GEDOP- What took you to Osteopathy?

Jody Jakob- I was drawn to the Osteopathic principals of wholeness and auto-regulation together with a hands on approach. A perfect blend of using the mind to diagnose and prescribe treatment, using the body, especially the hands, to implement. I was impressed with the principle of treating the person rather than the disease. I did some enquiries and discovered that many people thought that London, England, was the best place to study Osteopathy. I decided to move to London and was granted a place at the British School of Osteopathy.

 

GEDOP- When have you graduated in Osteopathy?

JJ- In July 1979.

 

GEDOP- How many students had the school per year at the time?

JJ- 15 students per year.

 

GEDOP- How was the course organized and structured in terms of number of years, supervised clinical practice, etc.?

JJ- It was a four year full time course, with clinical supervision starting in the second year and increasing every year until the last part of the fourth year. Each student had his/her own “list” of patients, as well as leading a team of second and third year students, always under the direct supervision of a qualified registered osteopath.

 

GEDOP- What can you tell us about Osteopathy in England when you started?

JJ- I can tell you that it was perceived allot differently than it is now! We were considered to be “fringe” medicine… not a nice term. We were not officially recognized by law and medical doctors could be struck off the register just for referring patients to us! It is heartening to see the progression of Osteopathy in the U. K. to be in a position where we are now considered to be a vital part of Health Care, totally recognized legally and compensated for by private health insurers. Osteopathy is even offered in the NHS (National Health System). I often reflect on the U.K. history of osteopathy to give us hope here in Portugal for full recognition.

 

GEDOP- Why and when have you decided to come to Portugal and work as an osteopath?

JJ- I came to Portugal in 1985 because of the weather! My wife and I, together with our two young children, decided to have an adventure in this wonderful country. Little did I know that I would fall in love with Portugal, its people, culture, food and wine and make it my permanent home and my adopted country.

 

 

GEDOP- What kind of osteopathic community have you found in Portugal?

JJ- When I first arrived there was a very small osteopathic community indeed. There was Mrs. Margaret Edelman-Reynolds the first true osteopath to practice here, who had graduated from the BSO and a few people who called themselves Osteopaths but who in reality were not properly trained and worked more like bonesetters. My first patients were mostly foreigners as the Portuguese did not know what an Osteopath was. Little by little I built up a reputation and now 98% of my patients are Portuguese. I have also seen an increase of the number of properly qualified Osteopaths and a raising of the standards, although to be honest the average Portuguese trained Osteopath is well below American, British or French standards. But, and this is important, there are exceptions and there are some excellent Portuguese trained Osteopaths.

 

GEDOP- How do you see the development of Osteopathy in the United Kingdom since you graduated?

JJ- I think I answered this already!

 

GEDOP- Yes, but do you think they are going in the right way?

JJ- I am aware that there is a controversy over the direction of osteopathy in the UK. Many osteopaths feel that we are compromising our principles to become more “recognized” and that we need to go back to our roots. I believe that this is a danger but that the GOsC is proceeding in the correct way. So yes they are going in the right way but they must be careful. Osteopathy MUST become more mainstream for two over riding reasons. One, is that I believe it truly is the medicine of the future and homo sapiens need it in order to evolve in a more natural way. Second, every year more and more osteopaths are coming into the market and they need to find jobs and patients for their practice! There will only be jobs for them if more people seek osteopathic consultations and for this to happen we need to be more integrated into the health system of the country and be acceptable to private insurers. For this to happen osteopathy (and it is happening) has to provide more quality research which is evidence based and which clearly shows an advantage over conventional treatment. As we build up a research portfolio of clear results there will be no more argument about our splendid results.

 

GEDOP- Looking back, how do you see the development of the profession in Portugal until today?

JJ- The profession IS developing rather slowly but it is developing. As more and more people become properly qualified and standard raise there will be one day a teutonic shift in the public’s perception of osteopathy. Of course there are many people working behind the scenes to establish osteopathy in law and among the medical profession and no one has done more than Augusto Henriques to further osteopathy in Portugal, although there are others as well. In my humble opinion the medical resistance to osteopathy is not the main reason we are not already legally regulated here. The main reason is the lack of proper standards and the lack of a self regulating osteopathic body which has the power to enforce higher standards of practice and restrict the use of the term Osteopath to only properly qualified practitioners. A disturbing trend that I see is Physiotherapists who have a very useful and valuable profession taking “weekend courses” in Osteopathy and Osteopathic technique and then declaring that they are Osteopaths! Osteopathy is NOT a bunch of techniques that we perform like trained seals! Osteopathy is a set of principles that we carry in our reasoning processes which help us to see the homo sapiens in the context of his whole environment, inner and outer. Physiotherapy has its place as does Osteopathy but they each have very different philosophies and ways of approaching the patient. I had one very bright student of osteopathy and already a qualified physiotherapist who was doing some clinical training at my practice. She was very concerned because she said she would never be able to master the “osteopathic techniques” and consequently would never be a good osteopath. I told her in very gently language that she was talking “rubbish”! I told it was her thinking mind that made her an osteopath… some osteopaths never use HVT’s… and they are very good osteopaths. The osteopathic toolkit has many tools. It is the same toolkit that all manual therapists use. Osteopaths simply use the toolkit in an osteopathic way… I hope I make myself clear.

 

GEDOP- In which way these weekend courses are different from the other courses that are running in Portugal, that train students to become osteopaths, in terms of curriculum and mode of delivery?

JJ- I will make a generalization here which may not be true in all instances… these weekend courses AND many of the so-called osteopathic schools in Portugal are not teaching osteopathy but rather techniques which osteopaths frequently use and they call them “osteopathic techniques”. Once again I will say, osteopathy is not techniques! There is no osteopathic techniques, there are just techniques which osteopaths use. Osteopathy is principles and a way of looking at and treating the body realizing that everything is inter-related to each other in a very intimate symphony. When we have “dis-ease” the symphony turns into harsh noise! Many of these courses are not teaching osteopathy but rather advanced minor orthopedics and massage.

 

 

GEDOP- Do you think these physiotherapists, who are also osteopaths, are causing more harm than the ones graduating in Portuguese schools that do not have as well the same standards, as in regulated countries, that look more as bonesetters, as you mentioned before?

JJ- There are physiotherapists who also have gone to proper osteopathic schools and who now practice osteopathy. Physiotherapy training is an excellent grounding to then study osteopathy. The practitioners that I have met from GEDOP are in that category. Most physiotherapists have at least a proper grounding in anatomy and physiology and disease presentation. I believe they will not harm patients. Many so-called osteopathic courses in Portugal have a very weak teaching of the basics and disease. The graduates from these courses and schools can harm people because of ignorance of pathology. The physiotherapists who attend badly run osteopathic courses are not in danger of harming patients so much as harming the public’s perception of osteopathy and as I have said there are osteopaths in Portugal who have a physiotherapy background and who are practicing proper osteopathy and who have gone to proper recognized osteopathic schools

 

GEDOP- You run a very successful project to help osteopaths in their clinical training. Can you tell us your ideas behind this project?

JJ- There is a huge gap in most Portuguese training of Osteopathy. There is little if any supervised clinical training! I try to fill this gap for students who I feel are gifted and through no fault of their own are lacking clinical training. The minimum number of hours of supervised clinical training that an Osteopath should have upon completion of their training is 1500 hours but preferably 2000 hours. This is the figure recently endorsed by the Forum for Osteopathic Regulation in Europe (FORE).

 

GEDOP- Another project you started, this one worldwide, was the creation of a forum – Osteopathy for All. Can you please tell us something about it?

JJ- This project grew out of a need that I had to discuss serious osteopathic topics with professional colleagues on a daily basis. Being in a busy practice I hardly have time to travel to discuss things and so I thought it would be a good idea to start a serious forum for discussing all matters osteopathic that I could access from my office at my convenience. Well, the forum has grown beyond my wildest dreams! We now have over 400 members from 20 different countries. We discuss topics as diverse as “Should we get back to the roots of Osteopathy” to how much to charge for giving a legal opinion for a case of whiplash compensation. Today the topic is the osteopathic treatment of Parkinson’s Disease. Through the forum I have met influential Osteopaths from all over the world and broadened my professional net. In addition time spent researching and learning on the Osteopathy For All website may be used for Continuing Professional Development (CPD) hours.

 

GEDOP- Some professional organizations in Portugal have been participating in FORE – Forum for Osteopathic Regulation in Europe. Are you involved in that?

JJ- What are your thoughts about it? Yes… I was at the founding meeting in London representing Portugal along with Bruno Leitão Quintela. I have, in a small way, made a contribution to the standards for training, practice and ethics document which will be launched in November 2008. I believe that having a Pan European Forum which sets voluntary standards for individual sovereign states is an important step to bring osteopathy to a similar standard across Europe in accordance with the Bologna Accord which stipulates that professionals from individual states should be able to practice across Europe without undue hindrance.

 

GEDOP- Which Portuguese professional organizations are involved in this European project? How much of the profession do they represent in total?

JJ- There are three organizations in Portugal who participate in FORE: Associação de Profissionais de Osteopatia, Associação e Registo dos Osteopatas de Portugal and Federação Portuguesa de Osteopatas. I think together they represent a substantial number of Portuguese osteopaths, but certainly not all.

 

GEDOP- I guess that the outcome of these meetings for the Portuguese participants is the exposure to standards unknown by the majority of them. Do you think these organizations are promoting a change in the profession towards the agreed standards?

JJ- No doubt! We cannot expect to see immediate results but as more people are exposed to higher standards and see other countries succeed we in Portugal will have a great motivation to be part of a European Standard project. There is no lack of talent in Portugal. There is a lack of vision and sufficient motivation to join together. Leaders in the field of osteopathy must emphasize the advantages of joining together the organizations rather than each group saying they are better than the others. This is why I say we must be inclusive not exclusive. When osteopaths demonstrate coherence the government will listen and regulation will follow. This will lead to proper standards and most importantly safety for the patient as they will know certainly that they are in good hands. Safety of the patients is the most important job of the regulator.

 

GEDOP- What do you expect of the Regulation Process in Portugal?

JJ- Osteopaths must first stop fighting among themselves and create a common umbrella organization which will then present a united front to the government. Because there are many voices speaking from different directions to government ministers, they do not know who to listen to… we must get our own house in order first AND SPEAK AS ONE VOICE and then we will be officially recognized and not before…

 

GEDOP- Why do you think it has not happened yet and what should be done to achieve that organization to represent Osteopathy as a whole and not interests of groups of osteopaths?

JJ- It has not happened yet because the political will has not been there and there has not been sufficient inducements for joining together and sufficient penalties for not joining. The umbrella organization that will eventually represent all osteopaths must have powers to restrict the title of “osteopath” or at least “registered osteopath” and have the power to punish practitioners who do not uphold high standards of practice and ethics. Portuguese osteopaths must be willing to pay reasonable professional fees for such an organization and we will need high quality well paid people dedicated to working towards our goals. Working osteopaths can not be expected to do this in there spare time. It demands 100% effort from a professional chairman or director. The British model adapted to Portugal of the Portfolio Process to assess whether or not practitioners have the required standards is a good one. This will be meant not to exclude but rather to INCLUDE all practitioners regardless of where they trained if they can demonstrate high standards of practice and ethics. This is a good way forward.

 

GEDOP- What steps should be taken in Portugal in order to raise the professional standards?

JJ- There should be an osteopathic register which sets high standards and only those practitioners who fulfill the requirements will be allowed to use the term REGISTERED OSTEOPATH or to place the initials M.R.O. (Member of the Register of Osteopaths) after their name and degree. Although we cannot restrict the use of the term Osteopath we can apply in law to restrict the use of Registered Osteopath and M.R.O. This would allow us to inform the public to only use M.R.O.’s to ensure that your Osteopath has been properly trained, is bound by a code of ethics and is insured. Once we accomplish this we can approach the government for official status. Another important issue is to create a teaching establishment in Portugal that ALL osteopaths can get behind. This establishment should be a non-profit charity entity so that no-one will be seen to make money from it. The teachers and directors of the school will be paid of course at a fair salary but any profit should go right back into the school. The school should have a clinic attached to it for students to get experience.

 

GEDOP- Has your vision of Osteopathy changed along the years?  

JJ- Yes… I have learned that treating the whole patient does not mean just treating him as a mechanical whole. But rather as a emotional, nutritional, cultural, psychological, spiritual whole. We must truly see the patient as a whole. I have come to the conclusion that an Osteopath can act as a Primary Care provider and that we can treat many problems beyond muscular-skeletal problems to the benefit of our patients. We treat people not disease!

 

GEDOP- Can you please expand a little more your ideas on this? For example, what is the role of the Osteopath in terms of emotions, culture or even spirituality?

JJ- The patient presents to us not just their physical body but their whole self. Emotional issues present to us as physical manifestations like muscle tension, blocks, lack of circulation and fluid movement. This is part of the osteopathic picture. The patient’s spiritual beliefs will have a bearing on how the patient interprets his pain and his hope for recovery… it does not matter if we believe, for example in the Virgin Mary, but it does matter allot if the patient does! If we understand well the cultural and spiritual beliefs of our patients we can then harness this belief to stimulate the autonomous healing capacity of the body sometimes called the placebo effect. Conventional doctors as well as osteopaths use placebo every day in their practice. I think osteopaths are particularly good at bringing about this effect in the patient through the use of touch. But let me be clear here. I am not saying that osteopathy is a placebo but rather we utilize this effect to help the patient as any practitioner would.

 

 

GEDOP- You seem to be one of the osteopaths that work with other healthcare professionals. What are your thoughts concerning inter and intra-professional relationships?

JJ- Good relations with professional health providers from the medical doctors to the acupuncturists are ESSENTIAL. We must strive to be on good terms with other Osteopaths and Doctors of Medicine as well. One good way to improve relations immediately is to ask for each patient’s approval to contact their GP and then write a letter or phone them to inform them what you are doing. We are not alternative but rather complementary! The one who will benefit most is the patient! You will find that before long you will be receiving referrals from the medical practitioners as well as others. Communication is the way for people to learn to trust you and believe in you.

 

GEDOP- From your experience with the osteopaths that undergo clinical training in your clinic, what do you think should be promoted in terms of continuous professional development in Portugal?

JJ- It is clear that supervision of clinical work would go a long way to help many young Osteopaths to develop themselves. Having said that anything which will enhance your skills and knowledge as an Osteopath can be considered as Professional Development. I would love for one of the teaching establishments in Portugal to start a non-profit clinic for the benefit of patients and for inexperienced student osteopaths to get supervised experience

 

GEDOP- Would you like to leave some message?

JJ- Everyday I am thankful for having chosen to be an Osteopath. It is a great profession where you can use all the talents that God has given you to help others to lead a better quality of life. We have a responsibility to do the best we can for each patient and to stay enthusiastic about all aspects of our work. There is still much work to do for us to build on the accomplishment of others in furthering our profession in Portugal, Europe and the world. We should each strive to be an ambassador for osteopathy with our patients and with the doctors we meet. Osteopathy is Andrew Still’s gift to the world to ease pain and bring health to many. We must all in our own way honour that gift for the good of mankind.