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B2, 1.11.1, Patient experience- I attended a clinic appointment  as a patient. I was suffering from tension headaches and was treated with cranial and soft tissue techniques in the upper thoracic region. As this was my first ever osteopathic treatment, I attended with an open mind and realistic expectations. The treatment relieved me of headaches for a significant period, resulting in an optimistic outlook for further treatment and the benefits osteopathy can have. The situation reassured me of the profession but also enabled me to analyse the situation in greater depth and have my own opinion through my own research, rather than being subject to bias.

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C2, 1.1 Clinic observation- I was shadowing the tutor when I witnessed viewing a patient who was still suffering from severe muscle pain following a motorcycle accident which occurred two years ago. When the practitioner presented the case to the tutor, they collectively diagnosed the patient with muscle fatigue due to his mental trauma. At this point I felt confused of how all the symptoms he was experiencing were due to his state of mind rather than physical trauma. After coming to the realisation of how the mind can affect wellbeing, I was amazed how the practitioner looked so far beyond the patients complaint, considering every option which could have been causing the pain. I would like to reflect heavily on this scenario and put it into my own practice. By doing this, I will hopefully fulfil the needs of more patients as my diagnosis and treatment will not be limited. As I did not see the treatment following the presentation, I cannot reflect of the practitioner. If I were in that situation, I would have made a large effort when choosing my method of treatment as it wasn't just his body that needed treatment, but his mind.

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D6, When reading through the OPS, relating to patient confidentiality and privacy, it has made me question what is morally right. An example of this is when analysing D6, 7.2; this particular section makes me question to myself what I believe as I have acknowledged that by disclosing information, whether it is in the publics interest or not, that it would be breaking the trust of a patient which I consider a key element to getting the most positive result out of treatment. Despite this negative impact of losing trust, it would be benefitting the public and possibly even helping the patient if that disclosure would then lead to help on the patients behalf. If I were in a situation where I had to decide whether disclosure is necessary, I would be sure to fully analyse the situation and only disclose the relevant information to ensure the highest level of confidentiality within that circumstance.

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A4.6 When reading through this section of the Osteopathic Standards it made me question what form of consent is necessary for certain situations. It states that implying consent by getting ready for the assessment I.e. dressing down, is a valid form. As I believe this contrasts everything I have been taught about consent, I think this to not be a true form of consent as if a patient feels under pressure by the presence of the practitioner, they would feel obliged to do as they say rather than what they feel comfortable with. Reflecting on this, I would always make sure that there is verbal consent to ensure security of the patient, to satisfy both the patient and the standards we abide.

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A4.3 When I was observing a new patient during the treatment stage, the patient seemed to be frustrated with the constant gaining of consent by the practitioner. The practitioner responded in a calm and respectful manner explaining the reasoning why consent is mandatory, of which I think is the right thing to do with the situation. By varying the way of asking for consent, it could reduce this frustration on the patient’s behalf.

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A4.2 When briefly observing a carry-on patient in clinic, the practitioner asked the patient if she could carry out a HVT of the cervical spine without fully explaining the risks and process. As the patient had been through this treatment before, the practitioner felt there was no need to re-explain. This made me consider the potential consequences this could have lead to if the treatment went wrong, making me note that I should always ensure the patient is fully informed and understands the risks surrounding certain treatments.

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A3.4 In a pathology lecture, we were given an example of an experience in clinic where a red flag patient who could not speak English had her daughter translate for her. The translation was described as poor, leaving the practitioner with an uncertainty of the true answers given by the patient. After giving consideration to this matter I have concluded that it is very important to have a reliable translator to make sure that everything is fully understood to the right standard, avoiding any potential serious consequences. This relates to the entire treatment; the case history, treatment, observation etc.

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B1, 1.3+4 Throughout my observations in clinic so far, every practitioner I have observed treating a patient has never just focused on the problematic area of complaint, but the entire body and mind. An example of this is when a patient, after thorough palpation and observation, was diagnosed with a TMJ dysfunction. The practitioner concluded that this was a result of the mental well-being of the patient as this caused grinding of the teeth during the day and night, leading to the dysfunction of muscles used for mastication. By considering the body as a whole and using precise palpation skills to support diagnosis, the  outcome of treatment would be much more focused and successful, as it would increase the likelihood of the true cause of the ailment being discovered.  This highlights to me the extent of the knowledge I need to be able to apply  when necessary and to make links that aren’t initially obvious. Through this, the safety of the patient is increased, as everything is considered during diagnosis. To achieve this to the highest standard, I believe that researching and understanding the Biopsychosocial model is key as this links the outcome of treatment to the entire wellbeing of the patient and not just the diagnosed dysfunction.

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A3, 1.2 When observing a new case in clinic, during the case history a question was asked of the patient’s expectations of the first session. The patient replied stating she wanted to be “fixed” after the initial treatment. This was perceived as an unrealistic expectation by the practitioner, who further explained how the treatment will hopefully improve the patients condition but will not necessarily “fix” everything the first time round. The practitioner explained this in a very respectful manner. Reviewing this demonstrates to me how you always need to, as a practitioner, make sure the patient fully understands a realistic outcome for the treatment to avoid any annoyance and frustration.

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A2.5 In a soft tissue lecture we were told to proceed with an examination of the gluteal and coccyx area. At first I briefly asked my model if I could palpate the gluteal region without fully explaining the purpose of what I was doing. When reading through the Osteopathic Practice Standards, it makes clear throughout that fully informed consent is always necessary. In lecture and clinic I need to be sure to fully explain what I’m going to do and why, especially when examining intimate areas. During a Professional skills and Identity lecture, we were reading through some cases where osteopaths had been reported to the General Osteopathic Council for misconduct. It occurred to me that a lot of these complaints were caused by poor communication of which I have heavily reflected on and will ensure to properly and professionally act upon to make certain this does not occur to me during my career.

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A2.4 When observing my first case history in clinic, I noticed just how extensive the process was and how much time and attention has to be put in by the practitioner. The case history has to be very thorough and accurate to make a diagnosis and to be sure that nothing is missed whilst eliminating any red flags. When the practitioner had to present the case to their tutor, I noticed that some of the information the practitioner had written down was very brief and had missed elements the patient had supplied. Reflecting on this I think that double checking key points with the patient is of great importance to ensure accuracy, minimising the margin of error during diagnosis.

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A1.3 During my first OSPE exam, it was reflected back to me that I needed to work on my method of talking to patients to ensure they can understand the instructions given and fully comprehend the situation. Looking back on this I have realised that the use of Lehmans terms is crucial, especially when  gaining fully informed consent as this must guarantee the patient understands the nature and purpose of the examination and suggested treatment. To make understanding on the patient’s behalf easier, I could try to incorporate the use of diagrams when explaining the areas of examination.

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A1.1 One instance of observing in clinic demonstrated the respect and care for patients needed as a practitioner. The questions being asked by practitioner were uncomfortable and difficult topics for the patient as was betrayed by the patients body language and way of speech as she answered. The practitioner made a conscious decision to leave out the very personal questions when observers were no longer present, creating a safer environment. To me this demonstrates how we need to adapt in situations to make this experience as holistic as it can be for the patient. Reflecting on this, it made me realise how being sensitive, able to move between different forms of communication and observing body language for individual patients is a key aspect of the career, enabling practitioners to tailor the experience to the patients needs.