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
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