As our clinic progressively establishes its reputation in Uxbridge and surroundings, one of the most rewarding aspects of our work is when patients start referring not only friends, but also members of their own family: spouses, children and grandchildren.

In a few instances, we are now treating three successive generations of one family, which is both exciting and rewarding. Equally pleasing is when spouses begin referring each other for treatment – even if one cannot exclude the odd bit of coercion in the process…

Treating couples or families can provide great insight into some contributory or maintaining factors behind a patient’s condition. Equally, the family unit at large may be taken into account when prescribing exercise, dietary of lifestyle advice – for instance, a couple can work as an excellent emulation unit to ensure exercise and dietary changes are implemented and complied with!

Also, there is the obvious satisfaction of seeing the health of a group of people improve over a prolonged period of time, as some patients revert to the principle of regular preventive check-ups once the presenting issue has been dealt with.

However, although these referrals can only be interpreted as a vote of confidence, they also come with their own challenges and issues to consider both for the therapist and the patient.

Increased Expectations
The referred patient naturally comes with heightened expectations regardless of their presenting complaint, lifestyle, outlook and tendency to comply with exercise and occupational advice – all of which have as great an impact on the outcome as the treatment itself.

Discussing Partner’s treatment
Particularly in the case of spouse referrals, there is a natural tendency to wish to discuss the partner’s ailment(s), or to use the therapist as a more credible conduit to issue recommendations and advice – “do please tell him to ….” occasionally rings in our ears as a refrain.

The fact of the matter is that unless spouses are present at each other’s treatment sessions, each spouse is treated privately and in the strictest confidence, and only advice that the osteopath considers clinically relevant to the patient can be prescribed with integrity. The only way to find out what is going on is to ask… the spouse.

Treating Friends
Another delicate situation is the friendship that inevitably develops between the practitioner and certain patients. There are of course the obvious boundaries between therapy and friendship, such that the clinician takes over throughout examination and treatment, even if the conversation is friendly. A less obvious trap is when patients may start to mask some of their enduring symptoms so as not to offend or embarrass the practitioner. Our view on this matter is clear: friendship must never get in the way of clinical judgment and therapy, and the patient must therefore be encouraged to be as truthful and accurate about their progress – or non-progress – as possible, to secure the best possible health outcome in the shortest time-frame.

The practitioner must in turn take the utmost care to ensure that his clinical judgment, treatment and advice remain at all times as lucid and objective as possible, and are not adversely influenced by the emotion of friendship.

Patient/Parent Consent
Another interesting situation with treating several generations in a family, including the youngest, involves the occasionally delicate issue of patient consent and chaperoning.

Young children must of course always be accompanied by a parent or guardian. However, the law suggests that from 16, young people are presumed to be competent to consent for themselves – indeed, it recognises that some children under 16 are competent to make decisions about their healthcare.

All in all, our take on treating young adults chaperoned by their parents is that rather than try and operate within ambiguous and occasionally contradictory legal guidelines, it is most important to provide very clear explanations about treatment rationale and objectives, and ensure that both parent and child understand and agree at all times.

In short, treating spouses and families is a privilege and a highly rewarding experience, but it does require from both patient and practitioner the recognition and respect of some important boundaries to support the smooth and effective progress of treatment.