Unregistered practitioners

[vlcebunny]

Hi All

I recently discovered that by law, anyone using needles as part of some therapeutic practise needs to be registered with the relevent local authority or risk a £2000 fine. This includes osteopaths and chiropractors too, but not dentists and doctors, who are covered by different legislation. The by-laws are different for the City of Westminster, where the Council has a seperate arrangement, and practitioners must be a member of the appropriate professional body, in this case the BAcC.

The reason I bring this up is that I know of at least 2 osteopaths in my area that use acupuncture that are not registered with the local council. The local by-laws stipulate specific arrangements regarding health and hygiene proceedures, meant to protect public safety, which are enforced by the Environmental Health department. Unregulated practitioners may well be in breech of local regulations, and therefore may invalidate their insurance.

I would suggest that anyone undergoing or planning treatment that involves needles ask to see the local authority registration; this normally needs to be displayed in a prominent position.

Regards
David

 

[Vega]

Thank you David for highlighting this matter.

[Personally I don't use needles, I believe it is the application of principles that makes a practitioner effective, not which particular collection of tools he keeps in his toolbox. In other words, I am not impressed by practitioners who simply collect lots of methods. That's not holism, that's eclecticism, but it is another story.]

One problem with being unregistered and only partly trained, is that these are the practitioners most likely to be unaware of the rules. It is doing both them and the public a favour to mention it to them that you have noticed a problem.

Unfortunately I can't promise that this will be well-received, on the other hand, they might be very grateful you have clarified a 'blind spot'. But it behoves us all to be vigilant of practitioners of all kinds failing to maintain necessary standards. One patient harmed by an 'uninsured charlatan' will reflect on us all to some degree.

I recently discovered that a massage therapist working near to me was offering 'osteopathic massage techniques'. I contacted him and explained that he might be breaking the law. The regulator would take a very dim view of this, and almost certainly act to protect the term 'osteopathic', which is only available to registered osteopaths. It turned out that this person had done some CPD training conducted by an osteopath and felt entitled therefore to call these techniques 'osteopathic', and on this occasion the indignation and arrogance I received for my trouble was remarkable.

I do know some excellent practitioners who work 'off register', but they do not use the protected terms, and they maintain the necessary standards and insurance - these are the things that matter. In the case you mention, the matter is needles entering the body and how that impacts on insurance, rather than use of terms: the may be no problem whatsoever with standards of work.

 

[Leuvaehari]

Hi Kvdp

I'd not rush to describe anyone as an uninsured charlatan, as you so nicely put it. I'm quite aware of the rigourous training that osteopaths and chiropractors receive in their relevent fields. Two weekends of osteopathic training however, would not make me nor anyone else an osteopath, in the same way two weekends of acupuncture training does not make an acupuncturist! Of course, were someone like an osteopath or physiotherapist cause a significant injury (it happened in 2008), it's the acupuncture that would draw negative publicity, rather than the practitioner, I feel.

By improving standards of clinical training for anyone practising acupuncture, hopefully we can move towards a place where allopathic medicine can start to accept the value of other modes of healing. This, I fear, will be a long time coming, so in the meantime I feel that the public should be made aware that not all acupuncture is the same. I'd be very surprised if say, a physiotherapist was able to tackle something like insomnia or anxiety with the acupuncture system that they so briefly learn, as the language of that system precludes treating in a holistic manner. This Cartesian approach is less relevent for a system of treatment that was only ever meant to be practised in a holistic way. It seems a bit like trying to squeeze a square peg into a round whole (pun intended!)

That Descartes has a lot to answer for!

Regards
David

 

[Marissa*]

Hopefully the CNHC wil sort all of this out! we should all be on one register.
There is rumour that the chiro's may be stripped of there titles soon

When i talk to people about offering treatment for the same conditions as chiro's, physios and osteopaths there is always a lack of confidence as it has been ingrained into western thinking that these proffesions are the be all and end all.

Lets not forget that these are 'Complimentary' Therapies with a protected title.

I do feel sorry for some new professional looking to get registered, as the BAC fights to monopalise acupuncture by jumping into bed with various uk universities. Not good for the future and those at the top are raking in the funds for this.

I know of a few collegues that have been refused registration by the BAC because they had not attended there particular courses, some have been classically trained in China and the BAC requested 90 hours of supervised clinical attendence to qualify , which is quite simply absurd!

Even some of the new Tui Na Registers are asking for clinical attendence to qualify for their registration!

If you search enough, all of these bodies are in some way connected!

Nothing like Feeding the fats cats

Back to topic .....I myself have local authority licensing and i display this for my clients to see.

INDO

 

[Daniii.]

I'm pretty sure that most District Councils (or Town Councils) will have a register you can check on-line to see who is registered to use needles - as in an acupuncturist, tattooist, ear piercer etc.

I know for sure our District Council does because I checked it a few years ago when I needed to find an acupuncturist. She was on it and also registered with the British Acupuncture Council so I could check she was fully qualified.

Interestingly before I found this person (who is wonderful by the way and very, very thorough) I rang another woman. She advertised various therapies. I rang her and told her what my problem was and I said "to be honest I'm also considering acupuncture" and she said "Oh I do that too." (She sounded a bit like that Catherine Tate character)

I was a bit surprised because she definitely wasn't on any of the 2 registers I mentioned and when I said this she changed the subject and wanted to talk about other therapies. So I never did go & see her!

 

[Nishadh]

Hi Indo

Only 90 hours? We did 450!

Having had the benefit of training both here and in China, I can say that some health and hygiene practices in China would leave most westerners running for the door!

I'm not here to defend the BAcC, or any other professional body. As a member I quite like being part of what feels like a large support group, but I realise it's not to everyones taste. Here where I live, membership seems to make little difference in the real world, but I like to feel connected to what's going on in the world of acupuncture.

I qualified from a BAcC-registered training institute, and my course manager and designer who has been involved in UK acupuncture for over 25 years was saying just how far its come in such a short time, largely due to the influence of the BAcC. That a kid can now leave school and enroll on a degree course in the UK, funded by loans so no upfront fees, is so far away from when she HAD to go to China because there were simply no reputable courses in the UK.

Back to the point of this post- I recently spoke to my brother in law who works for the large insurance company that covers the NHS for negligence and malpractice. He is of the opinion that anyone that practises acupuncture that does not comply with relevent local authority by-laws may not only be breaking the law, but also committing a "technical assault", even with the permission of the patient. Strong stuff indeed.

 

[amashrtd]

Ah, David, Indo
don't get me started on the rights and wrongs of regulation, and of the state's view of what a suitable training should be to meet an acceptable standard. Suffice to say that handing over one's freedoms and rights, and control of one's activity, to the state is not something that should be done voluntarily without an enormous amount of consideration: the state is not known for giving back these things willingly.

As for uninsured charlatans, there was a case in Europe where a physiotherapist killed a baby using a 'craniosacral' technique after a brief add-on training. In fact the methods were wholly inappropriate to the situation, as a proper craniosacral therapist would have known. However, it was not physiotherapists who had to deal with the back-lash, but, of course, craniosacral therapists.

I agree completely that two weekends' additional training does not turn an osteopath into an acupuncturist. I am of the view that if a practitioner believes that they need osteopathy for certain conditions and acupuncture for others, then they haven't understood either approach at all. The perception that the therapy and the tool are the same thing is the result of medical brainwashing. Hence, what is being offere in these cases is not alternative therapy, but medicine using esoteric methods.

As I told my 'osteopathic' massage therapist; be proud of your own therapy, your reputation depends on what you achieve, not on who's trademark you can nick. If you think my therapy is better, then study it like the rest of us have had to!

 

[Kyle S]

"your reputation depends on what you achieve, not on who's trademark you can nick."

There has been a recent move by the BAcC to gain chartered status for its members, partly in an attempt to separate the membership in the eyes of the public from so-called medical acupuncturists that usually decry the origins of Chinese medicine in an attempt to "westernise" it. Interestingly the process has been stalled by a body that represents a small group of medical acupuncturist, consisting (I believe) primarily of nurses and so on that have also trained in limited-use acupuncture. It seems a "dog in the manger" attitude along the lines of "we don't want your medicine, but we don't want you differentiating yourselves from what (acupuncture) we do".

I feel that there should be some space between traditional practitioners, and "western" practitioners, as the two modes of treatment only really have one thing in common, ie the use of needles to bring about a therapeutic change. Acupuncture has a long tradition, and to cut off its roots by medicalising it adds very little. Likewise, to "borrow" from acupuncture due to a lack of faith or results from other techniques seems to suggest that something might be missing.

Interestingly, these other styles of acupuncture often achieve good results. I know a physiotherapist that once told me that they often use acupuncture when nothing else has worked, and only then get a worthwhile result. This, however, is not Chinese medicine. In China, doctors that only treat "exterior" conditions, ie musculoskeletal problems, are known somewhat disparagingly as "Ahshi" doctors, with little real skill as healers. Often these doctors are very popular with patients, though, as they get visible results! I can see a parallel here with physios etc that use acupuncture with little real understanding of the background and culture that led to its development.

 

[Pompal 09.]

David, you manage to describe a major problem with great eloquence and clarity.

It does go deeper as well - after a few generations of our therapies being misrepresented in this way, the disciplines themselves draw in people who are attracted to them through contact with the westernised reductionist versions. After a while, nobody is clear who is really speaking for these disciplines.

There arises a new strain of practitioner with total disdain for the traditionalists, treating them as fusty, out of date, or refusing to modernise. On top of this is the influence of our culture, and state-regulated professions have the added pressure of political expediency. No government department is immune to the effects of lobbying, and that brings pressure to bear also.

Official recognition and university status for the colleges further means that validation of all our activities is ultimately in the hands of members of the medical profession and mainstream scientific fields, who are chosen specifically to determine the 'truth' in matters of health.

It makes it very difficult for traditional practitioners to continue.

In osteopathy we have yet another consideration, and that is the automatic desire of administrators to consider all manual therapies as broadly equivalent with maybe a few minor variations. Succumbing to all of these conveniences risks losing something incredibly valuable.

To my mind, alternative doesn't mean treating athlete's foot (for example) with a diffferent kind of antibacterial from a plant instead of out of a lab - it means having a different way of understanding the problem. Most systems, I believe, would not consider athlete's foot as a disease of the foot, or of the skin, or as an invasion by an organism - rather it is treated as the failure of the whole system; to provide itself with the basic needs of life, and to provide support for all its own elements. Medicine is unique, I believe, in approaching this as a random invasion with no rhyme or reason, a problem isolated to a tiny part of the body, and something that requries no considerations beyond the immediately observed tissue effect - and it also fails utterly to provide a safe, solid and lasting cure.

What I have noticed is that there is a seam of traditional practice across many fields. Perhaps what is needed is a union or association of traditional health practitioners, incorporating real alternative visionaries from many different fields, with the aim of resisting the cartesian influence and medicalisation of our work.

Ultimately, we are a few who have this thing in common, but are working in many different disciplines. Our patients come because they know what we do really makes sense and doesn't cause them any harm. And what we really require most of all is the assurance that, even if we are not able to change the world right now, we will be left to get on with our work.

 

[Spock (rhp)]

I never consider myself an 'alternative ' therapist, alternative to what?
Western medicine will deal with an illness or condition in a mechanical way, where as i will treat it from an energetic veiw, and without energy the mechanics can not work, so it makes sense that TCM will have a better effect for the overall problem, which is always holistic.

I do think that we are very over crowded with therapies, all claiming to help the same problems. A recent study published in the Daily Mail founded that Acupuncture and Massage are the most effective means of any intervention, with therapies like relexology, cranial, and rieki being the least effective....this is niether here nor there.

I have always said that there is a therapy to suit each and everyone of us, it just take time to find out what that is.

The one thing that will always seperate us from western medicine is the time we spend listening and diagnosing our clients.

I believe that people will always seek those they are comfortable with and no register or qualification will compound this. If 'A' goes to 'B' and the health is improved, then this is good enough.

Allowing Western Practitioners to practice traditional systems without
'the knowledge' quite frankly devalues a very effective and long tested methods of health care.

I also seems that the 'protected' title practitioners have seen the good work that TCM provides and they want to 'cash in' so that they don't lose business, providing a very inferior service.

Studies show that inserting a needle anywhere in the body will have an effect, but is this the effect that the patient requires at the time.

The reason why Acupuncture is such a safe method is that even if the wrong prescription is applied the body will re-balance itself within a few days. This might agrevate a condition , but it certainly won't releive it.

When i ask my clients if they have tried Acupuncture before many will say Yes , but it didn't do anything! When i ask where they received this treatment they will always reply with , GP, Physio, Chiro, Etc.

Much trust is given to these proffesions which i think they are exploiting. I suppose that once we have a suitable enough register this will give people piece of mind, but i think that The western practitioners must uphold the same level of training. not a brief course!

As for the BAcC i know some who are regitered and very good at what they do, my only concern is that every piece of advertising tells people to check the BAC register, leading people to believe it is a government regulated body. And as i have mentioned previous, if a practitioner has completed 3 years TCM training and 150 hours of clinical practice, who are the BAC to ask for another 90 hours supervison on their terms.

I am sure that when this does become regulated the 100's of BAC members will have a different tune to play when they are charged £2000-£3000 per year for membership! which will ultimately trickle down to the client making it more expensive and even in-accessable to some.

We need a new medium that is not bias and will support and represent all therapies, and i beleive that the CNHC will provide this for us.

INDO

 

[Corthghlind]

Thanks for that David,

I don't need to use needles and don't go for treatment that involves the use of needles but one on my client friends does. I'll get her to pass this on so she can check it out

JG

 

[Lisa S]

Actually I didn't think that.

 

[gars]

'Alternative' - for want of a better word, that's all. Non-allopathic, traditional, call it what you like.

You could rightly call allopathy 'alternative' if you prefer, after all it goes against the grain of all traditional medicines. The idea that each specific disease is a seperate thing to be combatted by a specific therapy for that disease is a hypothesis that is very very weak. In fact disease in the medical sense does not conform to any kind of rational system of classification.

I should point out that not all registered professionals are exploitative and cynical, nor do they all see the need to use needles. Some traditional chinese practitioners value the importance of structural adjustment - it can't just be the osteopaths who have realised the inextricable relationship between structure and function. Turning the physiology up and down around uncorrected postural distorsions may have some merit, but sooner or later can create further problems.

Hence I am sure that many energy-therapists have come to manual therapy second, realising they need this vital piece in their armoury, it's only possible to get by without structural adjustment for so long, just as it's only possible to heal in the presence of poor nutrition for a limited time before reserves run out.

The homoeopaths realised this too. Hahnemman observed that if the problem is caused by a bone out of place, homoeopathy can at best only palliate. Wish I knew the exact quote - anybody have it?

 

[Amanda Ramsbottom]

It wasn't directed at anyone..... i was just stating a personal preference.

INDO

 

[xsemkudkiqniywevi]

I whole heartedly agree with this, I had trained in Traditional Physical Therapy before Acupuncture as it was required to gain the foundations for TCM Diagnosis and Practice. I loved it so much i continued for 3 years traing in eastern bodywork.

My first few years in clinic were spent providing massage and body alignment techniques, to which i had very satisfactory results.

To this day i feel that the manual work gets better results than acupuncture. Acupuncture , for me, can be very specific when treating a condition, it is also used by TCM manual practitioners to enhance longevity of career as the physical work is very demanding on the body. Both together these therapies are IMO the best method of treatment...internal and external.

If i were to choose a long term therapy i would opt for Qigong as the benefits are huge when practiced regularly.

P.S.

If my comments seem a little brash at times, just blame it on the Yang!

INDO

 

[Me Fang You]

Kuno, I think you have identified one of the weaknessess in the way Chinese medicine and acupuncture tends to be taught now in the UK. To give the matter some context, TCM is anything but "Traditional", being a construct formed during the early Maoist regime to tackle a chronic shortage of healthcare, due in part to a previous ban on all non-western practices. The Chinese have historically been a very pragmatic people, and see no problem mixing methods and theories from different times, as long as there is a sense that they have some value. An example of this is the blending of religious practices, where Buddhism, Taoism and Confusionism have become intertwined and inseperable.

What this means in terms of medicine is a blending of ideas and methods that have become the system practiced in China today, where a combination of techniques are used in conjunction to achieve the best result, many of which have origins buried in time, but are thought of as having value due to an ongoing observation of practical results. Acupuncture is not taught as a separate modality in China, nor is it practiced as such, usually being combined with herb-lore, massage (tui na), warming techniques and bone setting. Certainly in the Nanjing hospital I trained in, there was a constant overlap.

A "traditional" chinese doctor takes 5 years of study, of which 1 year is "foreign" medicine, learning all of the afore-mentioned techniques. For a doctor training in western medicine, the figures are the other way around. However, there is an overlap in the real world, as both systems are practiced side by side in the same hospital. In practical terms, someone may present with say, pain in the cervical spine who is then sent for Traditional treatment after a "Western" x-ray. The treatment would be likely to include acupuncture for pain relief, deep tissue massage to "relieve stagnation" and herbs to "strengthen the bones". They may, however, be offered western surgery or painkillers, depending on the problem or the patient's choices (or pockets!).

When acupuncture is taught in the west, it is often (but not always) taught as a stand alone method. Useful, yes, but sometimes practitioners become aware of the limitations of acupuncture, and add other techniques to their armoury. I know this might jibe with your previous comments about an incomplete understanding of any given treatment system, but there it is. Patients tend to want a "quick fix" often due to the cost of private healthcare. Adding other methods may help to move things along, and then treatment may become a little more like the ones offered in China. I'm not sure that this overlap lessens the value in any way. Let's not forget that "internal" disorders and emotional disorders are often treated with acupuncture alone; I guess it's an example of the individualisation of the treatment, using what's "right" for the patient at the time.

I've no problem with say, osteopaths wanting to use acupuncture. In fact, I take it as a bit of a compliment! I do however, have a problem with 16 hours of training and non compliance with local registration. The BAcC requires members to have degree level training, with minimum of 400 hours of supervised clinical time. I understand this number is under review, and may well be increased in future.

 

[kandy-x]

Hi David,

This is exactly as i was trained, first 3 years were TCM Diagnosis, Application & Tui Na, then last 1.5 years Acupuncture.

I have looked at various means of training to gain a better knowledge of Western Medicine, but this is a very 'closed' avenue and requires around 5 years training. So this part is left upto myself to study in order to gain an additional perspective.

I wonder if there is a weekend course i can attend to be able to prescibe drugs?

INDO

 

[Lizzy]

Hi David
it is not the mixing and matching of methods that is the problem, it is the way this process inevitably pushes out the theories and principles of those disciplines.

Pragmatic is an interesting word, for some it is a dirty word, because it stands in contrast to principled. When our principles flip-flop between many different theories we lose our map and compass.

This brings us back to our overarching hypothesis of health and disease. For the holist, an hypothesis rooted in generations of observation is far more useful than an ever-changing collection of weakly supported theories attached to the latest nugget of data. Context is everything in healing.

So one reason why I could not allow myself to work in an NHS hospital is that I would wish to control the drug regime, the nursing input, the diet etc etc - all somebody else's department under medical oversight but absolutely crucial to my ability to make a difference.

That is why an elderly person may be given a £10,000 operation yet be discharged malmourished and dehydrated. The doctor is so concerned about the rocket-science of a titanium hip that the potentially life-saving relevance of the patient's bowel habit is off his radar. This is a fundamentally flawed vision of the situation - constipation could cause his operation to fail.

When I have been asked to help hospital patients before, I have always found it an uphill struggle to get the emphasis on the right elements of care, because the set of principles in charge has the wrong priorities. I have seen life saved by insistence on modification of other interventions, only for the next bright spark to put in his 'pinch of salt' to kill the patient.

To act as a 'medical joint cracker and neck specialist' would be in breach of my code of practice which requires me to follow my own osteopathic diagnosis. The system is bigger than me and won't be changed, so my duty is to be no part of it. Period.

In the case of pain in the cervical spine, what do you mean by this? 'Mechanical' cervical pain can be caused by problems in the gall-bladder, uterus, ventillation, nutrition, previous injury, tonsitllitis etc etc. It can be inextricably linked to their tonsilitis, their asthma, their stomach ulcer.

We must always get 'behind the problem' and look for 'causa causans' - cause behind the cause. We shouldn't be treating a painful neck with a seperate theory to a stomach ulcer, that's to ignore the reality of complex sytems. Many try, and many fail in this way.

Even the best of us cannot change the laws of physics - it is impossible to heal a spine or a stomach that is not receiving what it needs for life, and the needs of living structures are complex. The only thing that can provide those things is the body itself, and in turn the body has many needs in order to do so. So we should not be seeing the manual therapist working on the neck while the needler deals with the stomach ulcer. My sense of pragmatics is that the patient won't benefit.

As you know, the body is not a collection of elements that wear out each at its own rate. This eclectic view of holism reckons that if all the parts are functioning correctly, then the whole body will be well.

This is totally wrong - every part requires the support of the whole to be well. When the system is working properly, then all the elements have what they need to recover. This is diametrically opposed to the eclecticism you describe.

The practical consequence of the eclectic (some call integrated) mindset is that we end up with a heart patient getting treatment that harms the liver and liver treatment that harms the heart. The patient must drop to pieces eventually under this 'non-philosophy'.

In a pragmatic sense they may leave hospital with their immediate problem relieved, but now they are more chronically, deeply, unwell, and sooner or later they will be back. Great for business.

 

[Hankster]

Kuno, I think you and I are essentially in agreement. I think, however, that I need to be clearer in that in modern China acupuncture does not exist in isolation from other modalities. The Chinese have no word for "acupuncture" as such; the term "zengjiu" translating as needle-moxa explains the treatment process more adequately. It's probably the separation of acupuncture from its sisters that's caused many misunderstandings, a separation that's likely occured to satisfy a western world view that has historically had a tendency to compartmentalise.

In CM, something like neck pain would be described as "stagnation of qi and blood", and the treatment process would involve liberating the stagnation through various methods. Traditionally there would be little futher investigation on a biomechanical sense, demonstrating some of the limitations of CM. Often cause and effect are seen as the same thing in the Chinese mindset. Being "pragmatic" however, the Chinese have adopted western investigations such as MRI scans and x-rays, but whatever the underlying cause, the symptoms of pain and stiffness would likely be treated in more or less the same way, as these ARE the indications for "qi and blood stagnation" for which acupuncture, massage and heat would all be used. Now, here is the rub. "Stagnation" is a symptom, and so investigation would be carried out to determine the "why" of it, in CM terms. Is it "Wind" or "Cold" blocking the channels? Is the patient deficient in Qi? If so, why? These and lots of other questions and observations would determine the underlying pattern. Additional acupoints and herbs might then be chosen to treat the "person" as well as the "condition". This aims to treat the Qi, which is intrinically linked to the person; in fact in some ways, it IS the person. I would imagine this is far removed from the needling techniques described as acupuncture that is used by physios, midwives, podiatrists, and dare I say it, some osteopaths.

Modern Chinese medicine is a dicipline that involves lots of different techniques, acupuncture being only one of many. In one sense there has already been a medicalisation of CM in China, remembering that it's delivered in a hospital setting now. It's come a long way from the ancient mystic on the hill with unexplainable healing powers, not necessarily for the better!

 

[rabcnesbit]

Very interesting you describe the theory of neck pain that way.

Being someone who occasionally suffers from a stiff and painful neck myself, my own self-treatment involves resting, fasting, support for my organs, hydration etc etc. I do not believe in random affliction, so it has always come about as a consequence of my actions or some combination of environmental influence.

So I begin by asking 'what is my body asking for', and go from there. The answer is almost never 'stretching exercises'.

Conversely, I might well begin approaching a more metabolic problem in a patient by balancing out the structure, being the substrate in which function must take place.

Very interesting you describe the paradox of cause also, cause can be reciprocal, cyclical, non-linear, in other words. The best mental tool I have for understanding cause is to consider chaos theory. 'Sensitivity to initial conditions' is a description for instability, the more likely that a small influence will lead by a series of events to a big change, the less stable the system. We cannot tell whether a specific butterfly will be the deciding factor for a tornado, but we can prove that the relationship exists.

Our job is to understand the parameters in which the body can operate and be stable, and recognise what is causing it to be unstable. The name of the condition is irrelevant. If a pencil is poised on its point, it might fall to the left or the right, depending on infintessimal factors at the time. There is not a 'left-falling pencil disease' that is entirely different to a 'right-falling pencil disease'.

David, I know this is in the Acupuncture section, but it would be very helpful if you could give a few brief terms to help understand the particular variations of chinese practice/acupunture, and what the differences are. Also the correct name if there is one for your school of thought.