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Putting patients at ease

Alleged breaches of professional and sexual boundaries by osteopaths are a common theme in complaints made to the GOsC by patients.

Some of these complaints arise from a misunderstanding of osteopathic treatment and what it involves. Others could be avoided through better communication and taking steps to alleviate patients’ possible anxieties or concerns.

Here are some simple actions which may prevent a similar complaint being made against you.

1. Review the information you provide before the first appointment

This includes practice leaflets and your website. Is it clear to patients that they may be required to undress for examination and treatment, so they may wish to bring shorts and a vest? Is it clear that they can bring a friend or ask for a chaperone? Do you speak to new patients yourself when they book an appointment, or does a receptionist do it?

2. Be aware of the timings of appointments and whether other staff are on the premises

Patients may feel vulnerable if they are alone and in a state of undress with you when no one else is on site, or if appointments are repeatedly scheduled after working hours.This may be unavoidable, but reminding patients that they can bring a chaperone may make them more comfortable (even if they choose not to bring one).

3. Think about your treatment room arrangements

If the patient needs to undress, do you leave the room? If they want you to stay in the room in case they need assistance, are screens or a curtained area available? Do you provide gowns or towels to preserve the patient’s modesty during examination and treatment?

Patients increasingly expect that such arrangements will be made. When we carried out research into patient perceptions in 2014, one participant commented: “If you’re going to have to take your clothes off to be treated, you sort of expect them to say, ‘I’ll go out of the room while you get undressed and get ready.’”

4. Explain what you are doing, and why

If you think that watching the patient get undressed is helpful for diagnostic reasons, first ask for permission to do so, and explain why. If the patient is particularly frail, you may consider it safer to stay in the room with them, but ask whether they want you to do so.

Even though you will have obtained consent before commencing your examination or treatment, you should reaffirm that consent when treating a different part of the body – particularly if this might involve intimate areas. Even your existing patients may be surprised at being asked to undress to their underwear for treatment, if they are not used to doing so.

5. Do not adjust the patient’s clothing while providing treatment

If their clothing needs to be adjusted, always ask them to adjust it themselves. If they require assistance, obtain their consent first.

6. Cover parts of the patient’s body that you are not treating 

This may be impractical while you are examining the patient, as you may think that a gown interferes with the effective examination process. But once you are treating, consider whether the patient would feel more comfortable by being covered to some extent.

7. Keep conversations with the patient professional and appropriate to the clinical setting

Avoid personal comments – for example, about their hair, clothes, jewellery, tattoos or body art.

8. Be aware of your positioning

If the patient cannot see you because you are behind them, they may become uncomfortable – so explain what you are doing as you go along. If you are writing down findings as you go, let them know.

Think about how you are positioned in relation to the patient and the plinth. How close are you to them? They may not realise, for example, that to check their pelvis levels as they go through active movements you may need to kneel behind them as they flex forward.

Bear in mind that different patients have different concepts of personal space, privacy and dignity.

9. Be alert to signs of anxiety, discomfort or distress

Always ask the patient to tell you immediately if they feel uncomfortable with the examination or treatment. It is important to be sensitive to body language and non-verbal cues as to how the patient is feeling, as this may not be immediately obvious.