Osteopaths indemnity and liability insurance

Guild Insurance sees numerous allegations against osteopaths each year where the patient claims the osteopath has touched them in an inappropriate sexual way during treatment. Receiving and dealing with these types of allegations can cause a great deal of stress and anxiety. It’s therefore vital that practitioners understand what they should be doing during every consultation to avoid this type of complaint.

Case example one

An osteopath provided a range of assessments and treatments to a patient’s spine and pelvis. The patient alleged the osteopath didn’t provide adequate privacy to undress and dress, and that the towel used to provide cover was too small. Overall, the patient felt very vulnerable and uncomfortable throughout the consultation.

Case example two

During the consultation, the osteopath treated, amongst other areas, the patient’s adductor muscles. The patient complained they felt violated and didn’t understand why they needed to be touched ‘down there’ to help treat back pain. It was found that the osteopath did gain consent to treat the adductor muscles, however it wasn’t informed consent as the osteopath didn’t explain where the adductor muscles are located.

How can these allegations be avoided?

Be mindful when asking patients to undress

It’s generally accepted that removal of some clothing supports osteopathic assessment and treatment. However, it doesn’t mean your patients will understand the reasons, feel comfortable with it, or give their consent.

• Consider making patients aware prior to their appointment that they may be asked to remove or adjust clothing, if they’re comfortable doing so. This allows them to consider what clothing might be most suitable and practical to wear.
• Don’t ask a patient to remove more clothing than is absolutely necessary. Also consider when it might be possible to just move or adjust clothes, rather than remove them.
• Be very clear about what you want them to remove and what they should leave on. Simply asking them to undress is likely to cause confusion and apprehension.
• Be sure you explain to patients why you would like them to remove their clothing, keeping in mind it might not be obvious to them.
• Give patients privacy when undressing and dressing by either having a screen for them to go behind, or by leaving the room, even if they aren’t removing much. Simply turning your back is not acceptable.
• Provide the patient with clean towels and/or gowns. These must be actively offered to all patients; simply having them available in the treatment room isn’t enough. And they must be of a sufficient size and quality to protect the patient’s modesty.
• If moving or adjusting the patient’s clothing during treatment, such as unclipping a bra, seek the patient’s consent first, and ensure you offer to re-clip/re-position the clothing afterwards.
• Remember that patients can decline to consent to adjusting or removing clothes; don’t assume they’re ok with it.

Gender is irrelevant

It’s easy to think that allegations of inappropriate touching are predominately issues when treating patients of the opposite gender. However, this isn’t the case. Regardless of the patient’s or your gender, there’s always a possibility for the patient to feel uncomfortable. The way you explain treatment to patients and seek their informed consent should not differ based on the patient’s gender.

How soon is too soon?

There are varying degrees of touching patients with some treatment techniques being closer to sensitive and private areas. Consideration must be given to how soon some treatments should be provided to new patients. Osteopaths should use their professional judgement when determining appropriate technique choices for their new patients, even if the patient gives consent. A possible approach to introducing new techniques is to discuss the treatment in one consultation yet provide the treatment at a later consultation after the patient has had time to consider it.

Informed consent to treatment

Osteopaths would be aware of their professional obligation to ensure a patient has given their informed consent prior to assessment and treatment. For a patient to be able to give informed consent, they need to have had the assessment and treatment explained in a manner they understand. This means avoiding clinical language which may be confusing while providing the risks and benefits to what you’re proposing and allowing time for the patient to ask questions. As osteopathy is very hands on, it’s important to clearly explain to patients where you’re proposing to touch them, and why. It may even require you to demonstrate on yourself exactly where you’re referring to.

Remember that in some cases you won’t directly touch the patient where they feel pain, so the treatment area may not be obvious to them. And keep in mind that even after treatment has commenced, patients can withdraw consent at any time, if they don’t feel comfortable.

Signed consent forms should be considered, especially for treatment to particularly sensitive or private areas. However, asking a patient to sign a consent form MUST NOT replace discussing the treatment process with them.

Record keeping

Record keeping is a professional requirement which serves several purposes. Detailed and accurate clinical notes allow for continuity of patient care. They also provide evidence of what took place during a consultation, and why.

If a patient alleges they’ve been touched inappropriately, the osteopath’s clinical record will be examined for evidence of treatment provided and the clinical justification for this. The clinical record should also contain evidence of the patient consenting to the treatment. Without this information in the clinical record, it becomes very difficult for an osteopath to defend their actions.

Don’t make assumptions

As with any professional, osteopaths can become overly familiar with what they know and do every day. However, they must remember that patients won’t have that same level of familiarity when it comes to osteopathy. Regardless of how many times an osteopath has treated a patient, they should never make assumptions about what the patient will understand, be comfortable with and be willing to consent to. Treatment always needs to be explained to patients, even if they’ve received that treatment before.

Consider the patient’s demeanour

While it isn’t expected that an osteopath can be sure of what a patient is thinking and feeling just by their body language, we can sometimes gauge when a person is feeling uncomfortable with a situation. If you have a patient who appears to not be comfortable with the treatment being suggested or carried out, stop what you’re doing and assess the situation. You may need to further explain the treatment to ensure it’s better understood. You may need to reposition clothing or towels, so the patient is more adequately covered. Or you may need to remind the patient that they don’t have to consent to treatment being proposed and discuss other treatment options. It’s also worth informing patients that they can bring a support person, such as a friend or relative, into the treatment room with them, if that would make them feel more comfortable.

Talking while treating

Osteopaths are recognised as being very personable and friendly health professionals. While this can be very beneficial in terms of building relationships with patients, it can also have its downside. Having non-treatment related chats with a patient during treatment is acceptable, however there’ll be occasions when the chatting should cease so further information about treatment can be discussed. It’s far too easy to forget what has and hasn’t been explained, and consented to, when continually chatting during treatment.

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