Wednesday, August 15, 2007

Recognition of Osteopathy in France

At last Osteopathy is recognized in France !
It took more than 30 years for this recognition, yes... that's France. It takes time to change things.
Generally I believe that this is a good thing for Osteopathy to move towards regulation and medical acceptance. But there are a few points that are a bit bitter, unfair, obscure....

1. The Formation:

In France most schools provide an Osteopathic syllabus with a minimum of 5-6yrs of studies and practice. In general the number of hours accumulated is between 4500 and 5000hrs. In the UK, where Osteopathy is recognized as a primary health care profession, schools provide the same number of hours of teaching/practice but it is "compressed" into 4-5 years of syllabus.

From the official article concerning the syllabus of Osteopaths in France you need : 2030 hrs of studies! What a move from the Ministry of Health for the safety of the patients and to promote the competence of the future Osteopaths!

Why is this ? I believe that the lobby from the medical field was important : In France to become a GP you undertake a 9 years course. How as a doctor can you accept that another person can become qualified as a medical practitioner by studying for a mere 5-6 years ? How is it possible to accept that a profession that was so criticised (osteopathy) may now need more study than physiotherapy (3-4 years)? This is simply unacceptable : this is why it is necessary to cut the number of hours of the course to destroy the competence and the validity of Osteopathy.

Osteopathic Schools in France apparently decided not to follow the minimal course structure and agreed on a common programme spread over 5 years. Well done !

2. Restriction of certain manipulations :

With the regulation of Osteopathy in France came some restrictions concerning certain manipulations. It is forbidden for an Osteopath to practice :

-gyneco-obstetrical manipulations :
Personally I do not practice internal techniques (yet), but some Osteopaths do, and they have had good track record of success or various problems related to that area of the body. I do use external techniques on uterus, ovaries and coccyx. I believe that a lot of my female patients' complaints (lower back pain, hip pain, even headaches or neck pain) are often related to this area (eg :see article on scar/posture). The fact that I can palpate and feel any anatomical abnormalities (eg : cysts) helps me to refer the patient for some additional investigations and therefore enhances the safety of the patient.

-"touchers pelviens" : that's a good one! The translation is "pelvic touch". Well the pelvis is a wide area, it comprises : the sacrum and coccyx, the 2 ilium's, and a whole bunch of ligaments and muscles (sacro-iliac lgts, ischio-coccyx lgt, obturator membranes...). If there is ONE area that EVERY Osteopaths check and touch this is the ONE ! Any biomechanic's disturbances of the pelvis is likely to create some problems. Again not checking the pelvis leads to a poor osteopathic diagnosis and poor treatments...

-"cervical manipulations" must be recommended by a GP : It means that if anything happens during the manipulation the Doctor is responsible. There is a myth amongst some doctors that there is grave danger in this type of manipulation. In fact the risk is extremely low between 1/1000000 to 1/1500000 death per manipulations against 500/1000000 for taking NSAID (anti inflammatory) (see article on cervical manipulations). It is more dangerous to self prescribe and take NSAID for a neck pain...

Personally if I was a GP, I would not sign a lot of these letters : I would not put my career in the hands of a potential "death grip ninja" as I couldn't possibly vouch for every individual Osteopath...So you imagine how many referrals we will get through this route..

In most of the schools we start practicing cervical manipulations from the second year of study. We practice this techniques at least for 2 years before using it in clinic, under supervision of a trained Osteopath.
Some Doctors in France claim to be Osteopaths or to be able to manipulate the spine after a course, and can practice these techniques with force and extreme range of movement training directly on their patients. Don't worry ! they are Dr's, They know what they are doing ! In who's hands are you the safest ? This is your choice...

-There are also restrictions for treatments of pregnant women and babies under 6 months. Again a Dr. must refer the patient to the Osteopath. Why not, even if I still believe that an Osteopath should be competent enough to treat these types of patients.

3. Different types of Osteopaths ?

In France we have three major groups of Osteopaths:
-the Osteopaths-Osteopaths
-the Physio-Osteopaths
-the Doctor-Osteopaths

The Doctor-Osteopaths :
Generally he is s GP who became osteopath after a part-time course. The type of course here is really important. The most serious part-time course consists of 6 weeks a year over 6 years (1100 hrs + extensive homework) but some others are ridiculously short (few hundred hours). It is important to know if the Dr is a full time or part time practitioner, as the more you practice the better you are.

The Physio-Osteopaths :
The physiotherapist is in France a "masseur-kinesitherapeute". The courses taken to become Osteopaths are generally the same as above (serious or less serious). Now once they have their diploma either they leave their initial title of "kine" and become full time Osteopath or they keep their original title of "kine" and call themselves "kine-osteo".

I have a lot of respect for the "kine" who have abandoned their title to become Osteopaths. Some of my teachers followed this route and are fantastic Osteopaths. They exposed themselves to difficulties by carrying the Osteopath title to prosecution from Dr's, for illegal practice of medicine.

On the other hand "kine-osteo" use the title of "kine" to receive patients from Doctors : that way the patient does not pay for the treatments (because it is covered by the french NHS) and the practitioner can keep his practice busy... Ethically this is a bit dubious.

-The Osteopaths-Osteopaths :
This type are only practicing Osteopathy and their course lasted at least 5 years. They usually have the title DO (diploma in Osteopathy).
These are the Osteopaths I would recommend fr you to see, if you have any "osteopathic problems". The price is higher than a physiotherapy treatment (45 to 60 euros) and it is not covered by the Securite Sociale, the"french NHS". They are generally registered at the ROF (registre des Osteopathes de France) or at the UFOF (Union Federale des Osteopathes de France).

It is of course the patient who decides which practitioner to choose. Keep the one you feel comfortable with but keep in mind that in France the NHS is largely in debt. We are not used to paying for our own health but is it such a bad thing to pay for it ? To a certain extent, wouldn't it make us more responsible for our own health?


Anonymous said...

whou....whou....... what an article...... be aware gps pierre is on your back....
well well well, osteopathy has been recognise in france ... and under medical supervision... i just hope that it will be the patients who are gonna do the difference and of course the practionner who will promote the osteopathic view in the purest of its young tradition... don't be bitter pierre it'll all right as long as YOU know what you're doing and why...... a another good article anyway thank you pierre......

an osteopath in scotland

Anonymous said...

I am beginning my training as an osteopath and when I have qualified I want to work in France. Does anyone know whether my qualification will be valid in France or what I have to do to register as an Osteopath in France, once I have my UK qualification?

Pierre de Lasteyrie du Saillant said...

Hi Anonymous,

Well you should find some info on the website of the UFOF or ROF, please check the links on the left side of the screen. Good luck !