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When observing in the clinic i noticed that it was very clean and hyginic. The benches are wiped down after every patient. The practitioners have access and are required to use PPE - gloves, masks and aprons, which are changed between each pateint too. This is because of the covid virus. The clinic was able to remain open, while taking precasions to be safe with the virus. These precasions are in place to stop the spread of infection. this makes me feel safer observing because multiple patients are coming in and out of the clinic, but there is less or no chance of infectious spread.

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A4

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A3

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modification question in clinical intergration 

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modification question in clinical intergration 

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a5

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when patient is asked to change, practitioner leaves the room 

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when patient is asked to change, practitioner leaves the room 

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A6

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Honesty and professional boundaries D1 and D2  

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Honesty and professional boundaries D1 and D2  

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Throughout observations in the clinic there were many professional boundaries that are kept.
when a patient was asked to get changed, the practitioner left the room to respect the patient's privacy. This showed that the practitioner respected the patient and didn't take advantage of their professional power. They kept professional boundaries. This helps patients trust the practitioner and means they are also more likely to trust their ideas and skills during treatment. I think that this is very important as building a foundation of trust will help to make the treatment more effective and more likely for the patient to return.

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Referral of patients to other health professions D10

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Referral of patients to other health professions D10

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When in clinical observation, I observed a patient that came in with acute shoulder and clavicle pain who couldn't move her shoulder in any vectors. The practitioner decided to ask her tutor for help and from the case history and diagnosis she made of the patient, testing and treatment was not the right thing to do. So herself and her tutor decided to referred the patient to get an ultrasound to see if her diagnosis was correct and to get the right care for her patient, instead of treating her regardless of her acute pain.

This showed me that not all patients are able to be treated that come into the clinic. It made me feel that even when wanting to treat and help someone the best thing to do for them is refer them to the best care professional for that injury. The practitioner asked for help from her tutor, her admitting that she needed help showed me that if I needed help in a clinical situation that the tutors are there for that exact thing.

The experience in this observation was very good for me as it made me think of what I would have done in the situation. I thought that the practitioner asking for help showed that she was thinking about the patients needs over her wanting to do treatment for the patient. The practitioner could have continued with testing and treatment and either made the patient worse or still helped relieve pain but a referral may have helped more.

In future if I had a patient that may need referring but I also thought I could help. I should choose the best treatment for the patient themselves, whether its referral to another health professional or osteopathy treatment. osteopathy treatment can be good for a lot of things however it cannot fix every problem that a person has, so working with other professionals is really important too.

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c2

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Working within the limits of osteopathy B2

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Working within the limits of osteopathy B2

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during an observstion in clinic, I had observed a patient that had injured her shoulder and was unable to move. she was referred to get an untrasound. this made me relise that not everything i thought could be treated with osteopathy can be.
the patients injury was something i thought was able to be treated by osteopathy. it shows that as a profession and as an osteopath there are limits to what we can do to help people. In future this is something I would really think about because I could help a patient but could a different health professional help them more.

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During the covid pandemic there was alot of rules and regulations that were nessesary to be followed to continue with lectures and clinical observation. The GOsC had rules for what was allowed to be done during the covid pandemic. for example at christmas and during term 2 as first years we were not allowed to observe in the clinic.
We had to keep up to date and check these rules to know what we were able to do and what we were not.
For me i felt that the rules were nessesary for everyone to stay safe and to allow the 3rd and 4th years to continue clinic hours. It made me feel safer knowing that there were guidelines in place to allow us to continue learning in person and not have lectures all online, but also keep us safe in doing so. this was done by having PPE and allowing us to get covid tests if we wanted to. It has made me more appreciative of being able to socialise and having an in person education comapred to many other universities that arent able to have this.
If the covid pandemic occured again or continued i would be more patient with how long it takes, and to follow guidelines as i did in this pandemic.

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always think the worst possible outcome until you can prove it otherwise 

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always think the worst possible outcome until you can prove it otherwise 

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I had a patient, he presented with right lower rib pain rib7-10, he came had been cutting down a tree in his back garden, he had googled and thought he had pulled latissimus dorsi. He was also worried whether there was anything more serious. I  had Stephan as a tutor, we thought it could be a strain of latissimus dorsi, quadratus lumborum or intercostal muscles, or a displaced rib. Stephan did not come into the room and did not see the patient. I had done examination and found it to be an intercostal strain. This is what i treated in the session with very gentle techniques. I asked him to come back in a week.

The next week I had Mr Sullivan as my tutor, he talks a lot about it could be the worst possible diagnosis unless you can prove otherwise. For this case he agreed with the diagnosis as the onset fitted the character of the pain. But once he came in and saw the patient he knew it could be a rib fracture. The patient was very kyphotic through their thoracic spine and this is a clear presentation of osteoporosis - which I did not know. We then asked the patient if they had fallen when cutting the tree, they said they did not think so but when talking further he said he did. I had not previously asked if he fell as I was not aware it was a necessary question, but it was. This changed the session as I needed to do tests for a rib fracture, I percussed the thoracic spine to rule out a spinal fracture, then we did a rib squeeze test, this produced pain in the patients ribs. We could not rule out a rib fracture, because there was signs of osteoporosis in the way the patient had presented, and there was a fall that could have caused a fracture of a rib. Yes it could still be a intercostal strain but because we could not rule out a rib fracture, this is still a likely diagnosis. We did not treat him and instead told him to get a DEXA scan to check for osteoporosis and only come back in 6-10 weeks so that if it is a fracture it can fully heal.

From this I have learnt to check for the worst possible scenario and make sure to test and rule out those diagnosis. I think when I have more knowledge of how patients are presenting and as I learn more I will be better at this. But in the future I will not miss a rib fracture or a fracture in an osteoporotic patient.
26/10/2022

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We have had the first 6 weeks on clinic and our first set of tutors.
We had no clinic tutor on a friday so our group was split better others, I was mainly with Stephan on a friday.

Mr Sullivan
Stephan Vernon
Vanessa

I found it very difficult with the different opinions of the tutors. Some of them like Mr Sullivan think glass empty and that you have to rule out the worst case scenario first, which does made sense.
But then i will have other tutors and how they diagnose also works really well, I found individually that if you have the same patient with the same tutor it was fine, but of you had a patient on time with one tutor and then next time with another tutor then it is very hard as many times the second tutor had changed or gotten a different diagnosis to what me and the previous tutor had gotten. This was very confusing for me because each of the tutors made valid points but somehow had different diagnosis to each other. I understand that parts of it is what may have been missed previously, but it makes it very confusing.