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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. (GOsC 2018, p.27)

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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. (GOsC 2018, p.27)

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Reflection Using Jasper's Reflective Model

Experience

One day I was treating a patient and my R wrist became very painful during the treatment. Luckily I did not have any more patients that day and it was a Friday afternoon, with the whole weekend ahead to recover.

I received some treatment from my colleague and the wrist was perfect the next day.

Reflection

This seemingly minor incident served as a profound reminder of the physical demands and risks associated with a career in osteopathy. It highlighted the necessity of self-care, not only to prevent personal injury but also to ensure the safety and well-being of my patients. In reflecting on this experience, I realized that I must prioritize my health as much as I do my patients’.

The study by Smith, Goldacre, and Lambert (2016) explores the challenges that healthcare professionals, including doctors, face when dealing with chronic illness or injury. Many doctors feel compelled to continue working despite health issues, often due to the pressures of their roles and the fear of appearing weak or uncommitted. This can lead to more severe health problems and compromises in patient care. The study emphasizes the importance of proper support systems, both personal and organizational, to ensure that healthcare professionals can manage their health effectively without jeopardizing their careers or the care they provide.

In my case, the wrist pain was a wake-up call. It underscored the importance of taking proactive measures to protect my physical health, which is directly linked to my ability to perform my duties effectively. Without proper care and attention to my own health, I risk not only my well-being but also the quality of care I provide to my patients.

Action

Being familiar with the common or contagious skin conditions will enable me to spot them before getting in contact with the patient’s skin, wearing gloves is essential in these situations.

Hand hygiene after each patient will ensure that germs and bacteria will not be spread.

My posture and the correct treatment couch height will help me keep my body injury free, so making sure I can adapt the techniques to every patient body type is imperative.

It will be important to take up an income protection, to cover the financial loss in case of illness/ inability to work temporarily.

Smith, F., Goldacre, M.J. and Lambert, T.W., 2016. Working as a doctor when chronically ill or disabled: comments made by doctors responding to UK surveys. JRSM open, 7(7), p.2054270416649282.

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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. (GOsC 2018, p.27)

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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. (GOsC 2018, p.27)

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Reflection Using Jasper's Reflective Model

Experience

As I approach the completion of my osteopathic education, I am preparing to apply for registration with the General Osteopathic Council (GOsC) and obtain the necessary insurance to practice. While this may seem like a routine step, I realize that this process marks the beginning of my professional journey and establishes the foundational relationship with the regulatory body that will guide and support me throughout my career.

Reflection

Understanding the importance of communication and engagement with the GOsC is crucial as I transition into professional practice. The GOsC is not just a regulatory body that ensures compliance with standards; it is also a resource that offers guidance and support to osteopaths throughout their careers. As highlighted in the editorial by Sciomachen et al. (2018), professional competence in osteopathy involves more than just technical skills; it encompasses the habitual and good use of communication, clinical reasoning, and reflection in daily practice. This holistic approach to professional competence underscores the value of maintaining an open line of communication with the GOsC, especially when facing uncertainties or complex situations in practice.

In the early stages of my career, I may encounter situations where I am unsure of the best course of action. Whether it's a complex clinical case, an ethical dilemma, or questions about compliance with regulatory standards, the ability to seek advice from the GOsC will be an invaluable tool. As the editorial suggests, professional competence also involves the ability to manage ambiguous problems and make decisions with limited information. By proactively engaging with the GOsC and seeking their guidance, I can enhance my decision-making process, ensuring that my actions are aligned with best practices and regulatory expectations.

Moreover, the development of core competencies, as discussed in the editorial, emphasizes the importance of continuous professional development and the need for osteopaths to adapt to the evolving demands of healthcare. The GOsC plays a vital role in facilitating this development by providing resources, setting standards, and offering support for ongoing education and professional growth. Engaging with the GOsC regularly will help me stay informed about changes in the profession, new regulations, and emerging best practices, enabling me to maintain high standards of care for my patients.

Action

To effectively navigate my career as an osteopath, I plan to take the following actions:

Proactively communicate with the GOsC for advice and support throughout my career.

Engage in continuous professional development through workshops, conferences, and educational events.

Regularly reflect on my clinical decisions and seek feedback to improve my practice.

Build a support network of colleagues, mentors, and advisors, including connections within the GOsC.

Sciomachen, P., Arienti, C., Bergna, A., Castagna, C., Consorti, G., Lotti, A., Lunghi, C., Tramontano, M. and Longobardi, M., 2018. Core competencies in osteopathy: Italian register of osteopaths proposal. International Journal of Osteopathic Medicine, 27, pp.1-5.

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This process applies if you have a UK qualification in osteopathy from a GOsC-recognised course.

Beginning the registration process

Your osteopathic educational provider provides the names of all final-year students to the GOsC and we send you a registration application pack in the January before you graduate.

If you have not received the application pack, or need replacement forms, you can download copies of the booklet and forms from the students section of the o zone, our dedicated site for osteopaths.

Visits

GOsC staff will visit your education provider between January and March in order to meet you and tell you about the registration process and the work of the GOsC. These presentations are a valuable opportunity for you to ask questions about the registration process.

Completing your application for registration

You should answer all the questions and ensure that the forms are signed and dated.

You can send back your application forms before or after you are qualified. We encourage you to complete the forms as early as possible so that your registration application is not delayed unnecessarily if we have any queries.

To complete your registration application you will need to provide:

Please note that as part of your application you will need to tell the GOsC who your intended professional indemnity insurance provider is. You cannot start practising until your insurance policy has been activated and this will be after you have registered.

Confirmation of your Recognised Qualification comes directly from your education provider.
Once we have received all your paperwork it normally takes up to 10 working days for us to process your application.
After you have been registered

When your name has been put on the Register you will receive a confirmation letter and a registration certificate. You should not practise before receiving this confirmation.

You should also ensure that you activate your professional indemnity insurance policy before you begin practising and provide proof of your professional indemnity insurance to the GOsC.

Contact details

If you have any questions, please contact us at registration@osteopathy.org.uk

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This is the process that applies if you have a UK qualification in osteopathy from a GOsC-recognised course.

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D10. You must consider the contributions of other health and care professionals, to optimise patient care. (GOsC 2018, p.26)

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D10. You must consider the contributions of other health and care professionals, to optimise patient care. (GOsC 2018, p.26)

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Reflection Using Jasper's Reflective Model

Experience

During my second mock CCAS I had a patient with suspected neuroma. Mrs X, a 48 year old woman presenting with pain between 3rd and 4th metatarsal after 2 hours of walking on and off.

I diagnosed her with suspected Morton’s neuroma based on the history and examination.

After giving the patient all options, she decided to try a course of 3 treatments and then ultrasound imaging if there was no improvement. There was some form of improvement, however unclear, because of the modification in her routine, as he was on holiday. Patient decided to have the ultrasound with Mr Lance at the ESO clinic.

The report confirmed the suspected Morton’s neuroma.

Reflection

I believe that musculoskeletal (MSK) ultrasound is a valuable diagnostic tool that is both affordable and reliable, potentially saving patients money by providing clear options for management. This can include referrals to other departments, practitioners, or even surgical interventions, without the prolonged waiting times often associated with the NHS. This experience emphasizes the importance of integrating efficient diagnostic tools like ultrasound into osteopathic practice, as it aligns with the need for a more evidence-based and patient-centered approach, as discussed by Thomson and MacMillan (2023). Their commentary highlights the need for osteopathy to continually reflect on and improve its practices, particularly in areas like diagnosis, where the profession must balance traditional approaches with modern evidence-based methods.

Action

I emailed Mrs X information about the condition, options of treatment and life changes, that she was very grateful for and she was very happy that she has purchased the right shoes and her walks were more comfortable.

I have referred patients further and the reports were equally interesting and revealing, but also reassuring.

Thomson, O.P. and MacMillan, A., 2023. What's wrong with osteopathy?. International Journal of Osteopathic Medicine, 48, p.100659.

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Point-of-care ultrasound in musculoskeletal field - PubMed

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The musculoskeletal field is relatively new in point-of-care ultrasound (POCUS), a modality that has been gaining significance with the evolution of ultrasound (US) equipment and high-frequency probes. Images have become progressively clearer over the past decade, making it possible to diagnose many ...

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D9. You must support colleagues and cooperate with them to enhance patient care. (GOsC 2018, p.26)

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D9. You must support colleagues and cooperate with them to enhance patient care. (GOsC 2018, p.26)

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Reflection Using Jasper's Reflective Model

Experience

My first patient I had at the ESO clinic was a 62 year old male that had a cycling incident and LBP following that.

My physical examination did not indicate the possibility of fracture, even if there was a compression trauma involved. Also the clinical history did not indicate any signs of osteopenia or osteoporosis.

As I was off the next week, the patient saw one of my colleagues that diagnosed him with T12 fracture and osteopenia.

She has informed the patient that he was osteopenic and had suffered a T12 fracture. I did my examination again and treated successfully the patient again, and he felt better and better. He stopped coming after 4 sessions and also did some lifestyle changes I suggested and had an even better outcome.

Reflection

After discussing the case with my tutor, I questioned whether an osteopath could definitively diagnose a fracture or osteopenia without diagnostic imaging or should instead use the term “suspected.” My tutor indicated that this practice is common among osteopaths. However, this situation left me in a delicate position, potentially undermining my perceived knowledge and competency. Despite this, I maintained my professionalism, continued my treatment plan, and avoided putting my colleague in a compromising position.

This scenario highlights the importance of clear communication and the boundaries of osteopathic practice. According to Soliman (2024), educating colleagues and the broader healthcare community about osteopathic practice is crucial to ensuring that the profession is respected and understood. This includes understanding the limitations of osteopathic diagnosis and the importance of using appropriate language when communicating with patients to maintain professional integrity and avoid legal or ethical complications.

Action

It’s important to put the patient first by maintaining a great colleague cooperation, never speak badly about any practitioner or doctor. Always maintaining a composed, respectful attitude is imperative even when the patients require a second opinion, moreover if there is a possible insurance claim involved.

Soliman, S.B., 2024. Educating our colleagues and hospital administrators regarding osteopathic medicine. Journal of Osteopathic Medicine, (0).

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D8. You must be honest and trustworthy in your professional and personal financial dealings. (GOsC 2018, p.25)

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D8. You must be honest and trustworthy in your professional and personal financial dealings. (GOsC 2018, p.25)

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Reflection Using Jasper's Reflective Model

Experience

Being transparent with the estimated duration of treatment and patient management and prognosis is very important. We must be trustworthy and charge patients the same fee, be realistic about prognosis and also offer patient the empowerment needed to get better.

Many of my patients get better quick even after a long period of having the complaint and I always mention that I cannot heal them, however, if that was the case, osteopathic treatment could help the body find a way to start the healing process.

Reflection

My approach allows patients to choose when to make appointments based on how they feel, coupled with clear communication about the nature of their condition, prognosis, and management plan. This aligns with the findings from the International Journal of Osteopathic Medicine, which highlights the importance of professional identity in osteopathy (Phillips, 2022). Developing a strong professional identity involves not only adhering to professional standards but also fostering trust and empowering patients through transparency and ethical practice. However, I sometimes question whether this approach fully aligns with the broader expectations of the profession.

The scoping review by Phillips (2022) emphasizes that professional identity in osteopathy involves the integration of personal values, beliefs, and the collective ethos of the profession. My commitment to transparency and patient empowerment is part of my professional identity, but I recognize that this must be balanced with the responsibility to guide patients effectively, particularly when they may not fully understand the complexities of their condition.

Action

The patient should decide always if they benefit truly from the treatment, even if healing starts with some decompensation pattern, soreness for a few days, and increase in symptoms. We must always remember that the best way to attract patients is by doing our job in a great way and help patients get better, word of mouth is the best, free advertising.

Great communication skills and transparency will serve well in teh future.

Phillips, A.R., 2022. Professional identity in osteopathy: a scoping review of peer-reviewed primary osteopathic research. International Journal of Osteopathic Medicine, 45, pp.25-37.

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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. (GOsC 2018, p.25)

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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. (GOsC 2018, p.25)

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Reflection Using Jasper's Reflective Model

Experience

Being an osteopath is a true honour, from the hard years of work and dedication, the sacrifice during the study time must be cherished and protected through decency, being humble in and out of the workplace.

Respect is the base in everything in life and we need to offer it but also redeem it in and outside work.

We live in a digital era where the online presence can benefit you but also destroy you in 5 minutes. Many osteopaths choose to be very present on social media, some find the online content exposing and intrusive.

Reflection

Regardless of our online presence, it is essential to maintain a high standard of behavior in all aspects of life. Recently, I have observed a troubling trend in the osteopathic community where some online content involving female patients, often minimally dressed, seems to sexualize the profession. This trend is disappointing and undermines the dignity and professionalism that should be the cornerstone of osteopathy.

The rise of such content aligns with concerns raised by Thomson and Martini (2024) about the proliferation of pseudoscience and misinformation in osteopathy. They argue that the credibility and ethical standing of the profession are at risk when practitioners stray from evidence-based practices or engage in behaviors that compromise the profession's integrity. The sexualization of osteopathy, as seen in some online content, can be seen as a form of pseudoscience, where the focus shifts from the scientific and therapeutic aspects of the practice to sensationalism, which can harm the profession's legitimacy.

Action

Times and trends are continuously changing, but it’s our duty to keep osteopathy humble and respectful, but powerful and strong.

I am not sure at this point of my future presence online, however, I will make sure I will research the topic very well before posting any content.

Thomson, O.P. and Martini, C., 2024. Pseudoscience: A skeleton in osteopathy's closet?. International Journal of Osteopathic Medicine, 52, p.100716.

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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.  (GOsC 2018, p.25))

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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.  (GOsC 2018, p.25))

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Reflection Using Jasper's Reflective Model

Experience

World Health Organisation Constitution defines health as one of the fundamental rights of every human being … without distinction of race, religion, and political belief, economic or social condition. Moreover, medical, psychological and related knowledge needed for health “is essential” for all WHO(2019).

In the 1st year of this course we have been taught about the socioeconomic, racial and biopsychosocial aspects of healthcare.

I have been myself considered a foreigner immigrant in Italy and in the UK since 2011.

Whilst in the UK I have benefited from equal quality health services in the past, at some point I opted for a private insurance through work, as where I moved since 2018,  the services at my local surgery were generally slow and the medical and front of house staff didn’t always show respect.

Reflection

Over the years, the general respect towards patients has improved, yet the quality and speed of healthcare services have declined, largely due to a shortage of medical staff. The issues related to socioeconomic and racial disparities in healthcare, which existed before, have likely worsened in the post-COVID era. Populations with less access to healthcare have become even more vulnerable, leading them to seek out allied health professions like osteopathy.

This reflection aligns with findings from Draper-Rodi et al. (2024), who emphasize that individuals from underrepresented groups (UrGs) in healthcare face significant barriers, including disparities in access to services and respect from healthcare professionals. The study highlights the importance of cultural humility in healthcare, where professionals must recognize and respect the diversity of patients to provide equitable care. The declining quality of services I experienced can be seen as part of a broader issue of systemic inequality in healthcare, which disproportionately affects marginalized communities.

Action

Osteopaths must treat patients fairly and recognise diversity and individual values. Luckily in these times there is more information and education available than in the past and we must always be up to date with trends and also traditions, background of the patients entering the consult room.

Being curious is the key to unfold and embrace the diversity, even though we could never agree deep down inside with some preferences of patients coming from different parts of the world. Curiosity is the key to integration as well.

Professionalism means to treat patients with the same respect, even if sometimes we need to adapt the style of communication to make sure the patient has a good understanding of what is going on and a shared decision making is being practiced.

Draper-Rodi, J., Abbey, H., Hammond, J., Thomson, O.P., Brownhill, K., MacMillan, A., Fabusuyi, Y. and Vogel, S., 2024. Overcoming barriers to equality, diversity, inclusivity, and sense of belonging in healthcare education: the Underrepresented Groups’ Experiences in Osteopathic Training (UrGEnT) mixed methods study. BMC medical education, 24(1), p.468.

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D5. You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively. (GOsC 2018, p.23)

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D5. You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively. (GOsC 2018, p.23)

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Reflection Using Jasper's Reflective Model

Experience

Over the years we had to produce reflective, research based written work on some of the cases we had.

Protecting the patients’ rights to privacy and confidentiality is imperative, while making photocopies of the patients’ files. We must make sure that all the personal details are being hidden, and also the file destroyed after not being needed anymore.

Reflection

In today’s digital age, where internet attacks are increasingly common, data protection has become more critical than ever. The NHS and other private health workers manage vast databases on patients, making them prime targets for hackers. The importance of safeguarding both physical and electronic patient records cannot be overstated. Just as physical files in the clinic must be kept locked in a secure area away from public access, electronic content requires continuous safeguarding to prevent unauthorized access.

The ethical and legal obligations around patient confidentiality are complex and require diligent attention. As Maddick and Laurent (2012) discuss, confidentiality is a cornerstone of osteopathic practice, and breaches can have significant ethical and legal consequences. Whether dealing with children or adults, maintaining confidentiality is not just about protecting information from external threats but also about ensuring that information is shared appropriately within the healthcare team. This understanding reinforces the need to be meticulous in handling patient information, both in physical and digital forms, to prevent any potential breaches.

Action

Making sure we keep the computer, email passwords up to date and always have an active  anti virus installed on the computer, never opening any emails that do not look legitimate, opting for some IT training in internet security is mandatory after qualifying.

Maddick, A.F. and Laurent, S., 2012. Consent, competence and confidentiality for children and young people: Case problems from osteopathic practice. International Journal of Osteopathic Medicine, 15(3), pp.111-119.

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In today's digital age, where technology has revolutionized the healthcare industry, healthcare professionals must prioritize online safety and security. As we celebrate Internet Safety Month, Think Anew is here to provide you with essential tips and best practices to protect your sensitive data and maintain a secure online presence. So, let's dive into internet safety and discover how to safeguard yourself and your patients' information.

1. Protecting Patient Privacy:

As a healthcare professional, safeguarding patient privacy is paramount. Adhere to HIPAA regulations and take the following steps to maintain patient confidentiality:

Ensure your devices, such as laptops and smartphones, are encrypted and password protected.

Use secure communication channels, such as encrypted email or secure messaging platforms, when exchanging patient information.

Avoid discussing patient details in public spaces or over unsecured Wi-Fi networks.

2. Secure Password Practices:

Strong passwords act as the first line of defense against unauthorized access. Implement these practices to fortify your online accounts:

Create unique, complex passwords for each account and consider using a reputable password manager to store them securely.

Opt for longer passwords with a mix of uppercase and lowercase letters, numbers, and symbols.

Multi-factor authentication (MFA) wherever available to provide an extra layer of security.

3. Beware of Phishing Attacks:

Phishing attacks continue to be a significant threat. Stay vigilant and educate yourself on how to recognize and avoid them:

Be wary of unsolicited emails, messages, or calls requesting sensitive information. Verify the sender's identity before sharing any personal or confidential data.

Avoid clicking on suspicious links or opening attachments from unknown sources. Instead, hover over links to verify their destination before clicking.

Report any suspicious emails or phishing attempts to your IT department or security team.

4. Keep Software Updated:

Regularly updating your software is crucial for maintaining a secure digital environment. Follow these steps:

Keep your operating system, antivirus software, web browsers, and applications updated with the latest security patches.

Enable automatic updates whenever possible to ensure you have the latest protection against vulnerabilities.

5. Educate and Train Staff:

Incorporate regular training and education sessions to empower your healthcare staff to make informed decisions regarding online security. Topics to cover may include:

Recognizing phishing attempts and other social engineering tactics.

Best practices for secure data sharing and communication.

Strategies for maintaining strong passwords and implementing MFA.

Internet safety is an ongoing responsibility for healthcare professionals who handle sensitive patient information. By implementing the above tips and staying informed about the latest online threats, you can help protect yourself, your patients, and your organization from cyber risks. We are committed to supporting your journey towards a secure digital landscape at Think Anew. Don't hesitate to contact our dedicated team for expert guidance and customized solutions tailored to the healthcare industry.

This Internet Safety Month let's prioritize online security and ensure a safe digital environment for healthcare professionals and patients. Together, we can embrace the benefits of technology while maintaining the highest standards of privacy and data protection.

Are you looking for Managed IT Services for your long-term care facility or organization? Contact Think Anew today!

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Internet Safety Tips for Healthcare Professionals

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In today's digital age, where technology has revolutionized the healthcare industry, healthcare professionals must prioritize online safety and security. As we celebrate Internet Safety Month, Think Anew is here to provide you with essential tips and best practices to protect your sensitive data and

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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. (GOsC 2018, p.22)

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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. (GOsC 2018, p.22)

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Reflection Using Jasper's Reflective Model

Experience

In the past 2 years I have attended the ESO clinic, I did not receive any complaints, I guess my communication skills have improved, but also the fact that students are being supported by their tutors, makes them more confident in the eye of the patient.

Reflection

In the second year of this course we had a written assignment to reply to a complaint. I had to research in detail the subject, including the OPS, The GOsC complaint procedure, how important is the reflective process, accurate clinic notes, professional boundaries and so on.

In this process I also learned that, just like in health, prevention is better than dealing with the problem.

Action

Although my coursework mark was around 60%, the process of understanding the reasons behind complaints, even without dealing with a real case, was invaluable. This experience has equipped me with the tools necessary to handle such situations in the real world after I qualify. Knowing that the GOsC offers continuous support, as well as the backing of the Institute of Osteopathy and the liability insurance I will be purchasing, gives me confidence that I will have access to help when needed. However, as mentioned above, I will ensure that I always practice shared decision-making with patients and strictly adhere to the OPS. As Carnes (2016) highlighted, improving patient communication and managing expectations are crucial steps in reducing the likelihood of complaints, reinforcing that prevention is always better than having to face a complaint.

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

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D3. You must be open and honest with patients, fulfilling your duty of candour. (GOsC 2018, p.22)

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D3. You must be open and honest with patients, fulfilling your duty of candour. (GOsC 2018, p.22)

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Reflection Using Jasper's Reflective Model

Experience

A 65 year old male patient diagnosed with diabetes, HBP, overweight, physically active in his maintenance business, but not in his personal life, this making him prone to injury.

I called him to book him in as my returning patient in my mock CCA, as I saw him for his R gluteal pain after doing some work outside on the cold floor for your 2 hours. He was responding well to treatment and I thought it would have been a good idea to have him as patient during the mock exam.

Reflection

The patient revealed he had been to A&E 2 weeks prior the appointment, as he woke up with paraesthesia in 2 distal digits. The wife dragged him to the hospital and after investigations, they found he had suffered a small stroke. The consultant prescribed him aspirin and gave him treatment for 3 months, advising to avoid exertion.

Reflecting on this experience, it became clear how deeply professional identity influences decision-making in clinical practice. The development of professional identity in osteopathy is complex and multifaceted, as highlighted by Phillips (2022), who notes that professional identity is shaped by a combination of personal values, experiences, and the educational environment. This experience underlined the importance of adhering to these professional standards, which are not static but evolve through ongoing reflective practice and engagement with the osteopathic community. The need to balance personal empathy with professional responsibility is a key aspect of professional identity development, and this case emphasized the importance of continuous self-reflection and adherence to ethical guidelines to ensure the best outcomes for patients.

Action

I had to be honest with him and said that, although he had made the appointment at my suggestion and it was free of charge, I had to decline offering treatment due to the risk involved. The patient could not understand initially why I refused to treat him, but after explaining the possible risks, he could see I was fulfilling my duty of candour by not offering treatment.

Phillips, A.R., 2022. Professional identity in osteopathy: a scoping review of peer-reviewed primary osteopathic research. International Journal of Osteopathic Medicine, 45, pp.25-37.

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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. (GOsC 2018, p.22)

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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. (GOsC 2018, p.22)

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Reflection Using Jasper's Reflective Model

Experience

So far in my career I haven’t been treating family and friends much, because of how I live far away form everyone and also the lack of available time.

When I visited my family in Italy 2 years ago, my brother had a really stiff neck for 3 weeks and he was in distress.

I treated him immediately and also performed a HVT. His neck stiffness was gone in 30 minutes and felt good for 6 months after that. The following winter I went there again and he was again stiff, however, in the meantime he was diagnosed with diabetes and HBP.

I told my brother I would treat him using different techniques, but not HVT due to contraindications. My brother accepted and he again got better.

Reflection

Although my brother understood that I did not want to put him at risk, and that I needed to maintain my professional boundaries, I am aware that some patients could be very persuasive and try to direct the treatment in the direction desired. This experience highlights the importance of maintaining professional boundaries, even in situations where personal relationships may blur these lines. Research has shown that professional boundaries within healthcare can be fluid and influenced by various factors, such as social and physical environments, as well as organizational structures (Toloui-Wallace et al., 2024). In co-located clinical environments, where multiple professionals work together, these boundaries can shift, requiring practitioners to navigate and reinforce them as necessary to maintain professional integrity.

Action

During my CCA I had a patient with L4-L5 spondylolisthesis requiring soft tissue work on his lumbar ESM; I explained to him that we needed to work on those muscles strengthening, to help maintain the LSP’s integrity.

The patient accepted and he felt better straight away during the thoracolumbar fascia MET.

We must never allow family, friends or patients take the lead of our treatment, we should  make sure we are always keeping the professional boundaries, whilst respecting patients’ concerns and expectations

Toloui-Wallace, J., Forbes, R., Thomson, O.P. and Costa, N., 2024. Fluid professional boundaries: ethnographic observations of co-located chiropractors, osteopaths and physiotherapists. BMC Health Services Research, 24(1), p.344.

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Abstract

The concept of patient-centered care has received increased attention in recent years and is now considered an essential aspiration of high-quality health care systems. Because of technologic advances as well as changes in the organization and financing of care delivery, contemporary health care has evolved tremendously since the concept of patient-centeredness was introduced in the late 1980s. Historically, those advocating patient-centered care have focused on the relationship between the patient and the physician or care team. Although that relationship is still integral, changes to the health care system suggest that a broader range of factors may affect the patient-centeredness of health care experiences. A multidimensional conceptualization of patient-centered care and examples from our health care system illustrate how clinical, structural, and interpersonal attributes can collectively influence the patient's experience. The proposed framework is designed to enable any health system to identify ways in which care could be more patient-centered and move toward a goal of making it a "systems property."

Introduction

Patient-centeredness has long been recognized as a desirable attribute of health care. Proponents have described patient-centered care as that which honors patients' preferences, needs, and values; applies a biopsychosocial perspective rather than a purely biomedical perspective; and forges a strong partnership between patient and clinician.1,2 Until recently, most studies of patient-centered care and its impact on care processes and outcomes were largely focused on the patient's relationship to his or her clinician or care team.3,4 However, much of what a patient experiences occurs outside of the encounter in the physician's office. Interactions between patients and care clinicians have expanded beyond the in-office visit to include virtual medicine, peer support groups, and a range of information and communication technologies to support care. Moreover, the clinician's or team's ability to provide patient-centered care is affected by the context in which they operate; for example, a large hospital, small private practice, freestanding urgent care facility, or integrated multispecialty group practice.

As a result of changes to the notion of a care visit and the proliferation of care delivery arrangements, much of medical care and coverage in the US is fragmented; patients may visit a number of clinicians in different clinics or systems, especially for complex and chronic conditions, and continuity and coordination across clinicians and settings is often lacking.5 Moreover, the electronic medical records held in one health care setting are often not shareable or interoperable,6 further contributing to fragmentation. Hence, the absence of a true health care system has been detrimental to patient centeredness and continues to present obstacles to making care more patient centered.

Nevertheless, we believe that efforts to make the health care environment more responsive to patients' needs, preferences, and values will be most likely to succeed if they are based on a clear understanding of the full range of factors that promote or impede patient-centered care-that is, making patient-centeredness a "systems property."7 Thus, given the changes in contemporary medical care over the past two decades, it is worthwhile to revisit the opportunities for increasing patient-centered care.

In this article, we offer a multidimensional characterization of patient-centered care that could be applied to a variety of care delivery systems and settings. We describe attributes within each of three dimensions of health care that can affect patients' experiences, for better or for worse. Our goal is to provide a framework and real-world examples to readers interested in improving the patient-centeredness of their health care organizations. We use insights from the literature and illustrative examples collected from Group Health Cooperative (Group Health), an integrated health care delivery system in Seattle, WA, to show how the attributes of patient-centered care can be embraced at a systems level.

What Is Patient-Centered Care, and Why Is It Important?

The Institute of Medicine8 has defined patient-centered care as "care that is respectful of and responsive to individual patient preferences, needs, and values." Following a series of focus groups with patients, iterative feedback from research colleagues, and consultation with national advisers, we modified this definition slightly to describe patient-centered care as care that " honors and responds to individual patient preferences, needs, values, and goals." It is through this lens that we describe why and how patient-centered care should be an imperative for all health care systems, whether that "system" is a solo practitioner, a large multispecialty group practice, or a federally qualified health center providing care to underserved populations.

Several important arguments for making care more patient centered have been offered. Patient-centered care results in improved care processes9 and health outcomes, including survival.10 Two systematic reviews identified promising patient-centered interventions directed at patients, clinicians, or both, which resulted in improved communication and health outcomes.3,7 Patient-centered care is the right thing to do.11 In fact, it is hard to imagine how care that has not been patient centered could ever have been justified. There is a business case for patient-centered care, on the basis of evidence that patients who report stronger relationships with their clinicians undergo fewer tests and are less inclined to pursue legal action if a medical error is handled in a sensitive, patient-centered fashion.12 Finally, it has been argued that clinicians and their teams may benefit from a patient-centered orientation by knowing that they have more effectively addressed the needs of their patients.13,14 Collectively, these studies demonstrate that patient-centered approaches can lead to improved healing relationships.

Our Approach to Studying and Improving Patient-Centered Care

Group Health coordinates health care and coverage for more than 660,000 individuals in Washington state and operates as a consumer-governed nonprofit system. Nearly two-thirds of members receive care in Group Health-owned and operated medical centers, and promoting patient-centered care is an organizational guiding principle. Nevertheless, the complexity of patient-centered care in a large system-where every patient, clinician, team, and encounter varies across time and place-means that embedding patient-centeredness into all daily work remains challenging.

In 2009, Group Health Research Institute, the research arm of Group Health, initiated the Patient-Centered Care Interest Group to serve as a venue for stakeholders from across the organization to discuss timely topics, articles, projects, and related initiatives. The diversity of departments that are represented-including research, clinical care (primary, specialty, and nursing), health plan product development, organizational communication, quality improvement, measurement and analysis, and patient safety-shows that this is indeed a topic of interest across our system. The group provides a forum for formal and informal interactions with internal colleagues as well as outside colleagues who are regularly invited to share their expertise, and it fosters improvements to internal care delivery initiatives as well as research projects. Topics have included measuring patient experience in real-time, best practices for patient advisory boards, and user-centered design methodology, among many others. Medical Directors are among the regular interest group participants. As a marker of widespread leadership support for this work, patient-centered care was a featured topic of Group Health's annual internal conference targeted to all personnel in our integrated group practice (approximately 500 participants) in 2010 and 2011. The conference is a unique opportunity to describe high-profile organizational initiatives and to disseminate key messages to medical leaders and frontline staff simultaneously. Showcasing patient-centered care has spurred greater participation in the interest group.

The Group Health Cooperative Human Subjects Research Committee reviewed and approved this manuscript. However, no information on human subjects is included in this commentary.

What Are the Dimensions and Attributes of a Patient-Centered Health System?

The literature on patient-centered care spans a broad range of subtopics, including physician communication training, patient-centered health information technology, the built environment (the spaces and products in health care facilities), and strategies for measuring patient-centeredness. For this reason, Bensing15 describes patient-centered care as a "container concept" that envelops several different attributes and behaviors. It is useful to acknowledge and differentiate patient-centeredness from the patient-centered medical home model, which has gained traction in primary care as a practice model and is predicated on how a practice is organized to better support the patient's experience. With or without adoption of the patient-centered medical home model, care can be very patient centric, or not. For example, a clinic or practice may incorporate features in the evidence-based care plans and same-day appointments, or other operational improvements, but one unpleasant interaction with a team member can leave its imprint-a perception that the patient was not put at the center. Thus, patient-centeredness is a quality that must be earned time after time, encounter by encounter, and it is fragile, even in a medical home setting.

Within Group Health, we sought to make the overarching concept of patient-centered care more concrete and operational by identifying attributes of patient-centered care that recur in the literature, and organizing them into the three dimensions that we believe must be present and integrated to make patient-centered care part of the culture of care. Table 1 shows the attributes in these three dimensions: interpersonal, clinical, and structural. We have organized these dimensions to be applicable, and the attributes to be actionable, in any health care setting. These attributes build on and extend previous conceptualizations of patient-centered care1,2,16 by explicitly acknowledging the role of the entire health care team, emphasizing new modes of patient-clinician interactions, and characterizing aspects of the health care system beyond the built environment. Indeed, many of these attributes are part of the medical home model, but a practice model and a mindset are not synonymous. Group Health has adopted the medical home model systemwide and is endeavoring to fully embed patient-centeredness into the culture and fabric of the organization.

Table 1

Table 2 presents examples of specific changes we have made and how these changes tie to the attributes in Table 1 . Leadership support is imperative, and Group Health leaders have endorsed specific tactical changes and embraced the philosophy of patient-centered care. Still, culture change is a dynamic and living process, especially in a large organization, and ours is a journey in progress.

Table 2

In the course of reviewing the literature to identify key attributes, we also identified two fundamental tenets of patient-centered care that were reflected in all of the attributes. The first is consistency. Whether the patient is communicating with a physician or a radiology technician or a claims adjuster, whether being seen for a lifelong condition or an acute illness, whether the "visit" is in a clinic or via e-mail, and whether the patient's preferences are stable or change according to their health status, the patient should be able to rely on the health system to consistently provide a patient-centered experience.

The second underlying tenet is trust. Does the patient trust that the clinician is fully present and listening with the patient's needs in mind? Also, the patient and clinician must be able to trust the system on which the clinician relies to support high-quality, patient-centered care. Can the patient trust that the environment in which s/he is receiving care is safe and committed to error-free care?17 Can the patient and clinician trust that someone is looking out for the patient's interests as s/he transitions between health care settings? Can the patient trust the skills of the medical assistant who is inserting an intravenous catheter? All of these questions require both a system-level commitment to organizing care processes to meet patients' needs, preferences, and goals, and a philosophical commitment on the part of all of the participants in the health care setting.

In the next section, we explore the dimensions and attributes in depth, and provide examples of how they are being applied at Group Health. In some instances, the examples may evoke more than one dimension, again illustrating that patient-centeredness has a permeable quality and "contains" many aspects.15

Interpersonal Dimension

This dimension unites several well-studied aspects of patient-centered care: communication, knowing the patient, and acknowledgment that all members of a team affect the team's relationship with the patient. Effective communication must begin with active listening-empathically attuning to both the patient's medical and nonmedical needs (eg, values, fears, life events)-that can have a major impact on both the process and outcomes of the interaction. Effective communication will facilitate the ability for patient and clinician to find common ground.4,18 It is often critically important to involve the patient's friends, family, and/or caregivers, especially in times of stress (eg, acute events or serious illness) or when family support is important for achieving clinical goals (eg, management of chronic disease). Defining the team to include both clinical and service providers can also contribute to patient-centeredness of care. Sevin and colleagues14 note that becoming a patient-centered, highly functional care team takes deliberate work to define roles and responsibilities, and to ensure that everyone has the necessary information to meet the needs of the patient. Moreover, placing responsibility on everyone who interacts with a patient helps create and reinforce a culture of caring. Everyone on a team or in a system must recognize that one unpleasant or uncaring encounter can have a lasting negative impact on the patient and makes the lives of coworkers who have to deal with an upset patient more difficult.

Group Health has undertaken several initiatives in recent years to improve this interpersonal dimension:

Enriching its physician- and nurse-training programs to focus on the importance of interpersonal communication both with patients and between clinicians

Enhancing engagement among all employees through front-line improvement workshops that bring entire teams together to identify strategies to improve care

Surveying patients regularly about their care experience, and using results to identify opportunities to improve communication at the individual clinician level

Actively piloting patient advisory boards that tap into specific ways to improve ancillary clinical departments within our system, for example, pharmacy services.

Clinical Dimension

Many attributes in the clinical dimension-particularly decision support, coordination, care management, and continuity-are prominent in the health care improvement literature.19-21 These attributes are more important than ever, considering today's diverse and increasingly fragmented health care delivery landscape. Recent innovations in delivery system design, notably virtual medicine and redesign of primary care around the medical home model, lend themselves particularly well to ensuring a patient-centered experience. By its very name and nature, the patient-centered medical home model is intended to more fully support clinicians in delivering coordinated care across settings and types of encounters. For care to be fully patient centered, it should allow patients the option of interacting with their clinician or care team without visiting a facility. Similarly, the system should have a routine approach for equipping patients with the skills needed to prevent or manage illness outside of the clinician's office and should be able to connect patients with community-based agencies that provide social, instrumental, or emotional support.

... all members of a team affect the team's relationship with the patient.

Among the patient-centered improvements that Group Health has made in the clinical dimensions are:

Leveraging health information technology to extend care options beyond the office visit, via secure e-mail to clinicians, a smartphone "app," and online health risk assessment with personalized feedback

Longer in-person appointments

Ability to self-refer to medical specialists

Both online and in-person peer support programs for persons with chronic illnesses

For preference-sensitive conditions, (eg, bariatric surgery, prostate cancer treatment), a formal shared decision-making program has been established to give patients and clinicians a foundation from which to carefully explore trade-offs when more than one clinical option may be available.

Structural Dimension

The built environment is outmoded in many ways. Many existing facilities were designed to facilitate the clinician's experience and navigation; signage is often in medical jargon, as is paperwork (claim forms, test results, prescription instructions). The nurses' station in a hospital ward is often physically distant from patient rooms, which may contribute to patients feeling isolated. Patients are physically moved to procedures or services, rather than having the procedure or service performed wherever they are. System-level investments can go a long way toward creating a more humanized care experience, and principles for improving the health care environment have been articulated in the Planetree Model, which aims to shift the health care environment from one designed around the convenience of clinicians to one centered around the patient, with a more personalized and holistic approach.22 Design of Group Health's newest clinical facilities was undertaken with extensive input from its consumers as well as care delivery personnel, with the goals of making clinic visits more efficient and less stressful, by colocating patient services (laboratory, pharmacy, imaging), and developing more comfortable examination rooms.

Similarly, access to care-where clinic wait times are minimized, appointment making is efficient, and payment structures accommodate patients' ability to pay-can greatly enhance patients' experiences. Making patients wait 40 minutes to be seen, while feeling unwell or being around others who are ill, is likely to have negative consequences for the rest of the encounter for both the patient and the clinical team who must then deal with an upset patient. Finally, information technology innovations in health care, if developed and used properly, hold tremendous value and promise and have the potential to greatly enhance the patient-centeredness of care, especially as the "meaningful use" provisions of electronic health record adoption come to fruition. These provisions are designed to help clinicians better know their patients and use this knowledge to inform and improve care. As an example, increased use of electronic health records can dynamically capture and store a range of patient information around needs, goals, values, and preferences. Group Health regularly adds such features to its electronic medical record system. Another information technology-enabled enhancement at Group Health is the incorporation of laboratory and pharmacy wait times by clinic, built into the smartphone application.

Conclusion

Bergeson and Dean23 observed that "well-designed support and delivery systems are essential if care is going to center reliably and consistently on patients' needs and priorities." We have provided a new conceptualization of patient-centered care by identifying pertinent attributes in the interpersonal, clinical, and structural dimensions of health care, along with concrete examples of ways in which those wishing to improve the patient-centeredness of their care can intervene at various levels, using this actionable framework. However, because the attributes typically do not exist in isolation, all have the potential to affect a patient's care experience. Hence, a comprehensive, integrative, consistent approach to making patient-centered care a system property is most likely to succeed.

Although the goal of delivering an optimal patient-centered care experience may seem aspirational, the mounting pressures on health care settings make this a particularly opportune time to explore the ability of patient-centered innovations to improve care processes and health outcomes. A parallel may be drawn from the literature on improving reliability in health care. Just as each patient should reasonably expect care that is free from errors, there is every reason to set a similarly ambitious expectation that every patient will not only receive reliable and error-free care but also will consistently receive patient-centered care-in any health care setting, every time. We have the tools, the business case, and the evidence base-now we need the will.

Disclosure Statement

The authors are employees of Group Health Cooperative. They have no other conflicts of interest to disclose.

Acknowledgments

This study was funded by a grant from Group Health Research Institute, Seattle, WA.

Portions of this research were presented at the following meetings held in Seattle, WA: Group Health Cooperative Primary Care Leadership Forum in November 2010, Annual HMO Research Network Conference in March 2011, and AcademyHealth Annual Research Meeting June 13, 2011.

Kathleen Louden, ELS, of Louden Health Communications provided editorial assistance.

References

8. Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press; 2001. [[ PubMed] Google Scholar]

Articles from The Permanente Journal are provided here courtesy of Kaiser Permanente

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A Framework for Making Patient-Centered Care Front and Center

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The concept of patient-centered care has received increased attention in recent years and is now considered an essential aspiration of high-quality health care systems. Because of technologic advances as well as changes in the organization and financing ...

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D1. You must act with honesty and integrity in your professional practice. (GOsC 2018, p.20)

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D1. You must act with honesty and integrity in your professional practice. (GOsC 2018, p.20)

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Reflection Using Jasper's Reflective Model

Experience

When I started treating babies for the first time in the clinic, I thought I was a total scam. I felt that the training I was receiving through the clinic tutorials was not enough. After all, the parents trust us with handling and treating their new babies, their treasures. The information was confusing and contradictory at times, because the clinic tutors had different approaches to treating babies. Some of them just used terms like ’I feel shock in the system’, or unresolved breath. Many of the cranial osteopathic terms are so new to me and I don’t feel I understand them properly.

Reflection

So many times I had to explain the cranial treatment that was actually having a good effect on the baby’s symptoms, but I had no idea how to explain what was really happening in layman’s terms. I felt frustrated until I started having a more structural approach, encompassing the cranial one too. There is an amazing female tutor that has always given us the best guidance, with practical explanation regarding the natural process in the babies and mothers, but also between both of them. This aligns with the importance of honesty and integrity in healthcare practices, as these character strengths have been shown to significantly predict positive health outcomes and improve daily functioning (Weziak-Bialowolska et al., 2021). The ability to communicate effectively and truthfully, even when dealing with complex or confusing information, is crucial for building trust with patients and their families, ultimately contributing to better health outcomes.

Action

I have started to try to understand the IVM treatment from different perspectives and this has helped me to treat adults too, with great results.

Although I could not have been honest and say ‘I have no idea how it works, but it does’, I have put the effort into it and became knowledgeable, also to be able to explain it in a simple way.

Weziak-Bialowolska, D., Bialowolski, P. and Niemiec, R.M., 2021. Being good, doing good: The role of honesty and integrity for health. Social Science & Medicine, 291, p.114494.

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One of my colleagues has sent the patient an email from their personal email address.

When I asked if this was ok to be done, my colleagues said 'yes'.

I would personally avoid this kind of contact, for professional reasons.