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Exercise Advice and Progression. Year 1. A5

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Exercise Advice and Progression. Year 1. A5

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

What?
When observing in the clinic, I have seen a variety of patient reactions to follow up advice. One patient had made explicitly clear to the practitioner that they were not interested in doing anything that was recommended to them in terms of self-help at home. This was a difficult situation, as the practitioner still wanted to provide exercises in case the patient changed their mind, without making them feel like they weren't listened to.

On the other hand, one patient actively sought help and advice on what they could do at home and wrote down which exercises they did, how often and how difficult they were out of 10. This made the profession in strength easy to see for the practitioner who could then provide new advice- EG for helping the wrist, squeezing a ball of wool, to a ball of socks, then on to differing ranges of ball (tennis, cricket etc).

So What?
Providing home exercises or advice helps the patient take care of themselves and reduces the risk of treatment dependency. It is important to offer these options even if a patient is not cooperative, as shown above, as we must be aware of our role as healthcare providers outside of osteopathy.

Now What?
Looking back on this reflection, I think it helped me develop my patient management in 3rd and 4th year; part of this is having knowledge of the NICE guidelines and how to implement them. For example NG59 states that manual therapy should only be offered alongside exercise to manage low back pain (NICE, 2020), so rehab exercises should be offered for each patient.

References:
NICE, 2020. NG59: Low back pain and sciatica in over 16s: assessment and management. Available at: https://www.nice.org.uk/guidance/ng59. Accessed on: 3/3/2022

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

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This guideline covers assessing and managing low back pain and sciatica in people aged 16 and over. It outlines physical, psychological, pharmacological and surgical treatments to help people manage their low back pain and sciatica in their daily life. The guideline aims to improve people's quality of life by promoting the most effective forms of care for low back pain and sciatica.

The recommendations in this guideline were developed before the COVID‑19 pandemic.

For advice on neuropathic pain not related to sciatica, see the NICE guideline on neuropathic pain in adults.

In December 2020, we added links to NICE guidelines supporting discussion with people about safe prescribing of opioids, in response to a Public Health England evidence review on dependence on, and withdrawal from, prescribed medicines.

Recommendations

This guideline includes new and updated recommendations on pharmacological management of sciatica.

These supplement the existing recommendations on:

Who is it for?

Healthcare professionals

Commissioners and providers of healthcare

People with low back pain or sciatica, and their families and carers

Guideline development process
How we develop NICE guidelines
Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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Low back pain and sciatica in over 16s: assessment and management

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This guideline covers assessing and managing low back pain and sciatica in people aged 16 and over. It outlines physical, psychological, pharmacological and surgical treatments to help people manage their low back pain and sciatica in their daily life.

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Observation of patient management- Year 1. A2.

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Observation of patient management- Year 1. A2.

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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.
- 1: You must care for your patients and do your best to understand their symptoms and support their health.
-2: You should be sensitive to the specific needs of patients and be able to select and utilise effective forms of communication, which take these into account.

What?
This picture shows a reflection sheet I filled in whilst watching a particularly interesting case at clinic, in terms of patient-practitioner interaction.  The patient was full of personality and consequently it was difficult to keep the appointment on track but also to keep the patient happy. Unfortunately there was no time for treatment but the patient seemed happy to return.

So What?
The  student practitioner dealt very well with the circumstances and guided her through the appointment with sensitivity and respect, which was really inspiring to watch. He adapted to her communication style and allowed her to express her needs, whilst also managing her expectations and the format of the appointment.

Now What?
This experience showed me that the hands-on parts of treatment are not always the most important, and that sometimes patients feel supported by being listened to. It also gave me some ideas on how to manage patient expectations, as it wasn't possible to treat her in this appointment due to the time taken gathering information in the case history.

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

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A7. You must make sure your beliefs and values do not prejudice your patients’ care.
- The same quality of service and care should be provided to all patients

What?
In our professional skills and clinical integration lectures this year, we have been looking at recognising our biases. It was really interesting to see what we were unconsciously biased against - I did the test thinking I was fair to all but was actually was greatly biased against the elderly.

I have also experienced this from the opposite viewpoint; twice while observing in clinic now, I have seen patients who have reluctantly disclosed that they are seeing homeopaths. I found this a bit strange until I realised it was because they were afraid of judgement from the student and the observers.

So What?
I suddenly was aware of how important it is to be open and welcoming to not only the physical aspect of a person, but also the emotional aspect and their personal beliefs, in order to gain a full medical history and understanding of that patient. In order for the patient to trust you, they need to know that they are in a non-judgemental environment.

Now What?
From now on, I am going to make sure that I am open to all patient's values and beliefs, and continue to keep my personal viewpoints out of the treatment room in order to achieve the most honest conversation between patient in practitioner and provide the best care. I must also make a conscious consideration to be neutral when interacting with elderly patients to avoid stereotypes and prejudices; age is also a protected characteristic set out in the Equality Act 2010.

References:
Equality Act 2010. Available at: https://www.legislation.gov.uk/ukpga/2010/15/contents. Accessed on: 4 June 2019.

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

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Personalised feedback from video taken in technique class - Year 1. OPS B1

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Personalised feedback from video taken in technique class - Year 1. OPS B1

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OPS B1: You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.
-1.6: an understanding of the principles of biomechanics sufficient to apply osteopathic treatment safely and effectively
-1.11: the ability to protect yourself physically and psychologically during interactions with patients to maintain your own health
-1.12: the ability to critically appraise your own osteopathic practice

What?
The lecturing assistants filmed us performing side-lying scapulothoracic techniques and gave personalised feedback based on the video (file too large to upload).
My personalised feedback points were:
-  Take off watch for patient comfort
-  Make sure the couch is at the right height for my own comfort
- Make a wider base with feet so give me the most stable position
- Patients shoulder should be contacting my manubrium/sternum, not my opposite shoulder
- Try to achieve the biggest contact underneath the scapula as possible (as is comfortable for the patient) to get the best range of movement
- Make sure nails are super short so best contact is achieved (not worrying about hurting the patient)

Now What?
I am going to take these points forwards in my practical classes to optimise both my own and the patient's comfort. This will ensure I can apply the techniques as effectively as possible to have an optimal impact on the area being treated.

So What?
Receiving and implementing feedback like this is important at this point in the course as it ensures that we are performing techniques correctly and effectively, as patients will not always be clear if in discomfort. Taking critiques to implement moving forward is a key part of reflective work on practical skills.

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

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CPOMS, FGM and Prevent duty training - Year 2. C4

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CPOMS, FGM and Prevent duty training - Year 2. C4

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C4. You must take action to keep patients from harm.
-1.0: You must comply with the law to protect children and vulnerable adults.
-6.0: You must comply with any mandatory reporting requirements, for example, those related to female genital mutilation (FGM) in England and Wales.

What?
Part of our training to get ready to enter clinic has involved training in what to look out for in order to keep our patients safe from harm. This has included Female Genital Mutilation (FGM) risk recognition and Prevent duty training, as well as training on how to use the Child Protection Online Monitoring System (CPOMS).

So What?
This training is really important to recognise both explicit and implicit signs that someone may be vulnerable to abuse or being drawn towards terrorism. They may not always outright say the struggles they are going through but may give subtle signs through their conversation or actors. For example, a young girl whose parents pull her out of school to visit her family abroad for a long period of time may be at risk. Another example could be a teenager that starts to become isolated from their friends and family, and become secretive about their beliefs and internet use.

Now What?
It is important to keep refreshing these training resources to ensure I am alert to the signs that someone is at risk in the clinic; this could be a patient or another student. The current estimations are that 4.8 in every 1000 women and girls in the UK are living with the consequences with FGM (Dixon et al., 2018), and awareness is a top priority.

References:
Dixon, S., Agha, K., Ali, F., et al., 2018. Female genital mutilation in the UK- where are we, where do we go next? Involving communities in setting the research agenda. Res Involv Engagem, 4(29).

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

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Patient requests a copy of their referral letter - Year 4. C3

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Patient requests a copy of their referral letter - Year 4. C3

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C3. You must respond effectively and appropriately to requests for the production of written material and data.
-1.1: produce reports and referrals, and present information in an appropriate format to support patient care and effective practice management

What?
I had a new patient in the clinic who presented with a temporal headache, associated with nystagmus, tenderness over the scalp and jaw, nausea, and other symptoms that meant I was unable to exclude temporal arteritis. We made the decision not to examine or treat, and refer her back to her GP with our concerns. She became very confrontational and the story of her symptoms began to change to try and convince me to treat her, as far as saying her GP had given us the all-clear to treat, when she had previously said she had not discussed it with them. I went to discuss her reaction with my tutor, who came with me to support and further explain the decision not to treat. She wanted to review the initial documentation signed at reception, as she believed she was entitled to treatment as she had paid a consultation fee; we immediately showed her the form which states that treatment is only given if deemed appropriate. Eventually, the patient agreed to the referral but requested a copy of the referral letter be sent to her as well as the GP.

So What?
I wrote the referral letter on the same day as her appointment and edited it alongside my tutor before handing it in for official printing. As we knew the patient had requested access, it highlighted how objective and impartial the letter needed to be; I was more conscious and considerate with the wording than I have been in previous referral letters. As soon as the letter was sent to the GP, I ensured it was also sent to the patient's personal email address.

Now What?
This experience brought attention to the way we discuss patients in communication with ourselves and other healthcare professionals. Although this was the first time so far that a patient has requested a copy of written materials related to their case, it doesn't mean that a patient in future won't request material retrospectively. Material concerning patients, including written notes and referral letters, should always be respectful and purely factual; we also must ensure it always reaches them in an appropriate and time-aware way.

References:
Ling, M.L., Yosar, J., Lee, B.W., Shah, S.A., Jiang, I.W., Finniss, A., et al., 2019. The diagnosis and management of temporal arteritis. Clinical and Experimental Optometry, 103(5), pp. 572-582.

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

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Understanding cover patient notes. Year 4. C2

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Understanding cover patient notes. Year 4. C2

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What?
Throughout the two years in clinic, there has been opportunities where I have needed to cover a patient to support my colleagues. Sometimes, the notes available have been very hard to read, or didn't make complete sense.

So What?
In order to provide safe care, I have needed to spend extra time reviewing case histories with patients to be sure that I had understood the information correctly. This is important to do in case there is a contraindication to a technique not clear in the notes EG a patient with a history of disordered eating and low BMI may not be suitable for HVTs.

Now What?
These experiences made me reflect on my own case histories and written material; although my writing is legible, I think the examination section would benefit from more detail. Making sure my notes are clear is vital beyond the clinic too, in case the notes need to be provided to the police or another official.

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

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Covid-19 cleaning procedures. Year 3.  C5

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Covid-19 cleaning procedures. Year 3.  C5

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C5. You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.
-1: Your practice premises must be clean, safe, hygienic, comfortable and appropriately equipped
-5: You should take all necessary steps to control the spread of communicable diseases

What?
With the new coronavirus pandemic, going into clinic we will be required to wear PPE, increase the cleaning procedures in the rooms between each patient, and ask screening questions before any patients are allowed inside. This aims to reduce the risk to patients of contracting coronavirus from the ESO clinic and provide a safe environment for healthcare.

So What?
It is our responsibility to provide a hygienic, clean and safe environment, and GOsC has provided infection control guidance to help us achieve this. This is in addition to the Health and Safety Executive which aims to keep employees safe by ensuring PPE is provided, which will keep patients safe in turn.

Now What?
I will ensure to keep doing lateral flow tests at home as required to ensure I don't put patients at risk even if I am asymptomatic. I will also be aware of time management to ensure thorough cleaning can be done between appointments.

References for current updated guidance:
GOsC, 2022. Infection control guidance. Available at: https://www.osteopathy.org.uk/news-and-resources/document-library/about-the-gosc/interim-guidance-on-infection-control/. Accessed on: 3/5/2022

Health and Safety Executive, 2022. PPE guidance at work. Available at: https://www.hse.gov.uk/ppe/ppe-regulations-2022.htm#what-ppe-is. Accessed on: 3/5/2022.

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

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Interim guidance on infection control in osteopathy during COVID-19 pandemic - General Osteopathic Council

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CCA preparation tutorials - public health screening programmes. Year 4.  C6

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CCA preparation tutorials - public health screening programmes. Year 4.  C6

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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.

What?
We have had 6 weeks of case-based tutorials to focus on the type of cases that may arrive in the CCA exam. Part of these tutorials has been making us aware of the public health screening programmes available, such as abdominal aortic aneurysm screening for men over 60 and bowel cancer screening for men and women between 60 and 74.

So What?
It is important that I ask patients of the relevant ages if they have taken part of these screening programmes to help safe decision making and narrowing down the differential diagnoses. Some patients are also unaware of the screening programmes available and informing them may help aid an early diagnosis and intervention.

Now What?
These screening programmes are another example of how I must be aware of my scope beyond musculoskeletal injuries and how I should be able to support patients outside of the clinic room.

Screening programme references:
https://www.gov.uk/guidance/abdominal-aortic-aneurysm-screening-programme-overview
https://www.gov.uk/guidance/bowel-cancer-screening-programme-overview

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

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Information for the public about abdominal aortic aneurysm ( AAA) screening is available on the NHS website and in the below animation.
Male lifetime screening pathway
It is an individual's choice whether or not to have screening. People can opt out if they do not want to receive screening invitations.

Public Health England ( PHE) is committed to reducing inequalities and variation in screening participation to help make sure everyone has fair and equal access to screening services.

PHE provides information about data use and patient confidentiality in population screening programmes.

Target population

AAA screening is offered to men during the screening year (1 April to 31 March) that they turn 65. Men aged 65 and over are most at risk of AAAs, and screening can help spot a swelling in the aorta at an early stage.

Screening is not routinely offered to groups where there is a smaller risk of an AAA. These are:

men under the age of 65

women

anyone who has already been treated for an AAA

Men who are resident in England receive an invitation in the post for screening when they are aged 64 or 65.

Men over 65 who have not received an invitation can contact their local AAA screening service to make an appointment.

Any women, or men under 65 who think they are at higher risk (for example, due to family history of the condition) can talk to their GP about the possibility of having a scan outside the screening programme.

Condition screened for

An abdominal aortic aneurysm ( AAA) is a bulge or swelling in the aorta, the main blood vessel that runs from the heart down through the chest and tummy. The NHS website has more information, including:

AAA screening test

The AAA screening test is a quick and painless ultrasound scan of the abdomen (tummy).

It is like the scan pregnant women have to check on their baby.

For the scan:

1. The man lies down on a table and lifts up or unbuttons his top (he does not need to undress).

2. The scanning technician rubs a clear gel on the tummy and moves a small handheld scanner over the skin - pictures from the scanner are shown on a monitor and the technician measures how wide the aorta is.

3. The technician wipes away the gel and the man pulls down or buttons up their top.

4. The technician tells the man his screening result straight away.

The whole test usually takes about 10 to 15 minutes.

There are 4 AAA screening results. These are:

You can read more on the NHS website about what each result means, and what will happen next.

Evidence base

AAA screening is one of 11 NHS national population screening programmes available in England.

The UK National Screening Committee ( UK NSC) makes recommendations to ministers in the 4 UK countries on all aspects of population screening. It ensures that screening provides more benefit than harm, at a reasonable cost to the NHS.

Recommendations are based on internationally recognised criteria and a rigorous evidence review process.

Read the UK NSC recommendation on AAA screening.

Data and intelligence

PHE collects routine data and key performance indicators (KPI) data reports to monitor the uptake of AAA screening.

Requests for screening data and research

All requests for screening data need to be approved by the NHS Abdominal Aortic Aneurysm Screening Programme Research Advisory Committee.

PHE has terms of reference for NHS population screening programme research advisory committees.

Commissioning

PHE publishes the AAA screening pathway requirements specification, which provides an overview of AAA screening by describing what should happen at each stage of the end-to-end pathway. Providers and commissioners should use this to ensure high quality and consistent screening services.

Providers and commissioners should also use the supporting documents to ensure a fit for purpose programme is set up and meets the required standards.

Quality assurance

The role of the screening quality assurance service (SQAS) is to:

The programme specific operating model for quality assurance of the AAA screening programme should be read in conjunction with the operating model for PHE screening quality assurance service and the relevant programme standards.

Workforce: education and training

Education and training resources are available for healthcare professionals working in AAA screening.

There are also more general resources about population screening to support screening professionals in their initial training and continuing professional development ( CPD).

The Public Health England (PHE) screening blog has information on what is new in the programme, the latest guidance and good practice. Register to receive blog updates direct to your inbox.

Follow PHE Screening on Twitter.

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Abdominal aortic aneurysm screening: programme overview

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Information for the public about abdominal aortic aneurysm ( AAA) screening is available on the NHS website and in the below animation. Male lifetime screening pathway It is an individual's choice whether or not to have screening. People can opt out if they do not want to receive screening invitations.

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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.

What?
I was recommended to watch the documentary 'Athlete A' by a clinic tutor, as it follows the discovery of child sexual abuse of young female gymnasts at the hands of US osteopath Larry Nassar, and the abuse of power that the USA gymnastics institution used to silence the victims. Larry Nassar would regularly perform intimate examinations on minors without their consent, and without consulting their guardians; he went on to have over 500 victims. Although this is possibly one of the most extreme examples of abuse of power by an osteopath, it also highlights the lack of duty of care shown by members of the organisation responsible for the wellbeing of the athletes, as multiple adults were aware of the abuse but didn't act to protect the victims; in some cases they were actively silenced with non-disclosure agreements.

So What?
The prolific nature of this case shows the trust that the victims held in Nassar as a professional and as an osteopath; he knew he could abuse this under the guise of appropriate and necessary medical treatment. He intentionally used the oppressive nature of the USA gymnastics institution to win the trust of the athletes by manipulating them with care and attention they didn't receive from other staff; this caring nature was a far cry from the abuse he subjected his victims to, and was probably a key factor in it taking 20 years for him to lose his medical license.

Now What?
Watching this documentary reminded me of the trust our patients have in us as osteopaths and recognised allied healthcare professionals, and our personal responsibility in maintaining professional boundaries. I will continue to ensure that my patient relationships are purely professional, including more subtle emotional boundaries which are just as important as physical and sexual boundaries.

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

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

What?
I have a part-time job doing sports massage in a clinic with a diverse local population, which is quite different to the ESO clinic and the area I grew up in. The appointment was for a lady in her 60s who only spoke a little English- after she got undressed and called me back into the room, I was very surprised to see a curved knife attached to a strap across her body.

So What?
I was quite surprised as it wasn't something I had come across before - the client had arrived with her son and granddaughter and I made the decision not to ask any questions as I didn't believe my safety was at risk and didn't want to seem rude. After the appointment, I researched religious knives and came across the Offensive Weapons Act 2019 which discussed kirpans worn by Sikhs, and went on further to learn about the items required to be worn by Initiated Sikhs.

Now What?
This experience highlighted to me my lack of awareness of different cultures and religions, and this could have led to discrimination, for example if I had asked the lady to remove the kirpan or refused to treat her if she didn't. I need to do some further research around the common religions in the UK and the rules they follow which may change the process in the treatment room.

References:
Offensive Weapons Act, 2019. Article 47. Available at: https://www.legislation.gov.uk/ukpga/2019/17/section/47/enacted?view=plain. Accessed on: 23/03/2022

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

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Business planning assignment - focus on advertising. Year 3. D1

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Business planning assignment - focus on advertising. Year 3. D1

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D1. You must act with honesty and integrity in your professional practice.
- Your advertising and promotional material, including website content, is legal, decent, honest and truthful as defined by the advertising standards authority (ASA) and conforms to current guidance, such as the UK Code of Non-broadcast Advertising and Direct and Promotional Marketing (the CAP code

What?
We recently had to complete a business planning assignment to prepare us for life after graduation. Part of this assignment was to include how we would attract patients through advertising - I researched the guidance available for osteopaths and found that we are very limited in what we are allowed to say we can treat. It is provided by the Advertising Standards Agency and the Committee of Advertising Practice

So What?
The conditions that are suitable to advertise are all based on research and evidence from medical literature, whereas anecdotally many osteopaths will have experienced successful treatment outside of these conditions. This creates a difficult contrast between what we feel is appropriate patient management and what is legally required. However, being open and honest with patients about any lack of evidence for their presenting complaint allows them to make an informed decision about whether to proceed with treatment.

Now What?
Going forward, I will make sure to follow these guidelines in any marketing, like social media and websites. Being open and honest ensures that the public will hold the profession in high regard.

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

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1st Referral- Secondary Cancer Concerns. Year 3. B2

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1st Referral- Secondary Cancer Concerns. Year 3. B2

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B2. You must recognise and work within the limits of your training and competence.
-1.0: You should use your professional judgement to assess whether you have the training, skills and competence to treat a patient, seeking advice where necessary.
-2.1: seeking advice or assistance from an appropriate source to support your care for the patient
-2.2: working with other osteopaths and healthcare professionals to secure the most appropriate care for your patient
-2.3: referring the patient to another osteopath or appropriately qualified healthcare professional

What?
Today was the first time I had to refer a patient who wasn't safe to treat and then discuss this decision with them. She was aged 73 and came to the clinic presenting with a 6-month history of back pain from the lower Tsp down to the LS junction bilaterally- no axial movements could exaggerate the pain, although some palpation did. She had not discussed her back pain with any other healthcare providers. On questioning in the case history, she revealed that she was diagnosed with breast cancer earlier this year and had a lumpectomy a month ago, but refused lymph node removal and radiotherapy- the back pain started at the same time as the cancer diagnosis. She also refused imaging after surgery to confirm the complete removal of the cancer. These factors alongside her other symptoms such as constant pain, unremitting night pain, and weight loss, meant we could not rule out secondary metastases to the spine.

So What?
We made the decision to refer her back to both her oncology consultant and her GP to request further imaging. As a former nurse, the patient agreed that she had come across this thought herself but had dismissed it. Current research suggests that when a patient with a history of malignancy in the breast who presents with a new-onset of back pain, we should be highly suspicious of a secondary metastasis (Ju et al., 2014). This was further complicated by the patient's decisions made after surgery.

Now What?
It was a difficult conversation to approach but I explained my reasoning for not treating and requesting permission for referral, and she agreed to go ahead with that route. This experience highlighted to me the importance of knowing the red flags and pathophysiology of cancer as this patient was the first patient that I had seen that was not safe to treat. Going forward, I will research common metastasis locations of the common cancers I might come across in future, like lung and bowel cancer.

References:
Ju, D. G., Yurter, A., Gokaslan, Z. L., & Sciubba, D. M., 2014. Diagnosis and surgical management of breast cancer metastatic to the spine. World journal of clinical oncology, 5(3), pp. 263–271.

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

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B3. You must keep your professional knowledge and skills up to date.
-1.1: be professionally engaged, undertaking professional development activities and complying with GOsC requirements regarding continuing professional development
-1.2.3: research and other relevant developments in healthcare

What?
I chose to participate in the specialist headache clinic at the ESO, and to accompany this work through a 3.5 hour workshop introduction to headaches. I was shocked at the huge range and number of headaches and the number of people affected by them. Previous to starting the headache clinic, I had only seen one patient with a new onset headache; it was associated with nystagmus, scalp tenderness, nausea and ultimately we decided that we were unable to exclude temporal arteritis from the differential process. The other differentials were BPPV, Meniere's disease and vestibular neuritis. Although I believe the outcome would have been the same after the headache course (referral to GP and no treatment), I feel my clinical reasoning lacked knowledge and justification at the time.

So What?
Working through the online course showed me exactly how much more I need to learn to be a competent practitioner dealing with headaches, especially with how prevalent they are in primary care in the UK. Recognising a pathological secondary headache is crucial to being a safe practitioner, which is complicated by the overlap in symptoms with non-pathological primary headaches.

Now What?
I recognise that the course I have undertaken is only a starting point for working with headaches, and that keeping up to date with knowledge and skills is a requirement of the OPS. I could achieve this by undertaking further courses and research, which would help me fulfil my CPD requirements, such as keeping up to date with NICE and the BASH guidelines and further courses supported by the OPHM and EdACHe group. A good starting point before this would be to go through this 3.5 hour course again, to refresh anything forgotten. I could also request to do some work shadowing, for example at the National Migraine Centre.

References:
NICE, 2021. CG150: Headaches in over 12s: diagnosis and management. Available at: https://www.nice.org.uk/guidance/cg150. Accessed on: 10/04/2022.
British Association for the Study of Headache (BASH), 2019. Guidelines for the diagnosis and management of common headache disorders. Available at: https://www.bash.org.uk/guidelines/#. Accessed on: 10/4/2022.
Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

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Overview | Headaches in over 12s: diagnosis and management | Guidance | NICE

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This guideline covers advice on the diagnosis and management of tension-type headache, migraine (including migraine with aura and menstrual-related migraine)

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'European School of Massage' - Year 3. B4

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'European School of Massage' - Year 3. B4

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

- 1.0 To achieve this you will need to have sufficient knowledge and ability to collect and analyse information and evidence about your practice to support both patient care and your own professional development.

What?

While treating a returning patient for upper thoracic and cervical spine pain, diagnosed as trapezius and thoracic erector spine myalgia, I received feedback that my treatment routine was lacking in osteopathic approach. Specifically, my tutor said that we don't study at the 'European School of Massage'! My treatment was composed of STW to the traps, rhombus, TES, long level TSp articulation, ST joint articulation, MET bilaterally to traps, and some GOT style CSp articulation.

So What?

Although I had included some osteopathic techniques, I did agree with the tutor that my treatment was not wholly osteopathic, since the emphasis was placed on the massage and soft tissue aspects. When I saw the patient again this week, I included the above techniques into a full supine GOT routine to better integrate the whole body back with the areas of concern.

Now What?

On reflection, I think I feel more confident using soft tissue and massage techniques due to my qualification in Sports Massage. I need to practice osteopathic techniques like further METs and HVT that could also be used to address the area, like an MET of SCM or a CD lift, in order to feel more confident in implementing them in the treatment room. I am going to continue to ask for feedback from my tutors for areas I could improve of each appointment and make sure to take forwards any summative feedback EG from CEX assessments.

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

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Overall, I was not unhappy with my exam results but am using it as a learning experience in order to improve my results next time. I was very nervous for the exam as I have never done any kind of practical exam before- all exams at school tested theory knowledge. Most of my results were in the 'good' and 'very good' ranges but none were in the 'excellent' category so this is where I'm aiming for my next practical results to be.

Throughout my personal feedback forms, these are the comments that were common to many of them that I could improve on:
-  Interact more with the patient throughout the station EG checking comfort and pain
- posture and positioning- check the height of the couch and maximise the space available in the exam space. Also make sure to always look at the patient throughout techniques to check their response
- adjust terminology better when talking to patient and switching to practioner

Some good points included:
- Good anatomical knowledge on palpation
- good explanations of procedure to patient
- consent gained at each station

Next time, I feel I should be more confident in my skills as I do revise and often spend spare time practising techniques on friends and family.

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1st Referral- Secondary Cancer Concerns. Year 3. C1

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1st Referral- Secondary Cancer Concerns. Year 3. C1

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Today I had to have a very difficult conversation with my new patient. She came to the clinic presenting with back pain from the lower Tsp down to the LS junction bilaterally- no axial movements could replicate the pain, although some palpation did. On questioning in the case history, she revealed that she was diagnosed with breast cancer earlier this year and had a lumpectomy a month ago, but refused lymph node removal and radiotherapy- the back pain started at the same time as the cancer diagnosed. She also refused imaging after surgery to confirm complete removal of the cancer. This made it very difficult for us as due to her other symptoms such as constant pain and unremitting night pain,  we could not rule a secondary metastases to the spine.

We made the decision to refer her back to both her oncology consultant and her GP to request further imaging. As a former nurse, the patient agreed that she had come across this thought herself but had dismissed it. It was a difficult conversation to approach but I explained my reasoning for not treating and requesting permission for referral, and agreed to go ahead with that route.

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Importance of Clinical integration - Year 1. C1.

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Importance of Clinical integration - Year 1. C1.

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

What?
After recently having done a mock Clinical Integration exam, I have come to realise that this is the class that really sets us up for treating patients in clinic and into the future as an osteopath. The 5 stations in the exam will be:
1) listening to and taking notes on a case history
2) writing a summary of the case history and diagnosis
3) active, passive and special tests
4) treatment
5) writing a management plan
All of the elements of this exam will be applied to the individual case given, just as they would be applied to each different person in clinic.

So What?
Having observed in clinic for 27 hours so far this year, it is clear to see that this structure is almost identical to that which I have seen students follow in the clinic. Often 3rd and 4th year students have been encouraging, saying that the clinical integration course should set us up for clinic better than they felt they were without the course.

Now What?
Clinical integration is also important as it gives us a chance to consolidate knowledge and apply it in real-life situations provided to us. It reminds us that everything we learn in both practical and theory lectures needs to be mixed together in order to achieve the best possible and most appropriate patient outcomes.

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

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Impact of my own health on patient care - Year 4. D11

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Impact of my own health on patient care - Year 4. D11

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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.

What?
I have tried to avoid missing lectures and taking time away from clinic as much as possible, but occasionally the best decision has been to stay at home and avoid passing any illness on. However, the impact that being ill and not in the right mindset for decision making can make can't be underestimated; I recognise that I must always a safe practitioner and this should reside in priority above any guilt I may feel for cancelling or rearranging appointments.

So What?
I decided to research whether much literature had been published around the impact of healthcare professionals' own mental and physical health on their patient care. I discovered that although the true prevalence hasn't been concluded, the rate of compassion fatigue and burnout could be high among healthcare professionals (Van Mol et al., 2015). The GMC has also released some research that states that among doctors in the UK, high workplace stress negatively impacts patient care and the doctor's own health. It also states that 'doctors with high levels of burnout had between 45% and 63% higher odds of making a major medical error in the following three months, compared with those who had low levels' (GMC, 2019).

Now What?
Seeing the direct impact that my own mental and physical health could have on patient care, including major errors, was quite alarming. As a graduate, with less of a support system in place than at uni, I need to be mindful of recognising signs that I may be heading towards burnout - this could include negative thoughts or feelings above work and feeling fatigued by work emotionally or physically.
I will also take preventative measures, such as sustainable weekly work hours and building relationships with with colleagues.

References:
General Medical Council, 2019. Caring for doctors, Caring for patients. Available at: https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf. Accessed on: 8/5/2022

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

van Mol, M. M., Kompanje, E. J., Benoit, D. D., Bakker, J., & Nijkamp, M. D., 2015. The Prevalence of Compassion Fatigue and Burnout among Healthcare Professionals in Intensive Care Units: A Systematic Review. PloS one, 10(8), e0136955.

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One particularly difficult case occurred when the patients interest and the tutors advice did not match up. This patient had been training for quite a while to run a half marathon, and came in for treatment the month before her race. The tutor told her ( quite bluntly in my opinion) that in order to get better she needed to give up training for the race, thereby telling her to give up on a goal she had been working towards for a long time. She was visibly upset by this, and when the practitioner took her over to reception, she cried. The human side and the medical side came into conflict, as the practioner wanted to comfort the patient in a human manner, but had to be very careful not to go against the advice of the tutor. I understand that it is our role to work for the best interest in the health of the patient but I do think the delivery of the advice should have been more of a discussion than it was.

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Observing the consent process- Year 1/4. A4.

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Observing the consent process- Year 1/4. A4.

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

What?
Reviewing my posts from previous years to complete the portfolio assignment, I reviewed the reflection sheet I filled out in first year. I noticed that the patient had effectively told the student that she consented to everything in advance to stop asking procedural consent, but the student was firm in saying that he needed to ask for her continued consent through the appointment.

So What?
The OPS makes it very clear that the consent is not valid unless it is informed; this means that the patient must be aware of the risks, benefits, aims, alternatives and the option of no treatment. The student was right to not implement this patient's particular request, as her consent would not be valid; if she decided to make a complaint, this could be a fitness to practice issue.

Now What?
Now that I am in clinic myself, I try to remember what it felt like to be at my first appointment and what my expectations were. I always make sure to inform the patients as much as possible, so that their consent is given voluntarily and is informed; I then record in their notes that consent was given, along with any concerns or questions they have.

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

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Informing patients of what to expect- including the possibility of undressing. Year 4. A6

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Informing patients of what to expect- including the possibility of undressing. Year 4. A6

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

What?
Most patients I have met so far in the clinic have been understanding about the possibility of undressing for examination and treatment; I think this has been largely down to the above form being signed on arrival, and the explanation given about why undressing would be useful. I normally explain it as being a useful tool for us to have a clearer understanding of the function of the area, but I do also always offer the option of a gown or not undressing at all.

So What?
Undressing can be a sensitive subject for a range of personal, cultural, or religious reasons. Some patients may feel more at ease with an appropriate chaperone present. Ultimately, we must respect patients' decisions and make reasonable adjustments to provide them with appropriate care.

Now What?
As a graduate, I will formulate a similar booking and consent form to inform patients on what to expect at each appointment, including a section about the possibility of undressing. Allowing a patient to read this prior to the start of the appointment will allow them to make an informed decision while not under pressure.

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

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

What?
I had seen a patient in the clinic about 6 times when I was unable to attend one day as I was ill, and the appointment was covered by another student with a different tutor. The next time the patient visited, they weren't happy with the previous appointment and came with a written list of feedback and things they felt weren't dealt with safely and appropriately.

So What?
The patient decided they didn't want to go through the official complaints procedure, but requested not to see that student or tutor again. My tutor came to support me and we tried to explain the reasons why there may have been differences in examination and treatment; for example there being multiple ways to test the L5 myotome.

Now What?
Although I was unable to this time, in future I will make sure to provide a summary of a patient to anyone covering where possible in future. If this patient had decided to make a formal complaint, I am aware of the complaints procedure at the clinic; after graduation, I know that I should make patients aware of their ability to report to GOsC.

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

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

What?
Over Easter break, I went on a Sports massage course to help me work alongside doing the osteopathy course. In order to pass the course, I needed to undertake 5x3 case studies, a practical exam and a theory exam (which I have since found out I have passed!).

The case studies and exam made for a great opportunity to practise my communication skills with people outside of the osteopathic world- when at uni, it can become very easy to forget that not everybody understands what or why we choose methods that we choose, or in fact the routine of undressing/active/passive testing/treatment.

Over the course of my 15 case study treatments I had devised a language routine so that the patient felt comfortable with the process and routine of the appointments. I also thought of ways around describing questions I was asking EG 'musculoskeletal injuries' I started to ask about and give examples like 'any broken bones? any trips or falls?'

So What?
It is easy to say that we must use Layman's terms while in uni to tick a box, but I hadn't realised how separate my own language has become from layman's terms until this point- it was very much a conscious decision to change my language to make sure my patient understood and that informed consent had been gained.

Now What?
Moving forward, I will make a conscious effort to use language that patients will understand, which is key to gaining informed and valid consent. This will expand further into making appropriate adjustments, such as for deaf patients or patients who speak another language.

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

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

What?
I recently had my final CEX exam in clinic, and I asked the tutor to perform it like the final CCA exam. I received some useful advice and feedback; I communicated well with the patient and gathered most of the necessary information, but had some points to work on in terms of presenting my knowledge.

So What?
As well as being vital for information gathering, taking the case history sets the foundation for the therapeutic relationship. It may also be the patient's first introduction to the profession, and would usually be the practitioner's first introduction to the patient and their experiences. I am aware of also needing to look out for verbal and non verbal cues to reflect how the patient is feeling.

Now What?
Moving forward, I will adapt my case history taking to gather all the information needed as well as start to build the trust and relationship. I will continue to adapt my communication style to the individual needs of the patient, and listen and respond to their needs and preferences.

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

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Multi-modal care approach in ankyloglossia - Year 4. D10.

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Multi-modal care approach in ankyloglossia - Year 4. D10.

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D10. You must consider the contributions of other health and care professionals, to optimise patient care.
- 1.2: understand the contribution of osteopathy within the context of healthcare as a whole
-1.4: work collaboratively with other healthcare providers to optimise patient care, where such approaches are appropriate and available.

What?
I recently had a 5 week old baby boy in Children's clinic who presented after being referred to us from a health visitor and breastfeeding clinic team. Prior to his appointment, he had had a lingual frenotomy for a posterior tongue tie, but this had not resolved the breastfeeding issues they sought help for.

So What?
We were open and honest with the mother, and discussed that we would try to help with osteopathic treatment, but sometimes tongue tie divisions may need to be revisited by the practitioner who performed the division for reassessment. We performed a full examination and did find some areas of tension to treat, and also gave some exercises to practice at home alongside those given by the division practitioner.

Now What?
I decided to write up this case and submit it for an assignment, as it covered an aspect of referral and working alongside other healthcare providers. On reflection, I feel that I collaborated well with my tutor to create a plan that included the possibility of referral to practitioners of other disciplines from the outset, as well as incorporating the exercises given elsewhere into my management plan.

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

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Supporting colleagues in developing patient care - Year 4. D9.

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Supporting colleagues in developing patient care - Year 4. D9.

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

What?
With CCA exams coming up, one clinic tutor suggested we give some mock-CCA style feedback using the CCA criteria when observing our team mates. I worked in a pair and we provided feedback to each other based on watching a continuing patient.

So What?
This was a really helpful exercise to perform as it highlighted some aspects that the student may have focused on different to the tutor. There was a general theme in the feedback given to me that I needed to be more precise in all aspects of the appointment; making sure to ask key when/where/what/how much questions to quantify symptoms and therefore narrow down to a clear diagnosis. I also received some feedback on my examination, suggesting that I think more globally.

Now What?
As the diagnosis impacts the treatment and management plan, giving and receiving feedback on this process will enhance patient care by impacting the action plan suggested; this may be the home exercises chosen, or the provider chosen for referral. Feedback given on physical skills like examination and treatment will enhance patient care by ensuring techniques are performed as effectively as possible to optimise patient outcomes.

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

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I was hoping to apply to medical school, had sat my UKCAT exam and was undertaking a range of work experience in order to build experience for my personal statement and to get a feel for working within the NHS. I had done experience in; pharmacy, SALT, radiography and was shadowing a lactation consultant in a mother&baby clinic when I had the opportunity to shadow a cranial osteopath on my lunch break. I was absolutely blown away by how different private practice was to the NHS practitioners I'd been following; treatment felt so much more personal and there was a lot more time allocated to really listen to the patients' concerns.

At first, I didn't want to admit how much I had fallen in love with osteopathy because I was so set on becoming a doctor and was aware of newspaper articles damning alternative medicine in the mainstream news. What I didn't know was that osteopathy is a recognised healthcare profession in the UK, with strict training and legislation. Following on from this experience, I arranged more work experience with 2 different structural osteopaths and was once again in awe. Osteopathy encompassed all the elements I wanted from a medicine degree; problem-solving, helping patients and an in depth knowledge of the structure and function of the human body, alongside many more. I decided to book myself in for an appointment to treat some ongoing back pain and came out feeling like a new person!

By the time I had applied to the ESO, I still was not aware of scientific literature and studies surrounding the efficacy of osteopathy, but what I had seen with the 2 different practitioners, experienced myself, and what friends and family had relayed to me finally convinced me to change my career path.

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In my latest observation in clinic, I realised the importance of osteopaths as primary healthcare practitioners.

A  patient came into clinic for a knee issue, but after undressing it became apparent that there was a major problem in both legs from the calf down. They were hugely swollen, red, hot, the skin was massively stretched and the toenails were starting to die- the student made the tutor aware, who was so concerned about the risk of infection if the skin were to split that she told the student not to touch the lower legs at all.. It transpired that the patient had been taking antibiotics for his legs for over a year, but he was not sure if he had originally had a diagnosis and hadn't had any check ups since his first appointment.

The patient became quite defensive when the tutor told him that he really needed to see his GP- 2 weeks previously he had tried to book a GP appointment but the receptionist had told him that it was not necessary and that a visit to the pharmacist would suffice as the GP appointments were booked up for weeks. When the tutor really pushed and urged him to try again, he finally agreed to try and book in again.

This led to me to investigate how many GP appointments are musculoskeletal related- according to NHS England this is 30%. Introducing enhanced physiotherapists in a few test settings greatly reduced workloads for GPs and could directly impact people such as this patient by freeing up appointments booked for musculoskeletal issues. It would require great communication and integration between the 2 professions, which, if not achieved, could cause lessen quality of care for the patient than keeping them seperately.
https://www.england.nhs.uk/elective-care-transformation/best-practice-solutions/musculoskeletal/

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A First Experience of Patient Communication, 18/10/18 - Year 1

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A First Experience of Patient Communication, 18/10/18 - Year 1

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Explaining Tests/ Treatment in a Patient-Friendly Way: this was a lot more difficult than it first seemed. We were so focused on getting the technique and process to make sense to ourselves that explaining it in simple terms to someone else was being over-thought. In our GOT class, we were palpating to find the PSIS'- after speaking to some of the observers, to make the patient most comfortable, it is best to explain the process and reasoning for the chosen test/treatment whilst demonstrating where you will be working on yourself, in an informative but concise fashion so that the patient does not feel too uncomfortable standing in their underwear, but also makes sure the practitioner knows and it confident that the patient understands where you will be touching them (so the patient has all information needed to be able to give consent). EG 'If it's ok with you, I would like to place my hands on your hips and use my thumbs to feel down your spine and locate some bony landmarks in your lower back to give me some more information about the pain/discomfort you've been experiencing- is that ok with you?' Also, warn patients of cold hands and place them on shoulders/upper back as this is not such a shock to the system as other places EG waist.

Phrasing and Consent: phrasing your method and the process of the treatment to the patient in the manner of 'First, I will do this, then I will do this' and then proceeding, does not mean consent has been gained from the patient. You must ask direct questions to the patient to have confidently gained consent, EG 'Do you feel happy to go ahead?', 'Do I have permission to place my hands on your shoulders?', 'If at any point you feel in pain or would like me to stop, let me know straight away.' You must continue to inform the patient when would like to start working on another part of the body (to gain consent) and continue to ask them if they feel ok, are comfortable etc.

Testing and Assessment: adapting your assessment for different age/gender. For seated passive-ROM of the lumbar spine for side-bending and rotation, it may be be easier to make the assessment straddling the bench, but for elderly patients this would often be difficult so the test would be better suited done sitting on the bench. For visual assessment, being mindful of 'If you need a ruler to measure it, rule it out!'- this is particularly important in visually assessing sensitive areas EG hip level, breast level.

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Financial Predictions and Planning. Year 4. D8.

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Financial Predictions and Planning. Year 4. D8.

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

What?
Looking forward to life after graduation, I decided to review my business plan assignment from third year to estimate the financial costs as a new graduate. Although my plan was based around starting a new business, I made some important points, such as pricing myself fairly to my competitors, to avoid undercutting in an unprofessional way. I also reviewed tax and cost expectations, to ensure I am operating legally as a sole trader.

So What?
I scored 75% in this assignment and I believe this was partially due to the thorough research and calculations I made in the financial plan. This included the sale of additional products like resistance bands and foam rollers, which I provided at a low profit margin for sales, as I would provide them as support for patients more than for financial gains.

Now What?
As I move closer to graduating, I will be sure to continue to be thorough in my financial calculations to make sure they are accurate and honest; this will be both personal and professional, such as in tax returns and invoices to patients.

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

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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.

Although this standard is not one I have evidence for, I have reviewed the Threshold Criteria for Unacceptable Professional Conduct and have also reviewed some of the recent Fitness to Practice hearings to further inform myself of the common issues resulting in a hearing.

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Reflection on confidentiality - Year 3. D5

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Reflection on confidentiality - Year 3. D5

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

What?
As student observers, we need to sign a confidentiality form as shown above to confirm we understand the need to keep patients' health data protected, and if taking notes from cases to keep them anonymous. We also must respect patients' decisions when requesting to disclose their data for example if referring back to their GP.

I have seen only one occasion where a patient declined to share their health data with their GP due to the implication it could have on their career. It was an 18-year-old male with low back pain and radiations following a high impact rugby tackle that had an axial impact; the tutor was concerned that due to the presentation of his symptoms and the nature of the injury, his back pain may have been caused by a traumatic spondylolisthesis. It was suggested that we refer him to his GP for imaging, but the patient declined as his life goal was to enlist in the army which he would finally be able to do as school finished a few months later, and this could stop his ability to enrol. The possible risks of improper management of spondylolisthesis were explained, and the patient agreed that possibly a private scan would be the answer as the results would stay off of his NHS record.

So What?
This experience showed me that although we want what is best for our patient's health, sometimes their health status can have a much wider impact than we first expect. We must respect our patients' wishes on their healthcare management, and provide them with as much information as possible to make an informed decision. Where information is disclosed without their consent, such as to protect the public, the information should be only what is necessary and should be recorded in their notes.

Now What?
Moving forward, I will place more emphasis on asking for the patient's goals, expectations, and concerns as this will create a clearer impact that health has on this patient as a whole. I feel this is a key element of the biopsychosocial model (Engel, 1981) and the holistic care we aim to provide, as it will help me to consider the consequences of my patient management.

References:

Engel, G., 1981. The Clinical Application of the Biopsychosocial Model, The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 6(2), pp.101–124.

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

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Observation hours outside of the ESO - Year 2. D7

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Observation hours outside of the ESO - Year 2. D7

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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.

What?
I recently took part in some observation hours at a clinic in my home town, to gain a wider variety of experience of osteopathic practice. It was a really useful session, and I got to see a variety of techniques including IDD disc therapy. When organising the session, I made sure to ask about any expectations, including dress code, that the clinic would have of me while I was there.

So What?
I felt proud to be a representative of the ESO in another clinic, and made sure to uphold the same standards as I would in the ESO clinic, such as being polite and issues of confidentiality.

Now What?
Looking forward, I understand my role as a representative of the profession; I will continue to act in a professional manner in both my personal and professional life. This includes my social media presence and personal relationships, as they are a reflection of my conduct and therefore my ability to perform to the high expectations of a healthcare professional, such as the Duty of Candour.

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

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Impact of missing patient files- Year 4. D3

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Impact of missing patient files- Year 4. D3

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

What?
Although it is not something I have personally experienced, there have been times when patient files can't be located for the appointment that day. This raises safety concerns, as a student may not remember all the details of the case history needed, for example, conditions or medications that could contraindicate a technique. It also raises concerns about where the notes have gone, and who could possibly have unauthorised access to them and potentially break confidentiality requirements.

So What?
Looking at this as a wider issue, the NHS found that 15% of patients in outpatient care had key clinical information missing from their files, and 20% of these patients were at risk of harm as a consequence (Burnett et al., 2011). This shows the direct impact that detailed and safe record keeping can have on the health of patients, and is something that I must be actively aware of as a graduate.

Now What?
As a graduate, I think I will use a password-protected database like Cliniko to store patient information, as I think this is a safer way to reduce the risk of lost data in comparison to paper notes. I will ensure all notes are detailed with all necessary information to decrease the risk of harm coming to the patient through negligence. If something was to go wrong in my management of a patient, I will be sure to follow the necessary steps to resolve the issue where possible.

References:
Burnett, S.J., Deelchand, V., Franklin, B.D., Moorthy, K., & Vincent, C., 2011. Missing Clinical Information in NHS hospital outpatient clinics: prevalence, causes and effects on patient care. BMC Health Serv Res 11(114).

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