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Rolfe et al.’s (2001) reflective model

Rolfe, G., Freshwater, D., Jasper, M., 2001. Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

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A1. You must listen to patients and respect their individuality, concerns and preferences. You must be polite and considerate with patients and treat them with dignity and courtesy

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A1. You must listen to patients and respect their individuality, concerns and preferences. You must be polite and considerate with patients and treat them with dignity and courtesy

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What ?

In second term of 4th year I had a 35 year old new patient who presented with bilateral upper trapezius pain and cervical spine restriction. The patient worked at a desk and and at home on the sofa. She had no neurological symptoms and no systemic issues. On examination she had an anterior head carriage and protracted shoulders. Actively she had reduced cervical rotation and side bending to the left. On passive testing she had reduced CD range of motion and no translation of rotation down to T4, with restrictions segmentally of C2 in left rotation and side bending. Both of her trapezius muscles were tender and hypercontracted. The diagnosis was Upper cross syndrome with CD restriction and C2 somatic dysfunction. The treatment plan included CD lift and cervical manipulation along side other treatment techniques including MET, articulation and soft tissue work. The patient had not visited an osteopath before and therefore had not have any manipulations prior, so for the first treatment I only did a CD lift. For the CD lift I explained the risks, adverse effects and communicated with the patient how the technique was set up and that if she was not happy I could do another technique, she was happy for me to continue with the manipulation. In the second appointment I discussed with the patient that I wanted to do a cervical wheel manipulation, she was unaware of what this technique was and asked if it was similar to a chiropractor technique she had seen online, which it was not. I explained the technique and how it would be set up, the risks, adverse effects and also talked about other treatment options. She seemed hesitant about having the technique but she wanted to try it, she had was hesitant because she had not had the technique before so she didn't know what to expect rather than being worried about the risks. I asked her if she wanted me to set the technique up but not put it through, so she knew what vectors her neck would be in. The patient wanted me to do this as she wanted that technique to be done, I kept checking with the patient ensuring she wanted this technique and not another treatment option. Once I set up the technique she was a lot calmer and very keen for me to do the cervical manipulation. I checked with her again and she consented to the technique. I did the technique on one side, and checked the patient was all okay, she said the technique was fine and consented to me doing the other side. After the technique the patient was very pleased and could feel more range of motion in her neck movements. I am confident in my cervical manipulation technique, I have practiced the technique many times. I would not have done the technique if I did not think it was necessary for the patient or if there were any risks involved. I asked the patient consent multiple times, checked that she was not worried about the risks and made sure she wanted the technique. The patient has also consented to me doing a cervical manipulation in future appointments. I was happy with the way I approached this situation, I felt like the patient really trusted me and that was something I feel is really important to have especially with a manipulation technique like that.

So what ?

It made me think a lot about how not all patients are comfortable with manipulation techniques. I always ask consent for a manipulation technique but this taught me to make sure and double check that patients are happy with the technique I am going to do. Some patients I've had in the past have known what cervical manipulations are and have had them before. But this patient did not know what they were, which is expected when she has not had treatment before. It made me think about how in class and with colleagues we practice cervical manipulations, we know how they are set up, we are fully comfortable getting them done, but patients are not. I was really happy with how I communicated with this patient, I ensured I got full informed consent as well as making her comfortable with the technique. Making sure the patient knew there were other treatment options was really important for me, so that they have a choice in their care. Cervical manipulation risks are higher than other manipulations but communicating to the patient that as a practitioner I would not do the technique if I thought they were at risk, none the less the risks still need to be explained. I think showing the patient how I set the technique up really helped to remove their hesitance and any worries they had around the technique.

Now what ?

In clinic I ensure I explain the technique fully, get informed consent and make sure to give the patient time to make the decision, especially when the reason they are hesitant is not due to risks or not wanting the technique. I will be making sure I set the technique up for future patients that have not had a cervical manipulation before, and for other manipulation techniques as well if patients have not had them before. I will be making sure that they know other techniques are available to them. I will listen to their concerns and if they do not want to do a certain technique I respect their decision.

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 'The Vital Role of Health care Translators: Breaking Language Barriers for Quality Care' (Language Solutions 2023)

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A2. You must work in partnership with patients, adapting your communication approach to take into account their particular needs and supporting patients in expressing to you what is important to them

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A2. You must work in partnership with patients, adapting your communication approach to take into account their particular needs and supporting patients in expressing to you what is important to them

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What?

In 3rd year I had a 50 year old male patient that could not speak English very well, he could speak some English but he brought in his wife to translate anything he did not understand. He presented with lower back pain which began after lifting shopping from the car 3 weeks ago. He did not get any neurological symptoms into his legs, it was Valsalva negative and worse for sitting and laying down. The questions I asked I directed towards him, I made sure not to just ask the wife the questions directly, which I had to correct myself on a couple of times. I made sure to ask questions in a way that was easily understood, as he could speak English, just not as well as his wife. I also asked many times if either of them had any questions or if there was anything I needed to clarify. On examination, there was pain on flexion and rotation. Flexion, rotation and side bend were restricted active and passively. I did a neurological screen because it was a lower back injury and to ensure that he was safe to do a lumbar manipulation in the future if it was necessary. His myotomes were all 5/5, reflexes were 2/4, he had no sensation changes and slump was negative. I was nervous communicating with the patient because I had to think a lot about how I spoke to the patient and his wife and made sure both of them understood everything throughout the session. I was also nervous because I had not had a scenario like this before so I did not know what to expect.

So what?

In clinic I have not had a patient before this where I had to think more about how I was asking questions, or how I would communicate with a patient. It taught me that it is important to practice how you would speak to patients when there is a communication barrier. In clinic I need to be able to easily explain, give informed consent to patients and understand any concerns they may have. I need to ensure the patient fully understands what I explain, I did this by making sure I asked if they had questions or understood everything. I felt I communicated well with the patient, but I could have asked the patient more questions directly to him rather than his wife as I noticed I would accidently directed some of the questions to her. It is important to make sure the patient can fully consent, this is a legal requirement and if they did not have someone to translate I would not have been able to get informed consent and would not have been able to treat them. A website 'The Vital Role of Health care Translators: Breaking Language Barriers for Quality Care' (Language Solutions 2023) talks about the importance of having a translator for health care scenarios. It gives the patient more access to healthcare, enhances their safety, promotes informed consent and enforces patient-centred care (Language Solutions 2023). This shows how important it was that the patient had their wife there to translate for him as it improved his overall care not just in osteopathy but in any part of health care.

Now what?

Now in clinic I feel more confident communicating in a way that is different to how I usually would. This was a learning experience for me and I found it very useful to prepare me for future times this may happen. I am grateful that he bought his wife with him because I would have not been able to receive informed consent and would not be able to examine or treat the patient. Being better at communication can help support the patients and make them feel heard. I think this will make me be more conscious about making sure my communication with the patient is as good as it can be. When or if I have patients like this in the future I will make sure I direct the questions to the patient and then also ask the translator if I need to afterwards.

Reference:

Language Solutions 2023, The Vital Role of Healthcare Translations: Breaking Language Barriers for Quality Care. Available at: https://langsolinc.com/the-vital-role-of-healthcare-translations-breaking-language-barriers-for-quality-care/ [Accessed May 11, 2024]

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The Vital Role of Healthcare Translations is evident in today's diverse world, where people from various linguistic backgrounds seek healthcare services, effective communication becomes paramount. Clear and accurate communication between healthcare professionals and patients is essential for providing quality care. Healthcare translations play a crucial role in bridging the language gap, ensuring that patients can fully understand their medical conditions, treatments, and receive appropriate care. This blog post explores The Vital Role of Healthcare Translations and how they contribute to enhancing healthcare outcomes for multilingual populations.
Improving Access to Healthcare:
Language barriers can be a significant obstacle for individuals seeking healthcare, particularly those who are non-native speakers or have limited proficiency in the local language. In such cases, healthcare translations serve as a gateway to accessing necessary medical services. Translating essential documents, such as medical forms, consent forms, discharge summaries, and medication instructions into patients' native languages can empower them to understand their rights, make informed decisions, and actively participate in their healthcare journey. This affects healthcare for all and helps to keep our communities, as diverse as they may be, healthy communities. The Vital Role of Healthcare Translations is instrumental in improving access to healthcare for diverse communities.
Enhancing Patient Safety:
Clear communication is vital for patient safety. Miscommunication due to language barriers can lead to misunderstandings, errors in medication dosage, improper follow-up care, and adverse medical outcomes. Healthcare translations minimize the risk of misinterpretation, ensuring accurate transmission of critical information between healthcare providers and patients. By facilitating precise communication, healthcare translations contribute to reducing medical errors, improving patient safety, and ultimately saving lives. The Vital Role of Healthcare Translations cannot be overstated when it comes to ensuring patient safety.
Promoting Informed Consent:
Obtaining informed consent is an essential ethical and legal requirement in healthcare. It ensures that patients have a comprehensive understanding of their medical condition, proposed treatments, potential risks, and alternative options. When language barriers hinder effective communication, healthcare translations become indispensable in enabling patients to make informed decisions about their care. Translating consent forms in clinical trials and providing interpretation services during discussions with healthcare professionals empowers patients to participate actively in their treatment plans, fostering trust and shared decision-making. The Vital Role of Healthcare Translations is evident in promoting informed consent.
Cultural Sensitivity and Patient-Centered Care:
Healthcare translations go beyond language conversions; they also encompass cultural sensitivity. Different cultures have unique beliefs, traditions, and healthcare practices that must be understood and respected. Translations consider cultural nuances, ensuring that healthcare information is culturally appropriate and sensitive. For example, certain medical conditions may carry specific stigmas in particular cultures, and accurate translations can help address those concerns and promote patient trust. By incorporating cultural sensitivity, healthcare translations contribute to patient-centered care, fostering a positive healthcare experience and improved health outcomes. The Vital Role of Healthcare Translations includes cultural sensitivity to provide patient-centered care.
Utilizing Technology for Efficient Translations:
Advancements in technology have revolutionized healthcare translations, making them more efficient and accessible. Telemedicine platforms can incorporate real-time interpretation services, allowing patients to consult healthcare professionals remotely, regardless of language differences. However, while technology can be a valuable aid, human translators and interpreters remain critical for complex medical terminologies and nuanced conversations, ensuring accurate and contextually appropriate translations. The Vital Role of Healthcare Translations is enhanced by the utilization of technology for efficient translations.
Overcoming Challenges in Healthcare Translations:
Healthcare translations come with their own set of challenges. Medical terminology, jargon, and complex concepts require expert knowledge and experience to be accurately translated. Finding qualified healthcare translators who possess language proficiency and medical expertise is a must. Additionally, ensuring privacy and confidentiality while handling sensitive patient information during the translation process is crucial. Collaborations between healthcare organizations, language service providers, and professional translators are essential to overcoming these challenges and ensuring high-quality healthcare translations. Overcoming these challenges is essential to maintain The Vital Role of Healthcare Translations in healthcare settings.
Conclusion:
In an increasingly multicultural and multilingual society, The Vital Role of Healthcare Translations play a vital role in breaking down language barriers and promoting equitable access to healthcare services. They contribute to patient safety, informed consent, cultural sensitivity, and patient-centered care. With the support of technology and qualified translators, healthcare translations can continue to improve communication, foster trust, and enhance healthcare outcomes for diverse populations. By recognizing The Vital Role of Healthcare Translations and investing in language access services, we can ensure that no patient is left behind due to language differences, ultimately creating a more inclusive and effective healthcare system.

Are you looking for a language service provider that specializes in healthcare translations? Find out if we are the right fit for you!

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By recognizing The Vital Role of Healthcare Translations, we can ensure that no patient is left behind due to language differences,

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A3. You must give patients the information they want or need to know in a way they can understand

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A3. You must give patients the information they want or need to know in a way they can understand

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What?

In children's clinic I had a 1 month baby who came in because they were unsettles and would cry from 8pm till 2 am. The mother had tried everything to get the baby to settle but nothing would work long term, she would stop crying and settle for 10-20 minutes but would begin to cry again. The baby was an elective C-section because there was polyhydramnios (increased amniotic fluid). The hospital attempted induction using ripening rods but that was unsuccessful, so the midwife suggested a c-section. I examined the baby and they had tightness in their thorax and reduced extension through the body because of the elective and early c-section. I explained to the mother that because the birth was fast and the baby was not ready to come out (also what the hospital told her) the baby was surprised / confused on what was going on. My tutor also explained this as well in a very similar way to what I did. I explained it in a way that the mother would understand. Before treatment I explain what I would like to do, that there may not look like much is going on from the outside but I can feel a lot going on. After the treatment I make sure to ask if they have any questions about any of the treatment done, to make sure they leave understanding everything that went on in the treatment. At the beginning of 4th year I did get a little flustered when explaining cranial as I was not quite sure how to explain it. This time I was happy with how I explained cranial osteopathy to the patient, I made sure to explain it in a way that they could understand and I was a lot less flustered.

So what?

Giving your patients all the information they need to make a decision is a necessary part of osteopathic practice. When learning cranial it is explained to us in a way that patients would not understand, so when I then explain it to my patients I have to use layman's terms to ensure they fully understand what I want to do and can get informed consent. During treatment cranial may not seem like much is happening but I can feel what is going. Explaining that to the patient is really important so they can understand the treatment I am going to be doing on their baby and that it may not seem like much going on.

Now what?

Now I am more confident in explaining to patients what cranial is and answering any questions they have about the techniques I am doing. I have had to explain it many more times after seeing this patient, every time I do cranial I explain what it is and what will be happening. In the future I will be confident in explaining cranial in a way that the patient can understand. I will however continue to practice what I will say to describe cranial osteopathy to patients.

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What can osteopaths learn from concerns and complaints raised against them? A review of insurance and regulator reports

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A4. You must receive valid consent for all aspects of examination and treatment and record this as appropriate

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A4. You must receive valid consent for all aspects of examination and treatment and record this as appropriate

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What?

In clinic I had a 36 year old patient who came in with left sided neck pain and felt she had restricted movement, she also had trapezius myalgia and thoracic restriction. She had previously visited the clinic before so she had received a variety of different treatments before. On examination I tested her cervical spine actively and passively, on active testing there was some restricted range of motion in rotation and side bending. On passive testing there was restriction of C2 and C6 on the left, in side shift, rotation right and side bending left. I recorded that the patient gave verbal consent, was told about after treatment soreness and told any risks that may occur, and consented for this. Her left trapezius had a trigger that radiated up her neck. For treatment I worked through her left trapezius and did articulation of her neck in rotation and extension. I wanted to do a cervical wheel manipulation due to the segmental restriction in her neck. I talked to the patient about wanting to do this technique, she was happy for me to do the technique as she has had the technique done in a previous visit to the clinic and found it improved her neck pain. She did not have any risks that stopped me doing the technique, her blood pressure was 124/87, she still had her periods regularly and has no systemic signs of cardiovascular issues or risks of fracture. I explained to the patient the risks of the technique including soreness, risk of vascular compromise like stroke and soreness 24 to 48 hours after treatment. I explained that these risks are very unlikely to occur due to her age and case history but must be told to the patient so they have full informed consent before the technique is done. I also offered alternative treatment that could be done instead if they were not comfortable with the technique or did not want to proceed. I wrote down in my notes that they gave verbal consent, were told the risks of the technique and consented to proceed.

So what?

In clinic the patient needs to be fully informed of the technique including risks or soreness that may occur and allow them to choose if they want to continue with the technique or if they would like to do another technique. This is informed consent and must be done for any aspect of treatment but for techniques like HVTs extra information needs to be given for it to be informed consent. With this patient if they had said they did not want the technique I would have done another that would have gotten a similar result. A 2016 study (Carnes) investigating osteopathic patient complaints found that in 2013 and 2014, 18% and 13% of patient complaints / concerns were about the failure to gain valid consent, this was one of the most common complaints (Carnes 2016). This shows how vital it is that as a profession we ensure that we give informed consent, to not only keep our patients safe during sessions but to also make sure we don't get complaints made against ourselves.

Now what?

On reflection of this patient I am happy with how my consent was, I felt I gave them informed consent while reassuring them that I would not do the technique if I thought they were at risk. In future I will continue to make sure I ask informed consent and explain that due to their age or case history I do not see them as being at risk. I will be keeping up to date with what needs to be included or not within consent for HVTs and adding anything I may need to add in the future.

Reference:

Carnes, D., 2016. What can osteopaths learn from concerns and complaints raised against them? A review of insurance and regulator reports. International Journal of Osteopathic Medicine, 22, pp. 3-10.

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A5. You must support patients in caring for themselves to improve and maintain their own health and wellbeing

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A5. You must support patients in caring for themselves to improve and maintain their own health and wellbeing

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What?

In clinic I have an 82 year old male maintenance patient. He comes in for lower back pain because of spondylosis and occasional left medial epicondylitis, which he gets if he plays golf or gardens for too long. I see him each month and I treat his back and his left arm if needed. He has a few medical concerns, he has had kidney stones for over 6 years, he gets the occasional flank pain that comes and goes but no other concerning symptoms. He also has cysts on his gallbladder that do not cause any pain or problems, the doctor is aware of both, they have been investigated and the GP is not concerned. The patient is very on top of his health and in contacting the GP. We talked about getting his kidney stones checked because he had not had a recent scan. The patient is already quite active, he gardens and plays golf a few times a week. He mentioned he was concerned about his weight and wanted to know anything else he could do. I suggested doing classes at a gym, and he mentioned his friend goes to one and he could join him. He asked if lifting light weights at home would help his strength and I said it would and suggested some exercises he could do. He was very keen to implement these into his week and slowly build up to doing more exercise. We spoke about diet but he eats well and does not drink so we discussed doing more activities rather than him changing his diet. The patient was very keen to improve his health, both in contacting his GP and trying to lose some weight. He was not sure what would be the best thing to do, he mentioned me discussing it with him really helped. I was happy he was comfortable enough to bring this subject up with me, as a lot of people do not want to openly talk about weight.

So what?

In clinic I am required to not only treat patients to make them better, but should also suggest lifestyle changes that can improve their health. I have had a few patients who are struggling with their weight ask how they could lose weight or if losing weight would help their back pain / presenting complaint. It is useful to have knowledge to support them to do so, I can suggest different exercise, discuss any exercise they did in the past that they really enjoyed. I know many gyms in the area that do classes for many different ages. It is important I support them in contacting the GP as well if they have an issue with their health they want or need to address.

Now what?

With this patient it has made me realise that not everyone knows how to fully look after their health. There is so many different suggestions on how to lose weight or eat better, especially from the internet. I have a good knowledge of good exercise and diet suggestions, but I would like to either do a nutrition course or exercise/ personal training course to have more knowledge in helping my patients improve their health. In the future I will discuss with my patients the importance of losing weight and how it can help their presenting complaint, rather than waiting for them to bring it up with me. It is a topic people aren't always comfortable in talking about so as a health professional it would be brought up as health related concern rather than a personal topic.

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A6. You must respect your patients’ dignity and modesty

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A6. You must respect your patients’ dignity and modesty

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What?

I had a 46 year old patient who came in with left knee pain going into her adductors, she came in wearing leggings, before examination I asked if she was comfortable to take her leggings off, she shared she was uncomfortable with taking them off and did not know that she would need to. I respected her decision and she kept her leggings on, this did not affect the treatment much as I just did other techniques and not any soft tissue in this session. At the end of the session I discussed with her maybe next time if she bought with her shorts or baggy trousers that could easily be rolled up to see her leg. She was happy with this and bought shorts in the following week to change into. When she was changing I left the room to give her privacy when she was undressing. I made sure I had this conversation with my patient because if I did not I would not have been able to work into the tissues using soft tissue as effectively as if she was wearing shorts. I can understand that she would not be comfortable taking her leggings off if she was not aware she may need to. I'm glad I talked to her about it because she could remain comfortable wearing shorts the nest session and I was able to do more effective treatment.

So what?

If the patient does not consent to removing their clothing then I have to work with that. I can discuss other options for future sessions, and that some techniques may not be possible like soft tissue techniques due to clothing, but that treatment is still available. I need to respect their decision as not many people are comfortable undressing. Leaving the room also gives the person privacy to undress or get changed.

Now what?

When discussing with patients about undressing I will give them more options, and discuss why I may need them to undress, or that they can put the clothing back after examination. This gives the patient informed consent and allows them to have privacy and control over their body. I always offer to leave the room while the patient undresses before examination, this ensures they feel respected and have privacy.

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A7. You must make sure your beliefs and values do not prejudice your patients’ care

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A7. You must make sure your beliefs and values do not prejudice your patients’ care

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What?

In clinic I had a 25 year old male patient, he presented with right knee pain around the anterior knee and on the joint line, he had a history in the military service. His knee was stiff in the morning and after sitting for a long time, but eased after 30 minutes. On examination there was pain with movement of the patella, active knee flexion and extension was painful but there was no reduced range of motion. His right vastus lateralis was very tender to palpate and hypercontracted. There was limited internal rotation of the leg leading from restriction in the tibia/fibula. From the case history the presentation seemed degenerative with a lateral pattern. I treated him using mainly structural techniques because that is what I tend to fall back on. I used articulations, MET and soft tissue. The treatment I did helped him a lot, he had less pain and on testing a few sessions later there was no pain in his knee actively or passively on any vector or when moving his patella. He still had the reduced ROM in his tibia/fibular leading to reduced internal rotation of the leg, I had tried BLT and other techniques but the restriction remained. I then saw the patient with a tutor that has a functional approach, I mentioned this to him and he helped me release off the tibia/fibular using a functional release. This was something I had tried previously but I was missing longitudinal compression which I was not aware I needed to add. The tutor also suggested I tried some other functional techniques like fascial release of the quadriceps and releasing off the SIJ. These all helped the patient get a lot better. I felt not as confident doing functional techniques and it was something I felt I needed help with. I was grateful I had a functional based tutor with this patient so I could learn what I was missing to help him get better. It was a good experience to have as I learnt a lot with this patient and how to do different functional techniques.

So what?

Functional techniques are not my strongest techniques, I tend to fall back onto structural techniques because that is what I am more confident at and believe works better for me. For this patient in particular I let my belief that functional techniques may not have worked as well because I was not confident at them. I also knew the tutor I first had the patient with was more structural so they suggested only structural techniques. When I had the next tutor they only suggested functional techniques, I find a lot in clinic that many tutors have a preference in what techniques they want you to do, I find I avoid some techniques depending on what tutor I have because they believe they are not as effective. When seeing patients like this I should think structurally and functionally even if it was out of my comfort zone. I should have been more global in assessing his knee as this would have helped me find the tibia/fibular restriction sooner.

Now what?

In treatments now I will try other techniques if the techniques I try do not work for that patient. I know I will have preferences on techniques but continuing to try different techniques, especially when learning and at the ESO clinic will help me become more confident in them.

If I have a belief that a technique may not work, I will still try the technique again as it may work for this patient or I did not do it right before, I don't have enough experience to know whether it is how I do the technique or the technique does not work for this patient, so I need to keep trying. I also will try to not let tutors beliefs in what treatments are effective or not alter the techniques I will do for my patients. I will also carry on practicing my functional techniques so that I am more confident and can use a wider treatment approach to care for patients.

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B1. You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath

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B1. You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath

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Attached is a CEX feedback form from a year 3 CEX for a returning patient.

What?

In my second CEX of third year I had a 66 year old female patient presenting with neck pain, lower back pain and right shoulder pain. In examination she had pain in her lower back on flexion and had noticed limited ROM when doing movements. Her neck was painful in end range of rotation and side bending 'stretched' on the opposite side of movement. The shoulder pain was at end range reaching above her head. I had previously examined her lower back in a previous session and found reduced range of motion active and passively, In this session she wanted to focus on her shoulder pain. I examined her neck and found reduced AROM and PROM in rotation, side bending and extension, her traps were also hypercontracted. I tested her shoulder actively and passively and found reduced internal rotation, abduction and flexion in the right shoulder. My tutors feedback was to improve my passive shoulder examination.

I felt that my shoulder passive testing was not as good as it could have been, I was not very confident doing it. I had not had a patient with shoulder pain for a while and had not practiced my shoulder examination. I should have been practicing all my examination, this would have gotten me a higher grade if I had been practicing more.

So what?

In the CEX I was confident in my active testing and what to look for. I should have retested the lumbar spine passively because it was an exam and to make sure it was not any other DD. My passive testing of the shoulder was not very smooth, I had not done it in a while and was not confident with it. It was good to have the exam to highlight that I need to stay on top of practicing examination, I know how to do it, it just was not as smooth as it should have been. I understand now that I need to be more precise with my testing and go to the end range on shoulder range of motion more, to really assess the barrier. This would have helped me with my working diagnosis, as it would have supported my diagnosis or gave me information to diagnose something else.

Now what?

I will ensure that I regularly practice my shoulder examination so I know it well. I will go over examination of all areas of the body so that I dont have another experience of not being confident in the examination I am doing. I also will make sure that I have enough knowledge of the DDs to know what examination I need to do for each. This will help me get the best working diagnosis and my patient will get the best care.

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B2. You must recognise and work within the limits of your training and competence

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B2. You must recognise and work within the limits of your training and competence

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Attached is an chapter about Ataxia, its causes and investigations.

What?

In year 3 I had a 52 year old female patient who presented with lower back pain but also had some worrying systemic and neurological issues. She has ataxia and leg weakness leading to 2 falls, dysphagia, dysarthria, slurred speech, trouble writing and clumsiness that started 2 years prior. On examination the cranial nerve screen was clear but her gait was shuffled and off balance, Romberg's was positive. She had a history of trauma that she opened up about that led to PTSD, which had led to issues with sleep and sleep apnoea. I wrote a letter to the GP because I was worried about her health and that as osteopaths we cannot help with many of the symptoms she was presenting with. I was panicking a little during the case history but I kept composed and took my case history and made sure not to look worried as this would have only worried the patient. I had not had a patient before with these kinds of symptoms so I was not sure exactly what to do, but my tutor guided me through and we talked to the patient together. I was really grateful that my tutor guided me through and was there when I needed them.

So what?

With this patient and the symptoms she presented with, there were many things as an osteopath I could not help with. We must work within our limits and this patient was someone who needed more help than I could give her. In clinic we must recognise that sometimes we cannot help everyone, that the best care they may receive is from another health care professional. I had good knowledge when I was doing my case history to know that she needed medical help and scans rather than osteopathic help. After the session I researched why she could be getting these symptoms and specifically why she had ataxia with them. I read an chapter about ataxia (Winchester 2013 pp. 1213-1217), what can cause it, what they do to investigate different causes. It was informative to know what the patient could have even though I could not treat her. It also helped my knowledge on the subject so know I know why I am asking certain questions in the case history.

Now what?

On reflection the patient was a great learning experience, she was so grateful that we listened to her and believed what she was going through. It made me really sympathise with the patient as what she was going through was really tough. I am happy I was able to help by sending a referral letter and listening to her. It will make me think in future with patients if there is any better care they can receive other than osteopathy as I may have limited skills or knowledge to help them fully. I will also be practicing what to ask when a patient says yes to a question that is worrying, to make sure I have the right follow up questions so I do not miss anything and I do not feel panicked when another patient comes in with worrying symptoms.

Reference:

Winchester, S., Singh, P. K. & Mikati, M. A., 2013. Ataxia. Handbook of Clinical Neurology, Elsevier.

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B3. You must keep your professional knowledge and skills up to date

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B3. You must keep your professional knowledge and skills up to date

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Attached is my certificate from the sports massage course from summer 2021

What?

In the Summer of 1st year I did a sports massage course. It involved going over anatomy of muscles and bones and strains that occur. We then went over the theory of the sports massage techniques online that we will be shown in person. Then over a weekend we were shown different techniques for pre and post event massages and then maintenance massage techniques like muscle energy techniques (MET), soft tissue release, effleurage, and other techniques. This added to my skills in osteopathy because we went over anatomy and techniques that we also learn in class, like MET and effleurage. I enjoyed the course, it was good to learn different techniques to be able to offer that alongside osteopathy, to be able to go over techniques twice and go through the anatomy again.

So what?

Along side my learning at the ESO the course helped me go over anatomy I had learnt in year 1 and apply it to muscles and the techniques we were learning. When in clinic I do not use sports massage techniques but some of the techniques we learnt on the course we were also taught in class at the ESO, like effleurage and MET. Specifically MET was useful to learn in the course because we started learning MET the September after the course, so some of the theory and techniques we had learnt already we got taught again so it was useful to go over and have that knowledge beforehand. I know have a better understanding of the MET techniques, as I was able to be taught them twice. Even though the sports massage and osteopathic way of doing MET is slightly different I still found it useful to go through twice.

Now what?

After clinic I will be using sports massage as an extra skill once I graduate, I will be able to offer more to my patients, as some patients only want or need a sports massage, so I can offer them that instead of osteopathic treatment which is more expensive for them. I will be going over this course to remind myself of what I learnt, it adds to the knowledge that I have and I will be interested in doing other courses similar to expand upon and keep my knowledge up to date. In the future I will also be required to do 90 hours of continuing professional development (CPD) over 3 years (GOsC 2018) to keep up to date with my knowledge in the profession, so doing courses like this could be a good way to do my CPD.

Reference:

GOsC, 2018. Continuing Professional Development Guidance. Available at: https://www.osteopathy.org.uk/news-and-resources/document-library/continuing-professional-development/continuing-professional-development-guidance/ [Accessed May 11, 2024].

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B4. You must be able to analyse and reflect upon information related to your practice in order to enhance patient care

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B4. You must be able to analyse and reflect upon information related to your practice in order to enhance patient care

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Attached is reflective essay from year 1

What?

In year 1 we had to write a reflective essay about our observations in clinic. We had to talk about how different OPS applied within clinic. I talked about what practitioners did to make sure they complied with the OPS. I talked about working within our limits, keeping patients safe and referring patients when they need to be. I was happy doing the reflective essay, but it was something I had not done before so I was worried I may have done it correctly, I think I could have explained more about how these scenarios made me feel, so it could be more personal. I felt it was important to reflect upon what I saw in clinic so I could think about what I would do in certain situations and learn from observing in clinic.

So what?

This was a good exercise to think about how the OPS apply throughout the clinic. It ensures patient care and safety. It makes sure that even in year 1 we are applying and looking out for the OPS in a clinical setting. It taught me that it is important to reflect upon how as practitioners we can improve our knowledge and skills, fix mistakes we may have made in the past and ensure the best patient care. Within the reflective essay I was not personal enough, I did not talk enough about how the scenarios made me feel or how they had an effect on me.

Now what?

Since I have reflected using the OPS about observing in clinic it has made it easier to reflect upon myself. Knowing what the OPS are I can ensure my patients get the best care. I can also reflect upon my own skills and improve them if I need to. Reading back on my reflective essay in year 4 it surprises me that now all of things I mention in year 1 are ingrained into us now, that referring a patient is just as important as treating them, that I know know what I can and cannot treat. Now when reflecting I am using a reflective model (Rolfe et al. 2001) to guide how I am writing my reflections, this has helped to ensure I include all the necessary points to properly reflect upon my past actions. Throughout my padlet I have used this reflective model to help me reflect upon the osteopathic practice standards (GOsC 2024). In the future I will be reflecting upon my treatments and how I am working because when I look back I will be able to see how much I have grown as an osteopath and how much more knowledge I have gained. I will also make sure my reflection is personal and talk about how it made me feel in the scenario.

References:

GOsC, 2024. Osteopathic practice standards. Available at: https://standards.osteopathy.org.uk/ [Accessed April 1, 2024]

Rolfe, G., Freshwater, D., Jasper, M., 2001. Critical reflection in nursing and the helping professions: a user’s guide., Basingstoke: Palgrave Macmillan.

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C1. You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients

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C1. You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients

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Attached a results from a clinical methods exam done in year 2

What?

In year 2 we had to complete two clinical methods exams. These included neurological, cardiovascular, respiratory, abdominal examinations, active and passive testing and orthopaedic testing of different areas of the body. We needed to know all of these and then answer questions regarding them. It was a PASS or FAIL exam and ensure we knew our clinical examination before we went into clinic in year 3. I ensured that I knew all my examination for this exam, it was really important to me that I was ready for clinic. I felt this exam was a really good way to test us, it put us into scenarios that would occur in clinic, with a time limit to get examination done. I was proud of how this exam went, I worked hard for it and felt I had done well.

So what?

Doing this exam taught me that I need to know all my examination really well and that patients can come in with any problem and I will need to be able to examine and treat them. Knowing my examination can ensure the patient gets the best and safest care, if the patient has neurological or cardiovascular symptoms they may need to be referred, by knowing these examinations it helps me to examine, write a letter and refer the patient to get the best care. Also knowing my examination means I can correctly diagnose and treat the patient with the appropriate osteopathic care. I understand the importance of the exam, they need to ensure we are safe and competent before going into clinic and treating patients.

Now what?

This makes me understand the importance of keeping on top of my knowledge and in future when I am out in practice I will be revising examinations for different areas, whether it is orthopaedic testing or pathological that can help a patient get referred. This will also help me get better at diagnosing patients as the more practice I have of examinations the quicker and more efficiently I can diagnose.

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C2. You must ensure that your patient records are comprehensive, accurate, legible and completed promptly

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C2. You must ensure that your patient records are comprehensive, accurate, legible and completed promptly

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Attached is a blank case history form, which includes space for their presenting complaint, past medical history, systemic health, examination and treatment and management plan.

What?

In clinic we have written case notes, for new patients we ask their presenting complaint, we ask about and record the onset, presentation, symptoms, exacerbating factors, and other factors that help us get to a diagnosis. We then have to record their goals and expectations. The next page we ask and record their past medical history, which includes operations, accidents, illnesses, investigations, medication, family history and other factors. Then we ask systemic health, about respiratory, cardiovascular, gynaecology, biliary and other systemic inquires. After that we record our differential diagnosis, examination findings, consent for treatment and treatment/ management plan.

The continuing patient form consists of the case history, examination and treatment. The tutor then reads and signs our notes.

When observing in a clinic outside the ESO, they use online patient case history recording. They have tick boxes for certain questions that need to be asked. They mention that it is quicker to record notes online that written. The case notes then get saved to a confidential online system where as the notes at the ESO clinic are kept in folders in locked filing cabinets. I personally like the hand written notes, you can annotate and draw how the patient looks and where their pain is. It is quite long to write out some of the examination and treatment. I have not used online case history notes so this will be interesting if I work at a practice that use them. I am always thorough when recording my patient notes and consent throughout, so I am happy with the way I use the forms. I find in the past I haven't recorded my neurological screen properly, I have said their myotomes are normal, but I should have put 5/5 instead so that the patients myotome strength can be monitored accurately with numbers.

So what?

It is important that we record patients notes accurately, so that if another practitioner were to take over or cover your patient they would be able to fully understand the notes. If the patient requests their records all the information needs to be there for them to access. It may be necessary in a severe case, if the patient choses to sue or complain to GOsC because of your treatment, you can pull your notes and prove your case because your notes are accurate, comprehensive and legible. We must also complete the notes during or just after the session and not days after, this ensures we do not forget to write anything. We also should not rewrite notes as it has to be the original copy of notes in the file, no matter how messy they are. Online case notes are accurate, they have tick boxes for important questions so that consent is always questioned, they also seem to be less messy but may not be as detailed as paper notes.

Now what?

In clinic now I am confident with writing notes and I ensure that I accurately record my case notes, especially examination and neurological findings. I make sure that I record my myotomes in numbers rather than stating they are good or weak. In future an not sure which case notes I will use, online case notes seem to be quicker to write and safer to store, especially if the clinic does not have much room. I know a lot of clinics that use online case history notes so I will make sure I look through how use them and familiarise myself with them.

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C3. You must respond effectively and appropriately to requests for the production of written material and data

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C3. You must respond effectively and appropriately to requests for the production of written material and data

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Attached is a referral letter of a 20 year old patient

What?

A 20 year old student presented to the teaching clinic with episodic lower back pain, lower bilateral neurological symptoms when seated or when squatting and deadlifting weights. He had a history of contact rugby from the age of 12 which is around when his lower back pain started. The pain was exacerbated with extension and rotation and the patient shared he gets lower extremity muscle tremors after exercise and markable L5 muscle weakness when the lower back pain is worse. The neurological symptoms including shooting pain and numbness of both palms of the feet and all digits developed 5 years ago and have been progressing. The patient was screened for cauda equina and asked questions to rule out disc herniation - Valsalva, bandlike pain, worse for sitting and bending over, these were all negative. When the patient had the appointment he had no lower back pain. In examination his neuro screen was clear, L2-S2 myotomes were all 5/5 bilaterally, reflexes L4/S1 were both 2/4 bilaterally, and dermatomes were all normal. SLR and SLUMP tests were both negative bilaterally. Due to the patients history of contact sport, the nature of his episodic lower back pain, the developed and worsening bilateral multiple nerve root neurological symptoms, I decided to write a referral letter to his GP for imaging to rule out a potential spondylolisthesis. With consent from the patient I drafted a letter which my tutor checked over and was happy with before we both signed. The letter was given to reception to be processed and sent to the GP. With this patient I felt quite overwhelmed because there were a lot of symptoms going on, but I asked all the questions I needed to and examined to rule out anything else. I was proud of how I managed this patient, my knowledge was good and I was happy with the examination I did and my decision to refer him. My tutor was also pleased with how I managed the patient.

So what?

This taught me that I need to be able to write letters well for patients to ensure they get the best care out of coming to see me. With this patient I was confident in writing the letter and requesting investigation to rule out spondylolisthesis. In the past I have found it difficult to write letters that only include the relevant details rather than everything I found in the examination. I have found tutors are always there to read through letter to help remove what information is not relevant.

Now what?

I will be carrying on writing referral letters with input from the tutors, and try to only include the relevant information. For our CCA exam if we need to refer a patient, we will be partly examined on the letter we write. due to this I will be asking for feedback from tutors on my referral letters like I have previously done, to ensure my letter writing is concise and includes all the information needed for the patient to get the investigations they may need.

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C4. You must take action to keep patients from harm

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C4. You must take action to keep patients from harm

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Attached is the first aid course done before going into clinic.

What?

At the end of second year we completed a first aid course in preparation for going into clinic. We learnt CPR, recovery position, how to help with cuts, burns and injuries. We did a test at the end to ensure we understood the course. I enjoyed the course, I thought it was very informative, I felt I fully understood and felt more confident after the course. I feel like if I needed to use first aid in a serious situation I would panic a little but I would know what to do. Now I have done the course I am more confident in being able to help in emergency situations if I needed to.

So what?

In clinic I need to make sure my patients are safe. If someone has a fall or an accident happens I need to be able to give them the best care, assess the situation and call for help or an ambulance if needed. This ensures that patients are not only safe to treat but also that their safety will be priority if something happens. The course ensures I can give emergency assistance and first aid to patients if I need to.

Now what?

When the course expires I will be retaking the first aid course as I think it is important to have and refresh my knowledge to help people in an emergency if they need help. I will also go through the course I did to remind myself of what to do in a first aid scenario so I do not feel panicked if it happened in a clinical setting.

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C4 . You must take action to keep patients from harm 

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C4 . You must take action to keep patients from harm 

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Attached is a safeguarding course done in 2020

What?

The safeguarding course was based on female genital mutilation (FGM), regarding risks, legality, signs of FGM, and what to do if we think it is happening or happened to someone and how to stop it happening. It was a very interesting course, it taught me that it happens to more women than I thought it does. It was quite a touching and sad subject to learn about because I did not realise it happened so often.

So what?

In clinic I see many women and young girls. I learnt the signs of FGM that I need to look out for, before I did the course I did not think that was something I would need to look for, but sadly it is. It is good to know the signs so that I can help individuals if I think they may be in danger. I can also talk to my tutor about what to do next and how to report it.

Now what?

It was very informative to know the signs to look out for so I can keep my patients safe. I will be taking other similar courses to ensure I have the knowledge to keep my patients safe and to be able to help if they are not in a safe situation. I will also be doing other safeguarding courses because I think it is important to know what other signs there may be when someone is in danger.

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Role of disinfection and hand hygiene: a Covid-19 perspective

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C5. You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation

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C5. You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation

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Attached is an article about the importance of disinfection and hand hygiene.

What?

During the beginning of third year I had a 82 year old female patient who came in with bilateral shoulder pain, with degenerative changes in both, I would do gently treatment and she felt benefit from coming in monthly for maintenance. During her appointments she always chose to wear a mask because of the potential risk of covid-19. At this point in clinic we were not required to wear a mask but encouraged to wear one if we needed to. I always wore a mask with this patient because she was older and more vulnerable, on discussion she felt more comfortable with her and myself both wearing a mask. The treatment rooms all have antibacterial spray and paper towel in to clean the bench before and after every patient. I always make sure that I clean the bench before I see patients in case another student has not cleaned the bench after their patient.

So what?

For this patient wearing a mask and myself also wearing a mask allowed her to continue to get treatment. If she felt vulnerable to getting covid-19 again then she may not come for treatment, so by her and myself ensuring we are doing what we can to stop her catching it. Cleaning the benches after ensures that the clinic is clean and hygienic for the patients. A study by Roy et al. (2020) talked about the importance of disinfecting your hands and commonly touched surfaces to stop the spread of the virus. By cleaning the bench it stopped the transmission of the virus and making it a lot less likely that she would get sick.

Now what?

I will ensure I always have a discussion with older patients if they would like me to wear a mask during treatment, especially if they come in wearing a mask. I will wear a mask when I have a cold to make sure I do not spread any virus/ infection. I will also make sure that in the future I have cleaning supplies to clean the benches between patients as it has been shown to stop the spread of viruses (Roy et al. 2020).

Reference:

Roy, A., Parida, S. P., Bhatia, V., 2020. Role of disinfection and hand hygiene: a COVID-19 perspective. International Journal of Community Medicine and Public Health, 7(7), pp. 2845-2849.

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Role of disinfectant and hand hygine covid 19

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C6. You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients

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C6. You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients

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What?

During summer between 3rd year and 4th year I observed at a multidisciplinary clinic for a few days. In the clinic there were osteopaths, physiotherapists, podiatrists, sports massage therapists and many more. During my time observing osteopathy I saw a few patients that were told that one of the other therapists/ professionals would be able to help as well or better than the osteopath.

I observed a young patient that had right shoulder instability, he had no trauma but his right shoulder would sub lux sometimes when throwing or swimming. The osteopath had treated him for a few weeks giving him treatment and exercises to strengthen the shoulder. The osteopath mentioned to the patient that they could book in with the physiotherapist instead because there were no more restrictions or symptoms that the osteopath could treat, the patient just needed to strengthen the shoulder.

Another patient I observed at the clinic was a 50 year old women who presented with hip degeneration. She had mentioned that she bought some insoles because her feet are flat, and they seem to help. The osteopath suggested seeing the podiatrist along side the osteopathic treatment to properly asses her feet and give her proper orthotics.

When observing at the clinic it made me realise that osteopaths can really easily work with other health care professionals, and that patients are happy to seek alternative treatment alongside osteopathic treatment if it means they get better quicker. It was interesting to see how they bought it up with the patients, especially with the patient that had shoulder instability, the osteopath was happy to refer the patient onto a physiotherapist to prescribe and guide then through exercises.

So what?

Working with other health care professionals enhances the patients care. With these patients the practitioner could have just kept treating those patients but the best care for them was to also see the other practitioners that work in the clinic. In the ESO clinic we are also encouraged to refer patients to other health care professionals if we think it will aid their recovery from an injury or enhance their health.

Now what?

It makes me reflect upon if any of my patients could have been referred or advice to see other health care professionals. In future when treating patients I will think if there is any other health care professional that may help them as well or better than I can. For example like the patient I observed in the multidisciplinary clinic I may have a patient that needs orthotics, I may advice them to go to a podiatrist. In future I would like to work in a multidisciplinary clinic so I could better the care and treatment for my patients by suggesting other treatments they may offer.

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D1. You must act with honesty and integrity in your professional practice

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D1. You must act with honesty and integrity in your professional practice

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What?

I had a 3 month old baby patient in summer clinic of year 3, I had only been treating babies for a few weeks. The baby had a prolonged birth with the use of forceps. The baby had trouble sleeping and waking up many times throughout the night for comfort, the mother just wanted to check there was no issues. When examining the baby I did a musculoskeletal assessment as well as a cranial assessment. When I was doing the cranial assessment I explained to the mother what I was looking for and trying to feel for, I found no musculoskeletal restrictions but cranially I found compression of the occiput and a dysfunction of the right temporal bone. Before I began treatment I explained what I had found and wanted to treat. I was honest with the mother that she may not see much going on but I can feel a lot going on. The mother asked a few questions about cranial treatment and how it worked. I felt a bit worried when explaining cranial to the mother because I had only been treating babies for a few weeks and had not explained cranial osteopathy to parents many times before this appointment. I was worried I would explain it wrong or not be able to answer their questions, but I managed okay. I treated this baby for a few sessions until the restriction was gone, the parents also saw some improvement. I discharged the baby as I did not need to see them anymore and did not want to charge the parents when the baby was okay. I was honest and explained this to them and they were happy with this. It would not be honest or working with integrity if I continued to see this baby when the restriction was resolved.

Sometimes parents just bring their child to the clinic just for a check up rather than coming in with a problem. If after examination I dont find anything I would explain that I cannot find any restrictions or issues with their baby, that I do not need to treat them. I have to be honest with the parents and not treat the baby just because or just to get money from the parents. They are worried about their child so if a health professional says they can help then of course they would pay to get treatment. This is not working with integrity. I do worry that parents may not be happy when I say I cannot help any more because they may have not seen much improvement compared to the improvement I can feel.

So what?

This makes me think about how I need to be able to explain and speak about what treatment I am doing cranially. Making sure I explain the techniques better can help the parents understand that they cannot see a lot going on with cranial treatment but as a practitioner I can feel what is happening. The parents may not see much improvement from treatment but when reassessing I can feel a change or improvement I can explain to them what I feel and can reassure them that there are changes occurring even if they are not visible changes yet. In clinic I also ensure that once the baby has no more restrictions I discharge them.

Now what?

From this experience it showed me I need to work on my explanation of cranial osteopathy to ensure I am confident and do not have to worry when explaining it. I will be make sure I practice this with my colleagues so we can all have a good explanation. This also helps the parent understand the techniques more in depth. I will try to have a set explanation of what cranial osteopathy is so I can be more confident when I am getting informed consent. In the future I will explain to the parents in the first session that I may not be able to make a full change to their baby as some things for example, reflux cannot be treated, but I can treat restrictions that may contribute to presenting complaint. I think talking to them about this in the first session will help me be able to discharge them once the restrictions are gone, even if they baby may not seem 100% better.

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D2. You must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath.

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D2. You must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath.

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What?

In clinic I greet patients with a handshake when I first meet them. This sets a professional boundary with my patients. When treating them I ask and talk about general questions rather than personal questions. I tend to not answer personal questions that patients ask me. This maintains a professional boundary with my patients. I think that professional boundaries are important especially as a female practitioner. I have heard about a few comments male patients have said to female practitioners, in this instance the reception book the patient in with a male practitioner. It makes me feel sad that this occurs within the profession but I think keeping that professional boundary can help stop this happening so often.

So what?

It is important in clinic that there is a professional line that is not crossed, for the practitioner and patients sake. It is for safety of young practitioners, safety for patients, if there is a clear professional line the practitioner and patient know not to cross. For the practitioner it could be inappropriate questions from male patients or that they feel uncomfortable around them. For the patient it ensures they get what they paid for, and do not get taken advantage of. Some patients can be vulnerable and a practitioner may be at fault for crossing a line. So by following the OPS it can ensure our own safety and the safety of our patients.

Now what?

I think it is good to have a set boundary with patients, especially younger patients it may seem more of a friendship to them if they have been seeing you for a while, but a boundary has to be set.

I personally have not had any problems regarding patients and boundaries, I try to keep a clear boundary and am not friends with patients, and not friends with them outside of the clinic. The conversations I have with patients are very general and do not include much if any personal information. In the future if I thought a patient crossed a boundary I would either, tell them, tell someone I work with to get advice or give them to another practitioner (for example a male practitioner if the patient made me feel uncomfortable).

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D3. You must be open and honest with patients, fulfilling your duty of candour

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D3. You must be open and honest with patients, fulfilling your duty of candour

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What?

I had a 33 year old patient for my second mock CCA in year 4.

She presented with lower back pain, which she had been experiencing since 2017, but had flared up in the last few months. She was overweight but had recently had a gastric sleeve and was continuing trying to lose more weight. She had some pins and needles sensation into her right lateral thigh and leg. Throughout the case history there was some answers to questions that were quite worrying. She had been experiencing bowel changes for the last 4 months, she had diarrhoea and constipation, blood in her stools, and abdominal pain. She had sent a bowel sample off to the GP which came back very abnormal. The back pain did not have an onset and had gotten worse around the time she started to experience the bowel symptoms. The pain also was constant and did not have a pattern to it. The patient had an appointment with a consultant about her bowel symptoms the next day to investigate if she had bowel cancer but wanted to come for her back pain. Due to her symptoms I discussed with the patient that I was not going to treat her today but I could examine to see if there was any other contributions to her pain. I examined the patient because she was safe to do so, I only did active and passive examination of the lumbar spine and a neuro screen. From the examination there seemed to be some degeneration in her lumbar spine and weakness of L5. I explained that there could be some musculoskeletal involvement to her lower back pain but she was not safe to treat due to the risk that she could have bowel cancer. I explained the link between her bowel and back pain, that there is a visceral referral that could be making her back pain worse. I was honest with the patient that she was not safe to treat until I could rule out that the back pain was not because of the potential bowel cancer. She was very understanding with this and was going to book in once she knew it was not bowel cancer. I felt sad for the patient because she really wanted some help for her back but she was understanding that she was not safe because of her symptoms. I just hope that she gets the investigations or treatment she needs.

So what?

With this patient I was honest in telling her I could not treat her until she was safe to do so. There was musculoskeletal involvement but there was risks involved with treating her that meant I could not. In clinic we have to be honest with our patients, there may be something we think we can treat but we must explain all the risks, the diagnosis and be honest with them so they can make the choice for themselves.

Now what?

On reflection of this patient, I am very happy with how I handled this patient, my tutor was happy with how I managed and handled the patient and I passed my mock CCA. In future if I have another patient like this I am more confident in the way I would handle the presenting complaint. Being honest with the patient is the most important, so they can make an informed decision, I must be honest with a patient when I cannot treat them.

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D4. You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise

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D4. You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise

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Attached is the response to the complaint letter.

What?

In second year we had a course work where we had to reply to a complaints letter. The letter was based on a parent who brought their child to a clinic and was unhappy with the treatment they received. In the reply letter I spoke about how the clinic should not have said they can treat certain things on their website as it was not in accordance to the ASA (2022). I also spoke about the negative connotations that GPs sometimes put on the profession, which was what the parent had experienced when they visited the GP. I spoke about why leg length discrepancy occurs and how this may affect the child. When writing the response to the complaints letter I felt it was important to understand how the mother was feeling, and why she may be upset with the treatment her child received. I feel like the course work to respond to this letter was important for us to know how to respond to complaint letters.

At the clinic there is a complains policy in place in case patients are not happy with their treatment. They can either speak to the practitioner, receptionist or can fill out an informal complaints form, if that is not resolved then a formal complaint can be made.

So what?

After this course work I was more informed about what we as osteopaths can say we can treat, before this course work I was not aware of the ASA (2022), so it was useful to have the coursework. It is important that we did this course work because patients may make a complaint about something that happened in a session, even if you think everything went fine they may not be happy. There could be any reason they complain, it could be consent or the technique, they felt uncomfortable or a misunderstanding. Of course as osteopaths we follow the OPS and by doing so there should not be a misunderstanding but sometimes this occurs.

Now what?

If I did not have this course work I would not know what to do if a patient complains. Other than this course work it has not really been spoken about unless it has happened to a tutor. I feel better about writing a response to someone if they did complain but I also would need to ask for help or look into it more before graduating.

Reference:

ASA, 2022. Health: Osteopathy, Available at: https://www.asa.org.uk/advice-online/health-osteopathy.html [accessed April 15, 2024]

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D5. You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively

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D5. You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively

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What?

In 4th year I had a patient (also mentioned in OPS B2) who came into the clinic with lower back pain and worrying neurological symptoms. During the session she had disclosed some personal details about abuse that occurred in her childhood, she talked about how it effected her, especially with her sleep. She felt that she could confide in me, I sat and listened to her and she felt heard, she was very grateful that I sat with her, listened and was happy to help push for more investigations with the GP. What she told me was private and I wrote down that she had abuse in the past but did not write the personal details of what she told me (unless they were imperative to the case). I also did not share with my group the personal details she told me because she trusted them to be confidential. The patient was very grateful to be listened to and even though we ran out of time that session she was really happy she could be understood and got to speak about all the symptoms and problems going on as doctors had not been listening to her. This made me feel sad for the patient, I was sympathetic to their situation. I was happy with how I dealt with the scenario because it was emotional for them to open up about, and I felt I really helped them.

So what?

In clinic I cannot be sharing all the personal details my patients confided in us. When discussing with the clinic group, the details she told me did not aid the diagnosis or case so they do not need to be shared. This taught me that sometimes patients need that space to talk and open up about what has happened, for them it can be a relief and really helpful for them to be fully listened to.

Now what?

In future I will be more aware of information that does or does not need sharing with the group when I present a patient. This has made me realise that some information does not need to be shared. If I do have a patient that confides in me like this again, I will be looking out for yellow flags and if there are any signs that the patient may need other professional help. If abuse is still occurring, I need to ensure my patients are safe and report it. If other students are talking about personal details that patients told them in confidence I will mention that they maybe should not talk about it to other students.

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D6. You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law

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D6. You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law

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Attached is the Equality act 2010

What?

The equality act (2010) was made to protect people in the workplace or within society from discrimination about protected characteristics, these include: age, disability, race, gender reassignment, religion, marriage and civil partnership, sex and sexual orientation. As well as these characteristics it also protects individuals from pregnancy and maternity discrimination. Reading this made me realise how often discrimination occurs within the work place, and how important it is to have this in place. I feel like this is an important topic that needs to be discussed more within clinic/ careers to ensure it does not happen accidently or around the work place.

So what?

Diversity occurs throughout the clinic, I recognise this.

I must respect my patients and must not discriminate against them in any way. It is illegal to refuse to treat or hire / fire an individual by discriminating against these protected characteristics. Reading the equality act taught me that it can occur anywhere and I need to look out for it as well as ensuring I do not discriminate against others. It also ensure the patients get the care they require.

Now what?

In future practice I will continue to follow the equality act. Within clinic I will be respectful to colleagues and patients no matter their diversity. I will not discriminate against any patients and correct or report others who may do so. It is really important that the act is abided by.

Reference:

Equality act, 2010. The stationary office, London. Available at: https://www.legislation.gov.uk/ukpga/2010/15/pdfs/ukpga_20100015_en.pdf [Accessed April 15th, 2024].

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D7. You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace

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D7. You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace

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What?

Before observing in clinic we were required to complete a DBS check, this was done through the university and is done to check our criminal record and ensure we are safe to be around children and vulnerable people before we could observe. It is also done to ensure the safety of employers and existing employees in the workplace as well as those who you may be caring for. Along with the DBS check it is important that we are professional outside of job so we do not put a negative reputation upon the profession. I feel like this is important because you don't want to b working with colleagues that may have a criminal record and could be unsafe to treat children and vulnerable adults.

So what?

A DBS check ensures the safety of the patients we observe and treat, it is important that within the clinic there is nobody that has a criminal record or could be a risk to other practitioners, staff and patients. We have all had a DBS check meaning everyone that works at the clinic is safe to be left with patients and trusted to work with them. It is also good for the patients and parents of children who may be patients to know that everyone who works at the clinic are safe to be around and safe to be treating children and vulnerable adults.

Now what?

I will continue to uphold the reputation of the profession, whether this is outside of the workplace when I am discussing the job, ensuring I am not giving advice or treatment unless they are my patient and in a clinical setting. I will ensure that I am following the OPS guidelines and by doing this I will be upholding the reputation. When I register for GOsC I am required to get another DBS check, I will ensure this gets done as soon as possible. It is really good that every osteopath has to register with GOsC and have to have a DBS check, this ensures the safety of all practitioners and patients.

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D8. You must be honest and trustworthy in your professional and personal financial dealings

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D8. You must be honest and trustworthy in your professional and personal financial dealings

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Attached is the finance part of the business plan course work from year 3

What?

In year 3 we had to write a business plan. I planned that I would set up my business up in the converted garage next to my house, to save money. I researched clinics in the area, how many were competition, their pricing and demographic they advertised to. I worked out the start up costs, yearly costs and predicted income based on studies. I planned my advertisement which was set to reach a different demographic than other clinics in the area, they were advertising paediatrics whereas I was advertising for sports patients as that was my interest to pursue. I set my pricing at a similar but slightly lower price to get people interested in a new clinic. I felt this course work was really helpful and it made me more confident in starting up a business in the future.

So what?

The assignment was an interesting course work, learning about how to set up your own business, finance and advertisement. It is useful for my future career if I want to build my own business/ clinic. Being able to work out finances is very important, making sure you have insurance and membership is vital to be able to open a clinic. Taxes need to be correct so keeping detailed financial information and costs is necessary. It taught me so much about how to be able to start my own business.

Now what?

After doing the assignment it made me think that it was more possible to start my own business. In the future I will be looking into how to expand upon my business plan if I do want to start a business in the future. It really helped me understand how to do it and makes me more confident in planning to open my own clinic. If I do chose to start a business I will research more into how I can do so, there is a lot more I would need to research to be able to actually start a business.

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D9. You must support colleagues and cooperate with them to enhance patient care

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D9. You must support colleagues and cooperate with them to enhance patient care

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Attached is a blank handover form

What?

In the last term of 4th year practitioners handover patients to 3rd years. The patients are mainly those who have been coming to the clinic for many years.

Another colleague and myself got handed a patient from two 4th years students that shared him as a patient. He was a 46 year old patient that would come to the clinic each week, he had suffered from a stroke over 10 years ago and felt that weekly treatment allowed him to keep working his own business and carry on with his life. I shared this patient with another practitioner and we each saw him biweekly. The treatment we would do included a whole GOT, focusing on symptomatic relief of his left side which was not affected by the stroke and increasing movement on the right side that had contractions and hypertonia of the muscles. We were seeing this patient for most of our 3rd year and decided to hand him over to 3rd years when we went into 4th year. Myself and the other practitioner both spoke to the patient and explained that we would be handing him to 3rd year students as we had more exams coming up and need more opportunity for new patients at clinic. I discussed with the other practitioner and the reception staff on which two 3rd year practitioners would be a good fit for this patient. The two practitioners we found came into clinic to meet the patient to see if they wanted to see him every other week and if the patient got on with them. Thankfully they all got on well and the handover went smoothly. I felt a little sad not having this patient anymore because I'd see him every other week and was a nice patient to have. We learnt a lot from this patient and handed him over so that other practitioners could also learn from him.

So what?

It was very useful to have a patient who had a stroke because it is very different to any patient I have ever had. Having the patient with tutors input as well allowed me to learn what treatment was best for him and what treatment I could use in future if I have another patient who has had a stroke. For the 3rd year practitioners it is a learning opportunity, like it was for myself in 3rd year.

Now what?

Now I know what treatment to do for someone who has had a stroke. I will be more confident in giving them treatment and can use the research I had done for this patient for other patients in the future. I think it is very important to help them manage symptoms and aches and pains they have developed due to compensations from the lack of mobility they may have. In future I will make sure to research and make sure I can give the best care to patients similar to this patient, and see how I can change my treatment to better support them. I can also support other colleagues that may have any questions about treating someone who had a stroke as I have not heard of any other patients who have had a stroke be at the clinic recently.

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D10. You must consider the contributions of other health and care professionals, to optimise patient care

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D10. You must consider the contributions of other health and care professionals, to optimise patient care

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What?

In clinic I was observing a colleague and their patient had been coming in for 6 months with right frozen shoulder. I chose to observe because I had never had a frozen shoulder patient before so I wanted to know what treatment the practitioner chose to do and if there was anything I could use if I have a frozen shoulder patient. The patients shoulder was in the frozen stage of frozen shoulder, the practitioner would work on increasing her range of motion, releasing off surrounding muscles and giving exercises to do at home. The practitioner had previously talked to the patient and suggested hydrodilation, where fluid is injected into the joint to help increase range of motion in the joint. They wrote a letter to the patients GP explaining the findings and asking for the patient to be referred to get hydrodilation. I felt I learnt a lot from observing this patient, it made me more confident if I had a patient with frozen shoulder. I was impressed with what the practitioner knew about frozen shoulder and how to help. It was a good learning experience.

So what?

For this patient, treatment was helping and did ease pain and increased range of motion in her shoulder, but the practitioner know there was more that could be done to optimise patient care. In referring the patient to get hydrodilation the practitioner recognised there were other health care professionals that could help the patient and ensure they got the best care available. After the patient I researched hydrodilation and how it helps frozen shoulder. Hydrodilation was shown to significantly improve functionality pain and disability of patients with frozen shoulder. (Debeer et al. 2021). So for this patient this would be a great treatment option.

Now what?

From this patient I have not only learnt more techniques I could do for a frozen shoulder, I also learnt a lot about other pathways and treatment options available along side osteopathic treatment to optimise patient care. In future if I have a frozen shoulder patient I will be discussing the benefits of potentially having hydrodilation as a treatment option. I will be looking into more pathways and alternative options for other diagnoses, so I can be fully informed on the best treatment choice to ensure they get the best care.

Reference:

Debeer, P., Commeyne, O., De Cupere, I., Tijskens, D., Verhaegen, F., Dankaerts, W., et al. 2021. The outcome of hydrodilation in frozen shoulder patients and the relationship with kinesiophobia, depression, and anxiety. Journal of experimental orthopaedics, 8(1), pp. 85.

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D11. You must ensure that any problems with your own health do not affect your patients. You must not rely on your own assessment of the risk to patients

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D11. You must ensure that any problems with your own health do not affect your patients. You must not rely on your own assessment of the risk to patients

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What?

In December 2022 I was sick with covid, the rules at clinic were to not come into clinic if we had tested positive with covid. So for over a week I had to stay home and not come into clinic. My group covered my patients I had that week so they still got treatment. I felt a bit upset that I could not come to clinic and treat my patients but I understood that it was necessary to keep my patients and other colleagues safe. I think it is important to have this in place, if we came in and everyone got sick then the clinic would not be able to run properly.

So what?

It is important to firstly look after myself, I was quite sick with covid and likely would not have felt well enough to come into clinic anyway but the regulations meant I had to stay home whether I felt well enough to come to clinic or not. The rules meant that patients did not get sick because we were sick and still came into clinic. It is important that we do not let our own sicknesses affect our patients. So isolating at home ensured that I did not get any patients sick.

Now what?

In clinic now we do not need to wear masks or isolate because of covid but if I was sick with a cold or respiratory issue I would wear a mask especially of the patient is elderly or vulnerable, this ensure they are safe and I do not put them at harm because I am sick. I will also give them the choice of treatment and if they too would like to wear a mask if I am worried about their health. If the regulations change and we need to isolate again or wear masks I will follow these rules.

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D12. You must inform the GOsC as soon as is practicable of any significant information regarding your conduct and competence, cooperate with any requests for information or investigation and comply with all regulatory requirements

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D12. You must inform the GOsC as soon as is practicable of any significant information regarding your conduct and competence, cooperate with any requests for information or investigation and comply with all regulatory requirements

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Attached is the student fitness to practice policy

What?

The fitness to practice policy ensures patient safety when a student may be unfit to practice, this may be if they are medically unfit, either physically or psychologically, if there is evidence they will not act in accordance to the values and behaviours expected within the osteopathic profession, or if it effects student, staff or patient safety. There will be support academically and mentally provided by the university if need the student must withdraw themselves. I feel that this is an important policy to have in place because if an individual is not safe to treat there are guidelines in place to follow to ensure they also get help if they need it. I make sure that I am fit to practice and try to look out for other practitioners and make sure they are also fit to practice.

So what?

The fitness to practice policy is in place to ensure the safety of patients, staff and students. If an individual is not deemed fit to practice then guidelines are in place to ensure safety of themselves and others. This is very important in clinic as all patients must be given the best care and their safety has to be ensured. This also ensures that students learning and participating in education are kept safe and are not missing out on learning if another student is not fit to practice or causing them safety issues. I have been aware of the fitness to practice policy and do my best to follow it.

Now what?

I will continue to ensure that I am fit to practice and treat patients. If I do not feel I am fit to practice then I know there is support to help me with that. In future I will be checking that clinics I work at have a policy in place and has support if their practitioners are not fit to practice. If I ended up running my own business in the future I will make sure I have policies in place to keep everyone safe.

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ASA, 2022. Health: Osteopathy, Available at: https://www.asa.org.uk/advice-online/health-osteopathy.html [accessed April 15, 2024]

Equality act, 2010. The stationary office, London. Available at: https://www.legislation.gov.uk/ukpga/2010/15/pdfs/ukpga_20100015_en.pdf [Accessed April 15, 2024].

Carnes, D., 2016. What can osteopaths learn from concerns and complaints raised against them? A review of insurance and regulator reports. International Journal of Osteopathic Medicine, 22, pp. 3-10.

Debeer, P., Commeyne, O., De Cupere, I., Tijskens, D., Verhaegen, F., Dankaerts, W., et al. 2021. The outcome of hydrodilation in frozen shoulder patients and the relationship with kinesiophobia, depression, and anxiety. Journal of experimental orthopaedics, 8(1), pp. 85.

GOsC, 2018. Continuing Professional Development Guidance. Available at: https://www.osteopathy.org.uk/news-and-resources/document-library/continuing-professional-development/continuing-professional-development-guidance/ [Accessed May 11, 2024].

GOsC, 2024. Osteopathic practice standards. Available at: https://standards.osteopathy.org.uk/ [Accessed April 1, 2024]

Language Solutions 2023, The Vital Role of Healthcare Translations: Breaking Language Barriers for Quality Care. Available at: https://langsolinc.com/the-vital-role-of-healthcare-translations-breaking-language-barriers-for-quality-care/ [Accessed May 11, 2024]

Rolfe, G., Freshwater, D., Jasper, M., 2001. Critical reflection in nursing and the helping professions: a user’s guide., Basingstoke: Palgrave Macmillan.

Roy, A., Parida, S. P., Bhatia, V., 2020. Role of disinfection and hand hygiene: a COVID-19 perspective. International Journal of Community Medicine and Public Health, 7(7), pp. 2845-2849.

Winchester, S., Singh, P. K. & Mikati, M. A., 2013. Ataxia. Handbook of Clinical Neurology, Elsevier.