Coccyx Examination
 
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Coccyx Examination


shibboleth
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My partner recently consulted an osteopath for low pack pain and he diagnosed the symptoms were coming from her coccyx and then undertook an examination of her coccyx rectally. Is this standard practice for osteopaths to perform? Also, the examination was performed by the osteopath without any other persons present - no nurse, chaperone etc. My partner was naturally uncomfortable with the procedure and rather embarrassed by the circumstances. He has suggested a course of nternal coccyx manipulation and understandably, she is extremely reluctant to have this performed in similar circumstances.

What are the recommended procedures for this type of treatment - assuming this falls within the osteopathic scope of practise?

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CharisNLP
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Having worked in orthopaedics, yes, rectal examination is part of a full assessment of coccyx pain. I couldn't advise whether or it is specifically part of an osteopathic assessment, but it doesn't seem unreasonable to assume that it would be.

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shibboleth
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Thanks. Perhaps one of the osteopaths would care to comment. It's not what seems reasonable, but what is the proper and appropriate care in respect of the osteopath's scope of practise that is relevent.

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tigress
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Did you consider calling eg a national school of osteopathy?

tigress

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(@jabba-the-hut)
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Surely there should have been a chaperone?

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CharisNLP
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What I MEANT was it may have been handled badly, in that your parter was left feeling embarassed and uncomfortable, and there is no excuse for that, but that doesn't mean it wasn't a reasonable and appropriate investigation. Osteopathy is regulated in the UK - perhaps you should make the enquiry here where you will get the correct information.

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CharisNLP
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Surely there should have been a chaperone?

I think this is a difficult one. I've been having ongoing and intensive chiripractic and osteopathic work done recently, and I've never been offered a chaperone. And to be honest, I wouldn't expect a sole practitioner to be able to offer me one. Sure, he has his receptionist, but I would rather have no one than someone unqualified and unknown. I've aslo seen a private orthopaedic surgeon, and he certainly hasn't offered me anyone. The difference may be that I would have no hesitiation is saying I wanted a friend/partner/husband with me if I wanted one, and he (my osteopath and my chiropracter) has created an environment where I could say that easily if I needed it. So I'm not sure if he should have had a chaperone - more worrying for me is that the person didn't feel able to say SHE needed one.

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kvdp
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Thanks. Perhaps one of the osteopaths would care to comment. It's not what seems reasonable, but what is the proper and appropriate care in respect of the osteopath's scope of practise that is relevent.

Well as always it's extremely regrettable that a patient has had a bad experience. I am in not in any way an appointed spokesperson, but I think this issue deserves an answer, and a resounding silence here would be a shame. I'll try to be as neutral as possible.

Osteopaths are considered qualified to perform a manual rectal exam, prostate exam, coccyx exam, cervix etc. A doctor has no qualm about drawing the curtains and just getting on with it. However, not everybody expects this of an osteopath, we tend to be called upon far less often for this, so it is accepted as sensible that there be a heightened degree of consideration.

Not all osteopaths are trained in these techniques, and it is required of each practitioner to work within his ability at all times. There is no such thing as implied consent - the osteopath must be sure you are in informed agreement at every stage - and the patient can withdraw consent at any moment.

I'd say that whether this procedure is necessary is down to the judgement of the practitioner present, given many factors, including his own skill set. Some osteopaths specialise in these techniques, and are used to being consulted specifically for this purpose. Many would think this a necessary part of the repertoire but only employ them rarely. Others would tend to refer for this kind of work. And still others might have different approaches to the same problems.

Because osteopaths differ in so many ways, I always recommend patients to contact any practitioner they are thinking of visiting and discuss their case in advance. This is not to shift responsibility in any way, it is to help ensure that the patient as client is really getting what they want from the consultation, and establish good communication from the start.

There are protocols regarding this kind of work for osteopaths, and the General Osteopathic Council will be able to tell you the most up to date wording. But stated loosely, they involve clear explanation, written consent, and time to think about it and make further enquiries before deciding. A chaperone is not required, by the code, but a patient can require one at any time. It may be provided, or the patient can nominate their own.

Hopefully the procedure will have the desired result, and the patient will be feeling better as a result. That, of course, is not in itself proof that it was necessary. Similarly, if the practitioner has stepped outside of the protocols, that also does not necessarily mean that he had anything less than the best of intentions, or that his skill is any less. But it could in itself be a disciplinary matter. In any case you still deserve adequate communication, and I think this is the point here. Even a late explanation now might go a long way towards allaying your concerns.

If you think you may have grounds for a complaint you would normally go directly to the osteopath in the first instance, or his clinic, whereupon you can also ask to see his written formal complaints procedure. You will probably be invited to put your concerns in writing; this is not to be taken as hostility, but it is in everybody's best interests if things are written down, given the nature of the situation. If the matter cannot be resolved this way, you can escalate this to the GOsC.

You can of course go straight to the GOsC at any time if you prefer. They are a statutory body, and as such they will take your concerns and/or complaint very seriously. Their remit is now squarely about public protection.

But if you are comfortable with going first to the practitioner concerned, you may find that a frank discussion and more detailed explanation clears up a lot of misunderstanding.

I really hope that helps, best wishes.

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Sarah7
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I shudder at the thought of having a coccyx examination done internally!

In Bowen Technique there is some work we do over the coccyx but the examination is done externally, running our finger down the gluteal crease to the coccyx - much less invasive.

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stephen jeffrey
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Hi Shibboleth, even if the procedure was fully explained, your partner would sureley have wanted:-

A/ time to think about it.
b/ Decide if she would prefere a female osteopath instead.

For the osteo to assume all ok and go ahead like that shows a huge lack of consideration to your partner who now will be put off osteopathy because of it.

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Thanks for the replies. I have to say that I am somewhat surprised that osteopaths conduct internal examinations and manipulations of the coccyx - and even more surprised that they do the same for the cervix and prostrate. I cannot imagine why an osteopath, who is concerned with musculoskeletal complaints, would undertake examinations of this nature. I should declare an interest in addition to the fact that it was my partner who experienced the coccyx exam - I am a General Practitioner. ASide from the scope of practise issue, I am astounded that, providing such an examination falls within the osteopathic remit, that their code of practice does not stipulate the provision of a chaperone - not just for the patient's benefit, but for the protection of the practitioner.

I have tried to contact he relevent membership and regulatory bodies to clarify the matter, but have been unable to make contact with the appropriate person(s) as yet. 😎

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kvdp
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Well, as for the chaperone, more than once I have had very intimate exams by various GPs, who just got on with it - no chaperone, no offer of a chaperone. One waived away my objection to his locking the door, but his explanation was reasonable, and I believe he was sincere.

I also had a friend who was given a rectal exam by a GP for a sore shoulder, and I advised him to report the doctor concerned. I have no idea what the GP code says, the important difference is that at the end of the day one group were trying to help, and another clearly was not.

I'd say that you have highlighted a big battle for osteopaths, the nature, origins and background of our work are very misunderstood. I'm afraid I can't go into that here, too big a subject, but it does bring us back to the point about communication. In any case, osteopathy was conceived not as a form of physiotherapy, but as the reformation of a medical system that had completely failed.

I am more than happy to offer presentations, seminars etc to other state-regulated professionals and lay people to try and break down some of those barriers. Many of my colleagues work tirelessly at this too, but it is a struggle.

What I will say is that scope of practice is not limited to 'conditions', because we do not treat 'conditions' according to a medical view. It is not limited to parts of the body, because everything is connected, hence the Occam's Razor model of healthcare is deeply flawed. Modern understanding of complex systems shows us that small remote details can have an important influence.

I can see that some interventions may seem strange, some people think spinal manipulation is ridiculous, but there are many patients who do value the continued availabillity of this work. Likewise, it may seem strange to a GP that many patients have a deep mistrust of everyday medical interventions, and view much of it, vaccination for instance, as complete voodoo. This is not the point.

The point is that if you think you have been treated unfairly then you may well have been. Lack of clear informed consent with an intimate procedure is a big one. Keep pressing the GOsC, they have a duty to respond, that's why we pay them big fees.

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kvdp
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As an afterthought it does occur to me that you'll probably get more ideas and more participation in the discussion at the dedicated osteopaths' forum site sacral musings, . Plus there's loads there that will help increase your understanding of the osteopathic view of the world. Best wishes

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southosteo
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This shows a lack of consent or at least a lack of proper communication, so still a lack of informed consent.

Any coccxygeal dysfunction is often best treated PR (most often successfully) by those with appropriate training (I am not trained in this and refer patients to other osteopaths that are).

In my view a PR examination is not always required.

An examination and or treatment should be preceded by:

- The reasoning behind the technique and the benefits behind it.
- An explanation of the procedure and what it involves.
- The offer of a chaperone (or for the patient to return with one)
- INFORMED CONSENT from the patient.

If it is felt that the practitioner operated in an inappropriate manner, then the General Osteopathic Council should be informed.

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Patchouli
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Although I am not an osteopath, I carry out rectal examination for doing colonics.

I explain fully to the person that this will happen and the reasons why I am doing it. When they understand and give verbal consent, I get them to sign the consultation form that it has been explained and they give consent.

Do the osteos that do coccyx procedures rectally do that? If not it may be an idea to include it.

Patchouli

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 kvdp
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Well they certainly should, it's a requirement.

Although I am not an osteopath, I carry out rectal examination for doing colonics.

I explain fully to the person that this will happen and the reasons why I am doing it. When they understand and give verbal consent, I get them to sign the consultation form that it has been explained and they give consent.

Do the osteos that do coccyx procedures rectally do that? If not it may be an idea to include it.

Patchouli

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sportstherapy
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hi guys,
there has been at least one osteo struck off in recent months for not gaining informed consent or having a chaperone whilst performing an internal examination.

My GP friends will not do any form of examination like this without a chaperone.

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kvdp
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My GP friends will not do any form of examination like this without a chaperone.

And therein lies the presumption of mistrust, which can create as many problems as it solves.

I agree fully about informed consent, but even massaging a shoulder without informed consent is a problem. For many patients an internal exam is not a big deal, just a necessary part of healthcare. In those cases we shouldn't create a big deal unnecessarily, sensible precautions and codes of practice notwithstanding. Others may be more wary, and it is right and proper to give all cases the consideration each deserves.

There risks so many layers being built around the situation, that practitioners can be disciplined for not providing the right guarantees of good intent, even though their actual intent may not be in any way at fault.

On a personal note, some patients prefer NOT to have a chaperone - personally I prefer to go to a practitioner I trust and as few people present as possible.

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CharisNLP
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On a personal note, some patients prefer NOT to have a chaperone - personally I prefer to go to a practitioner I trust and as few people present as possible.

I couldn't agree more. My GP DID offer me the chance to make another appt with a female doctor recently, but I wanted some reassurance then - not another week down the line! And certainly wouldn't have wanted a third party that I didn't know there. I would have been mightly offended had he refused to examine me without a chaperone. I'd find it much worse to have someone rolled in on the sole criteria of being female, and not necessarily operating under any sort of code of professional conduct. And I hate the way random nurses hang around in OPD when you are seeing a consultant for similar reasons. It doesn't reassure me in the slightest. Nice to be offered, I guess, but certainly not someone I'd choose to have there. I never think internals are a spectator activty!

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Mtbw
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My partner recently consulted an osteopath for low pack pain and he diagnosed the symptoms were coming from her coccyx and then undertook an examination of her coccyx rectally. Is this standard practice for osteopaths to perform? Also, the examination was performed by the osteopath without any other persons present - no nurse, chaperone etc. My partner was naturally uncomfortable with the procedure and rather embarrassed by the circumstances. He has suggested a course of nternal coccyx manipulation and understandably, she is extremely reluctant to have this performed in similar circumstances.

What are the recommended procedures for this type of treatment - assuming this falls within the osteopathic scope of practise?

Strange question.

Going to gynaecologist she also needs to have nurses and others around during her assessment. Or she needs to have an audience around.

This normal procedure and dr decide how and what

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Mtbw
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Thanks for the replies. I have to say that I am somewhat surprised that osteopaths conduct internal examinations and manipulations of the coccyx - and even more surprised that they do the same for the cervix and prostrate. I cannot imagine why an osteopath, who is concerned with musculoskeletal complaints, would undertake examinations of this nature. I should declare an interest in addition to the fact that it was my partner who experienced the coccyx exam - I am a General Practitioner. ASide from the scope of practise issue, I am astounded that, providing such an examination falls within the osteopathic remit, that their code of practice does not stipulate the provision of a chaperone - not just for the patient's benefit, but for the protection of the practitioner.

I have tried to contact he relevent membership and regulatory bodies to clarify the matter, but have been unable to make contact with the appropriate person(s) as yet. 😎

Omg... drama...drama... drama...

I always say- if you don’t like the go.

I think practitioner really needs protection from some clients and patients... absolutely like this your self-critical phrase

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