Gathering place for osteopaths
Duration of Treatment?
Out of purely idle curiosity, I wonder if there is a common duration of osteopathic treatment. Moreover, I wonder if there is a large difference between those practicing more physical manual manipulation versus those practicing more of a cranial - or other introspective approach.
The reasons for this idle curiosity are two-fold: First, I work in the US and accept payment through insurance companies & third parties. I spend 20 minutes per established patient, sometimes a little less, sometimes a little more, I also do some teaching a couple half days per week, and I see 50 patients per week on average. I am looking to possibly radically change my practice in some undetermined way, and I am curious what others are doing. Secondly, I have heard that practitioners of the Jealous "Biodynamic" school, and of the Druelle "Central Chain" style (taught at the Canadian colleges of Osteopathy), spend 1 1/2 - 2 hours per patient. This is the most time I have heard of. On the other extreme, one of my mentors spends 5 minutes per established patient (and doesn't do high velocity - but does amazing mysofascial work in that short of a time!).
I am careful not to judge; this is not set up to be a critical of any approach (just like other important things in life - faster is not always better), but I truly am curious-
Replies to This Discussion
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Permalink Reply by Jody Jakob on -
I normally do half an hour and if I see that the patient needs more I ask them to book in for an hour....I charge per treatment rather than time.
About the 5 minute treatment......well its about the practitioner and his skill, charisma and ability to tap into his "stuff"....without too much time going by......its possible....haven't been able to channel the 5 minute thing as of yet...but then I'm just a beginner.....40 years into the "work"..............
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Permalink Reply by Quatermass on -
With me I'm looking for quite a left brain understanding. Not exclusively, but that's my predominance. It takes a little time (I'm a slow learner, like Jody(!), but with less experience - 18 years) so the bulk of my treatments are 30 minutes min, 45 max.
P.S. What perceptions or ideas are stimulating you to change your established system?
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Permalink Reply by Jody Jakob on
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Yes!.....that left brain experience certainly makes the difference between gettin the job done and excelling.........its like when you get in the "zone" and its just flowing...but...if you take any personal ego credit for it it goes and you become just another muscle pusher.
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Permalink Reply by Theodore Jordan on -
In answer to your PS- I'm considering going to a cash based practice ('payment at point of service' , i.e. no third party payors), versus joining the teaching faculty of a college, versus, staying in my same practice model until I go bankrupt (I estimate 2-5 years), versus giving up osteopathy and trying my hand at something totally different (which remains a private fantasy, but I really love helping patients). I also fear, based on the way my wrists and knuckles feel, that my grandfather's rheumatoid arthritis may have been passed down to me, and that may alter and/or limit my future practice. Thanks for asking-
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Permalink Reply by Quatermass on
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I thought it was the right brain that got you "in the flow". Interesting though. I like to analyze relationships rather than intuit them. But once at work, with hands, heart and mind all in tune and harmony (this is on a good day!) that "flow" is a wonderfully regenerative experience, for both parties I think. Getting off topic though.
Jody Jakob said:
Yes!.....that left brain experience certainly makes the difference between gettin the job done and excelling.........its like when you get in the "zone" and its just flowing...but...if you take any personal ego credit for it it goes and you become just another muscle pusher.
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Permalink Reply by Jody Jakob on
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Your right...it should be the right brain that intuites more and the left that is more logical.....but its not that cut in dry in real life.......best is to know your stuff really good and then let go.......like when you learn a sport you have to learn the basics and practices the bits but to play well once those things are engrained you have to let go........
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Permalink Reply by Alex Cram on -
I feel duration of treatment is not the real question How long is a piece of string No matter what approaches we may use once we have perceived a positive tissue response that is the time to stop Any more than 20 miutes I think you should re examine your aims of treatment
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Permalink Reply by Small Fry on -
I charge per consultation not per minute, during a 30 minute slot, patient may gets 2 or 3 minutes of case revision/update, 15 mins of treatment, 2 or 3 minutes advice, and 5 minutes for everything else. That leaves about 5 minutes slack which often has a useful purpose. If there is more talking to be done it is done during treatment or scheduled for email or phone.
Much more than 15 minutes on the table can exhaust the patient and practitioner. If they are going to respond to treament, rather than simply collapse under it, then they need some energy left. And if a useful change can't be caused in that time, then either they are not ready for change or the wrong theory is being applied - in other words, preparing them for change may be better in the long run than trying to solve all their problems in one session.
Endless soft-tissue treament on every patient will cause havoc with your thumbs, hands and wrists, but there are plenty of other reasons to avoid it also. Nevertheless, your belief system will guide your input more than your own preference or convenience. So if your methods are knackering you, then at least make sure you are happy with the rationale. Personally I don't think loads of soft-tissue is the way forward for resolving chronic pain.
50 patients a week is a lot to sustain, and if you are not making a profit from that number then you should find another way of doing things - and I don't mean different techniques, but business practices. Sounds like you are accepting inadequate compensation in exchange for volume of trade. Standard marketing theory calls this 'buying clients', and warns most strongly against it. I now know somebody stuck with 400 loss-making massage clients through Living Social, in the hope that some of these will be good clients.
For 5 years I have done a 'day job' while working with fewer clients and finding my way. This I feel gives me a better balance while working on my systems and skills, and my arms are still in good condition.
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Permalink Reply by Hume O'Rous on -
On first reading the initial sentence of this topic I assumed it may refer to the number of sessions that could be considered an average for a course of treatment? Clearly the discussion has related to time per session, rather than overall number of sessions.
I'd be interested in what others consider an estimated course of treatment for a chronic back pain or neck pain complaint–and intervals between sessions? Do some ask patients to attend for post treatment review or maintenance–and what are your intentions/justifications for suggesting this approach?
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Permalink Reply by rafalkra on -
As long as you accept the fact that everybody is unique you can't really say what would be an average number of sessions.I tell my patients 'I don't know but if you agree on 4-6 sessions and there's no step forward I give up and you should seek another opinion'.If that is not an acute, recent problem I see them once a week as a rule.
I admire your determination as it is uncommon for a patient to understand that time doesn't count and 30 min session is enough to solve at least some of the problems that link with their complaint.
I try to picture pain as an onion being peeled layer by layer and we have to employ time as a natural ally of the treatment.I also emphasize the need of their contribution as without this this is wasting their money and money is something that not too many people like to spend for health.
My Dry Bones said:On first reading the initial sentence of this topic I assumed it may refer to the number of sessions that could be considered an average for a course of treatment? Clearly the discussion has related to time per session, rather than overall number of sessions.
I'd be interested in what others consider an estimated course of treatment for a chronic back pain or neck pain complaint–and intervals between sessions? Do some ask patients to attend for post treatment review or maintenance–and what are your intentions/justifications for suggesting this approach?
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Permalink Reply by Jody Jakob on
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Every condition and patient have different PROGNOSIS.....that is really what we are talking about.....i.e. the likely outcome and duration of the treatment considering the diagnois and individual.
After the first consultation in 90% of patients I am able to given them a PROGNOSIS......is it going to get better, cured, somewhat better and how many treatmentsand how frequent.........this is a starting point so that the patient will know what they are in for...both in terms of treatments and cost..........at the end of the given time period and treatments if the patient is not improved to our satisfaction we re-evaluate....which may mean referring on or altering the treatment or simply continuing along the same lines as it is simply taking longer than expected
JJ
rafalkra said:As long as you accept the fact that everybody is unique you can't really say what would be an average number of sessions.I tell my patients 'I don't know but if you agree on 4-6 sessions and there's no step forward I give up and you should seek another opinion'.If that is not an acute, recent problem I see them once a week as a rule.
I admire your determination as it is uncommon for a patient to understand that time doesn't count and 30 min session is enough to solve at least some of the problems that link with their complaint.
I try to picture pain as an onion being peeled layer by layer and we have to employ time as a natural ally of the treatment.I also emphasize the need of their contribution as without this this is wasting their money and money is something that not too many people like to spend for health.
My Dry Bones said:On first reading the initial sentence of this topic I assumed it may refer to the number of sessions that could be considered an average for a course of treatment? Clearly the discussion has related to time per session, rather than overall number of sessions.
I'd be interested in what others consider an estimated course of treatment for a chronic back pain or neck pain complaint–and intervals between sessions? Do some ask patients to attend for post treatment review or maintenance–and what are your intentions/justifications for suggesting this approach?
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Permalink Reply by rafalkra on
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The word 'prognosis' didn't appear in any of the above posts but I certainly have to agree with you.You have simply put it in other words.As far as the diagnosis is concerned, it is merely an outcome of the treatment that confirms it and a prognosis is no more that 'weather forecast' (it sounds the same in my language i.e.polish). I am not sure if you experience the same amount of pressure from a patient's side to solve their problem 'in one thrust' as we do in our 'never-ending-pressure country'? Pardon me if this doesn't match with the main discussion.
Jody Jakob said:Every condition and patient have different PROGNOSIS.....that is really what we are talking about.....i.e. the likely outcome and duration of the treatment considering the diagnois and individual.
After the first consultation in 90% of patients I am able to given them a PROGNOSIS......is it going to get better, cured, somewhat better and how many treatmentsand how frequent.........this is a starting point so that the patient will know what they are in for...both in terms of treatments and cost..........at the end of the given time period and treatments if the patient is not improved to our satisfaction we re-evaluate....which may mean referring on or altering the treatment or simply continuing along the same lines as it is simply taking longer than expected
JJ
rafalkra said:As long as you accept the fact that everybody is unique you can't really say what would be an average number of sessions.I tell my patients 'I don't know but if you agree on 4-6 sessions and there's no step forward I give up and you should seek another opinion'.If that is not an acute, recent problem I see them once a week as a rule.
I admire your determination as it is uncommon for a patient to understand that time doesn't count and 30 min session is enough to solve at least some of the problems that link with their complaint.
I try to picture pain as an onion being peeled layer by layer and we have to employ time as a natural ally of the treatment.I also emphasize the need of their contribution as without this this is wasting their money and money is something that not too many people like to spend for health.
My Dry Bones said:On first reading the initial sentence of this topic I assumed it may refer to the number of sessions that could be considered an average for a course of treatment? Clearly the discussion has related to time per session, rather than overall number of sessions.
I'd be interested in what others consider an estimated course of treatment for a chronic back pain or neck pain complaint–and intervals between sessions? Do some ask patients to attend for post treatment review or maintenance–and what are your intentions/justifications for suggesting this approach?
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