By John Tourle
Registered Osteopath | Rehabilitation Lecturer | CrossFit Coach
5-minute read
By John Tourle | Osteopath, Rehabilitation Lecturer & CrossFit Coach | High Peak Osteo, Buxton
Healthcare and business have an uncomfortable relationship.
Private healthcare clinics need to generate revenue. We have premises to maintain, equipment to purchase, staff to pay and businesses to keep financially sustainable.
I'm no exception. High Peak Osteo is a business, and the appointments I provide generate income.
There's nothing inherently wrong with that.
But I think we should be asking a difficult question more often:
At what point does the need to generate revenue begin to influence the healthcare we're recommending?
It's a question that applies to osteopaths, physiotherapists, chiropractors and many other healthcare professionals.
And it's one I believe every clinician working in private practice should be prepared to answer.
When the treatment becomes the product
Imagine attending a clinic with back pain.
After an initial assessment, you're offered a package of twelve appointments, perhaps combined with a specialist machine or treatment technique.
You're told the approach will help correct the underlying problem, restore normal function or prevent symptoms from returning.
It might sound reassuring. There's a plan, a clear number of appointments and the promise of a solution.
But what happens if you improve after three appointments?
What happens if you don't improve after six?
And perhaps most importantly, what evidence justified twelve appointments in the first place?
I'm not suggesting that longer treatment programmes are inherently inappropriate. Some conditions genuinely require extended rehabilitation and support.
But the number of appointments should be determined by clinical need, meaningful goals and ongoing reassessment.
Not by how many sessions happen to be included in a package.
A treatment plan should be flexible enough to change when the patient's circumstances change.
The appeal of expensive technology
Healthcare has always been attracted to innovation.
New machines, specialist techniques and advanced treatment systems can offer patients the impression that they're receiving something more effective than conventional care.
Sometimes, innovation genuinely improves outcomes.
But technological sophistication isn't the same thing as clinical effectiveness.
Consider machine-based spinal decompression, including systems marketed as IDD therapy.
These approaches are promoted for conditions such as disc-related back pain, often with claims about reducing pressure on spinal structures.
However, high-quality evidence demonstrating that branded spinal decompression systems provide superior outcomes to established conservative management remains limited. NICE recommends against traction for managing low back pain and sciatica.
Shockwave therapy presents a more nuanced example.
There is evidence supporting its use in selected musculoskeletal conditions, but results vary according to the diagnosis, treatment protocol and research examined.
For some patients, it may be a reasonable treatment option. For others, the evidence is insufficient to justify confident claims of benefit.
The problem isn't necessarily the technology itself.
The problem arises when the availability of a treatment becomes the reason for recommending it.
A clinic investing thousands of pounds in equipment has a commercial incentive to use it.
That doesn't mean the treatment is inappropriate or that the clinician is acting dishonestly.
But it creates a potential conflict of interest that deserves recognition.
The same scrutiny should apply to expensive manual therapy courses, routine maintenance appointments and any other intervention that generates income through repeated treatment.
Are we treating patients or selling appointments?
I think this is where the conversation becomes particularly important.
In private healthcare, the person making the clinical recommendation is often also the person who benefits financially from that recommendation.
That arrangement creates an inherent tension.
If I recommend that a patient returns next week, the clinic earns money.
If I explain that they're progressing well and can continue independently, the clinic may earn nothing further from that episode of care.
Neither recommendation is automatically right or wrong.
But the decision should be based on what is clinically appropriate, not which option generates the most revenue.
The patient should never have to wonder whether an additional appointment is being recommended because they need it or because the business does.
And as clinicians, we have a responsibility to make that distinction as clear as possible.
What does good treatment actually look like?
For me, good healthcare should be built around a few straightforward principles.
A clear explanation. Patients should understand what their clinician believes is happening, where uncertainty remains and why a particular treatment is being recommended.
Meaningful goals. Success should be measured by improvements that matter to the patient, not simply by the number of appointments attended.
Evidence-informed decisions. Treatments should be supported by the best available evidence, considered alongside clinical expertise and individual patient circumstances.
Regular reassessment. If treatment isn't helping, we should reconsider the approach rather than simply continue delivering the same intervention.
Patient independence. Wherever possible, healthcare should help people develop the understanding and confidence to manage their own health.
None of these principles requires expensive technology.
And none excludes hands-on treatment, specialist equipment or longer rehabilitation programmes when they're genuinely appropriate.
The distinction is whether an intervention is being used to achieve a meaningful clinical outcome.
Does more treatment mean better treatment?
Not necessarily.
Some people experiencing musculoskeletal pain benefit from a relatively small amount of professional input.
An assessment, explanation, practical advice and a short period of symptom management may be enough.
Others need more sustained support, particularly when recovering from significant injury, rebuilding physical capacity or managing persistent symptoms.
The important point is that the number of appointments should reflect the individual.
I don't believe patients should automatically be sold a predetermined course of treatment simply because they have a particular diagnosis.
Nor do I believe everyone needs regular maintenance appointments to keep their body functioning properly.
If a patient is progressing well independently, that should be recognised as a success.
Not a missed opportunity to sell another appointment.
What about osteopathy itself?
It's important that this criticism doesn't become selective.
Osteopathy isn't immune to commercial pressures or unsupported treatment claims.
Some explanations traditionally used in manual therapy — particularly those involving spinal alignment, correcting structural imbalances or treating a single underlying cause of complex pain — go beyond what the evidence can reliably establish.
And while hands-on treatment can provide symptom relief for some patients, it isn't automatically necessary, nor should it create a belief that the body requires regular professional intervention to remain healthy.
If I'm going to question the evidence supporting an expensive treatment machine, I have to be prepared to apply the same standards to the techniques I use myself.
Otherwise, the argument loses its credibility.
A different measure of success
Private healthcare businesses naturally measure performance through revenue, appointment numbers and patient retention.
Those figures matter. A financially unsustainable clinic cannot continue providing care.
But they don't tell us whether patients are getting better.
I'd argue that healthcare businesses should also be asking different questions.
Are patients returning to the activities that matter to them?
Are they becoming more confident managing their symptoms?
Are we identifying people who aren't progressing and reconsidering their care?
And are we helping people reach a point where they no longer need our services?
These are more difficult outcomes to measure than appointment numbers.
But they're considerably more meaningful.
Five questions every patient should feel comfortable asking
Before committing to a treatment plan, particularly one involving multiple appointments or significant expense, I think patients should be comfortable asking:
What are we trying to achieve?
What evidence supports this treatment for my particular condition?
What alternatives are available, including doing less or managing the problem independently?
How will we know whether it's working?
When will we reconsider or stop treatment?
These questions shouldn't be perceived as challenging a clinician's authority.
They should be part of good healthcare.
Healthcare should create independence, not dependency
I don't believe private healthcare and ethical practice are incompatible.
Clinics can be commercially successful while providing proportionate, evidence-informed treatment.
But doing so requires us to recognise that the interests of the business and the interests of the patient won't always align perfectly.
Sometimes the right decision is to recommend further treatment.
Sometimes it's to refer someone elsewhere.
And sometimes it's to explain that they don't need another appointment.
At High Peak Osteo, I want the quality of our care to be judged by what patients achieve, not how frequently they return.
Because the ultimate success of a healthcare professional shouldn't be measured by how many appointments they sell, but by how effectively they help the people who trust them with their care.
Our Approach at High Peak Osteo
High Peak Osteo provides osteopathic assessment, treatment and rehabilitation in Buxton.
Our approach combines clinical reasoning, clear explanations, appropriate treatment and practical rehabilitation, with an emphasis on helping patients manage their recovery independently.
We believe treatment should be proportionate, evidence-informed and guided by meaningful outcomes.
Learn More About Our Approach to Osteopathy
References and further reading
NICE guideline NG59: Low back pain and sciatica in over 16s: assessment and management.
NICE guidance HTG426: Extracorporeal shockwave therapy for Achilles tendinopathy.
General Osteopathic Council: Osteopathic Practice Standards, including professional responsibilities relating to patient interests, consent and communication.