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To do after graduation plan -  evidence A4-(ll) - 20.05.2021 

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To do after graduation plan -  evidence A4-(ll) - 20.05.2021 

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

Description
Everything is a cause of stress these days. The question on my mind today - even before graduating - is how will I make sure I keep good standards of practice in the next few years and don't become complacent?

Feelings
Things are stressful enough as it is, but I noticed recently I have been worried about the type of practitioner I will be.

Analysis
It is probably necessary to keep a little bit of that fear alive in order to continue to develop myself.  Both clinics I will work in have specifically stated that they value tutoring and group work. Not only basic osteopathic science knowledge but also communication related skills. This is partly because to be fully practicing in my country I will have to sit a rather difficult CCA-like exam . Getting informed consent is part of the marking criteria. On the one hand it represents more work and more studying, which is daunting. On the other hand the exam is a guarantee that this hard work and standard of practice will at least stay with me for longer.

Lastly, I am going there with my boyfriend, a practicing osteopath. A very annoying one, a challenging one. We are determined to support each other in this process, and call each other when needed.

To do, after graduation

-I can’t wait to have time to explore and study what really interests me. During the first lockdown I suddenly had a lot of time for myself. My different jobs all stopped: the café, the music lessons, the orchestra projects and the administration work for my osrchestra. I started to watch webinars, do online lectures, read.. things that did not fit into my busy routine before that. I enjoyed it and expolred lots of different ressources. A few months later, fourth year started and it left like a marathon with deadline after deadline… dissertation, finding a job, poster, case report, FOPE, portfolio, CCA. It is not that much when I think back about it but it felt like lots of different levels / skills.

In the meantime, for revision's sake, I had to put all my personal projects (CPDs) on hold  and I can’t wait to come back to the nice free-style study dynamic I had found at the end of third year.
This includes :

CPD about the Shoulder with Jo Gibbson

CPD about runners with Tom Goom

Amboss (clinical reasoning website)

Therapy live day, 11th June (the day after my CCA!)

Neurosciences with Laurent Fabre

Women’s health course

Conclusion
Looking at this reflection I realize I naturally tend to enjoy learning, working practicing.. potentially due to my education or due to my background in classical music and the discipline around it (practicing at least 3 hours a day since I am a teenager). I think, curiously, setting up relaxing time and holidays will potentially more challenging than setting up studying and reflecting time, but we will see, I might be wrong! The context (clinics dynamic, osteopath boyfriend, extra exam after a few years of practice) will allow be to continue my professional development on different levels!

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Motivational interviewing -  evidence A1-(ll) - 03.05.2021

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Motivational interviewing -  evidence A1-(ll) - 03.05.2021

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OPS 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.

Description
My boyfriend keeps banging on about motivational interviewing and asked me to read this document.

Feelings
It looks great, it sounds great... But how do we fit in there, where does the hands on fit? It is a little daunting, a litte uncomfortable, especially at this stage of my career...

Analysis
I do think there is going to a succession of periods in the next few years where I'll undertake courses and they'll feel like revolutions... and I might or might not end up using any of it. I am quite keen to avoid doing this for too long but instead want to focus on developing my own style. With that said I can see what he means. One thing in particular caught my eye (among the myriad of tools offerend by the technique), the focus on avoiding the "Righting Reflex". It is something I came across with in the shared decision making literature actually. The idea that we should be aware of when it is our place to "correct" a patient's belief or not. We mean well. We want them to be safe, to know better... but I ask myself, going to a therapist, do I really want to feel like I am given a lecture on how wrong I am? Funnily enough, the word "correction" is sth that I have hated ever since I started here : some tutors like to call HVT corrections or adjustments. People might think this is just semantics, but I think it does shape our interactions and beliefs, conscious or not...

Conclusion and action plan
Well... one more thing on the list I guess... but already I feel through that type of reflection I am just a little bit more equipped to deal providing decent, thoughtful communication in the clinic.

References
Internet 5: https://www.umass.edu/studentlife/sites/default/files/documents/pdf/Motivational_Interviewing_Definition_Principles_Approach.pdf [Accessed May 03, 2021]

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A young oboist, my case report - evidence A2-(l') - 30.04.2021

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A young oboist, my case report - evidence A2-(l') - 30.04.2021

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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.

I finally decided to choose this patient's management for my case report assessment. I was hesitating between a very interesting pregnant patient case I had in women's health and this young musician. I believe this case illustrates more a reflection about musician's management that I developed over the last years. Writing the case report was actually a great experience. It made me aware of how easy it is to let self doubt get in the way and think we are not doing enough, that we always need more. Reflecting on the case was a great way to assess my strenghts and weakness (as seen in the report below). Obviously the great strengths in the case is the fact that we were both musicians and how that allowed powerful and efficient communication to forge a great therapeutic relationship. It made me reflect on attitude to adapt when a lack of interest/exposure to the patient's valued activity or social domain would be a hindrance. Is this a valid enough reason to refer a patient to a colleague?

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

We just received our FOPE results. I had done quite a lot of work for it and am happy with the results (72%) and the different feedbacks. The results in individual stations reflected quite well how I feel it had gone.

Looking at the points, I was quite consistent in terms of different criteria (knowledge, physical skills,  patient handling, communication and professionalism) and I am happy that I achieved something overall balanced, especially given the fact that it was the last osteopathic exam!

Looking back at the whole FOPE process, I think it was a push in my osteopathic development, and it also helped me to be more confident in the basic osteopathic thinking, which was slightly put in brackets during beginning of third year (clinic time) and first term of fourth year (dissertation writing and finding a job procedures). It is a good reminder that like may things in life, there is a process. Not everything can be done at once, but many things do change in the background without our full knowledge. While developing my reasoning and clinical skills, it turns out my understanding of the osteopathic principles matured! The FOPE revisions helped me expressed that.

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The exercises for patients I prepared - evidence A5-(l) - - 10.04.2021 

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The exercises for patients I prepared - evidence A5-(l) - - 10.04.2021 

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

Description
I have been giving exercises to nearly all of my patients (see attached). I don’t think this is something that was asked from the school, and believe this came from myself.

Evaluation and analysis

Before I decided to become an osteopath, I was hesitating between physiotherapy and osteopathy. Why? Because in my experience both had something really valuable to offer. I was slightly more attracted towards osteopathy. If I could, I would have done both because I believe they are complementary. But I had already studied 5 years had to chose between the two. I chose osteopathy and I never regretted it. But I knew I wanted to develop this exercise-based approach as well. At the time I was hesitating between both, an inspiring physiotherapist told me: « osteopaths seem to have a bigger knowledge of the human body, but keep in mind the aim is to make patient independent, give them tools to manage their symptoms, and not make them dependant on your treatment - this is too easy ». This advice stayed with me on my osteopathic path.

Conclusion

For me, giving exercise to patients is a way to give them a tool to manage their symptoms, a way to empower them, and a way to optimise the benefits of our treatment. But giving exercise is far from being something easy, for different reasons: I don’t feel like I have the background to do it, and it is not easy to give something that makes sense to the patient and to get their motivation. And actually the evidence about how people get better through exercises is not clear!

Action plan

This is something I want to become good at, so I need to practice it.

I also plan to

Do Jo Gibbson's course

Do Tom Goom's course

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Communication in osteopathy... what do we do in visceral?  - evidence A3-(l) - 24.02.2021 

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Communication in osteopathy... what do we do in visceral?  - evidence A3-(l) - 24.02.2021 

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

Description
In women’s health clinic. I should not say that, as it is quite shameful.. but….. ok, this is probably the first time I dared to do some visceral in clinic. The first time a tutor expects it from us, so I follow the routine, and I enjoy it.

In this specialist clinic, we all have to include a visceral part in our examination routine. The routine is clear and makes sense to me.

On day, I observe a colleague in my group. He was actually doing this routine and then explained to the patient that her kidney were « really restricted» and « did not move as they should ». The patient was really scared about it.

Feelings

I felt quite uncomfortable and wanted to take part in the discussion, but I felt like it was not my role.

Evaluation

This situation is just the tip of the iceberg of a communication challenge we have in osteopathy. We look for restrictions in vital organs and if we are not careful with the way we communicate, it might be misinterpreted as pathology.

Having had treatment (a few years ago) from a student-osteopath who told me my liver was in a bad state, I was really worried at the time and took her words for granted. After this I realised: our words can have a strong anxiogen / nocebic effect on our patients.

Conclusion

I am particularly sensitive to this subject and the powerful impact our words can have. In addition to individual damage, I believe this type of communication can be harmful for the profession.

Even though I don’t know exactly which tissue we work on, talking about fascia instead of organs with patients might be a solution for this problem. Or talking about mechanisms: circulation, drainage, change in information processing.  Simply being aware of the impact of our words is important and is empowering.

Action plan

Continue my notebook about communication (see file), stay vigilant and double check with patient what they understood.

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They asked the patient to leave - evidence A7-(l) - 15.02.2021 

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They asked the patient to leave - evidence A7-(l) - 15.02.2021 

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

Description
I was observing in clinic, a colleague from my year. She had a new patient, who seemed quite rude, from the beginning on. He finally told her « she was not good enough.. she should not be studying in this school ». My colleague stayed professional in the room. In the team room she explained the situation to our tutor. The tutor took the responsibility to go and talk with the patient, and asked him to leave our clinic.

Feelings

I felt really bad for my colleague, and I felt relieved that our tutor took this position and defended the student.

Evaluation

I don’t know what was right or wrong in this situation, and perhaps there is no black and white answer. At the very least, the thought that in a few months I won’t have someone that can make those calls is not not an easy one.

Analysis

At this point there are a lot of situations that I don’t know how to respond to. It might be valuable for me to work in a clinic which offers mentoring/tutoring. Additionally I have looked at what GosC and more particularly the iO are offering and it looks like it is relatively easy to seek help in terms of legal / ethical conundrums.

Conclusion
I am glad I was « only » in the observer role in this situation as I would not have known how to react myself in the student or tutor’s situation. After digesting this case, I realised that there is a limit to how the patient can treat us, and we can set this limit and set our rules.

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Written material - evidence C3-(l) - 29.04.2021 

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Written material - evidence C3-(l) - 29.04.2021 

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

I have not had to provide any written material or data so far so it is difficult for me to reflect on that.

For what it is worth, I have always handed in my assignments on time, have provided patients with  exercise protocols in a timely manner and in my first career I used to organise concerts for my orchestra which requires good organisational skills. I am yet to find out if I will be able to apply them to my osteopathic career.

Interestingly, practitioners seem to disagree on social media regarding whether or not we should charge for the production of (at least some) of the documents patients request (see screenshot below) and I think there should be more discussion in the profession regarding the need to decide if those responses should be charged or not.

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Referral scenarios - evidence C1-(l) - 11.04.2021 

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Referral scenarios - evidence C1-(l) - 11.04.2021 

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

Time is passing. Final exams are coming. I have never had to refer any of my patients. Moreover, I never observed an «emergency situation» or « unsafe » situation.. this is scary for two reasons: am I going to be ready for real life? Would I pass an exam if I am not experienced or confident enough to refer a patient during my CCA?

I must say I feel we have not had appropriate training on that: referral pathways, where, how, when, to whom to refer… Discussing with people in my year, it feels like some of them saw quite a lot of referrals and are therefor more trained, and others did not. But there is no homogeneity in our knowledge about the topic.

So we decided with a friend to make a document about potential scenarios (see file attached).

In addition, I took a weekend course on Axial Spondyloarthropathies which was really enlightening and slightly scary. I wonder how many low back pain patients I potentially I have failed to send to a rheumatologist. The course introduced us to referral pathways, a clinical decision aid called the Spade Tool (internet 6), and very useful referral template letters (http://www.spadetool.co.uk).

Even though it is still quite scary to think the first time will be either in a CCA situation or in real life, on my own, I feel slightly more confident in my capacity to acknowledge something is not right now.

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Finally managed to give exercises to my maintaining patient - evidence C6(l) - 11.03.2021 

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Finally managed to give exercises to my maintaining patient - evidence C6(l) - 11.03.2021 

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

Description and analysis

My patient comes in every week to manage his symptoms following the stroke he had: mobilise his hemiparetic side and address the compensations developed on the other ‘functional’ side. His expectations are very clearly hands on treatment. We (me, the other practitioner, and some tutors) had a few discussions on the benefits of some exercises alongside the hands-on treatment, but he was reluctant to even have a discussion about it.

I saw him today, and his priority was his ‘good’ knee. He is in pain and his surgeon said he would need a replacement one day, based on the images that showed meniscal damage and OA of the tibial plateau. He really wants to avoid a replacement. In his case, a replacement would mean a lot: on the professional level, he would lose his job (he is self employed), on the recovery level, he would be in a wheelchair for a few months due to his pre-existing hemiparesis. I feel like it is my role to discuss the benefits of exercises/strengthening, surgery or not. So, with a certain amount of apprehension I told him that the evidence nowadays seems to show that exercise is the best conservative way to manage his condition, and that it is even beneficial to have done some strengthening if he decides/needs to have a surgery, in terms of replacement outcomes. For the first time, he agreed to start an exercise program and we decided together to do it alongside manual therapy.

Feelings

I feel a little bit proud to have been able to have this discussion with him, as it wasn’t easy. I didn’t want to force him but ethically, and in line with the OPS I had to have this discussion.

Conclusion

The context probably helped to find this agreement: he would do anything to avoid a surgery, my tutor myself and the other practitioner were coherent in our speech.

Action plan

Make a document and find exercises that are appropriate for him (considering the pre-existing hemiparesis and what positions he can or can’t be in).

Edit, a few weeks later

My patient is engaging with the exercises (see document) and we routinely do them at the beginning of the consultation.

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The long dissertation journey - evidence A3-(ll) - 15.09.2020 

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The long dissertation journey - evidence A3-(ll) - 15.09.2020 

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

What

I had a solid plan for my dissertation. Initially I wanted to observe and analyse patient’s understanding of what we tell them. Many people say « my osteopath told me this or that about my back », this or that being potentially nocebic and outdated language ("your hip/vertebra is out", "you should be careful with your back" etc ). I’ve been shocked more than once.
Where do you draw the line between info the patients "want" and the "need". Oftentimes, I believe the info they want to hear (because they were told by previous practitioner perhaps) is not the info they need. But if they don't get confirmation from us they lose trust... it is a tricky circle.
So I wanted to see upstream where was the problem with these informations / understanding. Did the practitioner really say that or did the patient get it wrong ? That was the initial plan. My supervisor actually had a precise plan in mind for me: he told me, before we check patients' understandings we need to check the quality of the information. So my plan became : re run a project done in the past about shared decision making.

Then COVID arrived and I the plan fell apart : we couldn’t know when we would be able to go back to clinic, hence was data collection realistic and early enough ? I changed the plan because I had to, and felt like my supervisor lost interest in my project. He was simply not answering any emails anymore and I felt like he was ignoring me. I also knew he was helping other people (who were not his students ..) and my motivation collapsed. I was left alone with no plan.

Finally a few months later I managed to get a meeting. He  told me that « to be honest you’re a bit late in the process », which felt a bit ironic given the situation. I tried to stay calm (outside, not inside). I knew I was not late, actually my protocol was on point and i'd had a solid look at the literature already. As part of the points we had to address, he mentioned it would be good to find a second year second marker, so that someone could run my initial plan the year after. The good news I found someone! A really motivated second year student.

I am now collaborating with this student and it really  is working well. He has got the perfect profile to join the project.

The academic year starts next week. I aim to have a dissertation draft 3 weeks later.

So what

To summarize the whole process until now, I went through a big disappointment initially: my supervisor disappeared. It made me lose my motivation. I came back to it, accepted the idea of a plan B, was really lucky to find the perfect collaborator, and regained my motivation.

Now what

Now I want to definitively get over this big disappointment, get over the jealousy I’ve been having regarding other students that had help and meetings whilst I had no answer, be grateful for all the people that supported me throughout the process (2nd marker, my boyfriend, my sister) and just do it, do it well without losing too much energy in the process, turn the page and spend my time doing things I really want to become good at (osteopathic skills / clinic skills).

Let’s see on the 12th of October where I am.

Edit from end of October: I managed to finish my dissertation quite early, and at the end of the process my supervisor agreed to read my draft and gave me really constructive and positive feedback. I was grateful for that and I looking back I feel slightly stupid to have make a big thing of the small disappointments. These obstacles I encountered because of the pandemic were just NOTHING when  you compare to what other people have been through in the pandemic. I guess the problem was that I had high expectations with the initial plan, got disappointed, and did not manage to understand my feelings at the time or communicate them. This way of functioning is quite typical and I seem to be repeating that pattern again and again.. how can I get out of this vicious circle? Well, the first step is probably what I have just done: recognize what happened and reflect on it. The second step might be to get some professional help (CBT?). At any rate I am very happy with all the reading I've done on the topic, it really feels like it can improve my patient's communication.

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Reflective time - evidence B4(lV) - 15.05.2021

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Reflective time - evidence B4(lV) - 15.05.2021

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

Description
I have been writing in different padlets since year one; it is the first time (interestingly) that I am asked to do it as part of a curriculum. I never had to do it for my previous degrees, I wonder if it indicates a different focus in other European cultures or if Britain is in advance in that domain.

Feelings
It was quite difficult and not enjoyable at the beginning  but as I became better at it (by just doing it), I started enjoying it more and more!

Evaluation
Trying to put everything together and make some sense out of it (for the portfolio assignment of year four), I realize that the different posts in my padlets from year one and two were actually not structured (at all) and were mostly descriptions of situations during which I got upset. Fulfilling the role of a sort of personal diary I guess.. it was quite helpful to be able to  offload my personal struggles somewhere at the time, but looking back I realize how stuck I was (or am?), repeating the same patterns again and again... Ironically, I note that looking back at these written descriptive entries helps me now understand behavioral patters, so even purely descriptive reflections have a role.
However, following a model (mostly Gibbs model) helped me truly reflect by giving me a structure in which I felt free within each step but was still guided by the steps. This personal observation contradicts what others have described as a challenge within  reflection in medical studies (de la Croix et al., 2018).

Conclusion
This process of writing has now become a habit and I hope it will stay with me. Reading this article made me realize how valuable reflection was but also started a whole new question: what is true reflection versus conditioned prescribed reflection (de la Croix et al., 2018)? Education science is a complex and ever-growing field, what is clear is that there are no perfect solution, I am glad I have started engaging in reflective activities more regularly and I am sure it will help me on a personal and professional levels.

Action plan
Buy a nice notebook to continue reflecting (...really looking forward for my new life with less computer time!)

References
de la Croix, A. and Veen, M., 2018. The reflective zombie: problematizing the conceptual framework of reflection in medical education. Perspectives on Medical Education, 7(6), pp.394-400.

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Communication in children's clinic - evidence A3-(lll) - 09.09.2020

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Communication in children's clinic - evidence A3-(lll) - 09.09.2020

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

A student practitioner told me that «the baby almost died and it was so amazing, we went through the whole process of death together again… »

Description

It’s wednesday morning, the 9th of September. I arrive at clinic early, and I run into him in the changing room. I ask him how he is, he asks me how was my first baby, and I ask him how was children’s clinic for him.

« Oh yeah, it was so amazing. Really intense. So I have a baby who almost died and so yesterday I treated him and we went through the whole death process again together, it was so amazing ».

I didn’t what to say. I probably just said « oh, interesting ».

Feelings

I was quite shocked. It wanted to ask him so many questions :

-If you really really « go through the whole death process », how can you be sure that the baby won’t die this time…?

-was it on purpose? is this a controlled environment a controlled technique? Do you think it’s needed for the baby to go through this traumatic experience? What are your aims?

-Why did you « go with him though the process »? It does sound like someone looking for intense feelings / beliefs. …why?Is this about you or your patient's health?

-Isn’t there a need of power? Is that heathy and is it what we are supposed to do?

-What did you tell the parents? The tutor? What did you write on your notes?

Evaluation

I was so chocked that I knew I needed to tell it to someone, but I also didn’t want to get anyone from school / friends involved. So waited and told my boyfriend in the evening, we had a nice conversation. Not too much focusing on what we thought about this approach but more on what is ok for the patient or not. And the conclusion of this discussion was that, as long as the communication with the patient is adequate, we are allowed to have our own beliefs. I do now know how - if I'd had gone through that type of experience - I would communicated my "findings" and reasoning to the parents.

What did not work well

On this morning, I did not manage to have any sort of conversation with my friend. Why? Was I not brave enough? Or did I know that it wouldn’t change anything?

Analysis

I learned, during my conversation with my boyfriend, to focus on what is important: what we tell the patient.

What else could I have done

I could have asked my friend more questions. I could have told him I disapproved of this approach and all the problems / questions it raises from my point of view. It does make me feel a little unsecure to see that I hesitate to confront my friend's beliefs.

If it happened again

I would probably ask him what he told the parents and if he went trough the process intentionally, if he thought it was needed and why.  I would also say the problems I can see with this approach: practitioner has SO much power. What happens when the practitioner is not there anymore..? How can you ethically gain the consent to do this intense experience with a little human that can’t even talk?

Action plan

If there is an appropriate occasion, neutral environment and enough time, talk about this episode.

Continue to ask myself what disturbs me in this approach, why I am affected.

Am I jealous to not have the access to these experiences? Or am I honest and modest and do I refuse to go in that « superpower » direction? Or is it just all a communication issue, either the way the practitioner told me the story, or the way I understood it?

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Identity crisis - evidence B2-(ll) - 02.05.2021 

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Identity crisis - evidence B2-(ll) - 02.05.2021 

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

Description
As I’ve mentioned before, I think as a profession we are sometimes very adamant to prove we are "doing" stuff. I have come across articles that I would like to mention.

Feelings and analysis.
Doing is very important to us, it seems to validate our differences, our training, our spirit. For instance, it seems anathema to talk about contextual effects or the role of therapeutic touch, everyone gets very sensitive arout those topics It is odd to me, because surely this means we are makings things about ourselves, and not about the patient. We love claiming that we are holistic and patient centred, but some evidence goes against that idea actually (Thomson et al. 2013). Because of the pandemic, it feels a separation has occurred between those who think we can help «directly » and those who think our role is « indirect ». I.e we can literally help with immunity, inflammation with our techniques, and the more specific they are the better. At the other hand of the scale some practitioners are fully embracing the Allied Health role and are helping with track and trace or even working as vaccinator. At the very least to limit the spread of infection and misinformation surrounding the vaccine for instance.

I enjoyed the strong and global response from a large part of the chiropractic community regarding claims that spinal manipulation boost immunity (Côté et al. 2020). I like that they are however saying that caring, helping people move more, touch, all in all a good msk management can indirectly help with stress, inflammation. It was also interesting to see the response to the article on vaccine hesitancy within osteopathy (Thomson, O.P., MacMillan, A., Draper-Rodi, J., Vaucher, P., Ménard, M., Vaughan, B., Morin, C., Alvarez, G., Sampath, K.K., Cerritelli, F. and Shaw, R., 2021. Opposing vaccine hesitancy during the COVID-19 pandemic-A critical commentary and united statement of an international osteopathic research community. International journal of osteopathic medicine.) My belief is that our communication on that topic has to be extremely precise and skilled because patients do listen to us. We 100% have a responsibility here. I think through that means and respecting the limits of our competence we can actually have a huge impact on people’s lives.

Reference
Côté, P., Bussières, A., Cassidy, J.D., Hartvigsen, J., Kawchuk, G.N., Leboeuf-Yde, C., Mior, S. and Schneider, M., 2020. A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity. Chiropractic & manual therapies, 28(1), pp.1-5.

Thomson, O.P., Petty, N.J. and Moore, A.P., 2013. Reconsidering the patient-centeredness of osteopathy. International Journal of Osteopathic Medicine, 16(1), pp.25-32.

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Portfolio Thomson, O.P., Petty, N.J. and Moore, A.P., 2013. Reconsidering the patient-centeredness of osteopathy. International Journal of Osteopathic Medicine, 16(1), pp.25-32

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

Listening to WORDS MATTER podcast episode with Jerry Draper-Rodi and I realise: I don't know much about prognosis, although it is one of the only thing patient want / expect (OPS A3!) see : Shared Decision Making—The Importance of Diagnosing Preferences | Cardiology | JAMA Internal Medicine | JAMA Network

Action plan
Learn about it!

Reference:
Elwyn, G., Cochran, N. and Pignone, M., 2017. Shared decision making—the importance of diagnosing preferences. JAMA internal medicine, 177(9), pp.1239-1240.

Edit 17.05.2021 (exactly one year later!)
I did not manage to apply that action plan. I still don't know much about the art of prognosis, still not very confident with what to tell patients and set realistic expectations... I tried to read about it but it is so much different from one person to the other, not black and white at all, that I feel like the only way to learn is experience... It is frustrating since I have learned A LOT on shared decision making through my dissertation so I am a bit more confident with  sitting down and inviting the patient to talk and voice their preference. I am simply feeling like I can't provide any answer. The evidence around tissue healing time is strong, but sadly pain is much more complicated than that and in osteopathy we see a lot of "functional" disorders which have little to do with normal tissue healing times. Are we supposed to lie? To extrapoloate to patients? How can you realistically communicate to worried patients that uncertainty is very normal part of the equation?

References
Internet 11: https://www.wordsmatter-education.com/blog/podcast-06-breaking-free-and-diving-in-becoming-a-biopsychosocial-manual-therapist-with-dr-jerry-draper-rodi [Accessed May 17, 2020]

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Welcome to episode 6 of The Words Matter podcast. On this episode I spoke with Dr Jerry Draper-Rodi.

Jerry is a Senior Research Fellow at the University College of Osteopathy and is an academic clinician.

His current roles include working as the Head of Continual Professional Development and as a Research Lecturer at the UCO, running an osteopathic practice in Oxford, and delivering CPD on BPS skills to MSK clinicians, mostly in France.

He is the treasurer of the Society for Back Pain Research, and a fellow of the International Osteopathy Research Leadership group at the University of Technology Sydney (Australia). Jerry was awarded a Professional Doctorate in Osteopathy in 2016.

His doctoral research was on the acceptability, feasibility and likely impact of a biopsychosocially-informed e-learning programme for non-specific LBP on experienced osteopathic practitioners' attitudes to back pain. See some of his published research here and here.

Jerry is also on the PhD supervisory team for David Hohenshurz-Schmidt who was my guest on episode 2 of this podcast where we talked about MSK going remote in light of COVID..

Jerry is a colleague and friend of mine at the UCO; our desks sit opposite each other in the same office. In between (or sometimes instead of) doing work we have endless chats often centring around our passion and occasional frustrations of enhancing students and clinicians' practice towards a BPS approach to back pain.

Jerry, like many of us, came from a strong biomedical approach manual therapy background. So I was really keen to speak with him about his experience of breaking free from his traditional training and how he perceives his transition and the transition of others towards a BPS approach. Including how he manages the resistance, obstacles and opportunities to incorporating the BPS framework into clinical practice.

I really this enjoyed talking with Jerry, it was really helpful to have insight from someone who has successfully made the tradition and is now immersed in BPS practice, teaching and research.

This should be interesting to all MSK clinicians but especially those who are struggling to break free from the biomedical chains or perhaps are unsure or anxious about what a BPS future might hold. I bring you Dr Jerry Draper-Rodi.

Find Jerry on Twitter and Instagram

Subscribe to www.wordsmatter-education.com , and if you liked the podcast, you'l love the Words Matter online course in effective language and communication when managing back pain - ideal for all MSK therapists or students.

Help the podcast grow and don't miss an episode- Subscribe, Rate and Share.

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Incorporating the biopsychosocial model into manual therapy practice

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Welcome to episode 6 of The Words Matter podcast. On this episode I spoke with Dr Jerry Draper-Rodi. Jerry is a Senior Research Fellow at the University College of Osteopathy and is an academic clinician.

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Interviewing with potential employers - evidence B1-(ll) - 14.04.2021 

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Interviewing with potential employers - evidence B1-(ll) - 14.04.2021 

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

Last week I had 7 interviews with different clinics. I have observed all these different osteopaths and it was really inspiring to see all the different possibilities within osteopathy.

1. I really liked his osteopathic hands-on approach (« tissulaire » in French, mostly functional I suppose in English), and also what / how much he communicated with his patients. On the other side, I found him slightly too familiar with his patients and it was somehow conflicting with my view on how to ‘be’ professional with patients.

2. They were really kind and I connected well with them. I did not observe them working but they seemed quite open to different osteopathic approaches.

3. I really appreciated his way to care for patients. Very respectful, very professional, very calm. Listening a lot and caring. The osteopathic approach consists of doing a lot of tests and then picking 3 structures to do recoil on. The mechanical link. I am sure it works, like any other approach, but I find it frustrating to ‘only’ do a minimalist treatment. I like the treatment part, as a patient and as a practitioner. That is something all this reflective practice made me realise. I like treating patients, with hands on. He would like to teach someone this very specific approach and I am not sure I’d like to do that. It is like learning to play the violin, and then ‘only’ playing very contemporary pieces with 3 notes.. what about all the classical repertoire? What about the romantic pieces? In addition, am I going to be good in this very particular approach? Maybe yes, but maybe no…

4. I had coffee with the team during their break. This clinic was for me the most ‘fancy’ clinic and I was really glad they took the time to meet me. They seemed really chill and not too strict on which osteopathy you do but more on the human side.

5. I observed 2 patients with each of them 3. Very ‘colourful’ variety of technique: really inspiring! They mix visceral, cranial, functional, structural and I really liked this aspect. I also liked the way they communicated with the patients.

6. I observed him a few days. Osteopathically I liked his approach, which looked to me like a « functional improvisation ». He tried to release the blockages. From the BPS point of view, I found him quite challenging with some patient, in the way that he was not telling people what they wanted to hear, but confronted them with their beliefs. Challenging, but in a constructive way.

7. She is really inspiring. She really does not care about business. She cares about people. Her clinic feels like a meditation room. She takes 1 hour with every patient (more than all the others..!). I would love to learn with her, and I really like the « tissulaire » approach she uses.

All these observations/interviews helped me to see all the possibilities, helped me to realise there are as many osteopathic approaches as there are osteopaths. I’m really looking forward to develop my approach,  as now in clinic I feel more like adapting to different styles, without building something. Clinic was great to discover and learn, but it feels like time to turn the page.

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

Description
Suddenly, one morning, it is almost the end of the osteopathic course. I went so quickly. But there are still a few steps before the end. One of them is the FOPE. It is time to start to revise for it (see attached document). I make a document with all the different notes I have. And I asked a few friends if they are willing to revise together.

I printed 10 different cases from the learning zone and from some of my patients.

With 2 friends we decided to go every Monday afternoon to school and to run through those cases, making a role play with one model, one practitioner and one examiner. It is not easy for me and I need to force myself to do it.

Feelings

I feel stupid each time I try to make osteopathic link on made-up cases and I feel no space in my head to learn new informations or ‘clever’ reasoning. So I decided to just do it, and the fact is, to revise with friends is really helpful because I can’t give up. I just have to do it., they are not forcing me but there is enough pressure so that I don’t back down. It is not completely clear to me why I have these feelings. I feel like I don’t belong, like I am pretending. Surely the others, everyone else is better and I will be caught soon. It is hard for me to trust my skills and the judgement of those (friends and tutors alike) who are telling me what I am doing is enough. I guess it is partly what the Imposter Syndrome is about. This quote from a recent paper on the impostor syndrome in healthcare education has struck me (Sotiropoulos, M.G., 2021): « students who are most affected may be the ones most invested in growth and learning, and the impostor feelings could signify a tendency to simplify, understand and explain essential concepts »

This article https://pmj.bmj.com/content/97/1146/264.abstract  clearly would fit with what I have discussed above but I would hate for it to be only an excuse to explain my discomfort.

Conclusion

After a small break for job interviews, I need to come back to this practice I have started a few weeks ago. I hope I’ll progress until the exam.

Action plan

Next week we fixed 5 half days sessions with 2 friends to just practice and do FOPE role play games.

Reference
Sotiropoulos, M.G., 2021. Impostor syndrome: a calling for a career in medical education?. Postgraduate Medical Journal, 97(1146), pp.264-265.

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Impostor syndrome: a calling for a career in medical education?

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New patient - feeling like at the beginning of third year.. but I am almost at the end of my fourth year - evidence B4-(l) - 16.02.2021 

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New patient - feeling like at the beginning of third year.. but I am almost at the end of my fourth year - evidence B4-(l) - 16.02.2021 

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

Description
I am quite stressed at the moment. In general, and also in clinic. I have not had a new patient since more than 2 months, I see months and time passing and I am not sure I am progressing as well as I should.

Feelings and analysis

Yesterday, I arrived in clinic and had a new patient. I felt really stressed, fragile. One part of me thought I should take it easy, it was not a good day to be asking for challenges. The other part of me thought : you haven’t had a new patient in over 2 months, you have not been observed by a tutor in over 5 months, exams are coming and now is the time to be challenged. So I asked my tutor to come in the room and observe me. This was the first challenge, as I had to insist a little bit (he would have preferred not to come).

He observed the whole case history. It went well. I think I did an ok job. My tutor’s feedback was that I was not directing the questioning enough. It is true that I was trying to ask open question and listen to the patient’s story. He told me that they would not be able to see my clinical reasoning if I was listening instead of directing the case.

Conclusion
This feedback came at the perfect time. I was trying hard to be a good listening practitioner, but that is not the sole priority for now. First I have to pass my exams. I need to change direction in my focus.

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In 7 months, the ESO chapter is closed... - evidence B3-(lll) - 03.01.2021 

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In 7 months, the ESO chapter is closed... - evidence B3-(lll) - 03.01.2021 

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

Description
I just came back from Christmas break.. it is potentially the last time I "come back to the UK".. it definitely feels like the last stretch of road to cross, the last hill to climb.. The circumstances are special, a dramatic increase in COVID cases is hitting Kent, right now, right here. We don't know what that means for us yet. Well, we know it means lots of emails and lot of adapting, still. The resiliency of people is phenomenal. You always think "thi is it, this is all I have..." but I guess we are more ressourceful than we think. Something to keep in mind with patients when we are afraid to push them, maybe.
I will focus here on what / where I feel in terms of "knowledge, skills and performance". In terms of knowledge, I wamt to learn a lot and reinforce what I already know. We've done a "general-plan" with my study-buddy / housemate. By mid march, we will have covered what we think is all we need to cover for the final exams: ankle, knee, hip, LB, SI, Tsp, CSp, GH, elbow, wrist TMJ, Headaches, neurocreen, CN, abdo screen, CV screen, resp screen, systemic questions, medications, red flags, rheumato.. we also do one "fake-case a week".
With that general-plan I feel like nothing can go incredibly wrong, in terms of knowledge for the exam; it also feels like it's a good basic for later, and I'll have documents that I can come back to. In terms of technique-skills, well... harder with social distancing... I certainly can't do much at the moment. And it seems like I've lost most of my patients with the new system of one week out of two in live-online. I should practice a bit more on my boyfriend, which is the only person I'm not socially distancing from ATM.. but I haven't found a way to regularly do it now. Again, in terms of technique, I don't believe too much in the specificity of our techniques but I'd REALLY like to have a wider "menu".., be more comfortable with more techniques, because it is (or should be) the perfect environment to develop that aspect. Back to the knowledge, there are a few courses and CPDs I'd like to re-watch and integrate more, especially the shoulder with Jo Gibbson, neuro with Annina Schmidt, headaches in ESO specialist clinic, the words matter course with Oliver Thomson. But I think I need to set priorities!

Feelings
I feel good. Motivated, in general. I did feel a bit stressed over the last few days - a lump in the throat. I think it is not only due to the "revisions" but also with the general "am I going to find  work later? after these 10 years of study, I HAVE to..". I also feel for the first time that this is MY time. I can't work as I always used to (teaching music, in the café, taking care of a disabled person...), I would if I could but I just can't. I feel like I could learn a lot these next 6 months.

Analysis
It's interesting that I need a pandemic to set more "my-time-to-study". I'm proud of the general plan we've made and am grateful to have someone to do it with me, which is essential. I feel bad for everyone going through this on their own.

Conclusion
After writing all that down, it looks, once more, that I have big expectations about how many things I want to do.

Do it, but don't over-do it. Just do it. Enjoy.

Action plan
-Write a revision plan (see file below)
-Set up consciously more "meditation" time, chilling time..

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Clinic where I will be practicing - evidence D10-(l) 02.05.2021 

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Clinic where I will be practicing - evidence D10-(l) 02.05.2021 

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

Description

One of the 2 clinics where I will be practicing has got osteopaths, dentists and GPs. Their aim is to work together and improve patient’s management. It looks like a great application of all the concepts we discuss in the books / articles / lectures: pluridiscilinarity, patient centred care, …

I believe the fact to work in the same place and be able to exchange, during breaks, or during seminars, really allows to engage in this direction. I am looking forward to this new adventure and will try my best to be proactive and create my place in this environment.

I hope this dynamic is real, and not only «on the paper». I think: if even in these perfect conditions, it doesn’t work, then is it ever possible?

Action plan
After I am somehow used to practicing as an osteopath and I have adapted to my new profession and professional environment, I really wish to be pro active with other healthcare professionals, in my future clinic, but not only.

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Business plan 3rd year - evidence D8-(lll) - 10.05.2021 

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Business plan 3rd year - evidence D8-(lll) - 10.05.2021 

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

The process of writing my business plan
Here is the business plan I made in third year. It was in the middle of the first lockdown, at my boyfriend's mother's place (in a very small flat), allowed to go out only once a day, with police men in the village checking us regularly, I quite enjoyed the process of making a business plan. I guess it helped me to remind myself each single day I was working on it, that one day I would graduate and be out there as an osteopath. Checking all the different aspects of building a practice, I found myself dreaming about my future life and it helped me to keep my motivation in these weird pandemic times and challenges.

The feedback
I was pleased with the feedback I received. It mainly showed which aspects were realistic or not (mainly about number of patients expected at the beginning and progression curve) and I am really glad we had a whole module dedicated to that. I think I am not a business person, but I also believe this is something we have to develop / work on as a future self employed person. I am not a business person but I know what I want and I know I am very organised!

Reflection, one year later
I did not want to start my business right after graduating for different reasons, and I just found two clinics in which I will work, as an employee. I am glad to have this status, at least to start my career. I don't know what the future holds for me but I might one day open this musician clinic I described in my business plan.

Thinking about this whole module, I realize how relevant it is in a profession where most of us will be self employed. I realize that in my previous Master degree in music, we did not have any lectures on business, which was a major gap in the curriculum.

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Patient letter second year - evidence D3-(l) - 10.03.2021 

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Patient letter second year - evidence D3-(l) - 10.03.2021 

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

So far I never had to offer any apology to a patient, but I think that statistically this will happen one day. Our school helped us to prepare for that by making a fictional apology-letter in second year, which I received a good feedback for (see file letter 2nd year & feedback attached). Reading this letter two years later, I am quite impressed of the work I had done, especially given the fact that I had never seen any patients at the time.

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Feedback for a colleague - evidence D9-(ll) - 16.02.2021 

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Feedback for a colleague - evidence D9-(ll) - 16.02.2021 

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

Here is the feedback I gave to my colleague, including some elements of the reflection D9.1. I tried to adopt the constructive "sandwich style feedback" that we were taught in clinical integration back in year two (starting with positive points, with things to improve in the middle, and ending with positive elements) :

Observation 27th January - wrist-climber-patient

Excellent session. The practitioner is fully « in charge »: the case presentation is clear, the flow of the consultation is really good. Time keeping is really good, the practitioner makes a detailed but « to the point » interview and examination (just check the carpal names.. even though no one really knows them), but has still time for a nice treatment and even to run through exercises at the end.

Holistic treatment addressing wrist and forearm locally but also neck and T Spine. Wide range of technique, indirect work but also T Spine manipulation. Techniques look really well performed, and practitioner takes the time to apply them.

Communication with patient was very good. Something I would have done : the patient made demeaning comments on previous practitioner she had the week before -> given the fact that patient is a student, and will soon be a learning practitioner in clinic,  I would have taken the time to clarify that this sort of comment is not welcome and that the climate in this teaching clinic is about respecting everyone’s learning rhythm, individuality and osteopathic approach.

An idea: when patient said that onset was practicing GOT-upper-trapezius-technique, we could have used the observer (me) as a model and ask her to do the technique on me. That might have allowed to understand better the mechanism, and also maybe to give ergonomic tips or alternative to this technique.

Practitioner is ready to be an osteopath in the real outside-ESO world and patient seemed really happy with the consultation!

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Unprofessional climat at clinic - D9-(l) - 16.02.2021 

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Unprofessional climat at clinic - D9-(l) - 16.02.2021 

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

Description

Another evening in clinic. We are four, and we have got only two continuing patients. I really want to learn something tonight. I would like to observe someone. So I ask practitioner * if I can observe her. I realize the name of her patient reminds me of something. ... She is a new ESO student... and I met her at the café where I work. She ordered café and asked for a student discount. I said there was no student discount. She insisted. She was pissed off. She insisted again, she refused to pay the price of an americano, and told me to do the price of an espresso + free water. I gave up. So here I was, observing her as a patient.

Back to the observation. The flow of the consultation was really good. Organized. Click this, "oh, it's much better", click that "oh it's moving now".. the practitioner was very mechanical, very good in her way, but this style does not resonate with me. It was too much fixing and show. But very good in that way. At the end the practitioner gave a few exercises. She kindly asked me if I had anything to add. I initially said no, but then remembered of an exercise a climber friend gave me, especially for me. I told the patient, and she said, "no thank you, that's not good for me, my hands are too strong".

At the end if the session, the practitioner said she would come back in a session especially for this patient, even though she was not in clinic the following week. She said "because it's me, or it's practitioner ***, so it's better to do that". They started to spit on this practitioner ***:/. I thought : not very professional ....

Feelings

I felt some degree of arrogance in the patient's speech which irritated me. But I know I was biased with my previous experience with her.. so, is it just me?

Conclusion

I should have told my practitioner friend I did not approve the way she behaved with our classmate (saying he was not good, among others). We are all learning, and it is not professional to project her opinion on the patient.

Action plan

Mention this impression in the feedback (see reflection D9.2 above).

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Postulations update - evidence D8-(lV) - 28.01.2021 

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Postulations update - evidence D8-(lV) - 28.01.2021 

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

Description
Finding a job is important to me. I am 27 and have been studying my whole life.. I'm a bit stressed about it. Probably because

-I have got high expectations (it's important).
-my family has got expectations (they want me to be fully independent and are generally stressed).
-this whole ESO was a big commitment, so there is a hope of it being "for something" in addition of the experience (which was amazing itself).
-One of my initial motivation was to have a job where there is job, not like music.
-It makes me face my fear: be able to knock at doors and "sell" myself, believe in me and my "value".

Anyway, I wrote a nice letter and curriculum vitae back in autumn and sent 6 files or emails. The file is ready, I'm happy with the result, and I already had good feedback about it. I've had a few "encouraging-but-not-really-concrete" answers, which clearly motivated me to move forward and continue. I had plan to send  new "wave of files" and reminders beginning of January.

January 2021
I spent 10 days thinking : "I should do it, I should do it". The stress builded up until a morning where I woke up with a migraine. I woke up and straight jumped to my computer. That day, I prepared 5 new files, sent an audio to a Swiss osteopath friend to get advices and to know "when was the good timing", and sent a message to the Red Cross about recognition of the diploma.

To do by end of January
-follow-up red cross
-follow-up osteopath friend
-add a reference in my letter
-send reminders to X and Y..

To do before end February
-Do more files.

To do before end March
-Even more files and contact previous employer (care center).

(See attached file with all organization details)

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Reflection on an article - evidence A1-(l) - 29.12.2020

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Reflection on an article - evidence A1-(l) - 29.12.2020

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OPS 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.

This quote from an article (Epstein et al., 2013) on shared decision making was, I thought, an incredibly powerful testament to the complexity of the patient-therapist relationship.

« Clinicians can firmly believe that they are acting in the patient’s best interest, yet have a poor grasp of the patient’s motivations, values, and preferences. Power can create illusions of agreement and suppress open discussion. Clinicians can confuse a patient’s passive assent with true endorsement of a plan of action. Clinicians’ certainty, persuasiveness, and charisma can overwhelm the patient’s voice so that both believe that they share a common frame of reference. Patients can be silenced by anxiety, to which clinicians may inadvertently contribute. »

When and how do we know that we truly have the patient’s best interest at heart? Are we sure that we are not covering our own weaknesses and fears with good intentions? Informed consent is costly, in energy and time. A strength of of the osteopathic approach is indeed time ,which I think can help guide us is the core declaration that each patient is unique. There are no recipes.

We cannot know fully our biases. Biases are useful, they help us make sense of the world and deal with it efficiently. To the best of our ability we need to be able to keep them in check. I am trying to gather more information on the topic, I am planning to pay closer attention to specific articles or courses about biases, especially in healthcare. This article for instance gives a few examples http://citydoc.recova-19.com:

-White male physicians are less likely to prescribe pain medication to black patients than to white patients.

-Doctors assume their black or low-income patients are less intelligent, more likely to engage in risky behaviours, and less likely to adhere to medical advice.

-Pregnant women face discrimination from healthcare providers on the basis of their ethnicity and socioeconomic background.

-Women presenting with cardiac heart disease (CHD) symptoms are significantly less likely than men to receive diagnosis, referral and treatment, due to misdiagnosis of stress/anxiety.

References
Epstein, R.M. and Gramling, R.E., 2013. What is shared in shared decision making? Complex decisions when the evidence is unclear. Medical Care Research and Review, 70(1_suppl), pp.94S-112S.

Thomas, A., Kuper, A., Chin‐Yee, B., & Park, M. (2020). What is “shared” in shared decision-making? Philosophical perspectives, epistemic justice, and implications for health professions education. Journal of evaluation in clinical practice, 26(2), 409-418.

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Walking in underwear in front of my osteopath - evidence A6-(l) - 10.11.2020 

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Walking in underwear in front of my osteopath - evidence A6-(l) - 10.11.2020 

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OPS A6. You must respect your patients’ dignity and modesty.

Description
Yesterday I was discussing with a non-osteopath friend. She told me about her experiences of osteopathic treatment as a patient. She told me how she had to get undressed and then had to walk and that her osteopath would observe her walking in underwear.

Feelings

I am in my fourth year of osteopathic training. The first time I had to get undressed in my underwear in front of the whole class was 3 years ago, and now it just seems something normal. But it wasn’t at the time. I am scared that I my patients could have felt uneasy without me noticing.

Evaluation and analysis

Initially I thought « yes, that makes sense, this is what we do the whole day long ». But I realised it did not make sense for her and she felt weird. This discussion occurred at a perfect timing for me: at the point in my training where I was just getting used to these things and was starting to forget it might be weird for the patients. So what is the solution? Communication. The patients should not be observed walking in underwear without understanding why it can be helpful for us. It is so easy to forget how it feels like to be a patient who does not understand what is going on. Secondly accept people’s preferences and very importantly, that people can change their mind!

Conclusion and action plan

Taking a step back and discussing certain aspect of osteopathy with friends is really helpful, and so is patient feedback.

I still need to improve my communication and check the patient’s understanding.

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OPS 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.

Description and evaluation
A new patient in children’s clinic. Children’s clinic is still new and I still feel like I am not fully ready to examine and treat children. The patient comes in - actually she is a teenager. We start the case history and she tells me about her wrist pain, which she relates to her oboe practice. I quickly realise she plays at a high level and wants to become a professional musician. At this point, my observer says: « you’re in good hands, your practitioner is a professional violinist ». The patient seems to be surprised but also reassured to have someone who can understand what she is going through.

Feelings

I feel excited, what a great coincidence that this patient was allocated to me, a musician! Actually at this precise point, I think « how great this is going to be, I’ll ask her to take her oboe, we will discuss all the possibilities, maybe I’ll share my experience» and I can’t focus on the case history anymore. I am in my head, I am not at her service anymore.

I feel alive and happy. I also feel under pressure: now is the moment to apply all the knowledge I have gained during my training in musician medicine in Paris 5 years ago. But I feel like it would take me a lot of time to re-visit all these concepts and I feel not ready.

Analysis and conclusion

My background as a professional musician, my musician medicine training, together with my history of tendinopathies and struggle to play 8 hours a day in my orchestra helped me to establish a good therapeutic relation with my patient. The outcome with this patient (she had a 4 months history of wrist pain and after the first treatment never experienced any pain anymore), are probably not only due to the hands-on treatment but to the whole context and management. Secondly, I realise how easy it is to get excited in a situation like that and, although it did not happen here, push your own agenda forward.

Action plan

I will contact the teachers from Paris to ask the access to the course I have followed as I have lost my notes and the power points which were on my old computer.

I will also contact a few oboist friends to discuss this case and the potential posture or instrument adaptation.

I will prepare a document with specific exercises and advices for my patient.

I will write an email to the person who helped me pay my study and support my project to specialise for musician.

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Prescribing exercises - evidence A5-(ll) - 10.09.2020 

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Prescribing exercises - evidence A5-(ll) - 10.09.2020 

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

Description

One week ago, I had two patients in their thirties, both active (yoga pilates / football running). Both of them were happy when I suggested to give them exercises.

Yesterday, I prepared and printed the two exercise prgrams.

With the first patient (-> neck strength exercises), she was late so I almost didn’t have time, but we managed to run through the exercises and it all went really well.

With the second patient (-> calves and LEx strengthening), it felt like it all went wrong. I was initially less confident with the exercises and I had asked my tutor (sport specialist) if she could come in with me at the time of the exercises, to help me with guidance, repetitions etc. She came in and it started to be awkward. The patient asked us if we could feel the scar tissue and tell him when to go back to football. She told him that it wouldn’t be very helpful and that it would be better to see what he could tolerate in terms of exercises. Then we asked him to stand up and started to run through the exercises I had prepared. We asked him to do 1-2 heel raises and observed his calves. My tutor saw a lot of things, with head of gastrocnemius was activating more, which Achilles was bigger.. I didn’t see anything. Well I kind of saw but did not manage to integrate what I saw and make sense of it. Then it wasn’t clear if we would actually do the exrcises**, if we could just talk through them, we didn’t ask him to try. My tutor did give a few general tips, demonstrated 1 or 2, said what was the normal repetitions without checking what was tolerable / normal for him.

Feelings

I felt lost… completely.

Evaluation

The preparation of the exercises worked well (the sheet). The actual plan on the day, the collaboration with my tutor did not. I was not confident to give advice and didn’t dare to ask my patient to do the actual exercises.

Analysis

Know what you are going to do before you do it. Always do the exercices with the patient. Take the time, make the time, assume, be in charge.

What else could I have done?

Try with someone else before the ttm?

If it happened again...

I would communicate clearly with my patient what’s the plan if the session and then if they agree run through the exercises with them.

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Exercises for patient with calves strain history, playimg football and running  

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Exercises for patient with weak neck flexors and hypermobility (Mrs M)

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A young footballer - evidence A2(ll) - 20.09.2020 

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A young footballer - evidence A2(ll) - 20.09.2020 

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OPS 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.

Description
My new patient is a young football player. He is presenting with anterior knee pain, after a traumatic tackle 9 months ago. He had X-Rays twice after this injury which showed no fracture. The sharp pain is on and off, WF playing and running, BF rest, and associated with swelling of the knee. I was glad my tutor was specialised in sports injury. After the case history and examination, our working diagnosis was meniscus damage. After discussing the different options  with the patient, we made a referral letter for his GP and agreed to start conservative treatment with manual therapy and exercise, alongside this referral.

Feelings and evaluation

I was glad my tutor helped me with the whole process, as I would probably not have been confident to do it on my own. As we did not have time for both treatment and exercises, we suggested to book the patient for another treatment 4 days later. I went home, sat in front of my computer and thought : what am I going to do? I had already discussed with him the possibility to go to our sports clinic with another practitioner, but he could not do the specific time because of school. So I was going to be in charge of him and I had to get ready for that. I did a lot of work and asked my boyfriend for some help with a rehabilitation program (see document below).

We started the program and I saw him 3 times. I was surprised how I seemed to know more about exercises than he did. He was in a school for pre-professional footballers and I thought strengthening was an important part of this program, but the only thing he was doing, alongside football, was stretching. We did some work together, he was progressing in the exercises but the pain was not getting better. After one month, as it was holiday for him and he could come in the morning, I suggested again he might benefit from our sports clinic, which he did.

Analysis

I was happy with the work I had done but also conscious that it might be better for him to see someone with who he could discuss football and what he was going through with - something that I could not offer, whatever amount of reading and work I would do to prepare our sessions.

Conclusion

Professionally I am aware that referring is sometimes a luxury, that the unknown or lack of familiarity is not always a bad thing. However, even if I was happy with happy with the improvement in function, I was confident in my referral in this case.

Action plan

Be patient, go in sports clinic, continue to work but also accept that experience only comes with exposure and repetition.

Edit from May 2021
I was lucky enough to be able to go to sports clinic twice, once with each tutor. I feel much more confident now in how to approach sports people and am really grateful for these special clinics experience, even though I did not manage to invest as much time as I would initially have like to do between the sessions.

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Portfolio - Exercise Program Footballer Meniscus

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Pandemic rules.. do we need to show the example as healthcare professionals? Do we need to be "more" then just human? - evidence D7-(l) - 28.12.2020 

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Pandemic rules.. do we need to show the example as healthcare professionals? Do we need to be "more" then just human? - evidence D7-(l) - 28.12.2020 

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

Description
This situation has been reported to me, so there is a huge bias already and this version might not be 100% accurate. However I chose to reflect on it because I found it illustrated really well the tensions around our covid-related-behaviours, as healthcare professionals..

2 long-term friends, X & Y... had an argument. I was regularly treating I's grandmother, at the ESO clinic. X, like many other students, is not following the rules, she goes to parties, sees lots of different people. She feels she is already doing her part. She feels it is "right" and "ok". Y, like many others, is strict about the lockdown. She learnt that her friend, who was treating her grandmother, was not particularly careful in her social life. She tells her friend she is not happy the way things are - she feels it is not safe for her grandmother to continue ttm. X says that if the grandmother was coming to an international-student-clinic, she should know is isn't the safest place.

Feelings
I find some people seem not to care at all, and I tend to be disappointed about that. I feel we have a role as healthcare professionals: follow the rules, as much as possible. I see and respect     that we all have different believes about this pandemic, and some people are very resistant with the medical view and sanitary rules imposed..  That is somehow ok? as long as you have your small clinic and see patients who are fully aware of what you do and don't do to protect them from the real or false virus.. but my feeling is that it is not ok when you are part of an institution.

Analysis
This situation is a good illustration of my disappointment with some friends over the last months. It shows 2 extreme views. One that seems quite selfish and irresponsible, and one that seems strict.. who is right? I don't know. I just realize once again a few things:  1 we ALL find excuses when we do exceptions to the rules (here, "I need to do that for myself"; 2 we are ALL more judgmental when our loved ones are somewhere in he equation (the grandmother); 3 this pandemic challenges us on many levels, professional but also relationships and friendship, and spiritual & beliefs..

Conclusion
1. When do I personally find excuses to justify what I want to do? Where is the limit between "faire de la merde" (which is potentially bad for the others, puts them at risk) and taking care of oneself (which we have to do)?

2. how to stay rational when emotions come in the game?

3. How can I keep my friends when we strongly disagree? Do we need to talk, argue, about the hot topics? How? How often?

Action plan
Judge less. But talk more. Share my views, reasoning, but keep in mind they are mine and I'm biased.

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

Description
I would like to reflect upon a patient presentation. I diagnosed mechanical low back pain. No neurological signs and symptoms, nor red flags. She has been diagnosed with hypothyroidism, diabetes mellitus type 2, and is overweight. She is trying to lose weight but lockdown really did not help.

She comes in quite regularly for maintenance treatment.

Feelings and analysis

It feels like a vicious circle, and even though osteopathic treatment seems to give temporarily symptomatic relief, I don’t think it is enough to break the vicious circle. I often wonder if it is worth the price, her time. What does it mean to her, long term…I feel able to identify some yellow flags element in this case, but I don’t feel qualified enough to really address them. I came to the conclusion that I should suggest her other approaches, and we discussed the possibility to follow the OSTEOMAP program. I told her it seems to really help people with daily persistent pain and to give tools to manage symptoms. She is interested, and almost started, but then she could not do it because she works on that day. I tried to ask whether she would be able to change her working days (as she works some weeks days and the weekend), and she says she has been working these days for 15 years and does not want to change them.

I should not be judging and I do not know the whole context and possibilities, but it looks like she is not ready to try to make a change.. or maybe she can’t make a change, or does not have the energy to do it right now. I know that tools like Motivational Interviewing would have been perfect in this instance, but it is outside the scope of my expertise at the moment, there is too much too learn and do. Some things have to give… (see article Frost et al,. 2019, at : https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204890)

Conclusion

I was not able to refer her to this program. But maybe, the fact to have discussed this option is a planted seed and might lead to a concrete change in future?

Action plan

Share these reflections with the 3rd year student who will take her over! I was recommended this book on helping adults change : A Toolkit of Motivational Skills: How to Help Others Reach for Change, Wilson, K., Taylor, P. and Fuller, C., 2019.

Reference
Frost, H., Campbell, P., Maxwell, M., O’Carroll, R.E., Dombrowski, S.U., Williams, B., Cheyne, H., Coles, E. and Pollock, A., 2018. Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: a systematic review of reviews. PLoS One, 13(10), p.e0204890.

Fuller, C., Taylor, P. and Wilson, K., 2019. A Toolkit of Motivational Skills: How to Help Others Reach for Change. John Wiley & Sons.

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PORTFOLIO Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews

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Therapeutic relationship, previous experience - evidence D2-(l) - 20.12.2020 

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Therapeutic relationship, previous experience - evidence D2-(l) - 20.12.2020 

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OPS 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

Description

Years ago, at the time I used to play 8 hours of music every day, I used to manage my upper back pain/fatigue with massage treatment. I had found a really good therapist near my music school. Over the years, the numerous discussions during treatment, we became friends. One day, she told me that she was in love with me. I had not seen it coming at all. She was married, I knew her husband, I am a woman, I had a boyfriend, she knew him… this was a shock. I did not know what to do and felt like I could not really ask any advice from anyone, as this situation seemed crazy. What if her husband discovered that? I thought the best thing to do was to temporarily cease all links with her. I felt rude but that is what I did.

A few months later, we talked about the whole situation, clarified what had to be clarify and now we are in good terms. She met someone else.

Feelings

I felt weird and I was not ready to deal with this situation. I felt almost betrayed, and maybe a bit manipulated because he had seen me in underwear. At one point I asked myself: is it my fault? Did I want her to like me?

The fact to be in a therapeutic relation with her added a level of complexity in the whole situation. And so did the fact that I knew the whole family (kids, husband, grandparents).

Evaluation and conclusion

Now that I am on the other side and have read around the therapeutic relationship and contextual effects, empathy and trust literature, having experienced that type of lack of boundaries to a certain limit helps me (I hope) to have a better understanding of the complexity and importance of the matter.

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

FINDING A JOB
A few weeks ago, on the 21st of November, I did it. I sent 5 application files. It was really hard. I worked weeks on my letter and curriculum vitae. I asked a friend to help me, I talked a lot with my sister, boyfriend… It’s really hard for me. Why… ? I’m afraid … « what are they going to think? » I’m afraid: will I ever find a real job? After 10 years of study, how will be the transition to real adult life? Am I able to do it?

Anyway, here I take a few moment to write down what I wish for my future. It’s 3 weeks later, I’ve only had one answer. So everything is still possible.

Mrs ***: she would be an interesting mentor. The clinic is in the perfect location, in my town, in a calm area. She is a very interesting person. It would be really great to learn from her.

Mr ***: I don’t know him but he is in the city centre.

Mrs ***: They called me yesterday! This clinic is probably a bit of a factoryline. Might have to work over weekends. But why not, as a start? It might be good to get to know other osteopaths, and to get some experience.

Mr ***. He answered, he doens’t have the space for another osteopath but he was really kind and encouraging. He was really positive about my profile.

Mr ***. I don’t know him very well. But I have a really good impression / feeling. It would be really great to work for him, plus, the idea to go in the countryside, not too far but somewhere different, is quite attractive.

Action plan:

Beginning of January, if I don’t have any answers, I’ll write or call them.

Edit February:
I did not manage to apply the action plan above... Felt too fragile. See action plan about CBT in post "Feeling bad - 08.10.2020 (evidence D11)"

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

Description

It happened yesterday, on the 14th of December. I arrived at clinic early. My phone rings. It’s a Swiss number.. is something wrong with my family? I answer. « Bonjour, c’est la clinique 7/7 ».  Oh I get it, it’s one of the clinic where I applied. They’re going to tell me thank you but we don’t need you. «your profile is interesting and Mrs * would like to meet you» Oh, oops, nice.

Feelings

I feel light. I feel good. I feel like there is a chance that it’s going to be ok.

Evaluation & analysis

In this short situation, of a few seconds, I realize that my first instinct is always «worst case scenario». It seems to be the way my brain functions. Where does it come from? Can I change it? Shall I change it?

It’s the second clinic telling me that my file is good. I don’t have a job yet, but I do have a good file which is a good start ?!

Conclusion

It’s  a small thing, but it’s helping me building some sort of confidence.

What I would have done differently: I did not know what to say when they said that my file was really interesting.

Action plan

Don’t let it go, send an email today or tomorrow, saying that following our conversation, I’m really interested etc… The more I wait, the less courage I’ll have to do it, the harder it is going to be… Just do it.

Edit
Action plan accomplished, I feel even lighter.

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News for my scholarship "godmother" - evidence D8-(Vll) - 20.10.2020 

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News for my scholarship "godmother" - evidence D8-(Vll) - 20.10.2020 

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

Description

The rules of the game for this « foundation » is that they give you money and you have to give news from time to time. After my first email, one month ago, I received a super-nice-enthusiastic answer from my « godmother ». I told her my plan was to have a first dissertation draft for the 12th October (now), so I thought it was a good timing to give news again (see email below).

Feelings

I’m always doubting when I write, always get this adrenaline rush coming with thousands of questions: is it ok, am I ok, is it appropriate, is it too much, not enough. But I manage to overcome these fears and just do it.

Analysis

This system is really great. Not only you hold them accountable  but also it makes you take stock of the situation, which is amazing. I probably wouldn’t have worked so much on my dissertation if I hadn’t told her, or someone, that this was my objective. My new objective is to apply for jobs back in Switzerland, and I guess the fact that I told her that was already a first step in that scary process. My boyfriend said « it’s a little bit like CBT » , and he is so right…  that makes a lot of sense to me. No judgement; observation; planning.

Conclusion

Great experience for me. But still my ego hopes she will reply.. I am afraid of what she thinks of me (-> I shall do some work on these fears).

Action plan

My plan is to write her an email after my dissertation is submitted. Of course I’ll adapt depending on her answer, if she is enthusiastic I might write earlier, if she wishes to unsubscribe form my newsletter then I’ll only write at the end of the year.

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Psychology video & handout - evidence  B4-(lll)  - 25.05.2020

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Psychology video & handout - evidence  B4-(lll)  - 25.05.2020

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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.

Description
Here is my psychology presentation. I am quite happy with the work I have done but once again, it is hard for me to let go and accept that it is imperfect.

Feelings
I am frustrated that despite all my efforts and what I can logically call a reasonably well thought and executed work, a little voice in my head continues to tell me it could have been better (and that my friends have worked harder/more efficiently).

Analysis
I want to learn to be more accepting of imperfections and flaws,  even loving of them, why not? Nothing is ever perfect in life, I have done my best when considering the situation, the resources available and the stage I am at, knowledge and experience wise. The layout and formatting work was maybe not necessary but I enjoyed it. Who knows maybe I can put these skills to good use when choosing graphic elements to market my future clinic, or produce educational leaflets to patients...

Note
I finally removed the video and put a screenshot instead, for anonymisation reasons.

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*entry above, psychology ...the handout - (evidence B4-lll')

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*entry above, psychology ...the handout - (evidence B4-lll')

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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.

I did not invest as much time for this one. I think it was a bit too much to deal with all the different informations about this module, and to have to make a power point, record us on it, a handout.

The technology aspect took quite a bit of time (power point + video + youtube account + padlet ....) but fair enough, I learned how to do it and now it would be easier.

The handout: I did not learn anything by doing it. Maybe because I did not invest enough time?

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OPS 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.

Description

Thursday the 8th of October. I feel worthless. I woke up late. There was no coffee at home. Supposed to receive a delivery but I forgot to arrange the details. In clinic I had one continuing (she was a cover patient over summer, my first patient after lock down.. no need to say that I didn’t do a great job) & a new patient. I was supposed to have lots of time (half of the morning) upstairs in the study room to work on my dissertation. But I ended up waiting for this patient. Waiting and waiting… she didn’t turn up. Reception called her and she « forgot » even with the text reminder.. She re-booked for next week, not with me, back with her previous practitioner. She’s just wasted my time and made me feel even more worthless.

Feelings

I’m now upstairs in the study room butI have got a new patient very soon. The tears are not far from coming out. Not a very enjoyable state. Oh, and I've got my periods coming.

Evaluation

Good: how to see it a good way: I actually didn’t really want to see this patient, so I could / should feel relieved. Also, intellectually, if a patient prefers to see someone else, I really want them to go and see this person. It does not mean I am a bad person/practitioner, it is impossible to be the perfect fit for everyone. Intellectually I know that. Emotionnaly it's a different matter.

Analysis

This illustrates the cup analogy from Greg Lehman (What? Pain is complex - the overflowing cup analogy of pain. - YouTube   +   Do our patient's need fixing? Or do they need a bigger cup? — Greg Lehman): my glass is small (beliefs, past exerience, self esteem, …) and very full (period pain, current stress levels...)

Conclusion

Digest this experience. Take more distance.

Action plan

a) Let's get to work
b) Contact a CBT practitioner

Edit
action plan b) enacted... 6 months later. There was quote a lot of waiting time, but I will actually start my therapy on the day the portfolio is due!

References
Internet 9: http://www.greglehman.ca/blog/2018/5/1/do-our-patients-need-fixing [Accessed October 8, 2020]

Internet 14: https://www.youtube.com/watch?v=IgFaOClDZAA [Accessed October 8, 2020]

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Quite proud of how I have been fighting - evidence D8-(l) - 30.05.2020 

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Quite proud of how I have been fighting - evidence D8-(l) - 30.05.2020 

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

FINANCING MY STUDY

Description

Here is just one of many documents for my funding research...

Feelings and evaluation
When I look back at the of documents I prepared (grant, funding applications... ), I wonder if I shouldn't have spent more time studying instead.

I received financial help for 1st, 2nd and 4th years but also lots of negative answers. I bounced back so many times,I tried tried tried and tried again. I guess I am proud, I have to realise (like everyone else it telling me) that it took some determination, organisation and dedication.

Conclusion
What I learnt from this process, and from the ups and downs: a general attitude, daring to knock on doors and daring to ask to make my projects/dreams become possible.

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Hopla, good news - evidence D8-(Vlll) - 02.09.2020 

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Hopla, good news - evidence D8-(Vlll) - 02.09.2020 

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

FINANCING MY STUDY

What
I'm really grateful. Last year I sent lot of qpplicqtions for scholarships and didn't get any. This year I got 3. I knoz now that I'll be able to go to the end of my studies. I knew from the beginning that the cost was too high for me or for my parents. But I told mum : its gonna be ok, I'll find a solution. It feels good: I found a solution (a series of solutions, step by step, year by year) and there I am, beginning of my final year here and I've found all the money needed. Do I deserve it? No. I'm just lucky. It is a luxury to be able to study. Despite all my efforts, my organisational skills my first thought is still that I am just lucky and undeserving...

Mum sent me a message to announce me that I got the RW scholarship: "t'es trop forte". The letter stated that I had to contact my "godmother" to give her news of my studies. I don't know why but I really struggled to write this email. But I did it and her answer was so nice: she literally answered each single statement/detail I made in my email (see below).

So what
So it it feels like I don't only have a financial support but also a moral support, which feels really good. I was really touched by her answer.
It is also nice to have like an "guardian angel" on the journey, for the last step, even though the journey started years and years ago. It feels nice to have someone interested in my project. And her email felt really "fresh" and positive, as she just discovered my project, my school.. sometimes along the journey we forget to enjoy the nice bits and it's good to have an external view to remind us to keep the eyes open on these nice things.

Now what
I'll answer her tomorrow, saying very honestly that it is a chance to not only have her financial but moral support. I'll also make sure that I send her a few emails throughout the year. Not only for her, but also for me as part of a reflection with "projectors" on the scene and not the backstage.

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

FINANCING MY STUDY

Saturday. We just arrived yesterday at s's sister's place. We're about to eat, and I receive a watsapp from **. "Miss * is willing to support you". I wasn't expecting such a generous gesture at the beginning of these unprecedented uncertain times... where the economy is hit in the face.

It's a huge motivation. It makes so much space in my head for all the rest. Space that was occupied by constant questions: how am I going to do? study vs work, where is the priority? Am I doing the right thing?

Now there are lot of other uncertainties on the horizon. But financially, it will be ok. It feels good. I'll keep 4/5 to pay my debt and the rest as an extra for * and myself (daily stuff if situation gets worse? Holiday? cpd?). No need to decide yet, let's stay excited but wait to use it wisely.

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

FINDING A JOB, EPISODE 1

Description

Time is flying… quite scary. In three weeks time dissertation is done, then it’s Christmas, then it’s all about enjoying a few more months in Maidstone with everyone, doing the CCA, and … and what? And go back home? Become an adult? Find a real job, finally? After 10 years of studies.

It’s in my head, somewhere. I have to find a job. I’m postponing this job search since a few weeks (or months maybe?). Last week for the first time I dared to send 3 messages.. these messages had been ready on my computer for 3-4 weeks, and they were on my to do list for 3-4 months..?

Feelings

I did not feel brave enough to disturb people and say : hi, I’m looking for a job. Why? I’m afraid of their reaction, what they are going to think.. I’m afraid of a « no ». Why? Probably that I’ve developed a sort of fear of abandonment and rejection… this fear is in me since I was a child, and I haven’t done anything serious about it. It is getting better, with time, but it’s still there, part of me.. and when I’m not 100% I don’t have the energy to face it, to go over it.

Anyway, last week, I finally sent 3 emails. the first one answered in a very positive way, the second one never answered and the third one did not see my message yet. The first answer was really encouraging. And I feel brave and relieved that I finally dared sending these messages.. it is the first step of my job research but also probably the biggest.

Analysis

Now I know that I can do it. I have got a cover letter and a CV, everything is ready, and I can dare to send them.

Conclusion

I’m a little bit proud that I finally made it… also grateful of the kind support (friends and boyfriend).

Action plan

Do an action plan: gather addresses of people/clinic I could contact, and just do it. Try to spend less energy and ask less support, just do it.

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

FINDING A JOB

Description

Wednesday morning, 28th of October. Sitting at Matestone. I’ve gathered my courage, and have started to write an email to X. While writing it, I thought it might be helpful to have a look at her website. It looks like Y is going to replace X. That’s the job that she offered me a few years ago.. she said hurry up. I probably haven’t managed to hurry enough.

Feelings
I ordered a hot chocolate with marshmallows. I felt depressed and full of regrets.

Analysis
I have to do something about it. Not about them, not about the situation, clearly the job is gone, but about me and my reactions. See things differently. Change my mindset. Stop wanting everything, the to have the cake and eat it as they say here. Remember what I really want. Stop thinking. Stop trying to interpret what happens in people’s mind.

I tend to want everything. But deep inside I know it’s not possible and it’s not preferable. Do I really want to go to Geneva? Probably not… so why am I jealous? I actually don’t know what happened, and I don’t know whether there is still a space for me or not. But I am afraid to fail again if I ask her. On a separate note, patients feel like this all the time. We treat their pains and talk about their muscles and joints, but every single day they face those struggles too.

I could see the situation in two ways:

1. X promised me a job, I changed my life for that job, moved in another country, broke up, left everyone, left my musical career, struggled, studies, struggled again, got older, and the job is gone.

2. She supported me in my change of career, she helped me to find my first scholarship which allowed me to integrate a great school, now I’ve got a new life full of new possibilities, and I can chose what I want to do.

Conclusion

I want to be person 2. I know that. But how can I get away from person 1? Maybe person 1 is there to challenge me.

Action plan

Write to X. And so what? She might not answer, she might be distant, she might not remember what he said.. and so what? What is it all about?

PS: re-reading this post and just to let you know that I found the courage to write her!

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Lockdown - my study plan while in France - evidence B3-(ll) - 19.04.2020 

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Lockdown - my study plan while in France - evidence B3-(ll) - 19.04.2020 

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

Description
We arrived here 3 weeks ago.

What I have done:

-examination routines documents
-videos on osmosis
-clinical edge
-patho exam
-some cases
-finished the protocol
-started the psychology presentation
-some portfolio
-CPD'S

What I haven't done:

-practical
-osteopathy
-pain science

Evaluation
Why?
-practicals -> I tried and I felt like a loser. It is hard to create some "hands-on" time when locked in a house with the same people, and when everyone's priority is something totally different.
-ostepathy -> I tried to read the book "anatomie et ostéopathie", but am not convinced at the moment. It is interesting how interest in osteopathic philosophy comes ang goes...
-pain science -> I tried to read explain pain supercharged but wasn't interested in the chapter I tried to read. Maybe it is simply to information overload at the moment, maybe it is not the right time. Or maybe it is simply not for me.

What I have to do
Psychology presentation!
.

Action plan
Tomorrow: read the email, read assessment brief, ask some help, do a full day on that.

What could I do different
-Structure my time differently, do less of each with a timer. I have looked at this further, it is called the pomodora method : The Pomodoro Technique — Why It Works & How To Do It (todoist.com)
-Do the things which are not motivating in the morning, just a little bit
-But also go with what motivates me ATM (being motivated by examination routines is quite cool and might well stop one day)

Once pathology & psychology are done, I will have more time and mental space for the rest.

Edit, May 2021:

Reading through my padlet, the "hands-on practice time" during COVID-time is a recurring issue. I was actually going to almost every single morning practice in my first and second year, but since the pandemic the priorities have completed changed.
Now at the end of my fourth year, I still feel like I have not been practicing hands-on enough, and during the different lockdowns I felt like I had to chose between practicing or following the rules and minimizing the risks. Quite a few people continued to meet and practice in groups, even when we were not allowed to. I chose to follow the rules, and have thus probably lost some hands-on time, but this choice and discipline also shape the future healthcare professional I will be. It showed I was able to make choices adapted to a pandemic situation. It shows what lies at the core of our practice, our values.

References
Internet 8: https://todoist.com/productivity-methods/pomodoro-technique [Accessed April 19, 2020]

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

Description
Back to clinic after a few months online. One of my maintenance patients from last year comes back. He had an ischaemic stroke and is hemiparetic since then. After a few months of physiotherapy to regain some function, he discovered osteopathy and our clinic. He used to come every week, alternating between two practitioners. He finds the weekly treatment really helpful to manage his symptoms and improve his quality of life. The stroke in his frontal lobe also impacted his speech and it is sometimes hard to communicate, due to both his impaired function, and my personal struggles with English.

He arrived and started to explain something with the cameras. I finally understood that he wanted the cameras to be off, as he was afraid someone could be filming or taking pictures of the treatment.

Feelings and evaluation
Initially I did not know how to react, even though I fully understood my patient’s point of view. I knew we were supposed to be supervised by the tutors and I had never encountered a problem with a patient. I told my patient I had to go and talk with my tutor. My tutor was not fully understanding, and I tried to defend my patient’s interest, which I finally managed to do. Knowing that this problem would occur with other tutors, I decided to act in « prevention », go and talk with someone from the management team about this situation. This person agreed it was a shame for the learning process of other students and the tutor supervision, but said without hesitation that we would follow the patient’s preferences. I was glad with this conversation and felt like I did my job, and I had the head of clinic’s support in case a tutor would disagree.

Conclusion
This situation helped me to remember that the priority is always the patient.

Action plan
Turn the cameras off and put a note in my records, with a description of the event and how it unfolded.

Don’t assume it is ok for every patient, remember the importance of informed consent.

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Reflection on a podcast I have just listened - interview with Chad Cook - evidence D1-(l) - 20.08.2020 

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Reflection on a podcast I have just listened - interview with Chad Cook - evidence D1-(l) - 20.08.2020 

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

One of the take home message from this podcast is that hands on therapy does not create dependance, and it is all about the the way you communicate about it. It has been a recurring theme in the last few years for me. The more I dive into the BPS model the more I developed a fear of over-treating and creating dependency in patients. Especially at the ESO clinic where a large number of patients have been coming for a long time. It is tricky because we are students and we need to learn. At what point do we need to go against patients’ preference if we still think we are not harming them by asking them to come back? The study Chad Cook talks about is reassuring in the sense that despite what some claim, it is not the hands on approach itself that can be negative or harmful but the language around it.

Link to the podcast :

https://www.clinicaledge.co/podcast/physio-edge-podcast/093 (internet 10)

Further ressources I have looked into:

Another reflection on the topic:

I really appreciated watching this video. I find it quite rare in the profession to have people with conflicting views debating, in a clever and constructive way, and with much respect to the other's point of view. I am going to try to use this as a model when I engage in discussions with my peers.
https://www.youtube.com/watch?v=nGspYvZGTFg (internet 12)

Before engaging in such discussions (between peers and with patients), I believe it is important to be aware of our biases (see resources below) and try to be as neutral as possible.

Video on cognitive biases:

https://www.youtube.com/watch?v=B_rStLPDn3c (internet 13)

Cognitive Biases in Healthcare

Decision Making : hee.nhs.uk

See infographic attached

References
Internet 13 : https://www.youtube.com/watch?v=B_rStLPDn3c [Accessed August 20, 2020]

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«I feel I am naked like when I was giving brith» - evidence A6-(ll) - 24.04.2018 

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«I feel I am naked like when I was giving brith» - evidence A6-(ll) - 24.04.2018 

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OPS A6. You must respect your patients’ dignity and modesty.

Clinical Observation 1st year, 24th of April 2018

On Tuesday the 24th of April, during an evening clinical observation at the ESO teaching Clinic, I observed a treatment after which I asked myself questions about the gaining consent process and the situation of having observers during a treatment.

The patient was a 34 year old mother complaining of lower back pain, preventing her from taking care of her baby. During the case history, the practitioner collected much information that was relevant to understand the patient’s health context: the patient had a miscarriage before this baby, she worked a lot but was still short on money. She had never been to an osteopath before and came because she was hopeless after having been to her GP that couldn’t help her. After the case history and the examination, the practitioner explained her findings (SI joint dysfunction) and her treatment plan to the patient and gained her consent. The treatment started and at one point, the  patient said that she felt « weird », « naked » and « observed as when I gave birth». The practitioner answered « that’s normal, that’s fine » and continued the treatment. Four students were observing the treatment.

I felt really uncomfortable at this moment, but couldn’t do anything about it because of my observer status. Should I have done something? Should have I discussed this with the others afterwards? In hindsight this is not ok, especially since this led to no further discussion between the team. Maybe the patient was joking about it, maybe not. The student practitioner s response was extremely patronising and unprofessional. Hopefully it will stick with me and serve as a guide of conduct.

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CPD-big plan with friends - evidence B3-(l) - 14.04.2020 

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CPD-big plan with friends - evidence B3-(l) - 14.04.2020 

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

Description
April 2020. Clinic stopped, school stopped. People are leave, a few are staying, I don’t know what to do. I'm leaving too. If something happens to my family, I want to be able to be near them, even if I can't seen them. The borders might close and I might get stuck on this island.

We've arrived in my boyfriend’s country, in his family. We are not allowed to do anything. Suddenly I have got so much time for myself and a lot of motivation to put things in place. We wake up early in the morning, go for the daily allowed walk, then we come back, have breakfast and start working.

I've checked which courses I could do online, and I've subscribed to Osmosis and Clinical Edge. I've found an offer for a shoulder course with Jo Gibbson, which I am a big fan of, and other courses for free, the Therapy live day, and I've discovered a lot of inspiring tutors/teachers.

We exchange a lot with a few friends, and share what we learnt in different courses.

Feelings

I am quite proud of this dynamic learning environment we created with my friends, and grateful to be surrounded by these people. It is something to hold on to.

Analysis

I have completely switched my studying dynamic, from studying only for school to discovering and doing all the courses and CDPs available online. I now have to force myself to come back to focusing more on school. Interestingly I have also discovered that what people now call Zoom Fatigue is extremely real. It is hard to stay on the computer for long period of time, physically and mentally. My body aches, my mind is blurry. Making the simplest decision can be hard. It is the closest thing I can experience (I hope) to living isolated or with an anxiety disorder. I feel for people who have had to endure this for years.

https://greatergood.berkeley.edu/article/item/four_reasons_why_zoom_can_be_exhausting (internet 3)

Conclusion

I have set up a great colourful landscape of things that I want to explore in the future. However I need to focus on learning the basics first.

Action plan

Close this CPD-discovery bracket, be patient, finish my course and then enjoy all the rest!

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Should we be here? Discussion with a tutor - evidence C5-(l) - 09.09.2020 

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Should we be here? Discussion with a tutor - evidence C5-(l) - 09.09.2020 

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

After a few months of online learning, we are back in clinic, masks on, full PPE, sanitiser everywhere, it feels like we limit the risks of contamination (see screenshot email with all the different guidelines).. but do we really? How many people work in this place? Probably as many individuals as different views on the protocols, the pandemic and our role in this situation.

Today I discussed this situation with one of our tutor. His opinion was that small practices should remain open but a teaching clinic like ours shouldn’t. His argument was that there was no chance to control what was happening and no chance to reduce the risks. It made me realise I probably shared his view, but I was selfishly very glad to be able to continue my training.

Time and luck will tell us if it was right to remain open in these conditions.

My feelings and opinion on the question are really mixed: glad to be able to continue, grateful that the profession is recognised as having a role to play in this pandemic, but sometimes feeling like it is wrong to be so many people in small team rooms, to not be able to properly air the rooms between patients (the window don’t open fully).

Update from a few months later:

I did not realise at the time how much mental and physical load this situation could create. The fear to contaminate or be contaminated and become a vector, the time constraints linked with cleaning, the slow but steady decrease in vigilance we all go through. It has been hard.

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CPD big plan with friends - evidence B3-(l') - 14.04.2020 

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CPD big plan with friends - evidence B3-(l') - 14.04.2020 

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

Addition to post above
As most of my notes / files, this one was too large to fit in a single post. I take most of my notes by hand and add lot of drawing / pictures, and I did not manage to add as many as I wanted to in my padlet. The quality is also not really good, but I found over the last years that written notes are the best way to integrate what I write for me, I find it easier to organize as well, and don't need wifi or battery to access them, and I don't get distracted by pictures or the internet on my computer... so that's how I went through the course!  Especially now with Microsoft Teams tutorials, Padlet to write in, the courses to follow, dissertation material to look up online... there is something reassuring with writing in notepads. Something real and personal.

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

Description
During summer clinic, I have had a lot of cover patients and it made me face a new challenge: jumping in / taking over someone’s management plan, with ‘only’ their notes.

Evaluation and analysis

When I read my notes, I very quickly know / remember where we were at in the management plan. But I do not know whether they would help someone else or if they just help me. Beyond the difficulty to read someone else’s writing, it rarely helped me to fully understand where the patient was at and what to do. It has been a good practice for myself but made me realise it was probably not optimal for the patient.

From the interview, to the recording of the findings, the working diagnosis and the management plan, we all developed a very different style to record what happened during the session. Shouldn’t at least the examination findings be standardised to assess the progression?

I have made a little experiment in clinic on the circles-diagrams designed to record the ROM. I have asked everyone I have seen using them in summer clinic to ask something quite basic: where on this diagram is each vector (flexion, E.R, I.R side bending etc) for the spine but also for the limbs… the result was : no standards and a lot of confusion. Isn’t it a very first step we should agree on? I have further asked how they used these diagrams: is it about ROM? pain? discomfort? Compared to their normal or compared to the norm? Again, a lot of confusion arose from these questions.

For continuing patients, A simple approach I found is the SOAP model (link towards SOAP physiopedia, internet 4). The « A » part is very interesting. It goes beyond a diagnosis, it can be a summary of the situation, or a of where the patient is in the management plan, or a note on a particular angle that stands out. I don’t think I do this enough. Especially with maintenance patients, it is very easy to stick to a routine and write findings and treatment and never go beyond that.

Conclusion
As soon as we work with other practitioners, it is really important each time we write notes, that anyone else might have to take over, and needs to understand the whole situation and management plan with our notes.

Action plan
Continue to challenge people and myself at the ESO.

After the summer, in the clinics I will be working in, I’d like to take some time to clarify with the other practitioners what they expect from my notes and how to interpret theirs.

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Beta blockers and other substances in orchestras - evidence D11-(l) - 08.10.2019 

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Beta blockers and other substances in orchestras - evidence D11-(l) - 08.10.2019 

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OPS 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.

Description
A few years ago, I was in my first year of bachelor in music. One day, after a concert, I went to my class and my teacher told me: « you can’t continue like this. Your level and your progression are good, but each time you play in front of a public, your level drops, a lot. You should take something, something like beta-blockers. » I told him: « I hear what you say about my stress problems and I agree I should do something about it. But I will never touch your beta-blockers. Playing concerts is going to be my profession. I will not be taking drugs all my life long to do my profession. I won’t start. I’ll start a psychotherapy. »

Evaluation and analysis
During my bachelor and master, I went to a psychologist, a mental coach and a coach for musicians. I did improve in stress management, but it stayed a tough battle. I have set up a lot of different things, I have been pro-active, and I have progressed.

Feelings
With all this work I had done, I feel like I am not anymore stressed to be stressed, but only stressed. And I know my stress, I know myself better, what « symptoms » I might have, what tools I have.

Conclusion
This whole mental work I have done was not only beneficial for the concerts but also for any stressful life situations. I still consider myself as someone quite stressed and sensitive, but stress it is not such a barrier anymore.

Action plan

Part of this stress-problem comes from my education and the classical-music world. Throughout the years I have discovered that a huge amount of classical musicians suffer from that and take drugs or alcohol. All these mental-health issues are still very much taboo in this environment and I want to work on that, help people who suffer from stress and also prevent by teaching children easy techniques to manage stress.

Edit
At the time I was studying music, beta-blockers and other substances were completely taboo. Interestingly I realized a few years later that this problematic was actually mentioned in lots of different articles (see reference below), and I had no idea about that!

Reference
Matei, R. and Ginsborg, J., 2017. Music performance anxiety in classical musicians–what we know about what works. BJPsych international, 14(2), pp.33-35.

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What can we do to change? evidence D6-(l) - 20.09.2019 

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What can we do to change? evidence D6-(l) - 20.09.2019 

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

Description
I spent all my summers as a carer in a palliative / care home. Not every day was easy. I learned a lot by working with old people. Enriching but challenging. Not every life situation / end of life situation was easy and we had to face these challenges daily with our patients.

In the nurse/carers team, I am the only Swiss native. This outlines the ‘social classes’ phenomenon, and I can see all the inequalities in my country.

Quite a few colleagues were from a ethnic/non-swiss background. Quite a few patients demonstrated racist behaviours towards them. Quite a few times, I have been very shocked by patients words towards these colleagues. But often, my colleagues stayed calm and professional.

One day, I was taking care of a patient in the shower, and a colleague came in and said : could we please exchange our patients. Not very convenient, but I said ‘yes sure’. He explained me later that his patient refused to be washed by him based on the colour of his skin. The patient had told him: I won’t let someone black and dirty take care of me. Ironically, my colleague was cleaning the patient’s stools. I went and took care of this patient but had lost all my goodwill, knowing how she treated my colleague.

Another day, we were taking care of an old obese man who could not walk anymore. We had to be two to carry him. The old man said to my colleague: who is this girl (=me)? He said (joking): ‘she is my daughter’. He said, confused: ‘no! that’s impossible’. My colleague said: ‘why?’ He said : ‘because she is good looking’.

I was really shocked. The job we do is not an easy one, we are not well paid, and I still can’t believe some carers are treated like this by patients. On one hand I think : some of the patients have dementia, plus they are not in an easy period of their life.. but is it an excuse?

I talked with these colleagues and shared that I was sorry for these situations. They said: don’t worry, we’re used to it.

Analysis
Even though I will never be able to fully understand how it feels like to be treated like this, having been a whiteness is I hope enough ti make me aware of it and make me mindful of my behaviour. How can it change though? Is it ever going to change?

Conclusion
As professionals, we can’t discriminate based on race, there are clear laws about that.. but what about patients? And what about our role? Are we supposed to try and educate people? Are do we have to stay passive to such behaviours?

Action plan
I really don’t know what I can do to make a change.

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CPD FGM training proof - evidence C4-(l) - 01.07.2020 

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CPD FGM training proof - evidence C4-(l) - 01.07.2020 

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OPS C4. You must take action to keep patients from harm.

A few days ago, I have received another email reminding me to do the FGM training. I was late and it was on my to-do list since months. I was procrastinating because I thought I had better things to do with with my time, like studying my ddx.

I was wrong. It was eye-opening.

I shamefully admit I knew very little about the topic and what I knew I thought was only taking place thousands of kilometres away from our clinic.

I wonder what other topics I mistakenly think are outside of our clinic / scope of practice.

Conclusion

It highlights the need for active reflection. This training is my only experience with that but I hope in real life situation I will be able to act swiftly.

Action plan after the training:

I have looked at email address and phone numbers services in Kent that could help guide me in those situations ->>Regional Safeguarding lead (*the Kent community health NHS foundation trust* KCHFT, phone 03000 416 161 / social.services@kent.com.uk)

References
Internet 7: https://www.kent.gov.uk/social-care-and-health [Accessed July 7, 2020]

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Money money money - evidence D8-(ll) - 06.08.2019 

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Money money money - evidence D8-(ll) - 06.08.2019 

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

Do I actually have financial issues? Or do I just have money related emotional issues?

Description
Back to the time I decided to start another degree. I remember the talk I had with my dad when my plan was to "stop" music and become an osteopath. At first he was very reluctant. "We said we would support you for one master. Not more". I was thinking : I'll find solutions. I also remember the call I had with my mum "my friend told me the ESO was amazing, I really want to go there.. the only thing is it's really expensive, but I'll find solutions". She was a lot less enthusiastic than I was at the time.

Big topic. As I decided to become an osteopath, my ex-boyfriend was supporting me and telling me he was going to work and it would be ok for us. It didn't happen ... and I didn't pass the tests to study in my country.

As I started this whole adventure at the ESO I had a message from the person who encouraged me and inspired me to change career (a physiotherapist for musicians) saying that I'd get the scholarship every year. It stopped after one year. After that, I found help from another foundation. The president told me after my speech to the whole committee: "don't forget to send your file again next year! We don't abandon the young people we help!" Big disappointment in the summer between 2nd and 3rd year: they can't help me anymore. Following that I was feeling really really bad for a few days. No energy to bounce back.

The rules of the game changed, 3 times at least. And I (as well as my parents..) had to accept these changes and adapt. 2 promises were made, and 2 were broken.

Feelings
Now my parents are incredibly supportive, and I'm almost struggling to accept their help. I've just lost my job at the cafe (I was fired) and my parents transferred me straight away some money. I have to learn to accept gifts.

Why is it complicated? Is it because I don't want to be a burden for them? Am I a burden for them? Is it because I'm stubborn and want to manage everything?

Evaluation
I have had a strong desire to become independent for years and years. Where does it come from? My education? Me? Anyway, the plan to do a double master didn't help to make it happen.

I will try to find a scholarship for next year and I'll also work to have regular money income and feel active and not only dependent. Somehow, I will / we will get there.

Conclusion
All of these ups and downs are a good preparation for real life. With my future profession I will probably have an independent status, so the ups and downs will continue!

Action plan
I also need to work on the emotional aspect of it. -> mention this topic to my therapist!

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My clinic team: what a treat - evidence B4-(ll) - 02.01.2020

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My clinic team: what a treat - evidence B4-(ll) - 02.01.2020

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

I remember this summer when we were waiting, quite impatiently, to receive our team. Not so many people I didn't want to be with, but more the hope to be in a supportive and nice team.

It's been a term now and I'm still glad to be with them. I've never felt judged. Respect, laughs, practice, support, tea breaks, a nice environment to start to evolve. Maybe a bit more feedback would be helpful now*. The only one I've really asked feedback to is *, and he thinks it's totally useless so he wouldn't tell me.

I've just been one week with another group (new year shifts) and it was interesting to see other practitioners as well. I had wrong preconceived ideas about some of them, and I am a little but ashamed about it.. Is it normal to have preconceived ideas? But at least I was able to realize I was wrong.

Action plan: ask one of my team members to observe me and write a complete feedback before reading week.

I'm looking forward to go back into my group.

*Edit from May 2021

Back in December 2019 I already realised that we were not very pro-active in giving feedback to each other in my team. After almost two years, I am still really glad with my team, always happy to see them all, always feel supported, but we are definitely not the most pro-active team in terms of feedback! I tried at the beginning to ask people to give me feedback, but only managed to get one written feedback in two years... I guess the perfect team doesn't exist, although mine was almost perfect!

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The perfect intro with SDM document - evidence A4-(l) - 15.05.2020 

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The perfect intro with SDM document - evidence A4-(l) - 15.05.2020 

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

Description :

A few weeks before our end of 3rd year clinic exam, I am realising I am still not fully happy with my « introduction » part of the consultation.

Feelings
With all my talk of being interesting in patient centered care, I have focused on other aspects of the consultation until now in clinic,which  is a deflating realisation.

Analysis
With online clinic and exam, it is the ideal time to create a document about communication aspects and to write the « perfect intro ». The idea is to take some time at the beginning of the consult, clarify what will happen and address a few shared decision making points.
Example :

Name, nice too meet you

I’m going to be your osteopath today

I just need to ask you a few questions, because of the corona virus situation, is that ok with you? Have you experienced any cough, fever, loss of smell or taste, any other unusual symptoms?

Are you aware that we have live cameras because of the covid situation? Are you happy with that?

Have you already been to this clinic before? -> because it’s a teaching clinic, it might be slightly different from another clinic, my tutor Mr / Mrs … might pop in and out of the room, and ask you some questions as well. …

I’m going to talk you through the process quickly: I’ll ask questions about what you’re coming in with today; then I’ll go through your medical history and ask you questions about your general health. After that I’ll pop out and talk with my tutor about your case and then come back, do some tests to further understand what is going on. We will then take the time to talk about what we think is causing your symptoms, what we can do about it

If we’ve got time and if appropriate we will go on to some ttt. Does it sound ok for you? Any questions for me so far? If at any time you’ve got questions, let me know.

For the ttt and the tests it would be helpful if you could undress to your underwear, if that’s ok with you. I can propose you a gown, a chaperon if you’d be more comfortable let me know.

Just before we start, I’d like to make you aware that any of the tests or technique we do might results in some soreness within 24-48 after the session, it should not last longer than that - a little bit like when you exercise. Some people don’t experience any discomfort, and it is really hard to predict how patients will react. Is that fine for you to continue?

You’re in charge, if you want to stop at any point, if you have any questions, please feel free to interrupt me.

Edit: comment a few months later

Since I took the time to work on these aspects, I have been able to be more comfortable in clinic and I even had a few positive comments on my communication from observers.

I have adapted my introduction speech throughout my fourth year, and have refined it to incorporate more SDM elements:

"You told me that this is your first time in this clinic, so I would like to take the time to talk you through the process,

So basically we have one hour and twenty minutes, that gives us a lot of time for the case history, in which I will ask you lots of questions about your presenting complaint and what brought you here, I will also ask you questions about your medical history and your general health.

I will then pop out and discuss what you told me with my tutor, I will come back in and I would like at that point to carry out an examintation to further understand / refine what we think is going on. For the examination I will ask you to perform some movements, and will also assess some of the structures (I’ll explain as we go along). Depending on what is going on and examination we do, it might be helpful if you could undress to your underwear, or to your shorts if you brought some. If you’re not comfortable we can offer you a gown, or do it with your clothes on.

Some of the tests that we do are design to reproduce your pain, they are really helpful for us to understand better, but might cause you some soreness, up to 48 hours after the treatment, so if there is anything that you planned in the next 2 days and for which it is a problem, just let me know.

After the examination I’ll pop out again and discuss the findings with my tutor, then I’ll come back in and share with you what we think is happening and what are the treatment and management options for that, based on your expectations and our clinical reasoning. These options might include advices, hands-on treatment, exercises, or a referral to another healthcare professional. Together we will discuss what is the best way to go forward with you,

If you have any questions at any point, don’t hesitate to ask me, and if you would like to have a third person in the room that’s possible as well."

Conclusion
I know this is long. But it sets things straight, it helps build a comfortable, honest relationship which can dramatically influence the treatment outcomes. And I am hoping this can serve as a keepsake, I think the more I do now, the more I might continue to use in the future, trim the uneccesary parts. Rather than adding.

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Vaccine hesitancy in osteopathy - evidence C4-(ll) - 25.04.2021 

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Vaccine hesitancy in osteopathy - evidence C4-(ll) - 25.04.2021 

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OPS C4. You must take action to keep patients from harm.

Description
Back in December, one of the receptionist in clinic told me "they  found a vaccine, in a few months we will get over this pandemic". It felt weird and completely unreal at the time ... but only a few weeks later, it was there ! And we were allowed to get it as allied healthcare professional.

Are we, as osteopaths, going to do it? Am I going to do it? There is probably no right or wrong answer, and many layers of reflection came into this question.

Feelings & evaluation

My gut feeling:
I must say I was slightly afraid initially (on a purely selfish level). When I tried to be rational, my reflection was: this certainly is not the perfect solution, but here, now, in our society, it might well be the only solution, or the one with the less harm!
-> unclear conclusion

As a healthcare professional
I also tried to think: if my parents or grand-parents go to an osteopath or another healthcare professional, would I be happy if these healthcare professionals were vaccinated? The answer to this question was easy: yes.

In the past I worked in a hospital and at the time I decided to not have the flu vaccine. I had to work with a mask during the flu season and a tag on my shirt saying "not vaccinated". Looking back, I feel glad that we have the choice and I think it is was legitimate that we had the choice, but I regret that I had not done it for the patients (most of them had a weakened immune system). I want my patient to feel safe that I do my best to reduce the contamination risks.
-> one point for the vaccine

As an individual in a pandemic
I really want to do all I can, at my small individual level, to not be a covid-vector, to get over the situation with the less harm possible, the less deaths possible.

In that sense, if I were to chose to not have the vaccine, I would then do more than my best to strictly respect all the covid precautions.
-> one point for the vaccine

Conclusion
Result 2 points for the vaccine : 0 points against the vaccine -> I got the vaccine, quite early, took my courage in both hands (I admit after deciding to get it I was still afraid to have it, but there were too many good reasons to just do it). I accepted to be afraid and asked a friend to drive me (did not want to cycle one hour alone to my GP practice, in case I would feel weak afterwards).

Beyond the specific vaccine situation, this experience made me realize that it can be tricky as a patient to make decisions for your own health, and that when it is about health, everything becomes so emotional.

Action plan
-Read vaccine hesitancy article (see below)
-Discuss with other osteopaths what are their views

Edit after reading the article
It reassured me and helped me to understand my challenges given my position of healthcare professional student. This status adds a level of complexity into "where do I stand". It also reminded me that we need to be coherent as a profession, and we need to talk together, even if it sometimes creates some tension between us.

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Portfolio - Opposing vaccine hesitancy during the COVID-19 pandemic-A critical commentary and united statement of an international osteopathic research community 2

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Côté, P., Bussières, A., Cassidy, J.D., Hartvigsen, J., Kawchuk, G.N., Leboeuf-Yde, C., Mior, S. and Schneider, M., 2020. A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity. Chiropractic & manual therapies, 28(1), pp.1-5.

De la Croix, A. and Veen, M., 2018. The reflective zombie: problematizing the conceptual framework of reflection in medical education. Perspectives on Medical Education, 7(6), pp.394-400.

Elwyn, G., Cochran, N. and Pignone, M., 2017. Shared decision making—the importance of diagnosing preferences. JAMA internal medicine, 177(9), pp.1239-1240.

Epstein, R.M. and Gramling, R.E., 2013. What is shared in shared decision making? Complex decisions when the evidence is unclear. Medical Care Research and Review, 70(1_suppl), pp.94S-112S.

Frost, H., Campbell, P., Maxwell, M., O’Carroll, R.E., Dombrowski, S.U., Williams, B., Cheyne, H., Coles, E. and Pollock, A., 2018. Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: a systematic review of reviews. PLoS One, 13(10), p.e0204890.

Fuller, C., Taylor, P. and Wilson, K., 2019. A Toolkit of Motivational Skills: How to Help Others Reach for Change. John Wiley & Sons.

Matei, R. and Ginsborg, J., 2017. Music performance anxiety in classical musicians–what we know about what works. BJPsych international, 14(2), pp.33-35.

Sotiropoulos, M.G., 2021. Impostor syndrome: a calling for a career in medical education?. Postgraduate Medical Journal, 97(1146), pp.264-265.

Thomas, A., Kuper, A., Chin‐Yee, B., & Park, M. (2020). What is “shared” in shared decision-making? Philosophical perspectives, epistemic justice, and implications for health professions education. Journal of evaluation in clinical practice, 26(2), 409-418.

Thomson, O.P., MacMillan, A., Draper-Rodi, J., Vaucher, P., Ménard, M., Vaughan, B., Morin, C., Alvarez, G., Sampath, K.K., Cerritelli, F. and Shaw, R., 2021. Opposing vaccine hesitancy during the COVID-19 pandemic-A critical commentary and united statement of an international osteopathic research community. International journal of osteopathic medicine.

Thomson, O.P., Petty, N.J. and Moore, A.P., 2013. Reconsidering the patient-centeredness of osteopathy. International Journal of Osteopathic Medicine, 16(1), pp.25-32

Internet

Internet 1 : https://www.iosteopathy.org/covid-19/faq/ [Accessed May 15, 2021]

Internet 2 : GOsC, 2021. Standards Of Practice | General Osteopathic Council, Available at : https://www.osteopathy.org.uk/standards/ [Accessed May 20, 2021]

Internet 3: https://greatergood.berkeley.edu/article/item/four_reasons_why_zoom_can_be_exhausting [Accessed May 05, 2021]

Internet 4: https://www.physio-pedia.com/SOAP_Notes [Accessed August 28, 2020]

Internet 5: https://www.umass.edu/studentlife/sites/default/files/documents/pdf/Motivational_Interviewing_Definition_Principles_Approach.pdf [Accessed May 03, 2021]

Internet 6: https://nass.co.uk/homepage/health-professionals/nass-allies/ [Accessed April 11, 2021]

Internet 7: https://www.kent.gov.uk/social-care-and-health [Accessed July 7, 2020]

Internet 8: https://todoist.com/productivity-methods/pomodoro-technique [Accessed April 19, 2020]

Internet 9: http://www.greglehman.ca/blog/2018/5/1/do-our-patients-need-fixing [Accessed October 8, 2020]

Podcast

Internet 10:  https://www.clinicaledge.co/podcast/physio-edge-podcast/093 [Accessed August 20, 2020]

Internet 11: https://www.wordsmatter-education.com/blog/podcast-06-breaking-free-and-diving-in-becoming-a-biopsychosocial-manual-therapist-with-dr-jerry-draper-rodi [Accessed May 17, 2020]

Video

Internet 12: https://www.youtube.com/watch?v=nGspYvZGTFg [Accessed August 20, 2020]

Internet 13 : https://www.youtube.com/watch?v=B_rStLPDn3c [Accessed August 20, 2020]

Internet 14 https://www.youtube.com/watch?v=IgFaOClDZAA [Accessed October 8, 2020]