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

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

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Reflection: I stop treating the patient if I think they won't benefit from more Osteopathy. I believe that if you're honest you have happier patient and that will lead to more patients. I tell the patient if I think they need exercise if that's the case and maybe book a follow up in a month to check the exercise. I tend to work with a holistic approach and then there is often other parts that the patients need to work on by them self over time.

Referens: https://academic.oup.com/medlaw/article/30/2/324/6551541

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

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

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Reflection: I always put the patient in the center try to be open minded and don't ask closed questions, I try to not interrupt but always do a sum-up in the end to be sure I understand everything correct. If I feel a need more information in one subject, I try to get deeper into that but still with an open question so they can decide how much they want to share. I always explain why I ask some question, so they feel they have a better understanding, and it makes sense to them, I also say if they don't want to answer it's totally fine. I find it easier for patient to answer specific question if I in the beginning explain why I ask them. I also inform them that everything is confidential and wont be shared with others without their approval.

Referens:

https://journals.sagepub.com/doi/abs/10.1177/147322970100500303

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As health care providers, we want to do everything we can to help our patients achieve wellness. It can be tempting to share all of the information we have learned with them toward that goal of patient education and health literacy. However, all the best information can't be helpful if our patients can't act on it because they don't remember it.

To ensure patients have useful information they can benefit from, it is important to avoid patient education overload. Health care providers should help patients improve their health literacy and use effective 2-way communication to achieve better patient commitment to treatment and satisfaction.

Is More Information Always Better?

Research has consistently found that patients often forget information given to them by their physicians. ¹ Patients can immediately forget 40% to 80% of the medical information and recommendations they receive. Of the information they remember, only about one-half of it is typically recalled correctly. ² For any recommendation to be effective, patients must be able to remember what it is and how to achieve it.

A lower ability to recall medical information is associated with several factors, including 3,4:

Older age;

Low health literacy;

High and low anxiety;

Large amount of information; and

Low level of education.

The type, structure, and length of information can influence how much of the information a patient can retain. ⁵ The more recommendations a patient is given, the higher the likelihood they will be forgotten. A 2011 study conducted at a family practice in Slovenia found that there is a higher likelihood that recommendations will be forgotten when patients are given 3 or 4 at one time, compared with just 1 or 2 recommendations. The study authors recommend that if more than 1 or 2 recommendations are needed, a follow-up appointment should be scheduled. ⁴

Effective Communication

Effective communication can improve patient satisfaction and recall, ultimately improving patient outcomes. ⁶

A component of optimal health care delivery is ensuring that health information as communicated by clinicians is understood by their patients. The most effective type of communication will differ among patients. Health care providers have the responsibility of providing patients the information they need to achieve health and wellness, and patients have the responsibility of acting on the information. ⁷

Health Literacy

Improving patient care and communication should focus on improving patient health literacy. Health literacy refers to an individual's ability to find, understand, and use health-related information to make decisions and take action. According to the Agency for Healthcare Research and Quality (AHRQ), health literacy in the United States is low, with only 12% of Americans demonstrating health literacy skills adequate to navigate the complex health care system. ⁸

Health literacy is one of the best predictors of a patient's health. Low health literacy is linked to ⁹:

Poor management of chronic illness;

Decreased ability to participate in shared decision-making with health care providers; and

Lower levels of adherence to medical therapies.

Although health literacy can be an important factor in predicting a patient's outcomes, clinicians do not necessarily need to evaluate their patient's level of health literacy. Instead, health care providers should use universal precautions for all patients, regardless of their health literacy level. Universal precautions aim to ¹⁰:

Simplify communication;

Confirm patient understanding;

Improve the navigability of health care services; and

Support patients.

Barriers to Patient Education

Health care providers should be aware of what potential barriers may exist for patients to understand medical information.

Recall of medical information is strongly associated with patient education levels. One study found that people with less than a high school diploma recalled approximately 38% of recommendations made during an ambulatory care visit, while people with a college degree were able to recall approximately 65% of recommendations. ¹

It may not be possible for a clinician to be able to determine patient education levels, but patients with low health literacy often have red flags, such as ¹¹:

Missed appointments;

Incomplete written forms;

Lack of adherence to medication;

Inability to state the name or purpose of a medication;

Inability to provide a complete or coherent history; and

Lack of follow-through on testing or laboratory appointments.

Strategies to Improve Health Literacy & Patient Education

Even if a patient has high health literacy, clinicians should still take precautions to ensure comprehension. AHRQ provides a health literacy universal precautions toolkit to help health care providers promote better understanding for everyone. ¹⁰ The toolkit is available here.

Use Clear Communication

Clear communication can help patients to better understand medical information. Tips for clear communication include ¹²:

Maintaining a friendly attitude;

Avoiding the use of medical jargon;

Using the patient's own words;

Speaking at a moderate pace; and

Avoiding interrupting patients when they are speaking.

Focus on What the Patient Needs To Know

Health care providers should prioritize the information that needs to be discussed. Information should be limited to 3 to 5 key points. Repeating these key points can also help with patient recall. ¹²

Key points should be specific and focus on the steps the patient must take when they leave the examination room and when they return home to successfully follow treatment instructions. Patients are more likely to remember specific advice compared with generalized information. ³

Key information should be prioritized based on the patient's goals. For example, the key points for a patient being seen to diagnose a new condition will be different from those provided to a patient following up on an existing condition. ¹²

Use the Teach-back Method

The teach-back method allows health care providers to ensure that medical information is given to patients in a way they can understand and act on. This method has been shown to help ²:

Improve a patient's understanding and adherence to recommendations;

Reduce the number of canceled appointments;

Decrease the number of callbacks; and

Increase patient satisfaction.

The teach-back method should be framed as a test of how well the health care provider explained knowledge instead of a test of the patient's knowledge. Instead of asking yes or no questions to confirm knowledge (such as, "Does that make sense?"), use open-ended questions where the patient must summarize recommendations in their own words. ²

Examples of starter phrases that can be used in the teach-back method include ²:

"We covered a lot today. To make sure I explained things clearly, can you describe 3 actions you agreed to take today?"

"This is a new diagnosis for you. To make sure you understand, can you tell me what this condition means?"

"I've noticed lots of people have trouble remembering how to use their medication. Can you show me how you use your medication?"

Health care providers should check for understanding throughout the patient encounter instead of waiting until the end. Incorrect or incomplete understanding should be corrected immediately before moving on. ²

Some providers may feel that the teach-back method feels awkward or time-consuming when they first incorporate this method into their practice. However, when used over time, it can improve patient outcomes and satisfaction without increasing the length of a visit. ²

Use Alternative Teaching Styles

The use of different types of patient education materials may encourage effective retention of information among patients with different learning styles. Although oral communication is a faster way to share information, written communication may result in better patient recall. Ideally, information should be provided in more than 1 form. ³

Health care providers should consider having patient education materials available in different formats, such as ¹³:

Printed materials;

Pictographs and infographics;

Videos;

Slide presentations;

Models/props;

Group classes; and

1:1 teaching.

It is important to evaluate a patient's ability to effectively use the educational materials they are given. Materials should be provided in a language the patient speaks and ideally in their native language. ¹⁴

Written materials should be easy to understand. The average US adult reads at approximately an 8th-grade level, but up to 20% of adults read at or below a 5th-grade level. Written materials should be written at a 5th- or 6th-grade level to ensure all patients can understand the information. ¹⁴ Pictographs or drawings serve as a useful form of communication for all patients, especially when literacy is unknown. ³

Before using technology, it is important to make sure the patient is able to use it. For example, if a patient is instructed to watch a YouTube video, they should have access to a computer and know how to search for the video. ¹⁴

It may help to keep a tally of which materials are given to patients most often or how often the office runs out of each printed material.

Measuring Patient Education Outcomes

The continuous measuring of outcomes is important to improve the health literacy of patients. One of the fastest and easiest ways to measure outcomes is to ask for patient feedback. Feedback can be obtained verbally during the encounter or by a written survey at the end of a visit. Examples of feedback questions include ¹⁵:

"Which parts of today's visit did you find clear and easy to understand?"

"Which parts did you find confusing?"

"What information has been helpful for you?"

"Is it clear what you need to do based on the information given to you today?"

Other methods for receiving patient feedback include ¹⁵:

Suggestion boxes;

Shadowing patients during visits and while using health tools (such as a patient portal); and

Walkthroughs with a person unfamiliar with the practice.

The rate of patient adherence to treatment can also indicate the efficacy of communication. Studies show that patients with chronic conditions such as hypertension and type 2 diabetes who are satisfied with their provider's communication are more adherent to their treatment. 16,17

Patient Education & Health Literacy is Key

Patients are only able to take action on medical recommendations they understand and remember. Health care providers are responsible for improving health literacy by providing recommendations in a way that patients can understand.

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Patient Education & Information Overload: How Much Is Too Much?

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It's important to avoid patient education overload. Learn how to improve patient information, health literacy, and use 2-way communication.

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

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

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Reflection Kolbs model: I had a very mad patient she started the consultation saying that she didn't want me to inform her that insurance didn’t cover all her treatment cost, and she screamed to me that I just wanted money and so on.  Then when I started the case history, she said she wanted treatment right now not talking about it. I tried to explain that I have to take case history for safety reason and to narrowing done the examination. During the examination she couldn't answer my question about better worse pain, she got mad at me for asking. Then after the treatment she was made at me because it was to short consultation, and she did not want to pay. I was shocked over her behavior, but I learnt to not take it personal and that I’m not going to change my way of examination and do a full case history. I know I didn’t do anything wrong during that consultation. I maybe just must be better to explain for some patient why is important to do it even do I think I explained it quite clear to her. I also learn that you can’t help all patient, obviously behaving like her have nothing to do with me but all to do with her, she must have some other issues in her life when she is acting like this.

Referens https://pmc.ncbi.nlm.nih.gov/articles/PMC1488682/

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Physicians, nurses, support staff and anyone else in a practice have all witnessed this scenario too many times: a patient gets frustrated and takes his or her anger, confusion, or worry out on you. How you handle an upset patient can quickly determine the difference between a successful or disastrous outcome. If you learn to recognize the signs - sudden behavior changes, clenched fists, a red face, tense jaw, increasingly loud voice - you can also become proficient in diffusing difficult situations.

First, take a deep breath! This calms you down and gives you a chance to consider your reaction, rather than abruptly responding to the anger in kind. We often regret actions we make in haste, and taking a few deep breaths can give you the presence of mind to respond with more compassion and less frustration.

It is also important to put the situation in perspective. Working in a medical practice inherently means your customers are sick, hurt and or scared about a diagnosis or condition. This isn't about you, so do your best to avoid taking the situation personally. When you can take a step back, you can give yourself the distance you need to calm the situation down.

While it may be difficult, do your best to suspend judgement, particularly since you may not know what exactly is motivating the behavior. Do not engage others during or after the event, but do obtain assistance from a supervisor as needed, particularly if the situation is escalating.

The following seven steps can help you handle upset patients in your practice:

1. STEP ONE: Remain Calm. Listen to emotion without reacting with emotion. Never, ever tell a patient to "calm down," since that is the equivalent of revealing that you don't consider his or her frustration valid. Keep your cool even when patients lash out in anger. When you are calm, yet engaged, you will make the patient feel that his or her concerns are being attended to in a suitable manner.

2. STEP TWO: Listen Actively. This might be the most important step of all. Let the patient know you are truly listening by making eye contact, nodding your head and leaning in. Listen, listen and then listen some more.

3. STEP THREE: Empathize. There may be a lot of barriers or something personal happening with the patient to which you are not privy. Actively empathize with the patient, maintaining a calm and caring tone.

4. STEP FOUR. Apologize. An apology can be for the patient who feels upset. An apology can be for a misunderstanding or a miscommunication. An apology can be for not meeting someone's expectations. Apologize gracefully and without qualifying it with a "but...".

5. STEP FIVE: Initiate Problem Solving. Advise the patient that you want to help them find a solution to the issue. If the issue is something you are able to resolve on your own, do so. If you are not able to resolve the issue on your own, request assistance from your supervisor. If the supervisor is unable to find a solution, he or she should advise the patient that the complaint is being taken seriously and will be addressed in a timely manner by the manager. Thank the patient for bringing the issue to your attention. Ask if they want a manager to follow up. Finally, summarize what you have discussed and what steps will be taken to resolve the issue.

6. STEP SIX. Focus on You. Take a few minutes on your own, if possible, to ensure your own well-being. Get some water and take a few more deep breaths. If you are new to this, handling upset patients can be stressful. Give yourself a little time and space following the interaction to clear your head.

7. STEP SEVEN. Report to Supervisor. Verbally communicate and/or document the situation in full in a message to your supervisor. If the incident is reported in writing, it should be an objective, factual recap of what occurred. The physician should be notified when circumstances warrant.

If the situation requires follow up, ensure that the appropriate person or parties keep in touch with the patient to ensure the issue is resolved. Ultimately, patients want to be heard and understood - when you make the effort to listen, apologize and address the problem, you can effectively turn a negative interaction into a positive one.

The contents of The Sentinel are intended for educational/informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice, as specific legal requirements may vary from state to state and/or change over time.

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Physicians, nurses, support staff and anyone else in a practice have all witnessed this scenario too many times: a patient gets frustrated and takes his or her anger, confusion, or worry out on you. How you handle an upset patient can quickly determine the difference between a successful or disastrous outcome.

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

# data[].attributes.subject
A3. You must give patients the information they want or need to know in a way they can understand.

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I meet the patient after their state of mind , level of education, age , other condition involving , language barrier. I read the patient and try to give information that is necessary for the patient to now if they ask for more or deeper explaination I will explain more and develop the information.

Referens

https://journals.sagepub.com/doi/abs/10.1177/147322970100500303

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As health care providers, we want to do everything we can to help our patients achieve wellness. It can be tempting to share all of the information we have learned with them toward that goal of patient education and health literacy. However, all the best information can't be helpful if our patients can't act on it because they don't remember it.

To ensure patients have useful information they can benefit from, it is important to avoid patient education overload. Health care providers should help patients improve their health literacy and use effective 2-way communication to achieve better patient commitment to treatment and satisfaction.

Is More Information Always Better?

Research has consistently found that patients often forget information given to them by their physicians. ¹ Patients can immediately forget 40% to 80% of the medical information and recommendations they receive. Of the information they remember, only about one-half of it is typically recalled correctly. ² For any recommendation to be effective, patients must be able to remember what it is and how to achieve it.

A lower ability to recall medical information is associated with several factors, including 3,4:

Older age;

Low health literacy;

High and low anxiety;

Large amount of information; and

Low level of education.

The type, structure, and length of information can influence how much of the information a patient can retain. ⁵ The more recommendations a patient is given, the higher the likelihood they will be forgotten. A 2011 study conducted at a family practice in Slovenia found that there is a higher likelihood that recommendations will be forgotten when patients are given 3 or 4 at one time, compared with just 1 or 2 recommendations. The study authors recommend that if more than 1 or 2 recommendations are needed, a follow-up appointment should be scheduled. ⁴

Effective Communication

Effective communication can improve patient satisfaction and recall, ultimately improving patient outcomes. ⁶

A component of optimal health care delivery is ensuring that health information as communicated by clinicians is understood by their patients. The most effective type of communication will differ among patients. Health care providers have the responsibility of providing patients the information they need to achieve health and wellness, and patients have the responsibility of acting on the information. ⁷

Health Literacy

Improving patient care and communication should focus on improving patient health literacy. Health literacy refers to an individual's ability to find, understand, and use health-related information to make decisions and take action. According to the Agency for Healthcare Research and Quality (AHRQ), health literacy in the United States is low, with only 12% of Americans demonstrating health literacy skills adequate to navigate the complex health care system. ⁸

Health literacy is one of the best predictors of a patient's health. Low health literacy is linked to ⁹:

Poor management of chronic illness;

Decreased ability to participate in shared decision-making with health care providers; and

Lower levels of adherence to medical therapies.

Although health literacy can be an important factor in predicting a patient's outcomes, clinicians do not necessarily need to evaluate their patient's level of health literacy. Instead, health care providers should use universal precautions for all patients, regardless of their health literacy level. Universal precautions aim to ¹⁰:

Simplify communication;

Confirm patient understanding;

Improve the navigability of health care services; and

Support patients.

Barriers to Patient Education

Health care providers should be aware of what potential barriers may exist for patients to understand medical information.

Recall of medical information is strongly associated with patient education levels. One study found that people with less than a high school diploma recalled approximately 38% of recommendations made during an ambulatory care visit, while people with a college degree were able to recall approximately 65% of recommendations. ¹

It may not be possible for a clinician to be able to determine patient education levels, but patients with low health literacy often have red flags, such as ¹¹:

Missed appointments;

Incomplete written forms;

Lack of adherence to medication;

Inability to state the name or purpose of a medication;

Inability to provide a complete or coherent history; and

Lack of follow-through on testing or laboratory appointments.

Strategies to Improve Health Literacy & Patient Education

Even if a patient has high health literacy, clinicians should still take precautions to ensure comprehension. AHRQ provides a health literacy universal precautions toolkit to help health care providers promote better understanding for everyone. ¹⁰ The toolkit is available here.

Use Clear Communication

Clear communication can help patients to better understand medical information. Tips for clear communication include ¹²:

Maintaining a friendly attitude;

Avoiding the use of medical jargon;

Using the patient's own words;

Speaking at a moderate pace; and

Avoiding interrupting patients when they are speaking.

Focus on What the Patient Needs To Know

Health care providers should prioritize the information that needs to be discussed. Information should be limited to 3 to 5 key points. Repeating these key points can also help with patient recall. ¹²

Key points should be specific and focus on the steps the patient must take when they leave the examination room and when they return home to successfully follow treatment instructions. Patients are more likely to remember specific advice compared with generalized information. ³

Key information should be prioritized based on the patient's goals. For example, the key points for a patient being seen to diagnose a new condition will be different from those provided to a patient following up on an existing condition. ¹²

Use the Teach-back Method

The teach-back method allows health care providers to ensure that medical information is given to patients in a way they can understand and act on. This method has been shown to help ²:

Improve a patient's understanding and adherence to recommendations;

Reduce the number of canceled appointments;

Decrease the number of callbacks; and

Increase patient satisfaction.

The teach-back method should be framed as a test of how well the health care provider explained knowledge instead of a test of the patient's knowledge. Instead of asking yes or no questions to confirm knowledge (such as, "Does that make sense?"), use open-ended questions where the patient must summarize recommendations in their own words. ²

Examples of starter phrases that can be used in the teach-back method include ²:

"We covered a lot today. To make sure I explained things clearly, can you describe 3 actions you agreed to take today?"

"This is a new diagnosis for you. To make sure you understand, can you tell me what this condition means?"

"I've noticed lots of people have trouble remembering how to use their medication. Can you show me how you use your medication?"

Health care providers should check for understanding throughout the patient encounter instead of waiting until the end. Incorrect or incomplete understanding should be corrected immediately before moving on. ²

Some providers may feel that the teach-back method feels awkward or time-consuming when they first incorporate this method into their practice. However, when used over time, it can improve patient outcomes and satisfaction without increasing the length of a visit. ²

Use Alternative Teaching Styles

The use of different types of patient education materials may encourage effective retention of information among patients with different learning styles. Although oral communication is a faster way to share information, written communication may result in better patient recall. Ideally, information should be provided in more than 1 form. ³

Health care providers should consider having patient education materials available in different formats, such as ¹³:

Printed materials;

Pictographs and infographics;

Videos;

Slide presentations;

Models/props;

Group classes; and

1:1 teaching.

It is important to evaluate a patient's ability to effectively use the educational materials they are given. Materials should be provided in a language the patient speaks and ideally in their native language. ¹⁴

Written materials should be easy to understand. The average US adult reads at approximately an 8th-grade level, but up to 20% of adults read at or below a 5th-grade level. Written materials should be written at a 5th- or 6th-grade level to ensure all patients can understand the information. ¹⁴ Pictographs or drawings serve as a useful form of communication for all patients, especially when literacy is unknown. ³

Before using technology, it is important to make sure the patient is able to use it. For example, if a patient is instructed to watch a YouTube video, they should have access to a computer and know how to search for the video. ¹⁴

It may help to keep a tally of which materials are given to patients most often or how often the office runs out of each printed material.

Measuring Patient Education Outcomes

The continuous measuring of outcomes is important to improve the health literacy of patients. One of the fastest and easiest ways to measure outcomes is to ask for patient feedback. Feedback can be obtained verbally during the encounter or by a written survey at the end of a visit. Examples of feedback questions include ¹⁵:

"Which parts of today's visit did you find clear and easy to understand?"

"Which parts did you find confusing?"

"What information has been helpful for you?"

"Is it clear what you need to do based on the information given to you today?"

Other methods for receiving patient feedback include ¹⁵:

Suggestion boxes;

Shadowing patients during visits and while using health tools (such as a patient portal); and

Walkthroughs with a person unfamiliar with the practice.

The rate of patient adherence to treatment can also indicate the efficacy of communication. Studies show that patients with chronic conditions such as hypertension and type 2 diabetes who are satisfied with their provider's communication are more adherent to their treatment. 16,17

Patient Education & Health Literacy is Key

Patients are only able to take action on medical recommendations they understand and remember. Health care providers are responsible for improving health literacy by providing recommendations in a way that patients can understand.

# data[].attributes.attachment_link.title
Patient Education & Information Overload: How Much Is Too Much?

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It's important to avoid patient education overload. Learn how to improve patient information, health literacy, and use 2-way communication.

# data[].attributes.headline
A4 You must receive valid consent for all aspect of examination and treatment and record this as appropriate 

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

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As showed above in the feedback from my exam year I do ask for consent and have a god communication with the patient throw through the whole assessment. In my daily practice I always explain to the patient Im going to take a case history and then I will do an examination and ask them for consent if will asses any private areas and/or a special technique for example hvt. I always write in the journal that the patient gave consent for treatment.

Reflection:

I have colleague in the clinic that had som complains about his treatment and therefor we have talked about it even more how important that is to ask for consent and to document it, so now we have a standard line in the journal so we always remember to ask about it.

https://www.nhs.uk/conditions/consent-to-treatment/

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

# data[].attributes.subject
A5. You must support patients in caring for themselvs to improve and maintain their own health and wellbeing. 

# data[].attributes.body
Reflection: My goal is to always involve the patient in the treatment and explain to them that the problem/dysfunction will come back if they don't for example change their lifestyle. However it can be to much for a patient that maybe need to lose weight, exercise, reduce work hours and stop smoking. So after my experience I will give them one thing to start with for example drink water instead of soda, try to take a walk 15 min a day or try to go to sleep one hour earlier. And when they have succes with one task they are more willing to take new advice. Let the patient feel that they are in control and have a postive effect that will lead to more.

Referens: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1369-7625.2010.00593.x

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Strategies to Help Patients Make Sustainable Lifestyle Changes | The Institute for Functional Medicine

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Learn how to help your patients fully embrace lifestyle changes through proven functional medicine techniques.

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A6. you must respect the patients dignity and modesty 

# data[].attributes.subject
A6. you must respect the patients dignity and modesty 

# data[].attributes.body
Reflection: I always ask the patient if it's ok to take the clothes off, so I give them the change to make the decision. I don't discuss religion with the patient. I don't force the patient to take all clothes of if they don't want to or can't according to a religion. I ask the patient if they want the curtains down in the treatment room. When the patient is undressing, I turn to my computer and write something, so I don’t look at them. It the patient is lying prone, and I must pull the underwear a little bit down to assess the sacrum I always ask them if its ok first. I think it’s even more important to tell them everything I do when we can’t have eye contact to establish a secure environment for the them and I feeling that they are in control.

Referens:

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2702.2008.02365.x

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Promoting Patient Dignity in Healthcare | MedPro Group

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

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

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reflection: The first year of osteopath school I did not really understand how to combine al the techniques we learn to an holistic and effect treatment to the patient without over treat. I did so many test and wasn't god to narrow done differential diagnoses and just do a couple of test. Now I develop better knowledge about red flags and special test so I can test the most important and be sure that the patient is safe to treat. I feel more secure in my as an osteopath and I also. I do think even when you feel more experience you do have to stay humble and with an opened mind all the time to ensure safe patient care. I also try to take some time to do some self reflection and we ofte discus cases in the clinic.

https://www.sciencedirect.com/science/article/abs/pii/S1746068919300136

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

# data[].attributes.subject
B2.You must recognize and work within the limits of your training and competence. 

# data[].attributes.body
Reflection Kolbs model: I had a patient that tension around the pelvic area and bladder that lead to back pain and SI dysfunction, after the examination I found it relevant to treat the SI joint, the sacrum and the ligament around the bladder, the problem went better but she still has some pain left. I thought she may be needed internal treatment and referral her to my colleague and after one treatment with her she was totally fine. So, I learned that I could treat what I can manage and it's better to have another osteopath to also look at the problem than just say to the patient that this pain that’s left is what you must live with. And to remember that you are a student and still learning and always will, so don’t be afraid to ask for help or refer the patient to a colleague.

https://onlinelibrary.wiley.com/doi/abs/10.1111/scs.12136

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

# data[].attributes.subject
B3. You must keep your professional knowledge and skills up to date.

# data[].attributes.body
Reflection: I think that when I started the process of my master I wasn't so sure how to find the newest research and how to critically analyse it. But after I finished my master I have implemented that in my every day practice, Every day I write down on paper what I would like to look in to more and then I have 2 extra hours on Wednesday for search for new research or new guidelines or what's relevant for me at that time. That keeps me up to date.

Referens:

https://books.google.dk/books?hl=sv&lr=&id=jDe_9iriaAwC&oi=fnd&pg=PA180&dq=keep+your+knowledge+up+to+date+when+working+with+patients&ots=rFjKqt4OQA&sig=93UGTazs4LJXuiIk1BnrwN5-zUU&redir_esc=y#v=onepage&q=keep%20your%20knowledge%20up%20to%20date%20when%20working%20with%20patients&f=false

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

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

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Reflection: When I started with my master I did learn how to find god articles and learn how to search in databases. I learn to be critical to studies even it they have a high score on PEDro they can possible be miss calculated I discuss one article in my master as seen in the evidence above. So now I use PubMed and google scholar a lot to search for new research in relation to my patients problem. I also become much more critical to what a read and understand that a god quality article can have error. So I don't believe what I hear until I read it myself and critically appraise the information.

https://www.sciencedirect.com/science/article/abs/pii/S1746068919300136

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Evidence from my exam shows that I can deliver safe and relavant treatment to the patient 

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C1. you must to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patient 

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C1. you must to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patient 

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Reflection: I think that during the last 3 years I develop a better skil to take patients case history and during the case history I start to think of differential diagnoses that will lead to a better and relevant examination rutine for the patient. In the beginning I did a lot of testing that maybe wasn't that relevant and in the end of the consultation I didn't have much time to treat the patient. I think I wanted to be 100% sure that a covered everything but now I m more relaxed and I have time to treat the patient. I learn that its ok if you didn't test everything the first time as long as you did the safety test that were relevant. The patient safety is the first priority so If Im not sure about something I will consult with a colleague and if there is something that Im not trained in I will refer the patient to someone more experienced. When that happens I always try to observe that treatment to learn and develop my self.

Referens: https://pmc.ncbi.nlm.nih.gov/articles/PMC6900193/

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C2. you must ensure that your patients records are comprehensive, accurate, legible and completet promptly.

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C2. you must ensure that your patients records are comprehensive, accurate, legible and completet promptly.

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The importants of a complete journal for your patient and your self. Reflection Kolbs model: When I started at this Osteopathic clinic, I had a new consultation every 30 minutes and that become a problem to have time enough to write everything done. Sometimes when the patient came back, I haven’t written everything done and that put me in a stressful situation. So now I always set time in after 3 patients to update journal and be sure I have written everything done. It is also important if I need to send the patient to the doctor that I have a complete journal or if there is a complain later. One of my colleagues have a patient complaining of the treatment and that involved lawyers and insurance companies. He could argue that he hasn’t done anything wrong, and all the necessary safety test was written in the journal. When I heard that I become even more accurate about always be sure to complete the journals and also write al safety test down even if it’s not positive.

Referens: https://pmc.ncbi.nlm.nih.gov/articles/PMC5707430/

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4 Reasons Why Documentation is Important in Healthcare - ‘Think with your Ink’

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Here are 4 reasons to document your medical records properly and best practices for how to improve your documentation.

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evidence for at two factor login journal system 

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C3. you must respond effectively and appropriately for the production of written material and data.

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C3. you must respond effectively and appropriately for the production of written material and data.

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Reflection: In our clinic we have a two factors login system to the journals så We have to Identify our self to login. When we send the bill to patient its with a safe link so they have to login in with there MITID to access the bill, its like an identity card online. So I believe We have a good an secure system both to excess the journals and to send the bills to patient. We don't store anything with name or cpr number on paper everything is in a looked system.

https://www.sciencedirect.com/science/article/pii/S2213076417300209

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C4. You must take action to keep patients from harm

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C4. You must take action to keep patients from harm

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Reflection ERA

I had a 54-year-old patient that came to me with headache and neck pain she also presented with dizziness when standing, she didn’t have headache normally and no dizziness but sometimes neck pain. She had been to a doctor and the doctor said she needs physiotherapy. It was obvious that she didn’t feel good and when a did quick cranial nerve exam she could follow the instructions but felt dizziness. I did do compression of the neck to check for herniated disc, but she didn’t experience any radiation but felt sick. I said to her I wanted to be totally sure she was ok and safe to treat for her own best and told her to contact the doctor again. She became nervous of course because she had been to the doctor, and he said it was fine. But I don’t think he had done all necessary test. I sent her back to the doctor and didn’t her from her again, I did send her an email, but she did not answer.

When a reflect over the situation I can see that if I was more as an Osteopath student, I could maybe have treated the neck muscle and then say she should have a follow up at the doctor. But I wasn’t used to patients with this symptom and wanted to be sure I didn’t do anything worse. I do think I kept calm and explain to her why I didn’t want to treat her that day. I was alone at the clinic. I think if it happens again I will maybe try to call a more experience college if there is nobody in the clinic before refer the patient back to the doctor.

Referens: https://qualitysafety.bmj.com/content/15/4/272.short

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First, Protect the Patient from Harm - Patient Safety & Quality Healthcare

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First, Protect the Patient from HarmApplying Adult Learning Principles to Patient SafetyBy Barbara Duffy, RN, BS Ed, MPH, CPHQ, LHRM “First, do no harm.” Today, unlike in the time of Hippocrates, evidence of harm may not become immediately obvious during healthcare interventions. For example, a lapse in attention while inserting a central line may result in a blood stream infection that becomes apparent days later.

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

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

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In my clinic we use one-time sheets for every patient and cleaning the treatment bricks after every treatment.  We have hand sanitizer in every room. We don't go to work if we are sick, we don't charge patient for late cancellation if they are sick. We have first aid course every 2 years. We are always to persons at work, so you don’t have to stand alone if something happens.

Referens:

https://pmc.ncbi.nlm.nih.gov/articles/PMC4675257/

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"First, do no harm" is the most fundamental principle of any health care service. No one should be harmed in health care; however, there is compelling evidence of a huge burden of avoidable patient harm globally across the developed and developing health care systems. This has major human, moral, ethical and financial implications.

Patient safety is defined as "the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care to an acceptable minimum." Within the broader health system context, it is "a framework of organized activities that creates cultures, processes, procedures, behaviours, technologies and environments in health care that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make error less likely and reduce impact of harm when it does occur."

Common sources of patient harm

Medication errors. Medication-related harm affects 1 out of every 30 patients in health care, with more than a quarter of this harm regarded as severe or life threatening. Half of the avoidable harm in health care is related to medications (3).

Surgical errors. Over 300 million surgical procedures are performed each year worldwide (6). Despite awareness of adverse effects, surgical errors continue to occur at a high rate; 10% of preventable patient harm in health care was reported in surgical settings (2), with most of the resultant adverse events occurring pre- and post-surgery (7).

Health care-associated infections. With a global rate of 0.14% (increasing by 0.06% each year), health care-associated infections result in extended duration of hospital stays, long-standing disability, increased antimicrobial resistance, additional financial burden on patients, families and health systems, and avoidable deaths (8).

Sepsis. Sepsis is a serious condition that happens when the body's immune system has an extreme response to an infection. The body's reaction causes damage to its own tissues and organs. Of all sepsis cases managed in hospitals, 23.6% were found to be health care associated, and approximately 24.4% of affected patients lost their lives as a result (9).

Diagnostic errors. These occur in 5-20% of physician-patient encounters (10,11). According to doctor reviews, harmful diagnostic errors were found in a minimum of 0.7% of adult admissions (12). Most people will suffer a diagnostic error in their lifetime (13).

Patient falls. Patient falls are the most frequent adverse events in hospitals (14). Their rate of occurrence ranges from 3 to 5 per 1000 bed-days, and more than one third of these incidents result in injury (15), thereby reducing clinical outcomes and increasing the financial burden on systems (16).

Venous thromboembolism. More simply known as blood clots, venous thromboembolism is a highly burdensome and preventable cause of patient harm, which contributes to one third of the complications attributed to hospitalization (17).

Pressure ulcers. Pressure ulcers are injuries to the skin or soft tissue. They develop from pressure to particular parts of the body over an extended period. If not promptly managed, they can have fatal complications. Pressure ulcers affect more than 1 in 10 adult patients admitted to hospitals (18) and, despite being highly preventable, they have a significant impact on the mental and physical health of individuals, and their quality of life.

Unsafe transfusion practices. Unnecessary transfusions and unsafe transfusion practices expose patients to the risk of serious adverse transfusion reactions and transfusion-transmissible infections. Data on adverse transfusion reactions from a group of 62 countries show an average incidence of 12.2 serious reactions per 100 000 distributed blood components.

Patient misidentification. Failure to correctly identify patients can be a root cause of many problems and has serious effects on health care provision. It can lead to catastrophic adverse effects, such as wrong-site surgery. A report of the Joint Commission published in 2018 identified 409 sentinel events of patient identification out of 3326 incidents (12.3%) between 2014 and 2017 (19).

Unsafe injection practices. Each year, 16 billion injections are administered worldwide, and unsafe injection practices place patients and health and care workers at risk of infectious and non-infectious adverse events. Using mathematical modelling, a study estimated that, in a period of 10 years (2000-2010), 1.67 million hepatitis B virus infections, between 157 592 and 315 120 hepatitis C virus infections, and between 16 939 and 33 877 HIV infections were associated with unsafe injections (20).

Factors leading to patient harm

Patient harm in health care due to safety breaks is pervasive, problematic and can occur in all settings and at all levels of health care provision. There are multiple and interrelated factors that can lead to patient harm, and more than one factor is usually involved in any single patient safety incident:

system and organizational factors: the complexity of medical interventions, inadequate processes and procedures, disruptions in workflow and care coordination, resource constraints, inadequate staffing and competency development;

technological factors: issues related to health information systems, such as problems with electronic health records or medication administration systems, and misuse of technology;

human factors and behaviour: communication breakdown among health care workers, within health care teams, and with patients and their families, ineffective teamwork, fatigue, burnout, and cognitive bias;

patient-related factors: limited health literacy, lack of engagement and non-adherence to treatment; and

external factors: absence of policies, inconsistent regulations, economic and financial pressures, and challenges related to natural environment.

System approach to patient safety

Most of the mistakes that lead to harm do not occur as a result of the practices of one or a group of health and care workers but are rather due to system or process failures that lead these health and care workers to make mistakes.

Understanding the underlying causes of errors in medical care thus requires shifting from the traditional blaming approach to a more system-based thinking. In this, errors are attributed to poorly designed system structures and processes, and the human nature of all those working in health care facilities under a considerable amount of stress in complex and quickly changing environments is recognized. This is done without overlooking negligence or misbehaviour from those providing care that leads to substandard medical management.

A safe health system is one that adopts all necessary measures to avoid and reduce harm through organized activities, including:

ensuring leadership commitment to safety and creation of a culture whereby safety is prioritized;

ensuring a safe working environment and the safety of procedures and clinical processes;

building competencies of health and care workers and improving teamwork and communication;

engaging patients and families in policy development, research and shared decision-making; and

establishing systems for patient safety incident reporting for learning and continuous improvement.

Investing in patient safety positively impacts health outcomes, reduces costs related to patient harm, improves system efficiency, and helps in reassuring communities and restoring their trust in health care systems (4,5).

WHO response

Global action on patient safety

Recognizing patient safety as a global health priority, and as an essential component of strengthening health systems for moving towards universal health coverage, the Seventy-second World Health Assembly adopted resolution WHA72.6 on "Global action on patient safety" in May 2019.

The resolution requested the Director-General to emphasize patient safety as a key strategic priority in WHO's work across the universal health coverage agenda, endorsed the establishment of World Patient Safety Day to be observed annually on 17 September, and requested WHO's Director-General to develop a global patient safety action plan with the involvement of WHO Member States, partners and other relevant stakeholders.

Global Patient Safety Action Plan 2021-2030

The Global Patient Safety Action Plan 2021-2030 provides a framework for action for key stakeholders to join efforts and implement patient safety initiatives in a comprehensive manner. The goal is "to achieve the maximum possible reduction in avoidable harm due to unsafe health care globally", envisioning "a world in which no one is harmed in health care, and every patient receives safe and respectful care, every time, everywhere".

World Patient Safety Day

Since 2019, World Patient Safety Day has been celebrated across the world annually on 17 September, calling for global solidarity and concerted action by all countries and international partners to improve patient safety. The global campaign, with its dedicated annual theme, is aimed at enhancing public awareness and global understanding of patient safety and mobilizing action by stakeholders to eliminate avoidable harm in health care and thereby improve patient safety.

WHO Flagship initiative "A Decade of Patient Safety 2021-2030"

WHO has launched the Patient Safety Flagship as a transformative initiative to guide and support strategic action on patient safety at the global, regional and national levels. Its core work involves supporting the implementation of the Global Patient Safety Action Plan 2021-2030.
References
1. Slawomirski L, Klazinga N. The economics of patient safety: from analysis to action. Paris: Organisation for Economic Co-operation and Development; 2020 ( http://www.oecd.org/health/health-systems/Economics-of-Patient-Safety-October-2020.pdf, accessed 6 September 2023).

2. Panagioti M, Khan K, Keers RN, Abuzour A, Phipps D, Kontopantelis E et al. Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ. 2019;366:l4185. doi:10.1136/bmj.l4185.

3. Hodkinson A, Tyler N, Ashcroft DM, Keers RN, Khan K, Phipps D et al. Preventable medication harm across health care settings: a systematic review and meta-analysis. BMC Med. 2020;18(1):1-3.

4. Slawomirski L, Auraaen A, Klazinga N. The economics of patient safety in primary and ambulatory care: flying blind. OECD Health Working Papers No. 106. Paris: Organisation for Economic Co-operation and Development; 2018 ( https://doi.org/10.1787/baf425ad-en, accessed 6 September 2023).

5. Slawomirski L, Auraaen A, Klazinga N. The economics of patient safety: strengthening a value-based approach to reducing patient harm at national level. OECD Health Working Papers No. 96. Paris: Organisation for Economic Co operation and Development; 2017 ( https://doi.org/10.1787/5a9858cd-en, accessed 6 September 2023).

6. Meara, John G., Andrew JM Leather, Lars Hagander, Blake C. Alkire, Nivaldo Alonso, Emmanuel A. Ameh, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The lancet. 2015; 386: 569-624

7. Rodziewicz TL, Houseman B, Hipskind JE. Medical error reduction and prevention. Treasure Island, FL: StatPearls Publishing; 2023.

8. Raoofi S, Kan FP, Rafiei S, Hosseinipalangi Z, Mejareh ZN, Khani S et al. Global prevalence of nosocomial infection: a systematic review and meta-analysis. PLoS One. 2023;18(1):e0274248.

9. Markwart R, Saito H, Harder T, Tomczyk S, Cassini A, Fleischmann-Struzek C et al. Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis. Intensive Care Med. 2020;46(8):1536-51. doi:10.1007/s00134-020-06106-2.

10. National Academies of Sciences, Engineering, and Medicine. Improving diagnosis in health care. Washington (DC): National Academies Press; 2015 ( https://doi.org/10.7326/M15-2256, accessed 6 September 2023).

11. Bergl PA, Nanchal RS, Singh H. Diagnostic error in the critically ill: defining the problem and exploring next steps to advance intensive care unit safety. Ann Am Thorac Soc. 2018;15(8):903-7.

12. Gunderson CG, Bilan VP, Holleck JL, Nickerson P, Cherry BM, Chui P et al. Prevalence of harmful diagnostic errors in hospitalised adults: a systematic review and meta-analysis. BMJ Qual Saf. 2020;29(12):1008-18.

13. Singh H, Meyer AN, Thomas EJ. The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Qual Saf. 2014;23(9):727-31.

14. LeLaurin JH, Shorr RI. Preventing falls in hospitalized patients: state of the science. Clin Geriatr Med. 2019;35(2):273-83.

15. Agency for Healthcare Research and Quality. Falls. PSNet; 2019. (https://psnet.ahrq.gov/primer/falls, accessed 11 September 2023).

16. Dykes PC, Curtin-Bowen M, Lipsitz S, Franz C, Adelman J, Adkison L et al. Cost of inpatient falls and cost-benefit analysis of implementation of an evidence-based fall prevention program. JAMA Health Forum. 2023;4(1):e225125. doi:10.1001/jamahealthforum.2022.5125.

17. Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol. 2014;34(11):2363-71. doi:10.1161/ATVBAHA.114.304488.

18. Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. International journal of nursing studies. 2020 May 1;105:103546.

19. De Rezende HA, Melleiro MM, Shimoda GT. Interventions to reduce patient identification errors in the hospital setting: a systematic review protocol. JBI Evidence Synthesis. 2019;17(1):37-42.

20. Pèpin J, Chakra CN, Pèpin E, Nault V, Valiquette L. Evolution of the global burden of viral infections from unsafe medical injections, 2000-2010. PLoS One. 2014;9(6):e99677.

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WHO fact sheet on patient safety, including key facts, common sources of patient harm, factors leading to patient harm, system approach to patient safety, and WHO response.

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

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

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Reflection : I think that if you are overweight or if you are smoking you know that's not good for you so its not my role as an osteopath to tell them that. The patient are not stupid and they can feel that you talk down to them by telling them things they already now and haven't asked for. If the problem is related to a better outcome for the osteopathic treatment for example obesity and knee pain I will try to tell the patient that loosing weight can reduce the load on your knee and reduce the pain that he/she experience.

It the patient ask me or tell me that he/she been trying to stop smoking or loose weight I can give them some advice or recommend them where to get help with that. I think you have to read the patient between the lines if they are interested in help or not, but of course tell them when is necessary for the problem they are here for.

Referens: https://www.sciencedirect.com/science/article/abs/pii/S0091743504000167

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National Institute of Diabetes and Digestive and Kidney Diseases

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As a primary care professional, you are in a unique position to talk with your adult patients about managing their weight. Sometimes, these conversations can be challenging or uncomfortable. ¹ If your patient has overweight or obesity, the tips and resources below may help you talk with them about their weight in a sensitive and effective way.

Why should I talk with patients about their weight?

Studies suggest that many patients with overweight or obesity welcome guidance from health care professionals about managing weight to reduce health risks. 2,3 However, some patients may find it hard to start these conversations themselves.

Patients with overweight or obesity may benefit from discussions about weight-loss or weight-maintenance goals, lifestyle changes, weight-loss plans and programs, or treatments such as medicines or surgery. By speaking with your patients respectfully and collaborating with them, you may be able to help them reach and maintain a healthier weight.

Which patients should I talk with about weight loss?

Weight-loss information and counseling may benefit patients who have-or are at risk of developing-health problems related to overweight or obesity. In general, this risk can be higher in adults who ⁴

have overweight, with a body mass index (BMI) of 25 to 29.9

have obesity, with a BMI of 30 or higher

have a waist size of more than 35 inches for women or 40 inches for men

have metabolic syndrome or high blood pressure, unhealthy lipid levels, or high blood glucose levels

BMI and waist size don't directly measure the amount of fat in your patient's body. As a result, BMI and waist size may not be enough information to assess health risks related to excess body fat in some people. Some patients with lower BMIs and waist sizes may also have a higher risk of developing health problems related to excess weight. Likewise, some patients with higher BMIs and waist sizes may not have an increased risk of certain health problems.

Weight loss may not be an appropriate goal for every patient with a BMI of 25 or higher. ⁵ To help you decide if your patient could benefit from weight loss, consider other relevant factors, such as their age, race and ethnicity, sex, health status, medical history, and risk factors for cardiometabolic disease. In some cases, helping your patient avoid additional weight gain may be a more appropriate goal.

How does weight stigma affect patients with overweight or obesity?

People with overweight or obesity often experience negative attitudes, prejudice, and discrimination about their weight from other people, including health care professionals. Negative assumptions about patients based on their body weight can prevent health care professionals from providing effective communication and compassionate care to their patients. ¹ When talking with your patients about weight loss, remember that their weight can be affected by many different factors, not just lifestyle habits.

Experiencing stigma about weight can harm patients by ⁶

lowering their self-esteem

increasing their risk of depression, anxiety, stress, social isolation, eating disorders, and substance use

leading them to avoid physical activity and engage in unhealthy eating behaviors

making them more likely to avoid, delay, or stop medical care for overweight, obesity, or other health problems

How can I prepare a welcoming environment for my patients?

Ensure your waiting area and consultation rooms include furniture and equipment appropriate for all patients, including those who have overweight or obesity. A welcoming environment may include ⁷

a scale that can weigh patients with overweight or obesity and is stable, accessible, and placed in a location that ensures privacy

sturdy examination tables and waiting room furniture, such as sofas and armless chairs

gowns and blood pressure cuffs that fit a range of sizes

What words should I use to talk about weight?

When talking about weight with patients, word choice matters. Some words that people use to talk about overweight or obesity could have a harmful impact on a patient's self-perceptions, attitudes, and behaviors. ⁸ Because your patient might prefer certain terms, you may want to ask them about the words they feel most comfortable using when talking about their weight. ⁸

Avoid judgmental terms

Some terms about weight may suggest you are judging a patient's weight or lifestyle. To use less judgmental terms when talking with a patient about their weight, you may want to

discuss what measurements such as their BMI and waist size could mean for their health

use terms such as "weight" or "having too much weight for their health" instead of "heavy," "fat," "overweight," or "obese"

offer to help them "lower" their weight instead of "improve" their weight

talk about reaching a "healthier weight range" instead of an "ideal weight"

discuss whether they have "excess weight" instead of a "weight problem"

Use person-first language

Using person-first language emphasizes that you do not define your patients by their weight but rather see them as a whole person. It can be used to describe what your patient "has" rather than what your patient "is." For example, consider using phrases such as "people who have excess weight" or "people who have obesity" instead of "obese people."

How can I start a conversation about weight?

Try to open a conversation about weight in a way that shows respect for your patient's preferences and builds trust.

Address your patient's main health concerns first

Some patients with obesity say that health care professionals dismiss their main health concerns to immediately focus on their weight. ² Address your patient's main health concerns first, before talking about their weight. Doing so may show that you are listening and responding to your patient's concerns and needs.

Ask for permission to talk about weight

Ask for your patient's permission to start a conversation about weight. ⁷ For example, you may want to ask, "Would it be OK if we talk about your weight today?"

If your patient says, "Yes," ease into the conversation by asking how they feel about their weight. This can help center the conversation around the patient's perspective. If your patient says, "No," respect your patient's choice. You can ask if it would be OK to revisit the topic in a future visit.

How can I help my patients make healthy lifestyle changes?

Many patients with overweight or obesity-even those who do not wish to lose weight-may benefit from talking with you about healthy eating and physical activity habits.

First, ask your patient about their eating and physical activity habits, their weight history, and if they have a history or current symptoms of an eating disorder. If your patient has an eating disorder, you may want to refer them to a mental health professional.

You may also want to talk with your patient about the stages of changing habits that could improve their health. If they have thought about making lifestyle changes, try to determine if they feel ready to start. If they are ready, you can help them set lifestyle change goals, monitor their progress, and plan how they might overcome barriers and challenges.

Talk about healthy eating and drinking habits

Many adults who want to lose weight and keep it off will need to reduce the number of calories they take in from foods and beverages. Online resources such as MyPlate can provide patients with information about choosing healthy foods and drinks. The U.S. Department of Agriculture also provides resources on food security and access that may help patients find or afford healthy foods.

You may want to start a conversation about eating and drinking habits by asking your patient questions, such as

"I'd like to learn more about your eating habits. What kinds of foods and drinks do you consume on a normal day?"

"What barriers might keep you from having healthy foods or drinks? For example, is it hard to find healthy and affordable options where you shop for food or at restaurants?"

"In the past 12 months, have you ever been worried your food would run out before you got money to buy more?"⁹

"Would you like help to track how many calories you consume or how much physical activity you get?"

Talk about the benefits of physical activity

To talk with your patient about physical activity, start by discussing the important health benefits of being active, even for short periods of time, on a regular basis. You may want to ask about their physical activity habits, such as

"What do you currently do to stay active? Would you like to add some physical activity into your daily routine?"

"Are there any barriers that prevent you from being active? For example, is it hard to find a good time or a safe place to be active?"

"What kinds of activities do you enjoy? Do you like walking? Seated aerobics such as arm raises or knee lifts? Do you prefer activities you can do alone, with someone else, or in a group?"

Let your adult patients know that they may benefit from ¹⁰

at least 150 minutes a week of moderate-intensity aerobic activity, such as brisk walking

more than 300 minutes a week of moderate-intensity aerobic activity if they want to lose at least 5% of their starting weight and keep the weight off

Help patients set lifestyle change goals

Using behavior change strategies, such as shared decision-making, with your patients can help them make informed choices and become active participants in their care. You can work with your patients to make SMART goals for lifestyle changes that are

For example, your patients could set a goal to replace sugar-sweetened beverages with water for a month. They could aim to walk for 30 minutes at lunchtime on Mondays, Wednesdays, Fridays, and weekends.

To start conversations with your patients about setting goals, you may want to ask questions, such as

"What are some goals you would like to set about your weight?"

"What lifestyle changes would you be open to starting with?"

"What kinds of support would help you meet your goals?"

Follow up with patients and recognize their progress

Encourage your patient to monitor the changes they make to their lifestyle habits. They can also track changes in their weight. Smartphone apps or online trackers may help them keep track of the foods and beverages they consume, how much physical activity they get, and their weight. These tools may help your patient stick with lifestyle changes and stay motivated.

Agree on a time frame for regular visits to follow up with your patient. At follow-up visits, review their progress. Recognize and praise successes in meeting their behavior-change goals or making improvements in their health, such as lower blood pressure or cholesterol levels, regardless of changes in weight. Focus on their ability to accomplish daily tasks and improvements in how they feel, rather than focusing on weight loss alone. Noticing improvements in their health, along with praise, may help motivate patients and boost self-esteem.

Help with challenges and setbacks

If your patient is making progress toward losing weight, work together to develop a plan to prevent regaining the weight they lost. If your patient is not making progress, don't judge or show frustration. Setbacks are normal. Acknowledge that the approach is not working and be prepared to discuss other options. Work together to identify barriers and solutions, and help your patient set new goals or adjust existing goals as needed.

How can I treat patients who could benefit from weight loss?

Discuss treatment options

Provide information on obesity treatments that may be good options for your patient.

Lifestyle change programs

The U.S. Preventive Services Task Force recommends offering or referring patients with obesity for intensive lifestyle change programs. ¹¹ Safe and effective weight-loss programs should last at least 6 months and provide guidance and support for adopting a healthy lower-calorie eating plan and increasing physical activity. Weight loss varies from person to person, but some researchers estimate adults can lose an average of 5% to 7% of their body weight through lifestyle changes. ¹²

Many patients may also benefit from a referral to a registered dietitian.

Weight-loss medications

Research suggests that some people taking weight-loss medications lose 10% or more of their starting body weight. 13,14 However, the amount of weight lost can vary by medicine and by person.

Weight-loss medications may be an option for some adults with

obesity, or a BMI of 30 or higher

a BMI of 27 or higher and weight-related health problems, such as type 2 diabetes or high blood pressure

Weight-loss surgery or devices

Studies show that many people who have weight-loss surgery, also called metabolic and bariatric surgery, lose about 20% of their starting weight on average. The amount of weight they lose can vary by person and the type of surgery they have. ¹⁵

Weight-loss surgery may be an option for some adults with ¹⁶

a BMI of 40 or higher, also called class 3 obesity

a BMI of 30 or higher, and serious obesity-related health problems, such as type 2 diabetes, high blood pressure, or sleep apnea

The U.S. Food and Drug Administration has also approved several devices for obesity treatment. However, these devices cause less weight loss than weight-loss surgery, and researchers are still studying their long-term risks and benefits.

Agree on a treatment plan

Use shared decision-making to help your patient be an active participant in their care and make informed choices. Developing a treatment plan together can ensure that it is tailored to your patient's needs, values, goals, and preferences.

What if a patient needs more help?

Some patients may benefit from additional support from specialists or a health care team. Be prepared to make referrals to

obesity specialists, such as obesity medicine physicians, registered dietitians, or exercise specialists

structured weight-loss programs, including hospital-based programs and evidence-based commercial programs

mental health specialists who can identify and treat factors that may contribute to weight gain, such as anxiety, depression, or eating disorders

specialists in medical conditions that may be affecting your patient's weight, such as certain endocrine diseases

bariatric surgery centers, if appropriate

You can continue helping your patients by coordinating their care, managing their health conditions, and providing support.

Will I be reimbursed for talking with my patients about their weight?

Reimbursement for obesity treatment may vary based on your patient's age, BMI, health conditions, or health insurance coverage. Check with your patient's health insurance provider about coverage for obesity screening, weight-loss or nutrition counseling, or treatments such as medications or surgery.

Medicaid plans cover obesity screening and counseling as part of regular preventive care, and some plans also cover nutrition counseling visits. ¹⁷ Medicare may reimburse primary care professionals who provide intensive behavioral therapy to patients with obesity. ¹⁸

What other resources may help?

These resources may also be useful

References

[1] Kennedy AB, Taylor SS, Lavie CJ, Blair SN. Ending the stigma: improving care for patients who are overweight or obese. Family Practice Management. 2022;29(2):21-25. Accessed March 23, 2023. https://pubmed.ncbi.nlm.nih.gov/35290004

[2] Ananthakumar T, Jones NR, Hinton L, Aveyard P. Clinical encounters about obesity: systematic review of patients' perspectives. Clinical Obesity. 2020;10(1):e12347. doi:10.1111/cob.12347

[3] Johnstone J, Herredsberg C, Lacy L, et al. What I wish my doctor really knew: the voices of patients with obesity. The Annals of Family Medicine. 2020;18(2):169-171. doi:10.1370/afm.2494

[4] Bray GA, Heisel WE, Afshin A, et al. The science of obesity management: an Endocrine Society scientific statement. Endocrine Reviews. 2018;39(2):79-132. doi:10.1210/er.2017-00253

[5] Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocrine Practice. 2016;22(7):842-884. doi:10.4158/EP161365.GL

[6] Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity. Nature Medicine. 2020;26(4):485-497. doi:10.1038/s41591-020-0803-x

[7] O'Shea D, Kahan S, Lennon L, Breen C. Practical approaches to treating obesity: patient and healthcare professional perspectives. Advances in Therapy. 2021;38(7):4138-4150. doi:10.1007/s12325-021-01748-0

[8] Puhl RM. What words should we use to talk about weight? A systematic review of quantitative and qualitative studies examining preferences for weight‐related terminology. Obesity Reviews. 2020;21(6):e13008. doi:10.1111/obr.13008

[9] Hager ER, Quigg AM, Black MM, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics. 2010;126(1):e26-e32. doi:10.1542/peds.2009-3146

[10] US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Physical Activity Guidelines for Americans. 2nd ed. US Department of Health and Human Services; 2018. Accessed May 23, 2022. https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines

[11] US Preventive Services Task Force, Curry SJ, Krist AH, et al. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(11):1163-1171. doi:10.1001/jama.2018.13022

[12] Bray GA, Ryan DH. Evidence-based weight loss interventions: individualized treatment options to maximize patient outcomes. Diabetes, Obesity, & Metabolism. 2021;23(suppl 1):50-62. doi:10.1111/dom.14200

[13] Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014;311(1):74-86. doi:10.1001/jama.2013.281361

[14] Yanovski SZ, Yanovski JA. Progress in pharmacotherapy for obesity. JAMA. 2021;326(2):129-130. doi:10.1001/jama.2021.9486

[15] Arterburn D, Telem D, Kushner R, Courcoulas A. Benefits and risks of bariatric surgery in adults: a review. JAMA. 2020;324(9):879-887. doi:10.1001/jama.2020.12567

[16] Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): indications for metabolic and bariatric surgery. Surgery for Obesity and Related Diseases. 2022;18(12):1345-1356. doi:10.1016/j.soard.2022.08.013

[17] Waidmann TA, Waxman E, Pancini V, Gupta P, Tabb LP. Obesity Across America: Geographic Variation in Disease Prevalence and Treatment Options. Urban Institute; February 2022. Accessed March 23, 2023. https://collections.nlm.nih.gov/catalog/nlm:nlmuid-9918486680106676-pdf

[18] Wadden TA, Tronieri JS, Butryn ML. Lifestyle modification approaches for the treatment of obesity in adults. American Psychologist. 2020;75(2):235-251. doi:10.1037/amp0000517

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Talking with Your Patients about Weight - NIDDK

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As a primary care professional, you are in a unique position to talk with your adult patients about managing their weight. Sometimes, these conversations can be challenging or uncomfortable. 1 If your patient has overweight or obesity, the tips and resources below may help you talk with them about their weight in a sensitive and effective way.

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

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

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Reflection Kolbs model: I had a patient that wanted to know private things in a sexual way about me that I of course wanted to talk or should talk with him about. The first time he asked something private I just didn’t answer and talked about something else. I talked to my colleagues about it, and they asked If I wanted to refer the patient to them, I thought about it and decided that I will treat him again and if I ask something I will tell him to stop.  The next time he did ask things again and I explained to him this is in a professional setting and I don't want to talk about private things with my patients, I tried to say it in a nice way but aware of that he can feel insulted and maybe stop coming to me for treatment. He accepted it and did not talk about it anymore. So, I learn that it is ok to say no the first time a patient step over your personal boundaries.

Referens https://jamanetwork.com/journals/jama/article-abstract/388355

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A7 you must make sure your beliefs and values do not prejudice your patients care 

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A7 you must make sure your beliefs and values do not prejudice your patients care 

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Reflection: I always meet a new patient with an opened mind and not discuss any of my own beliefs. The patients are very different from each other, and I live different from most of them with a lot of fitness and healthy lifestyle, a way of living that I know most of them won't be able to follow. I don't give any advice about food if they don't ask. I describe the osteopathic way of think about the role of the artery and the lymphatic drainage and the benefit of moving for the circulation and the healing process. I learned from experience with friends and family that you can’t force them to start training or eat better. But when you just do your thing and get result that they also want they will come to you for advice and then I will help them.

Referens:

https://link.springer.com/article/10.1186/1747-5341-5-11

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

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

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I always try to be honest with all my patient, but there is a difficulty on this topic. If I suspect something dangerous during my examination of the patient and the patient is not concerned at all. Should I tell the patient what I think and make them nervous without even giving them a correct answer or should I tell them this is not matching my understanding of this working diagnose and refer them to the doctor. Usually if the patient asks me if somethings is wrong, I tell them what I found during examination and that it could be different explanation to that and then refer them to the doctor. For example, if the blood pressure is very high according to standards, I will tell them because I have that fact, if it’s more a diffuse finding I rather not talk so much about it with the patient because I don't feel that I know enough to have the discussion with them and answer their questions. I try to stay calm and don’t make them nervous but also, they have the right to know and should be referred when necessary.

Referens https://pmc.ncbi.nlm.nih.gov/articles/PMC6422557/

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Duty of candour animation offers guidance on the importance of being open and honest - NHS Resolution

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Being open and honest with patients and those close to them is always the right thing to do and is often referred to as the duty of candour. NHS Resolution has produced a short animation to help those working in health and social care to …

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

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

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Reflection Kolbs model: When I have a patient that wants to complain I talked to them and try to explain the situation and hear what they have to say often there is a miss communication or I miss understanding. I stay calm, apologies and I then give them the mail to the clinic. For example, I had a patient that booked only 30 minutes on the website through an insurance company. She was very angry because it says on our website the first time is 45 minutes, but the insurance had booked her in acute in a time slot at 30 minutes. I told her that was a mistake from the insurance they should have told her it was only 30 minutes. She complained to the clinic and got a new free 45 minutes appointment. We contacted the insurance to inform them in the future they must explain if they book a new patient not to use the time slot for acute patient (30 min) min to avoid this happens again. We also send a confirmations mail about the appointment and time but she hasn’t seen that.

Referens: https://www.tandfonline.com/doi/full/10.1080/16549716.2018.1458938

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Managing patient complaints - MDA National

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Discover effective strategies for managing patient complaints, improving communication, and addressing medico-legal implications in healthcare.

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Evidence when its ok to share patient information with family 

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

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

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Reflection ERA model: I had a patient that came to me because his girlfriend recommended me. When I treated the girl friend, she asked about how it progressed with her boyfriend, and I didn't really know what to say because in this case they live together she obviously know how its going with him and I am sure he doesn't care if I told her. But I told her I can't talk about other patient. After the treatment I reflect on that and talked with my colleges about it and we agreed that I shouldn't say anything, just polite answer that we are not allowed to talk about the other patient we are treating.

Referens

https://jme.bmj.com/content/31/9/531.short

https://www.ncbi.nlm.nih.gov/books/NBK538279/

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

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

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Reflection : To be honest I haven't experience any situation where I don't act professional or treat patient fairly, Of course I have patients that I can feel we don't have the best chemistry but I always treat them with the same respect. I always think it's good practice for me to handle patient that I think have a complicated way of being because I train me in situation that's not that comfortable.

referens: https://www.magonlinelibrary.com/doi/abs/10.12968/bjcn.2010.15.3.46901

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Treat patients and colleagues fairly and without discrimination Part 2

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61. You must respond promptly, fully and honestly to complaints and apologise when appropriate. You must not allow a patient’s complaint to adversely affect the care or treatment you provide or arrange.

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

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

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Reflection:  My private lifestyle is very healthy, a lot of training, real food, no alcohol, a lot of sleep, no stress and cutting of bad relationship. So, for me it’s not a problem that I will says something outside my work that’s does not align with the osteopathic principles and way of living.

Reflection ERA Model : In the beginning of my first year in osteopath school I did have and open profile on social media and hade a patient that wrote to me and checked my stories, and even if I don’t post anything inappropriate or not suitable for an osteopath, I didn’t feel comfortable with that, so I did make all my social media private. As an osteopath we work with the whole body and mind and to give the best treatment I think that you as an Osteopath also have done some work within yourself. I do believe if you want to be a good osteopath you must live like you learn and that will also give a signal to your patients and maybe unconsciously give more respect and a better treatment outcome. Personally, I wouldn’t have the same trust in an overweight tired osteopath that should give me advice on how to live, eat or train.

Referens:

https://www.sciencedirect.com/science/article/abs/pii/S1931720410001868

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Maintaining Professional Conduct Outside the Workplace

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Your actions and behaviours outside of work hours can significantly impact how you conduct yourself in the workplace. This article looks at the importance of upholding professional conduct both inside and outside of work.

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

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

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Reflection Kolb’s model:  This is a common issue as an osteopath. I have met a lot a patient that didn’t need osteopathy for example they needed exercise, surgery or they had many mental problems that needs to be work with before any osteopathic treatment will influence them.

This problem wouldn't emerge if we didn’t work as self-employed, because in a hospital for example we could just send them home and still have our salary, but in our own practice we are missing a one-hour income if we just send them home. So, after what I been through with a lot of patients, I do see them and charge them for the first consultation, talk and/or treat them the first time, often I give them advice where to seek help or to give them exercise and I don’t rebook them to follow-up treatment even if is a business. I know some people will say there is always something to treat but I don’t agree on that, sometimes the patient can treat them self and have the best outcome. I want my patient to feel that they don’t waste there many and that I’m honest with them, I also don’t want passive patients.  It’s important to me that I can guide them, treat a lot of problem but they have to be an active part in the healing process.

We also try to be specific on the website what we can help with to avoid this problem. My way of thinking is that if I’m honest they will respect me talk to their friends and in the long run I will build up I good reputation and respective clinic.

Referens: https://www.cmaj.ca/content/170/12/1817.short

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Profit, not patients: the risks of private medicine

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Ultimately, private providers have their shareholders’ interests at heart, not their patients’. A GP and celebrated writer shares his experiences of how the healthcare system works

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D9. You must support colleagues and corporate with them to enhance patients care  

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D9. You must support colleagues and corporate with them to enhance patients care  

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Reflection Kolbs Model:  In our clinic we have a meeting every week to discuss patient treatment and if somebody have a specific case they need to discuss. We are 2 osteopath students so it’s important to have the change to discuss cases with more experience colleagues. This meeting is because earlier we didn't have much time to talk about patient end often when we did it showed that somebody had maybe treated a patient with not so much success and other colleges could have helped with input earlier to minimize the treatment time and to get faster result and happier patients.  Me and my other colleague that also study osteopathy also have a meeting every week to discuss treatment, handhold, techniques and other relevant things to be sure we give the best and effective treatment to the patients. I will continue with this my whole carrier as an Osteopath because I think you can never learn everything, and you can always improve and learn from others.

Referens:

https://www.sciencedirect.com/science/article/abs/pii/S1322769617300422

https://pmc.ncbi.nlm.nih.gov/articles/PMC4949805/

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Introduction:

In the healthcare sector, collaboration is vital for ensuring that diverse medical professionals, including doctors, nurses, specialists, and other staff, work seamlessly together to enhance patient care and outcomes. The meaning of collaboration in this context extends beyond mere cooperation; it involves a dynamic synergy where skills, knowledge, and expertise are shared to solve complex health issues. Team collaboration in healthcare enhances communication channels, reduces errors, and ensures that care is patient-centered and efficient. By fostering a culture of openness and mutual trust, healthcare professionals can better coordinate efforts, leading to improved patient experiences and outcomes. For Professionals, understanding and implementing effective collaboration strategies is essential to navigating the complexities of medical practice and achieving outstanding healthcare delivery.

Collaboration in Healthcare Roles

In a healthcare setting, collaboration is key to ensuring that patient care is comprehensive, effective, and efficient. Professionals, including doctors, nurses, specialists, and administrators, coordinate closely to deliver high-quality healthcare services. Cross-functional teams in healthcare are composed of individuals from various disciplines who bring diverse expertise and perspectives to the table, optimizing decision-making and patient outcomes.

Collaboration Strategies:

1. Interdisciplinary Team Meetings: Regularly scheduled meetings involving all members of a patient care team are crucial. These meetings provide a platform for professionals to discuss patient cases, share insights, strategize treatment plans, and make decisions collaboratively. This approach ensures all team members are on the same page and helps tailor treatments to the individual needs of patients.

2. Use of Digital Tools: Electronic health records (EHRs) and other digital communication tools allow professionals to share information seamlessly and in real-time. These tools enable instant access to patient data, facilitating better coordination and faster response to patient needs.

3. Role Clarity and Defined Processes: Clearly defining roles and responsibilities helps streamline workflows within teams. When each member understands their specific duties and how they fit into the larger care plan, it minimizes overlaps, reduces errors, and enhances team efficiency.

Teamwork and Collaboration in Healthcare:

1. Multidisciplinary Rounds: These are structured sessions where various healthcare professionals, such as physicians, nurses, pharmacists, physiotherapists, and social workers, discuss patient care. Each professional contributes their unique insights, ensuring that all aspects of a patient's health are considered and addressed.

2. Shared Decision-Making: Involving patients and their families in the decision-making process ensures that care delivery aligns with patient preferences and values. Professionals collaborate to present options clearly, helping patients make informed choices about their care.

3. Training and Development: Continuous professional development and team-building exercises help keep all team members up to date with the latest medical practices and strengthen interpersonal relationships, fostering a culture of trust and cooperation.

In sum, collaboration in healthcare revolves around the integration of diverse skills and knowledge to improve patient care outcomes. Effective collaboration strategies and commitment to teamwork and collaboration are vital for healthcare professionals to navigate the complexities of medical care and deliver holistic health services.

Collaboration Tools in Healthcare

Collaboration tools are transforming the landscape of healthcare by enhancing teamwork and communication among Professionals. Digital collaboration software platforms like KanBo are at the forefront, offering solutions that help streamline healthcare operations. These platforms play a crucial role in connecting healthcare teams, from doctors and nurses to administrative staff, allowing them to collaborate more effectively.

KanBo: An Overview

KanBo is a sophisticated work coordination and collaboration software designed to meet the specific needs of healthcare organizations. By providing a centralized space for task management, real-time communication, and patient care tracking, KanBo helps hold the complex web of healthcare operations together. Here's how KanBo benefits Professionals in the healthcare industry:

1. Enhanced Communication: KanBo facilitates seamless, real-time communication among team members, ensuring that everyone is on the same page. This is especially important in healthcare, where timely and accurate information can significantly impact patient outcomes.

2. Task Management and Coordination: With its hierarchical structure of Workspaces, Spaces, and Cards, KanBo provides a comprehensive system for organizing tasks and projects. This structure is pivotal in managing various patient care processes, ensuring nothing falls through the cracks.

3. Integration with Existing Systems: KanBo integrates deeply with Microsoft environments like SharePoint, Teams, and Office 365, making it a perfect fit for healthcare organizations already using these platforms. Its ability to bridge on-premises and cloud-based systems ensures compliance with security and accessibility standards.

4. Customizable Workflows: Healthcare Professionals can use KanBo to develop tailored workflows that suit their specific needs. Whether through Kanban, List, Gantt Chart, or Timeline views, teams can visualize tasks and progress in a format that best suits their work style and methodology.

5. Tracking and Accountability: Features such as Forecast Charts, progress indicators, and real-time task visualization make it easier for teams to track patient care processes and stay aligned with project goals and deadlines.

6. Operational Efficiency: By utilizing advanced features like Mirror Cards and Card Blockers, KanBo helps avoid bottlenecks and improves transparency across complex workflows. This efficiency is crucial for healthcare professionals who need to balance numerous tasks and responsibilities.

Collaboration in Healthcare

The use of collaboration tools like KanBo impacts healthcare by improving how teams work together within digital environments. The platform's ability to handle both simple and complex tasks, support synchronous and asynchronous work, and foster a culture of transparency and trust is vital. Healthcare Professionals can better focus on providing high-quality patient care by devoting more time to core activities rather than getting bogged down by inefficient processes.

In summary, collaboration software such as KanBo enhances the ability of healthcare teams to communicate, coordinate, and deliver care effectively. By incorporating digital collaboration tools into their operations, healthcare organizations can optimize teamwork and improve patient care outcomes.

The Importance of Communication in Healthcare Collaboration

Summary: Importance of Communication in Healthcare Collaboration

Effective communication is essential for Professionals involved in healthcare collaboration to optimize patient outcomes and minimize errors. Through communication and collaboration, healthcare providers ensure a cohesive and strategic approach to patient care. Interprofessional collaboration, which relies heavily on strong communication, enables diverse healthcare teams to share insights, align treatment plans, and address patient needs holistically. This improved synergy not only enhances the quality of care but also reduces the likelihood of misunderstandings or mistakes, leading to safer and more efficient healthcare delivery. By fostering clear and consistent communication, Professionals contribute to a high-functioning, patient-centered healthcare system.

Overcoming Collaboration Challenges in Healthcare

In the healthcare industry, specifically in the realm of product management for clinical evaluations like those for the Artis fixed C-arms angiography solutions, collaboration is paramount. However, professionals often encounter several challenges that can impede effective collaboration.

Common Challenges in Collaboration for Healthcare Product Management

1. Time Constraints:

- The busy schedules of healthcare professionals and product managers mean that finding common available times for meetings and collaborations can be difficult.

2. Differing Priorities:

- Internal and external stakeholders such as marketing teams, clinical experts, and physicians may have varying priorities, which can lead to conflicting agendas.

3. Technological Barriers:

- Differences in technology platforms and systems, especially across international service teams, can create communication and data-sharing bottlenecks.

4. Complex Regulations:

- Working with notified bodies and maintaining compliance with healthcare regulations requires meticulous coordination and frequent updates.

Overcoming Collaboration Challenges: Strategies and Solutions

Collaboration Examples and Strategies:

1. Utilization of Collaboration Platforms:

- Implementing digital collaboration tools like KanBo can streamline project management by providing a centralized platform for task management, document sharing, and communication. These tools help keep all stakeholders updated on project developments in real time.

2. Structured Communication Protocols:

- Establish regular communication protocols, such as weekly check-ins and updates, to ensure that all team members are aligned. This structured approach can mitigate misunderstandings and keep the collaboration on track.

3. Clear Task Delegation:

- Clearly define roles and responsibilities among team members. This includes both internal stakeholders (product managers, risk engineers) and external stakeholders (notified bodies). Well-documented responsibility matrices can reduce overlap and confusion.

4. Regular Team Meetings:

- Schedule regular meetings that accommodate different time zones and work schedules. Use these meetings not just for updates, but also for problem-solving and brainstorming to enhance team synergy.

5. Cross-functional Workshops:

- Organize workshops that bring together diverse teams for strategic planning sessions. These workshops can foster a shared understanding of goals and align efforts across different functions.

6. Feedback Mechanisms:

- Implement feedback loops that allow stakeholders to voice concerns or suggestions regularly. This can be done through surveys or direct communication channels incorporated within the collaboration platform.

By addressing these challenges with strategic collaboration examples and solutions, healthcare professionals involved in product management can improve their coordination and efficiency, ultimately enhancing the success of important projects like the clinical evaluations of Artis fixed C-arms angiography solutions.

Exploring Digital Solutions: Using KanBo to Address Collaboration Challenges

Overcoming Collaboration Pain Points in Healthcare with KanBo

Business Problem

Healthcare professionals often work under high-pressure environments that necessitate efficient collaboration across various departments. Challenges such as miscommunication, lack of transparency, and uncoordinated task management can adversely affect patient care. Therefore, the goal is to streamline healthcare workflows utilizing KanBo's features to enhance collaboration, ensure clarity in task allocation, and improve overall service delivery.

Understanding KanBo Features and Principles

Before proceeding with the solution, familiarize yourself with the following KanBo features:

- Activity Stream: Provides real-time visibility into actions taken by team members.

- Card Blockers: Helps identify and address obstacles hindering task progress.

- Card Status: Indicates the current stage of a task, assisting with workflow tracking.

- Calendar View: Visualizes deadlines and schedules.

- Card Relations: Enables the establishment of dependencies between tasks.

- Card Templates: Ensures consistency in task details and information.

Step-by-Step Solution for Addressing Healthcare Workflow Challenges

1. Setup Workspace and Define Structure

- Create a workspace specifically for each hospital department (e.g., Radiology, Emergency Room).

- Establish spaces within each workspace to handle specific workflows (e.g., patient admittance, diagnostic testing).

2. Organize Tasks with Cards

- Use Cards to represent individual tasks or patient cases. Include all pertinent information such as patient details, required actions, and timeline.

- Attach relevant documents to cards via Card Documents, ensuring easy access to medical records and test results from the SharePoint document library.

3. Strengthen Communication and Information Sharing

- Encourage the use of Comments on cards, enriched with text formatting, for ongoing communication about patient care and task updates.

- Use @mentions to notify specific team members, ensuring accountability and prompt response.

4. Implement Card Relations for Task Dependencies

- Use Card Relations to link related tasks, such as scheduling an initial patient consultation followed by necessary laboratory tests, ensuring a coherent workflow.

5. Identify and Mitigate Obstacles

- Employ Card Blockers to flag tasks that encounter issues, allowing quick identification and intervention by relevant teams.

6. Monitor Workflow Progress with Visual Tools

- Utilize the Kanban View for real-time tracking of task progress through different stages, such as "Pending", "In Process", and "Completed".

- Implement the Gantt Chart View for long-term planning and visualization of various healthcare projects or campaigns.

7. Schedule and Manage Task Timelines

- Use the Calendar View to manage task schedules, provide visual oversight of deadlines, and plan ahead with day, week, or month projections.

8. Establish Consistent Practices Using Card Templates

- Develop Card Templates for repetitive processes, such as patient discharge tasks, ensuring consistent information and standardized procedures.

9. Enhance Transparency with Activity Stream

- Leverage the Activity Stream at both card and space levels to maintain a transparent record of actions performed by teams, enhancing trust and allowing for informed decision-making.

10. Leverage Quick Actions for Efficiency

- Utilize Quick Actions to expedite routine tasks without delving into complex menu structures, increasing time efficiency during critical operations.

Presentation and Explanation of KanBo Functions

By incorporating these KanBo features, healthcare professionals can achieve a higher level of coordinated care, supporting quick decision-making processes. This ensures that professionals focus on delivering optimal patient outcomes, while compliance with healthcare norms and protocols is maintained, creating an 'invincible organization with people who care'. With an invincible collaboration platform, the focus is drawn back to patient care, the very heart of healthcare services.

Glossary and terms

Glossary and Introduction

KanBo is a versatile digital tool designed to enhance task management, collaboration, and project visualization. Its interface offers a plethora of features enabling individuals and teams to organize, track, and accomplish tasks effectively. To make the most out of KanBo, it's essential to understand its various components. Below is a glossary of important terms you'll encounter while using KanBo.

- Activity stream:

A dynamic, real-time feed displaying a chronological log of activities. It offers details of actions, timestamps, and the contributors involved, linking directly to related cards and spaces.

- Bookmark:

A feature to mark and collect critical activities and discussions from cards and spaces for easy future reference, organized within the user's profile.

- Calendar view:

A traditional calendar representation of cards, allowing users to visualize upcoming tasks and manage their scheduling responsibilities efficiently by days, weeks, or months.

- Card:

The basic unit of task management in KanBo, cards represent tasks and include notes, files, comments, and checklists, adaptable for diverse needs.

- Card activity stream:

A log specific to each card, detailing all activities and changes in chronological order. It aids users in tracking the card's history and updates for transparency.

- Card blocker:

An issue or obstacle hindering a task's progress, categorized into local, global, and on-demand blockers to specify standstill reasons.

- Card relation:

The connection between cards indicating dependency, helping break larger tasks into smaller ones with clear working order. Types include parent-child and next-previous relations.

- Card status:

Indicates the current stage of a task (e.g., To Do, In Progress, Completed) to help organize and track project progress.

- Comment:

Allows users to add message threads on cards to provide additional information and communicate. Supports advanced text formatting.

- Gantt Chart view:

A bar chart view arranging time-dependent cards chronologically on a timeline, ideal for complex, long-term planning.

- Kanban view:

This view divides space into columns representing different work stages. Cards representing tasks move across columns as they progress.

- Card template:

A reusable, predefined layout for creating cards, ensuring consistency and saving time by setting default details for new cards.

- Card documents:

Files attached to cards, stored in SharePoint document libraries and organized within card document groups and folders.

- Mind Map view:

A graphical method to represent card relations, fostering brainstorming and structured planning by organizing tasks hierarchically on a single canvas.

- Quick Actions:

Time-saving shortcut features that enable users to execute card-related actions efficiently at the space level without extensive navigation.

Understanding these terms will enhance your navigation and utilization of KanBo, making your project management tasks more seamless and organized.

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6 Proven Strategies for Enhancing Healthcare Collaboration and Patient Outcomes

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Table of ContentsIntroduction:Collaboration in Healthcare RolesCollaboration Tools in HealthcareThe Importance of Communication in Healthcare Collaboration Overcoming Collaboration Challenges in...

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

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

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Reflection Kolbs model: I always refer patient back to the doctor if I think there is something that needs to be follow-up or if they need other examination. For example I had a patient with headache and he had been to the doctor and the doctor explained that there was the muscle in the neck that was tense, but when I checked the blood pressure it was 158/89 and the patient was 33 years old normal weight no other disease. In that case the patient was a little bit irritated because I sent him back again, but the doctor didn’t check the blood pressure. So, I explained that I want him to be safe to treat and to first find the cause to the high blood pressure.  So, it’s important not just to ask if they went to the doctor but also ask what the doctor did check. And it’s Important to always have the patient’s best interest in mind an involve other healthcare professional when is necessary.

Referens https://www.sciencedirect.com/science/article/abs/pii/S1322769617300422

https://pmc.ncbi.nlm.nih.gov/articles/PMC4949805/

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How to Optimize Healthcare Staffing for Better Patient Care | Shiftmed Blog

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Learn how to optimize healthcare staffing processes to improve patient care, reduce costs, and enhance staff satisfaction with effective strategies and technology integration.

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

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

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I will never put my patients in a risk to get an infection from me. I won't go to work if I feel sick in a way that can transfer to them.

Referens: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2344551

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Doctors often work while sick, putting patients at risk

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Survey of hospital staff reveals why they don’t take sick days, even when they know they should

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

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

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In Denmark you have to show your workplace that your criminal record are clean. I have a clean criminal record and will continue to have that.

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I have develop my understanding of treating women with dysmenorrhea in a more 3D approach and include the 5 osteopathic models. I work a lot with the posture and to release the congestion in the pelvis (lymphatic drainage) and with the viscera-somatic reflex from the uterus level T10-L3 and also if the patient experience gastro intestinal problem I found it effect to threat TH5-Th9. I believe when treating the diaphragm and optimize arteriel and venus blood supply and influence the pelvic organs has a key role in primary dysmenorrhea. Before studdy osteopathy I used a lot of pelvic and lower spine mobilisation and stretching exercise of the hip. I do use that musculoskeletal approach now also but combine with other osteopathic technique. I give the patient advice on how to reduce the inflammation with diet and how to improve the circulation in the area. Even do we can treat a lot with osteopathy I found on my self and is proven in studdies a very god effect of doing physical activity and reduce intake of sugar and fastfood that reduce the symptoms significant. I think it's important to educate the patient in an active lifestyle and take responsible for her own healing to receive the best possible outcome of the osteopathic treatment. I develop a huge intresse for womens health and planning on taking the 2 years course after graduated as an osteopath.

Referens

https://pubmed.ncbi.nlm.nih.gov/38389612/

https://www.sciencedirect.com/science/article/abs/pii/S0965229916300309

https://pubmed.ncbi.nlm.nih.gov/31538328/

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Osteopathy & Dysmenorrhea | Full Circle Health Network

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Reflection: I have many pregnant patient that come to me with pelvic, back pain or symphysis pain. There is some thing I need to make sure I covered in the case history that can make this I high risk pregnancy, for example I ask if she hade experience premature birth before, if the blood pressure is checked recently and I always check it by my self, if she have any symptom of preeclampsia for nausea, changes in vision, headache, pain under right ribs or suddenly swelling in hands or face. If she have any of the acute symptoms I will refer her to the doctor and not treat her.

When working as a physio and treat pregnant patients I did a lot of stretching piriformis and psoas muscles, articulation of the SI joint and lower back. Since learning new techniques I come to often use counterstain techniques and taking the joint or muscle in to relaxation instead of stretching I found that very effective and the patient respond positive and have a feeling of not have so much weight on. Often there is tension around the bladder and the attachment of ligament to pubic bone is tight and I experience good result with counterstain techniques. To reduce swallowing in there legs I work with mobilisation of pelvic ilium, ligament inguinale and make sure there is a good circulation in the hip are so the venus system can transport fluid back again. I also work with poster and breathing, ribs mobilisation. I use GOT adapted to pregnancy to increase drainage and blood circulation. I always ask if they been to check for blood pressure and I don't treat during the first trimester because I want to make sure it could not be my causing an eventual miscarriage.

Overall I develop an understanding of treating the whole body during pregnancy to optimes fluid return, work with congestion, cavity pressure, balance ligament tension and hypertone muscles.

Referens

https://pubmed.ncbi.nlm.nih.gov/27661020/

https://pmc.ncbi.nlm.nih.gov/articles/PMC10530515/

https://www.sciencedirect.com/science/article/abs/pii/S1360859217302310

https://pmc.ncbi.nlm.nih.gov/articles/PMC2811218/

https://pmc.ncbi.nlm.nih.gov/articles/PMC7739277/

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Osteopathy and Pregnancy - how can Osteopaths help during pregnancy?

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Osteopathic treatment can help to ease muscle and joint tension, provide a little more room for your baby and make you both more comfortable.

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I have meet a lot of women that I treated for pelvic pain, dysmenorrhea etc and many of them also told me they have a lot of urinary infection and that antibiotics is not helping. Because of the anatomy of the bladder close to the pelvis there is a mechanical pressure ont the bladder if they have an anterior tiltet pelvis so I mobilizes the pelvis to neutral position, release tension of the pubovesical ligament and treat the tissue causing the tilt and they experience less pressure on the bladder an no infections.

https://pubmed.ncbi.nlm.nih.gov/23294678/

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Osteopathic manipulative treatment (OMT) for lower urinary tract symptoms (LUTS) in women - PubMed

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The findings of this systematic review and meta-analysis are promising and encouraging to conduct larger, rigorous osteopathic intervention studies for female urination disorders. Future studies should compare the osteopathic treatment with established standard procedures in the control group.

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Reflection:During this years of studding osteopathy I became very humble over to treat babies. In danmark there is a big intress for baby treatment and I thought I also wanted to treat babies when I started. I joined my colleagues at my clinic that studied a 2 years diploma in pediatric. They deliver af very high quality treatment and have a big knowledge about the development of the babies different stage and also about abnormalities. I experienced during the consultations with them that the parents have many questions and that you have to have a big knowledge and be able to answer all there questions also. I always want to deliver where high quality to my patients and want to have a good knowledge about the topic I m treating. I came to realize that the more I participated in baby treatment the more I figure out how much there is to know before I think it's safe to treat them and that I wasn't really interested in baby treatment. I have 4 colleagues at a my clinic that are specialized in baby treatment I can't se why I should treat them without the right knowledge or interest. I want all patient to have the best possible treatment and as a mom I wouldn't let anyone without the right knowledge treat my baby either. I don't think the lectures we had in the osteopath course is enough to treat babies and I think many osteopath student treat babies because there is good money and many parentes that want there baby to se an osteopath. When my kid was a baby there were almost no osteopaths and nobody had treatment for there babies and everything turn out totally fine with here and the other kids at her age. Im not saying it's not working but from what I seen during consultation with my colleagues I do think many parents are over reacting and there is nothing wrong with their baby.

Referens

https://pmc.ncbi.nlm.nih.gov/articles/PMC9369972/

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How can osteopathy help your baby?

Osteopathy can:

Release any strains or torsions throughout your baby's body, for example, within the cranio-sacral base and diaphragm.

Release any compression throughout your baby's cranial bones that could have been caused during the labour process.

Release any tight muscles that could be causing constipation or making it difficult for your baby to look one way.

Some of our osteopaths can also teach you a baby massage routine to do at home daily. This will help soothe your baby, not only physically, but mentally too. It's a great way of connecting with your little one and giving them your full attention.

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How can osteopathy help your baby? Osteopathy can: Release any strains or torsions throughout your baby's body, for example, within the cranio-sacral base and diaphragm. Release any compression throughout your baby's cranial bones that could have been caused during the labour process.

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lector about female cycle .

Periteneum surrender the uterus.

broad ligament attach to pelvic walls.

Douglas potch its lowest so its more liquid inflammation endometriosis often in Douglas potch.

removing appendix fluid can go to Douglas potch and give inflammation.

puboviscecal ligament between pubis and bladder

referens:

seminar 15-17 november 2024 lecture Anja Engel-Schulmeyer

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Reflection: I always been treating sports patient in my career as a physioteraphist. With time I develop a deeper understanding and examination rutine, often the primary problem is not where the present complain is. I see a lot running injures that I earlier treated where the problem occur for example the Iliotibial band or runners knee. (se the attached evidens from my sports presentation last year).Now I exam and treat the whole body and often there is a dysfunction in the ilium and spine witch can lead to dysfunction in muscles and also cause problem with cavity pressure and decrease circulation to lower limb. That will reduce the healing capacity. Many sport patient often has been through surgery earlier and I now focus a lot of the fascia strain and dysfunction that can occur due to scare tissue for example ankel surgery can lead to dysfunction in SI joint and impaired gait. When correction posture imbalances and restore normal functions in the body it is often not necessarily to treat directly where the complain is.

One of the biggest difference I se when treating sports injuries compared to people that don't have a "deadline" where they need to be symptoms free is that they often don't want to wait for the body selfhealing and they often start to earlier with to much load to the joints and muscles. Also if they have an important competition in the nearest future I treat them with a physio approach for example with soft tissue techniques stretching and more frequently than I usually will. And after the competition I can treat them more holistic and less frequently with an Osteopathic approach. The problem can often be the stress load they have from either work and life or the stress from training and not be able to rest or decrease trainings load that can be an issue with the healing of the injury.

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Reflection: I did my poster about diabetes. Regardless of what long term condition (like in the poster in above) I think that maintaining a healthy life stil and exercise regularly will contribute to a better outcome for most of the long term condition. Specially the one that are self-inflicted like type 2 diabetes. As an Osteopath you can give guidance and advice and maintain a good mobility and circulation in the body combine with exercise and training. I think during this 4 years Osteopath school there is is not enough education about nutrition, hormons and fitness. In diabetes both type 1 and 2 nutrition guidance should have a big role and can make a big difference in the patients long term health and minimize the risk of complications.

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Baby need to be born in 25 hours after water broke. Important bacteria from the mother during birth.

during birth the head got a natural cv4 when the occiput pushes to the pubic bone.

Vomiting -pyloric stenose - cry after throwing up can be in pain because of accid irritated

colic 3 hours 3 days 3 weeks

23/1 baby course

always treat the membrane as primary bones are secondary. referens the teatcher Kok Weng Lim

Reflux baby better lying on the left side resolve after as sphincter is to open to often

could help they sleep on the stomach

first thing to look for with baby with bad sleep is to look at the gut.

At 6 month WHOs guideline, start with solid food because of the risk of allergi.

Headache - baby that arch back and crying always exclude headache and colic.

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How can osteopathy help your baby?

Osteopathy can:

Release any strains or torsions throughout your baby's body, for example, within the cranio-sacral base and diaphragm.

Release any compression throughout your baby's cranial bones that could have been caused during the labour process.

Release any tight muscles that could be causing constipation or making it difficult for your baby to look one way.

Some of our osteopaths can also teach you a baby massage routine to do at home daily. This will help soothe your baby, not only physically, but mentally too. It's a great way of connecting with your little one and giving them your full attention.

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How can osteopathy help your baby? Osteopathy can: Release any strains or torsions throughout your baby's body, for example, within the cranio-sacral base and diaphragm. Release any compression throughout your baby's cranial bones that could have been caused during the labour process.