Professional development - Becoming a GP osteopath

Osteopathy can be invaluable in general practice, says Dr David Babbs.

In 2003, I qualified as a GP osteopath and it changed my professional life. Training at the London College of Osteopathic Medicine (LCOM) I learned examination and treatment skills that have improved my job satisfaction and given me an alternative career pathway.

Dr Neil Watson, LCOM course tutor, performing a pelvis quad stretch on a student

New skills
Like most of us, by the time I completed GP vocational training I could perform a basic musculoskeletal examination.

However, training as a medical osteopath taught me valuable observational and palpation skills. For example, when assessing a patient with back pain I observe not just the range of movement but where that movement is taking place.

Vertebral segments may be stuck due to structural abnormalities as with osteoarthritis, but often in general practice more simple back pain is seen, which may be due to a disorder of function. This is associated with changes in segmental autonomic reflexes.

Resultant alteration in local sweat rates, pilomotor activity and tissue pliability are readily detected with practice by changes in skin drag and tissue tension as you palpate the spinal tissues.

New concepts
The concept that musculoskeletal pain may be due to a disorder of function without structural cause is extremely valuable.

While alien to doctors, it is second nature to IT specialists. If your computer stops working properly, it is far more likely to be due to a dysfunction of the programming (software) than a structural (hardware) problem.

It also explains the well-known poor correlation between patients' experience of back pain and findings on imaging.

A patient could, of course, develop severe low back pain after a long car journey without any change to their MRI scan.

Manipulation
The beauty of incorporating these techniques into general practice is that they take only seconds to perform.

If appropriate, I go on to manipulate the key areas of dysfunction. This resets segmental autonomic reflexes, relieves pain and restores function.

Few things are as rewarding as the patient who leaves the consulting room after a few minutes with their pain relieved.

As GPs, we are well placed to consider the whole person, the likely cause of their pattern of dysfunction and advise on measures to prevent recurrence.

Not just back pain
Most chest pain presenting in general practice is musculoskeletal rather than cardiac and it usually responds well to manipulation at the level of dysfunction in the thoracic spine.

Similarly, tension and occipital headaches respond well to cervical manipulation. Osteopathic mobilisation of the painful hand or wrist in an elderly patient is another particularly quick and rewarding treatment.

Osteopathy course
Founded in 1946, the LCOM is the only college in the UK to teach osteopathy exclusively to qualified doctors.

As well as GPs, the course attracts doctors from specialties such as rheumatology, orthopaedics, sports medicine, pain management and paediatrics. This fosters integration of a variety of clinical perspectives.

The course runs either three days per week for one year or two days per week for 18 months and includes four weeks' annual leave. Currently, the course fee is £6,000.

There are formative exams throughout and the final clinical exam is externally examined. Passing the exam entitles you to the qualification MLCOM, registration with the General Osteopathic Council and the right to call yourself an osteopath, which is a protected title.

The course begins with an introductory, intensive two weeks teaching of examination skills and simple treatments.

Thereafter, at least 75 per cent of each week is spent treating patients. Every patient treatment is supervised by a clinical tutor.

Where does it lead?
GP alumni generally integrate their skills into everyday practice, even within the 10-minute consultation. Many work as GPSIs in musculoskeletal medicine. Some practise privately either as a registered osteopath or musculoskeletal physician.

LCOM alumni have become team doctors at the Olympic and Commonwealth Games as well as medical officers of Premier League football teams.

  • Dr Babbs is a GP principal and registered osteopath in Lincolnshire

Train as a GP Osteopath

Seek agreement from your:

  • Partners - a sabbatical?
  • PCT - training for GPSI in musculoskeletal medicine?
  • Postgraduate dean.

Seek funding from:

  • Postgraduate education allowance.
  • GPSI in musculoskeletal medicine service development.
  • Partnership drawings or salary.
  • PCT GPSI development fund.

Further information

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