatic in my earlier post - but only saying things that I felt needed to be said.

Without realising osteopath-Traditional Chinese Medicine trained (TCM) trained acupucturists have allowed themselves to be backed into a corner.  And this is where they find themselves.  I think a worthy area for discussion.

Both the registrar and chairperson of the Osteopathic Council NZ seem very nice people to deal with. Genuinely helpful. The former chair of the osteopathic council as some of you might remember was an altogether different character - and it is his legacy that we osteopaths and acupuncturists now all have to live with. 

Yes, he may have made some contribution to the osteopathic profession here in NZ,  but almost certainly at the expense of the acupuncture profession here in NZ.  Don't worry, S and I are old friends, and still talking to each other (well. I hope so anyway) as well as being paradigm rivals.  We both went to the London School of Osteopathy together, and go back a long way together. S will probably find this all quite stimulating.  Well done, mate.

Unfortunately, I cannot forward the contents of the osteopathic registrar's email to me to anyone, or divulge it's contents here in any detail - without his permission. But I can interpret the gist of his response and share it here:


What the osteopathic registrar pointed out in his email is that TCM acupuncture is not, and cannot be within the osteopathic scope of practice.  Fair enough.  

Western medical acupuncture (WMA) can be, of course within the scope (and that was always the intention), but Traditional Chinese Medical (TCM) acupuncture can never be.

So the best, or most liberal possible interpretation of the osteopathic registrar's comments is that this does not necessarily mean that one cannot necessarily include any TCM during an osteopathic treatment (as it's not in the osteopathic scope)  -  it just that practically speaking one would have a hard time explaining to most patients the above distinction, and were one to do some TCM acupuncture at the same time, within (or just before or just after) an osteopathic treatment, this theoretical distinction would get very messy.

One would have to stop during a treatment (perhaps several times) then asking if the patient wanted any TCM acupuncture, say to them something like: ''Well, now I'm not doing Osteopathy anymore, and we can do some Acupuncture now. Is that OK with you?'

And many patients might get a bit confused perhaps at that point - as perhaps some of you are trying to follow this rather slippery distinction.


So essentially what the Osteopathic Council have now done is place severe practical restrictions on how osteopath-TCM trained acupuncturists can work on a day to day basis.

In effect, what they are almost doing in a draconian way is forcing us to register in the Western Medical Acupuncture scope, as osteopaths. Or risk messy infringement if we mix and match our treatments, as most of us do most of the time.

Thanks for a very helpful reply from the osteopathic registrar. Perhaps the pebble pad osteopathic CDP portfolio discussions and social networking might be a saving grace for both the Osteopathic and Acupuncture professions here in NZ

Today, I received a reply to may earlier post from the Registrar of the Osteopathic NZ,  which was actually very helpful. 

Reflecting on this - networking and exchange of views and information like this, is a powerful and effective method to protect ourselves, our osteopathic profession here in NZ, and also the Acupuncture profession, which deserves our respect also.

Forgive me if I was being a little excessive or melodramatic in my earlier post - but only saying things that I felt needed to be said.

Without realising osteopath-Traditional Chinese Medicine trained (TCM) trained acupucturists have allowed themselves to be backed into a corner.  And this is where they find themselves.  I think a worthy area for discussion.

Both the registrar and chairperson of the Osteopathic Council NZ seem very nice people to deal with. Genuinely helpful. The former chair of the osteopathic council as some of you might remember was an altogether different character - and it is his legacy that we osteopaths and acupuncturists now all have to live with. 

Yes, he may have made some contribution to the osteopathic profession here in NZ,  but almost certainly at the expense of the acupuncture profession here in NZ.  Don't worry, S and I are old friends, and still talking to each other (well. I hope so anyway) as well as being paradigm rivals.  We both went to the London School of Osteopathy together, and go back a long way together. S will probably find this all quite stimulating.  Well done, mate.

Unfortunately, I cannot forward the contents of the osteopathic registrar's email to me to anyone, or divulge it's contents here in any detail - without his permission. But I can interpret the gist of his response and share it here:


What the osteopathic registrar pointed out in his email is that TCM acupuncture is not, and cannot be within the osteopathic scope of practice.  Fair enough.  

Western medical acupuncture (WMA) can be, of course within the scope (and that was always the intention), but Traditional Chinese Medical (TCM) acupuncture can never be.

So the best, or most liberal possible interpretation of the osteopathic registrar's comments is that this does not necessarily mean that one cannot necessarily include any TCM during an osteopathic treatment (as it's not in the osteopathic scope)  -  it just that practically speaking one would have a hard time explaining to most patients the above distinction, and were one to do some TCM acupuncture at the same time, within (or just before or just after) an osteopathic treatment, this theoretical distinction would get very messy.

One would have to stop during a treatment (perhaps several times) then asking if the patient wanted any TCM acupuncture, say to them something like: ''Well, now I'm not doing Osteopathy anymore, and we can do some Acupuncture now. Is that OK with you?'

And many patients might get a bit confused perhaps at that point - as perhaps some of you are trying to follow this rather slippery distinction.


So essentially what the Osteopathic Council have now done is place severe practical restrictions on how osteopath-TCM trained acupuncturists can work on a day to day basis.

In effect, what they are almost doing in a draconian way is forcing us to register in the Western Medical Acupuncture scope, as osteopaths. Or risk messy infringement if we mix and match our treatments, as most of us do most of the time.

Don't worry, I myself have now successfully registered in the so called Western Medical Acupuncture scope of practice (essentially to cover myself) and so have most of the other TCM trained acupucturist-osteopaths, or so I believe.

It's just that we osteopath-TCM acupuncturists have almost been coerced into doing so.  Not something that rests lightly with my egalitarian-liberal sentiments, and perhaps not something that the osteopathic profession (and the osteopathic council) should be proud of.

If we allowed this to happen to a relatively powerless minority of just a few of us - just think what might be in store for many more of you, my dear osteopath colleagues.

There are wheels slowly turning, if you haven't noticed  (I better not say the vice slightly closing - to strong a metaphor, I agree).  And as all of us osteopaths are only to keenly aware, there is still a lot in the pipeline with the pending paediatric specialism registration issue, if you haven't noticed.  Read the writing on the wall.  I hope its good, and I hope you like what it's going to say before it get's carved in stone.

I don't care, I don't treat children.  I and some of my TCM acupuncture-osteopath friends and colleagues have already been burned. A baptism of fire that we didn't necessarily want, and didn't see coming.

So what is the pebble pad professional osteopathic CPD portfolio forum for - if not for exactly this kind of discussion?

Be grateful for this, as both S and our beloved osteopathic council have graced us with this wonderful social networking medium.  Lucky us.  I hope we learn to use it wisely.  Perhaps the pepple pad portfolio might after all be the saving grace of the osteopathic profession.

Any reflections, comments or suggestions would be most welcome.

Thanks for a very helpful response from the Osteopathic registrar. Perhaps discussions like this might be the saving grace of both the osteopathy and acupuncture professions here in NZ

Today, I received a reply to may earlier post from the Registrar of the Osteopathic NZ,  which was actually very helpful. 

Reflecting on this - networking and exchange of views and information like this, is a powerful and effective method to protect ourselves, our osteopathic profession here in NZ, and also the Acupuncture profession, which deserves our respect also.

Forgive me if I was being a little excessive or melodramatic in my earlier post - but only saying things that I felt needed to be said.

Without realising osteopath-Traditional Chinese Medicine trained (TCM) trained acupucturists have allowed themselves to be backed into a corner.  And this is where they find themselves.  I think a worthy area for discussion.

Both the registrar and chairperson of the Osteopathic Council NZ seem very nice people to deal with. Genuinely helpful. The former chair of the osteopathic council as some of you might remember was an altogether different character - and it is his legacy that we osteopaths and acupuncturists now all have to live with. 

Yes, he may have made some contribution to the osteopathic profession here in NZ,  but almost certainly at the expense of the acupuncture profession here in NZ.  Don't worry, S and I are old friends, and still talking to each other (well. I hope so anyway) as well as being paradigm rivals.  We both went to the London School of Osteopathy together, and go back a long way together. S will probably find this all quite stimulating.  Well done, mate.

Unfortunately, I cannot forward the contents of the osteopathic registrar's email to me to anyone, or divulge it's contents here in any detail - without his permission. But I can interpret the gist of his response and share it here:


What the osteopathic registrar pointed out in his email is that TCM acupuncture is not, and cannot be within the osteopathic scope of practice.  Fair enough.  

Western medical acupuncture (WMA) can be, of course within the scope (and that was always the intention), but Traditional Chinese Medical (TCM) acupuncture can never be.

So the best, or most liberal possible interpretation of the osteopathic registrar's comments is that this does not necessarily mean that one cannot necessarily include any TCM during an osteopathic treatment (as it's not in the osteopathic scope)  -  it just that practically speaking one would have a hard time explaining to most patients the above distinction, and were one to do some TCM acupuncture at the same time, within (or just before or just after) an osteopathic treatment, this theoretical distinction would get very messy.

One would have to stop during a treatment (perhaps several times) then asking if the patient wanted any TCM acupuncture, say to them something like: ''Well, now I'm not doing Osteopathy anymore, and we can do some Acupuncture now. Is that OK with you?'

And many patients might get a bit confused perhaps at that point - as perhaps some of you are trying to follow this rather slippery distinction.


So essentially what the Osteopathic Council have now done is place severe practical restrictions on how osteopath-TCM trained acupuncturists can work on a day to day basis.

In effect, what they are almost doing in a draconian way is forcing us to register in the Western Medical Acupuncture scope, as osteopaths. Or risk messy infringement if we mix and match our treatments, as most of us do most of the time.

Don't worry, I myself have now successfully registered in the so called Western Medical Acupuncture scope of practice (essentially to cover myself) and so have most of the other TCM trained acupucturist-osteopaths, or so I believe.

It's just that we osteopath-TCM acupuncturists have almost been coerced into doing so.  Not something that rests lightly with my egalitarian-liberal sentiments, and perhaps not something that the osteopathic profession (and the osteopathic council) should be proud of.

If we allowed this to happen to a relatively powerless minority of just a few of us - just think what might be in store for many more of you, my dear osteopath colleagues.

There are wheels slowly turning, if you haven't noticed  (I better not say the vice slightly closing - to strong a metaphor, I agree).  And as all of us osteopaths are only to keenly aware, there is still a lot in the pipeline with the pending paediatric specialism registration issue, if you haven't noticed.  Read the writing on the wall.  I hope its good, and I hope you like what it's going to say before it get's carved in stone.

I don't care, I don't treat children.  I and some of my TCM acupuncture-osteopath friends and colleagues have already been burned. A baptism of fire that we didn't necessarily want, and didn't see coming.

So what is the pebble pad professional osteopathic CPD portfolio forum for - if not for exactly this kind of discussion?

Be grateful for this, as both S and our beloved osteopathic council have graced us with this wonderful social networking medium.  Lucky us.  I hope we learn to use it wisely.  Perhaps the pepple pad portfolio might after all be the saving grace of the osteopathic profession.

Any reflections, comments or suggestions would be most welcome.

to mix and match treatments: both osteopathy and acupuncture. For the most effective treatment, just techniques: Osteopathy is 'what works'.

Some time ago I received an email from the Osteopathic Council NZ stating:

If you are an osteopath who also practices traditional based acupuncture systems, you must not seek to combine these techniques with your osteopathic practice. You must be careful to ensure that you maintain clear boundaries between your osteopathic practice and these techniques and ensure patients are clear that you are not utilising those techniques within the practice of osteopathy.

So, I can understand what they might be getting at here, and there are definitely issues perhaps of 'informed consent' and is any given patient coming for osteopathy or coming for acupuncture.  And of course, I document this in my notes.  My consent form asks for consent for both osteopathy and acupuncture (although - to be honest - how many patients really know the difference between Traditional Chinese Medicine Acupuncture and the so called 'Western Medical Acupuncture' - when even I sometimes are uncertain, as there can be overlap. So I just say 'acupuncture'.

Some patients don't like osteopathic manipulation, even gentle manipulation (or worse, Chiropractic manipulation which might be rougher), some patients don't like acupuncture - and every clinician deals with this customer preference and their consent (or lack of it  -   for any given treatment technique they prefer or do not want ) every day, with every individual patient. So no problem here.  And I guessing that informed consent is a key issue here. 

The other question is  - is the above direction and instruction from the Osteopathic Council NZ only intended for Osteopaths NOT registered in their so called Western Medical Acupuncture scope, but who practice Traditional Chinese Medical acupuncture? Or for all osteopaths? 

However  -  the real issue that I am wrestling with is an Ethical one:

Would it not be highly unethical to withold treatment (or a part of a treatment that one had expertise in) for a given patient, who had consented fully to both acupuncture and osteopathy, or to have to tell the patient that they would have to rebook for another treatment, on another occasion?  Especially if they were in a lot of pain that day?

From a practical point of view this seems a bit ridiculous, highly unethical, and just wrong.  So how would one approach this dilemma?

I am very careful in my notes to write up a treatment as an Osteopathy one, or an Acupuncture one.  And yes - I still maintain my Acupuncture NZ registration, and ACC provider acupuncture registration.  The reason I do so, is that besides having a lot of friends in my Acupuncture peer-group, and wanting to support Acupuncture NZ, some new patients DO know the difference between Traditional acupuncture and the more reductionist Western medical acupuncture and ask me on the phone 'what kind of acupuncture I do'.  And this is on my website.  
for this see:  

http://www.christchurch-osteopathy-acupuncture.co.nz/acupuncture/traditionalDry.html


To be honest, I've never yet met a good Fertility or Women's health specialist  Western Medical Acupuncture trained practitioner - yet there are many excellent Traditional Chinese Medical (TCM) trained acupuncturists out there.

maybe see: 

http://www.christchurch-osteopathy-acupuncture.co.nz/acupuncture/fertilityIVF.html

So in conclusion, the above instruction from the Osteopathic Council from August tells us that Osteopaths cannot mix and match treatments.  Is this correct?  Or is it only telling us that we have to fully explain to each patient what kind of treatment we would offer them. It seems to me that the former one is more correct (not the latter).

However, how do we create such definitive boundaries?  In a solely Osteopathy treatment can I not take a patient's pulse ?

Traditional Chinese Medicine (TCM) acupuncture pulse diagnosis can be highly skilled and informative, and there are many pulses and qualities, not just rate, rhythm and strength in one pulse position as in Western medicine) or make a tongue diagnosis, or think a bit laterally in a TCM paradigm - even if I do no acupuncture an use no needles in that osteopathy treatment?

And I can, of course, do a bit of Western Medical Acupuncture in an Osteopathy treatment  - but not Traditional TCM acupuncture it seems - as this Osteopathic Council NZ direction dictates.

But let's get real here  -  and be honest.

Many patients don't know the difference.  Yes, I can explain it to them, and they are happy that I have expertise and training in both paradigms, and understand both conceptual frameworks.

But do I always know the difference between Western Medical Acupuncture and TCM traditional acupuncture when I'm actually doing it, with a patient there on the table?  Well, it's all a matter of interpretation and underpinning theory.  For practical purposes (for any given patient) it's usually a false construct, a fabrication.

If it's essential to maintain this facade for registration purposes, and play the game, and write my notes accordingly - then I can understand the politics and regulation process behind this.

But always the most effective, and ethical thing is to give any patient the best treatment one is capable of as a practitioner.   Any regulation that compromises this cannot be ethical, and seems ridiculous and just wrong.

I would be interested to hear anyone's view about this.

Don't worry, I've already written to the Osteopathic Council NZ to point all this out, and ask for their feedback.

Meanwhile, I do my best for all my patients, and good acupuncture and good osteopathy, and document clearly with good notes.  Everyone seems happy with this.

Andrew Still the founder of Osteopathy, once described osteopathy as 'what works'.  150 years ago acupuncture was unknown to him. But acupuncture is definitely something that works (and very well) so why not use it.

I'm on retreat next week, but back on November 30th.  If you want to book an appointment, best do so online:
http://www.christchurch-osteopathy-acupuncture.co.nz/default.html