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

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

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Met a patient suffering from a very seldom disease (Behcets syndrome). I inform the patient that I know nothing about it, which my patient already was expecting. I ask my patient to give me some further information, so I later can do some research on official homepages ( https://www.gigtforeningen.dk/viden-om-gigt/diagnoser/behcets-syndrom/) to receive further information. The patient was safe with that and happy that I was honest about my non-existing knowledge and my interest. Although I did not know the disease the patient could tell me about her symptoms, what she has tried of treatment earlier, information about what she experienced as helpful/not helpful, her expectations. All that communication and information helped us both to start an effective treatment of her symptoms.

7 th December 2022

Start to consider a case for my ESO assessment 1 for year 2. Think I found an interesting case and did some research about the L2 (spine). Red about cisterna chyli which is new for me. Don't know if it is relevant or not - but still interesting and new for me. Earlier I would have considered the patient with the musculosceletal model. But now I consider all the five osteopathic modells.

24 th June 2023

ESO seminar about patient history and GOE.

Interesting and useful teaching about differential diagnoses.

Upfreshing knowledge of red flags.

As a physiotherapist I am used to work with patients reffered by a GP. Of course, it is never a guarantee that possible red flags were found by the GP, but in most cases it is done. for me it is new that patients come to an osteopath often without the involvement of a GP. Therefore, it is much more important to be aware about red flags and it is neccessary with a bigger knowledge about DD. Also, I realize how important it is to do a thourough recording in the journal is very important.

25 th June 2023

Training of how to touch a patient during examination in ESO modul. Very useful to receive feedback from the teacher and getting more aware about motor- and sensory hand.

ESO neurology seminar

Very useful to work in a studygroup and discussing how to examine and how to make diagnosis. Today focus on neurology.

8 th October 2023

First time with real patients in ESO class. Very useful to work in groups with a patient. Discuss and receive feedback from other students and teacher for our patient history, examination and treatment. No doubt, that enriches my way of thinking, considering new treatment techniques and focus on other structures (thinking in the 5 models).

3 rd December 2023

Learning more about differential diagnoses. Among others I never thought about Clamydia and how it can influence the body. During ESO teaching we had an interesting discussion about it. As a physiotherapist I am used to the GP refers patients and has done some examination of the patient before I see the patient. But as an in near future-osteopath I have to be more aware that the patient has not been in contact with a doctor. Therefore, it is very important for me to learn much more about differential diagnoses.

15 th December 2023

Bought a useful book:

Differential Diagnosis And Management For The Chiropractor

by Thomas A. Souza

Find it important and useful to refresh my knowledge.

21 st March 2023

Doing a lot of article reading for my dissertation. Read a lot about hip osteoarthrosis and pelvic floor. This gives me further understanding on how things are connectet to each other.

5th April 2024

Bought a pelvic model for better understanding the anatomy. And also for patient demonstration. Very useful for both me and the patients. A 3-dimensional view is easier to understand than just a picture.

12 th until 14 th April 2024

ESO session with DD, red flags and yellow flags

As a physiotherapist I am familiar with most of the MSK system. Regarding cardisystem and GIT my knowledge is not as good as teached at ESO. I learned some useful techniques.

Furhter, I am aware of always asking (when relevant) the patient if they participate examination for Smear, colon cancer, breast cancer when they have the age, where it is offered by the Danish government.

6 th June 2024

Had a patient who was so stressed. Talked very fast, walked fast with heavy steps, fast respiration, .... Talked with her about what I saw and she was very happy with that. She was very surprised about that. Afterwards she had focus on her walking, breathing and talking. Awarness helped her to calm down in future. And she realized that she could feel her body again.

June-August 2024

Doing a weekly study group with one or two other osteopath students. We discuss a case every time which is very useful. It gets me to be more precise and aware of more conditions. E.g. we had a discussion about hemorides and what it can mean for the body, why a person can get them and how to treat.

13 th September 2024

ESO Teaching in pediatrics, year 4, modul 1: I have no experience with treating babies. Whenever, I was asked for baby treatment as a physiotherapist I always adviced the patient to an expert. Learning again how useful listening is: both listening to words, but also to the body.

Learned about nutrition and useful information for pregnant women: www.coursera.org

I was not aware of that before, and found it useful to gain further knowledge.

15 th -17 thNovember 2024 (ESO seminar)

Womens health

An unknown area for me. Learn a lot about hormons influence and the anatomy of the pelvic area.

I am positivly surprised how much we as osteopaths actually can do. Of course, there are limitations. But it is more that I can do now, then when I work as a physiotherapist.

December 2024

Unbelievable, that I am now a year 4 student. Thinking back to the beginning I was a very experienced physiotherapist and thought I know so much. I know a lot, but I also learned so much new. I love that. It makes me proud to keep on learning and thinking, always wish to do the best for my patients.

My handhold has improved a lot. I often remember one of our teachers who had "magic hands". He always repeated: "Be like water" and "shape". It makes so much sense and such a big difference. It is not only about touching, but really touching and feeling. A feeling that involves presence. My manual therapy is a craft that has been refined. And I am so happy and proud when my patients comment on it.

Bought a new book (Balanced Ligamentous Tension) written by passionated Kok Wim Lem. I love to read, getting repeated old knowledge, learn new techniques.

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Behcets syndrom er en sjælden bindevævssygdom og en inflammatorisk multiorgansygdom, der kan ramme mange organer. Læs om årsager, symptomer og behandling.

Behcets syndrom er en af de sjældne bindevævssygdomme, som ikke alene kan angribe leddene, men også hud, slimhinder, øjne og indre organer.

Sygdommen er mest udbredt i Middelhavsområdet, mens den er meget sjælden i Skandinavien - det anslås, at den rammer under fem personer pr. 1 million indbyggere. Flere og flere får dog diagnosticeret sygdommen, formentlig fordi der er øget opmærksomhed på den.

Sygdommen har navn efter den tyrkiske dermatolog Hulusi Behçet, der i 1937 som den første beskrev symptomkomplekset.

Hvad er Behcets syndrom?

Behcets syndrom er en inflammatorisk multiorgansygdom - dvs. at den kan ramme mange organer.

Den er karakteriseret ved tilbagevendende sår i munden og på kønsorganerne, forskellige øjensymptomer, hududslæt, karbetændelse og risiko for blodpropdannelse. Sygdommen kan angribe så godt som alle organer, og der kan forekomme ledhævelse, oftest i ankler og knæ - men symptomer og sygdomsforløb varierer fra patient til patient.

Behcets syndrom starter oftest i 20-40 års alderen.

Hvorfor får man Behcets syndrom?

Årsagen til, at nogle mennesker får Behcets syndrom kendes ikke, men arvelige faktorer og forhold, der vedrører immunsystemet, spiller en rolle i udviklingen af sygdommen.

Symptomer ved Behcets syndrom

Sår i slimhinder

Sår i mundhulen ses hos næsten alle. De kan ligne herpes-sår, og især de mindre sår heler som regel op uden ardannelse.

Sår forekommer også hyppigt på kønsorganerne - hos mænd på pungen. Disse sår efterlader ofte ar. Hos kvinder ses sårene på skamlæberne og sjældent i vagina eller på livmoderhalsen. Hvis symptomerne er begrænset til slimhindesår, er fremtidsudsigterne gode.

Hud

Huden rammes hyppigt på forsiden af underbenene i form af knuderosen (erythema nodosum). Bumser og akne-lignende udslæt forekommer også, og enkelte patienter udvikler karbetændelse.

Ca. halvdelen, især mænd, får øjensymptomer i form af regnbuehindebetændelse (uveitis). I enkelte, sjældne tilfælde kan der forekomme karbetændelse i øjet, hvilket kan medføre blødning i nethinden. Op til 20 procent med øjensymptomer risikerer synsnedsættelse.

Led

Især knæ- og ankelled kan være hævede pga. gigtbetændelse - oftest kun i et enkelt led ad gangen. Ledsymptomerne kan springe fra ét led til et andet - men leddet ødelægges ikke af betændelsen, sådan som man kan se det ved andre inflammatoriske gigtsygdomme som f.eks. leddegigt.

Karbetændelse

Karbetændelse er hyppigt forekommende, især i overfladiske blodkar og vener, hvor tilstanden er relativt ufarlig. Men også dybe, store kar kan rammes, og det kan medføre alvorlige komplikationer, herunder blodpropper.

Centralnervesystemet

5-10 procent har gener fra centralnervesystemet med uspecifikke symptomer som hovedpine og koncentrationsbesvær.

Sådan undersøger lægen for Behcets syndrom

Der findes ikke nogen test eller undersøgelse, der alene kan fastslå diagnosen Behcets syndrom. Diagnosen stilles derfor på baggrund af de synlige sygdomsforandringer og din sygehistorie.

Diagnosen stilles ved:

Tilbagevendende sår i mundhulen

Plus mindst to af følgende sygdomstegn:

tilbagevendende sår på kønsorganerne eller ardannelse

alvorlige betændelser i øjet

hududslæt (herunder knuderosen-lignende forandringer, kirtelbetændelser og aknelignende udbrud)

positiv patergitest (hvis en nål stikkes ned i huden, og der på stikstedet inden for 48 timer dannes en rød plet, som er større end 2 mm, er testen positiv)

Medicinsk behandling af Behcets syndrom

Behandlingen af Behcets syndrom afhænger af symptomernes karakter og sværhedsgrad.

Oftest anvendes binyrebarkhormon lokalt i de perioder, hvor sygdommen er i udbrud - for eksempel i form af salve til lindring af sårene. Længerevarende, fast behandling med binyrebarkhormon er derimod sjældent nødvendig.
Læs mere om binyrebarkhormon
Andre anvendte lægemidler er - efter individuel vurdering - blandt andet kolkicin og Imurel.

Behandlingen er en opgave, som i Danmark varetages af højt specialiserede enheder på universitetshospitalerne i et tværfagligt samarbejde med blandt andet hudlæger og gigtlæger.

Det kan du selv gøre - gode råd om Behcets syndrom

Behcets syndrom er en sjælden diagnose, og du kan derfor føle dig meget alene med din sygdom. I Gigtforeningens diagnosenetværk for Behcets syndrom kan du komme i kontakt med andre, der kender til de problemer og udfordringer, der kan følge med sygdommen.
Tag kontakt med Diagnosenetværket for Behcets syndrom

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Behcets syndrom - årsager, symptomer og behandling

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Behcets syndrom er en sjælden bindevævssygdom og en inflammatorisk multiorgansygdom, der kan ramme mange organer. Læs om årsager, symptomer og behandling. Behcets syndrom er en af de sjældne bindevævssygdomme, som ikke alene kan angribe leddene, men også hud, slimhinder, øjne og indre organer.

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

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

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Whenever I am in doubt I tell the patient. I realize that patients appreciate that I am honest about my knowledge.

22/9-2022 I asked a patient to go back to the GP as I was not sure that the patient was examined for borrelia. If there is an infection in the body it could be the reason for the unusual headache/neck pain my patient explains.  It could be a contraindication and therefore I will not treat fascia or muscles until I am sure.

26 th January 2023: First Aid course at my work. Refreshing how to identify and help unconscious people. Stroke, ....

My collegues, the instructor and me had useful discussions. And practicing first aid is very useful. Although I follow first aid courses every second year I am aware that it is important to continue doing it. It can save life.

15 th April 2024:

A patient with unclear symptoms arrived. Did a profound examination, however nothing made sense. The patient has been in contact with plenty of experts (doctors, physiotherapists, chiropractors) and he hopes that I can do something for him. I asked him if it is okay that I contact his GP, who referred him to me. I want to discus with his GP some consideration. The patient was happy with that and I had an interesting discussion with the GP. I got some useful information from the GP and vice versa. Maybe we can try something new for the patient.

august 2023, feedback from ESO examen

"IVM introduced self and set some expectation. Moved the couch a lot good. Prepared herself with grounding. Honest and took shoes off. Very nice set up for palpation and knew why she was doing it- very good. Very polite to patient. SBS hold was on the sphenoid- good but did have the other bones- will confused. Moved patient to other side because she didn’t like the face hole- very good. Interesting and realistic explanation of a BMT, knew the process, did a good release."

This feedback made me happy.

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

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

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I had a patient who wanted me to treat his back pain without using time to examine. The patient was desperate for treatment. I had to explain to the patient that I could not treat without knowing what was wrong. It would be unprofessional to guess a diagnosis, and I cannot guarantee that I will give the proper treatment. There is a chance of worsening the pain when not doing an examination. After that, the patient understood and was very happy to be taken seriously and to get an understanding of what had happened. The patient was thrilled after my examination and explanation and felt safer. When reflecting on the patient’s way of acting, I believe that his pain was so intense that he was desperate for a quick fix.

Research and professional class in ESO regimen:

It is thought-provoking and presents an ethical dilemma: Craniosacral therapy, BLT, and visceral therapy do not work as we were taught at ESO. The research does not support these techniques. However, we receive plenty of hours of education on those techniques and have several examinations. I have excellent results with those soft techniques. Maybe it is just a placebo, but a placebo can also be helpful. In many of my treatment sessions, I mix different techniques. I have never done only Craniosacral therapy. I always inform my patients about my methods and give them the choice to say yes or no.

When doing research, I can find studies supporting craniosacral therapy (such as https://link.springer.com/article/10.1186/s12891-019-3017-y and https://www.sciencedirect.com/science/article/pii/S0965229921000431).

Discussion about research and osteopathy with an ESO teacher. Very useful to hear other opinions and considerations. Always consider who is paying the research. This could be a reason why osteopathic research has "problems".

Had a patient with whiplash injury. As her symptoms in UEX are of neurological nature I recommended her to contact a neurologist. Her movement in cervical columna is very much restricted, too. My physiotherapy treatment helped a little, but not enough. Today, I asked her if we shall try some osteopathic visceral techniques. I informed her that I am a osteopath student - she agreed. The result was amazing. Her AROM in cervical columna was almost normally. (It is important to mention that I work as a physiotherapist where the GP sends patients to me for physiotherapy treatment. In Denmark only osteopaths are allowed to work with osteopathy. As a student I have to consider how to act.)

I am a physiotherapist (and osteopath student). Priority of my patients are sent by a GP to physiotherapy. Therefore, I have to consider how to work because physiotherapy is expected. But, I always inform my patients when I find it more effective to use specific osteopathic techniques (such as BLT, CST, visceral techniques) and give them the possibility to choose. But, I am also aware that I am only a third year student and have some lacks. Then I recommend my patient to contact an authorized osteopath instead of.

Had a patient today where I cannot find a clear diagnose. Told him about my thoughts. I know the patient has been talking with his GP several times and I dont want to make him nervous. But I prepared him today that we will contact his GP again in 3 days it painkillers dont help him. Until yet he didnt want to eat painkillers. But we have to try and find out if there is an inflammation going on or not. I am also worried that there could be a beginning cancer, but he has no pain in night. But he has changing stool. No weight loss, normal appetit. Familiy history of cancer. However, his GP doesn´t seem to worry.

Had a male retired GP as patient today. Although the patient knew a lot about his condition (rotator cuff tear) he acted like a non-professional. He was desperate for being able to continue playing golf. He did exercises for the shoulder. Further, he had been talking with an ortopaedian surgean, who did not recommand operation. The patient also had gotten 4 steroid injections and knew that further injections were not recommanded because of increased risc of further tears of the remaining rotator cuff and biceps tendon in shoulder. But he "promised" me to take a brake for the healing proces of the tendons, if he got one more injection. I told him that it is not up to me about injections, as I am not allowed to give him. Furthermore, I repeated his own words about the risc and remembered him that he should know better. And finally, I asked him why he would accept a healing brake with injection, versus without injection. The last question made him thinking and laughing. He realized that he, of course, could take a necessary brake for the healing without an injection. During the session with the patient I was very aware that the retired GP seemed to have a professional and personal crisis. I helped him to understand and accept the situation. Helped him to find his own answers (=things he would recommand his patients because he has the professional knowledge). He found it very helpful and respectful.

•Caneiro, J.P., Bunzli, S. & O´Sullivan, P., 2021. Beliefs about the body and pain: the critical role in musculoskeletal pain management. Brazilian Journal of Physical Therapy,  25(1), pp. 17-29.

•Sampath, K., Katare, R., Tumilty, S., 2019. Stress axis and osteopathy: A dual hormone approach. International Journal of Osteopathic Medicine, 33–34, pp. 24-30.

14 th February 2024

A well-known patient suffering from Parkinsons felt on her head. Got 6 treatments for it without effect. Sent her back to her GP and neurologist as I am not able to help her. Because of her Parkinsons I cannot find out whether it is her increased muscle tone causing neck pain, nor if she got a cervical spine trauma. She asked me if I believe that a chiropractor could help her. I told her that I dont believe so because she is not able to relax in her spine. Therefore a manipulation would not work. Further, she also has other conditions which are contraindications for HVT of her cervical spine. She was happy that I informed her. Instead, I recommanded her to contact her GP and neurologist again.

I am used to work with the psychosomatic aspect, cognitive therapy, coaching and Coping strategies. In most cases it works very well.

Have a women suffering from pain in os coccyx. During patient history she tells me that she had been in contact with several specialists (doctors, physiotherapists, psycholog) during the last few years. Without getting better.

Patient history has several yellow flags (depression, stress on-off during the last 10 years). I discuss with her that I evaluate her pain as psychosomatic as no expert was able to help her. However, I advice her also to contact a gynecological healthcare person again - just to make sure that nothing has been overseen when she is in my treatment. She knows that I am not an expert in urological or gynecological disorders, and she is willing to try to work with a psychosomatic aspect. We work with her respiration and how her thoughts influence her pain. She experience pain relieve. But it is difficult for her to live with pain, but also to live without pain. I inform her that she is used to her pain, maybe pain is her protection. We have interesting discussions and she is happy with treatment. She cries and appologies, but I let her know that it is normal and good to cry. Instead of hiding feelings. Feelings must get out. She gets more energy and looks better for every time. But we know it will take time for her to listen to her body. When she feels it is getting to difficult and "dangerous" I remember her that it is her choice if we should continue or not. I never force her. When she is in doubt what to do, I ask her to think about it. Before I don´t make new appointments with her.

After learning about pediatrics I realize that it is not an area of my interest - and never will be. In my 23 years as physiotherapist I was never interested in pediatry and after the ESO moduls in pediatry I am still convinced that other osteopaths and physiotherapists with special interest in pediatrics are much better for the smal patients.

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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.

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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.

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Today I learned much more about red flags in "General Medical Screening" seminar in osteapathic teaching (summerseminar ESO). Especially being aware on nails and sounds in the body were new for me as a physiotherapist.

22/9-2022 I realised how important it is to test and re-test. This is the only way to evaluate whether my treatment made sense. It is also important for the patient as it shows that treatment does help.

October 2022: It became a routine for me to repeat about 2 to 3 techniques during the week and practice them on my patients. This ensures that I don’t forget techniques.

November 2022:

In Denmark we can report unintended incidents in clinics to the Danish Patient Safety Authority. It has no consequences for the healthcare provider, but it is a tool that helps to introduce and change work processes and specific ways of doing something. We had a case in my clinic where we discussed what we could do after an elderly patient fell during balance training and hit their head on a chair behind. We decided to find another place for the chair. It was useful that everybody working in the clinic knew about it, and therefore could avoid similar episodes in future.

https://stps.dk/sundhedsfaglig/viola-viden-og-laering/utilsigtede-haendelse

1.4.2023

During Research and Professional module I realize how useful it is to both be a physiotherapist and an osteopath student. It is a very useful and powerful combination to work with manual treatment and to be able to instruct the patient in exercises helping to make the body stronger. And evidence for exercises is strong in several cases.  In Denmark we have strong research for arthrosis of knee and hip: https://www.glaid.dk. It is a treatment concept sold to other countries, too.

There a clinical guidelines which I follow, or at least argue when I do not.

https://www.google.com/search?client=safari&rls=en&q=nationale+kliniske+retningslinier&ie=UTF-8&oe=UTF-8

18.7.2023

Send a patient with red flag (high blood pressure, pain in shoulder, feeling stress in the body, palpitation, worsening when lying down, no restriction in neck and shoulder movement, became more worse after visiting a massage therapist) back to the GP. However, the GP found no red flags. Hopefully, the GP is wrigth and I am wrong. However, my patient journal is done and my concerns were mentioned. The patient was not happy, but better that than doing something wrong. I am a very experienced physiotherapist and still no idea what is wrong with the patient.

1.10.2023

During ESO session I learn (re-learn): It is important to let patients repeat what I told them. To make sure that the patient understood.

4 th November 2023: refreshing of red flags. I learned a lot about different kind of cancer and which symptoms to be aware. of As a physiotherapist most of my patients come from the GP and have been screened. However, I cannot always be sure that the GP has it done. Therefore, it is useful for me to gain a bigger knowledge.

15 th November 2023: Had a patient with red flag (obs. cancer). Told the patient in a neutral way to contact GP asap. The patient actually was aware of the symptom, but tried to deny it until I asked him to contact the GP. The patient was happy that I spoke about it.

2 nd December 2023: During ESO teaching heared about classification for headache: https://ichd-3.org/

7th January 2024: Had a 16 year old female patient with low back pain. The young patient showed no compensatory pattern when walking, sitting, bending in different directions. She took no pain killers. There was no pain when palpating her musculosceletal system. No history from her cycle related to back pain, no problems in abdominal area.

However, she told me that she was not able to go to school several days because of severe back pain (8/10). She loves being in school. No infections, no family history with reumatic disease. I saw the patient twice and also discussed her with my physiotherapy collegues and a reumatologist, because I wondered if there could be some diseases I was not aware of.

As I could not find a reason for her back pain I recommanded the patient to contact her GP for further examination.

6 th February 2024: Asked a 73 female patient with neck pain to contact GP again, as her symptoms worried me. She suffered from nausea during night and morning. She was happy that I did and also that I wrote to the GP. The GP send the patient to MRscanning.

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nationale kliniske retningslinier - Google Search

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Feb 13, 2023 — Sundhedsstyrelsen udarbejder nationale kliniske retningslinjer (NKR) og nationale kliniske anbefalinger (NKA), der skal medvirke til at sikre…

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

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

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I always write my patient records in the clinics IT-system, which is a GPDR-ensured and save system. Writing is done when the patient is sitting in front of me and finish after the treatment. All e-mail correspondence is done with secure e-mails.

https://www.danskeosteopater.dk/intranet/gdpr/

When I do not have time enough during a consultation I make notes in my book. At the end of the day I check my list to make sure that important jobs get done before I leave my job. E.g. information to GP, doctors, ....

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Når du arbejder som osteopat, skal du dokumentere dine behandlinger i den sundhedsfaglige journal. Journalføring er vigtig, fordi den sikrer den faglige kommunikation mellem dig og dine sundhedsfaglige kolleger om den enkelte patients sundhed og dokumentation af dit arbejde.

Det vigtigste om journalføring

Her på siden bruges ordet patienter om personer, der er i behandling hos en sundhedsperson, uanset om de i det daglige bliver omtalt anderledes, fx som borgere, klienter, beboere, kunder m.v

Du finder her de mest gængse regler og vigtigste principper for journalføring, hvis du vil vide mere, kan du læse vejledningen om journalføring for specifikke autorisationsgrupper.

Den sundhedsfaglige journal

Den sundhedsfaglige journal eller patientjournalen er den samlede dokumentation for en patients behandlinger i sundhedsvæsenet. På de fleste behandlingssteder bliver journalen ført elektronisk, men den kan også blive ført på papir. I journalen skal alle, der udfører sundhedsfaglige opgaver, dokumentere, hvilke opgaver, der er udført og planlagt, og beskrive patienternes tilstand. Den sundhedsfaglige journal skal føres entydigt og struktureret, så det er muligt hurtigt at finde de oplysninger, man skal bruge, fx hvis en anden sundhedsperson beder om oplysninger om observationer af en patient.

Hvem skal journalføre?

Du skal føre journal over de sundhedsfaglige opgaver, du selv udfører.

Den, der overtager en opgave, skal journalføre den

Hvis du udfører en sundhedsfaglig opgave, som du får overdraget fra en anden sundhedsperson, er det dit ansvar at føre journal, når du har udført opgaven. Når du overdrager en opgave til andre sundhedspersoner, fx en sygeplejerske, social- og sundhedsassistent, eller ikke-autoriseret personale, er det modtageren af opgaven, der skal journalføre den. Du er ikke forpligtet til at kontrollere modtagerens journalføring. Dette gælder også, når overdragelsen af opgaver foregår mundtligt.

Journalføring af råd og konferencebeslutninger

Hvis du søger råd om en konkret patientbehandling hos en anden sundhedsperson, skal du journalføre rådet, hvem det kommer fra og hvilke oplysninger der er forelagt. Det er kun den, der modtager rådet, som har pligt til at journalføre det. Når du har givet et råd, har du dog mulighed for selv at journalføre din rådgivning, hvis du vurderer, at det er nødvendigt.

Den, der fremlægger en behandling på en konference, har ansvaret for at beslutningen journalføres. Hvis behandlingsstedet har en lokal instruks, der siger noget andet, er det dog den, man skal følge. Husk at journalføre, hvem der har truffet beslutningen.

Hvor meget skal journalføres

Skriv det nødvendige for en god og sikker behandling. Det er dit faglige skøn og den faglige norm på dit område, der afgør, hvad der er nødvendigt at journalføre.

Journalen skal give dig og dine kolleger det samlede overblik over patientens helbred, den planlagte og udførte behandling samt opfølgning på den. Derfor skal du få det væsentlige med, men også sikre dig, at dine journalnotater ikke indeholder irrelevante oplysninger.

Dette skal altid stå i journalen

Patientens navn og personnummer

Dato for behandlingen

Titel, arbejdssted, og navn, initialer eller anden entydig identifikation af den, der har udført behandlingen.

Dette skal journalen indeholde, hvis det er nødvendigt for den aktuelle behandling

Oplysninger er nødvendige, når de understøtter dit sundhedsfaglige arbejde. Der er behov for dem i den aktuelle eller i en eventuel senere behandling, undersøgelse, opfølgning m.v., hvis det fx drejer sig om:

den planlagte og udførte pleje og behandling

beskrivelser af patientens generelle tilstand og reaktion på plejen og behandlingen

stamoplysninger, fx bopæl, pårørende, personlige forhold, allergier.

tidspunkt for plejen og behandlingen

tidspunkt for journalføringen (hvis det ikke er lige efter patientkontakten)

skemaer over observationer kan journalføres som resumé

oplysninger, som patienten selv har indsendt

eksterne samarbejdspartnere, fx hospitalsafdeling, hjemmesygepleje, sundhedspleje, egen læge

lyd- og videooptagelser kan henvises til som bilag, men kan ikke erstatte skriftlige journalnotater.

Oplysninger, der kan være nødvendige at journalføre ved første konsultation

Anamnese

Aktuel henvendelsesårsag

Tidligere relevante sygdomsforhold og/eller skader i bevægeapparatet

Relevant medicinering

Beskrivelse af eventuelle øvrige relevante undersøgelser og behandling, af betydning for henvendelsesårsagen og behandlingsplanen, herunder fx resultater fra billeddiagnostiske undersøgelser

Undersøgelse og test

Relevante kliniske undersøgelser, herunder overordnede undersøgelser af kroppen som helhed samt specifikke undersøgelser

Relevante safety test

Behandling

Indikation og mål med behandlingen

Behandlingsplan

Mundtlig information og eventuel vejledning givet til patienten, herunder behandlingsplan og behandlingsteknikker

Udført behandling

Eventuel henvisning til yderligere udredning fx hos egen læge. Indikation for henvisning og patientens samtykke hertil skal journalføres

Eventuelt relevant kommunikation med øvrige sundhedspersoner

Oplysninger, der kan være nødvendige at journalføre ved efterfølgende konsultationer

Status siden sidste behandling

Relevante undersøgelser og opfølgning

Eventuelle ændringer til behandlingsplanen

Udført behandling.

Skriv journalnotaterne til dine kolleger

Hvad ville du gerne selv vide, hvis du skulle overtage behandlingen af patienten? Skriv det, de næste sundhedspersoner, der skal tilse patienten, har brug for at vide, og skriv, så de kan forstå det. Journalen er til for jeres faglige kommunikation om patientens behandling. Derfor er en god tommelfingerregel, at journalen skal give mening for en anden sundhedsperson.

Husk at:

journalen skal skrives på dansk

journalen skal være entydig og struktureret

du må bruge alment kendte fagudtryk på fx latin eller græsk

du må bruge fagligt anerkendte forkortelser

hvis du bruger standardtekster/makroer, skal du tilpasse dem den konkrete patientkontakt.

Skriv journal i forbindelse med behandlingen

En sundhedsfaglig opgave er først gjort færdig, når den er journalført. Du skal journalføre snarest muligt efter, du har udført en behandling, ellers kan vigtige oplysninger gå tabt, og det kan være til fare for patientsikkerheden. Hvis der kommer en akut opgave i vejen, må du vente, men alle sundhedsfaglige opgaver skal senest være journalført ved arbejdstids ophør.

Ledelsen har ansvaret for, at der kan føres journal

Den daglige administrative ledelse på et behandlingssted har ansvaret for, at der kan føres journal over den behandling, der udføres på stedet. Ledelsens ansvar for journalføringen omfatter:

at de ansatte har adgang til at føre journal

at de ansatte er oplært i at føre journal

at det nødvendige udstyr til journalføring er til rådighed

at de ansatte har tid til at føre journal

at journalerne bliver opbevaret forsvarligt i den lovpligtige opbevaringsperiode

at journalen bliver givet videre, fx hvis patienten skifter behandler, eller hvis behandlingsstedet skifter ejer eller ophører.

Rettelser og tilføjelser

Du må ikke slette oplysninger fra en patientjournal. Hvis du har lavet en fejl i dit notat, skal du rette den ved at tilføje de rigtige oplysninger. Den oprindelige version skal dog fortsat være tilgængelig. Du skal også notere af hvem og hvornår rettelserne er foretaget. Almindelige slå- og skrivefejl må dog godt ændres, mens du skriver.

Kort om journalføring af det informerede samtykke

Ingen behandling må gives, uden at der er indhentet et informeret samtykke fra patienten eller dennes stedfortræder. Det informerede samtykke skal derfor noteres i patientjournalen. Journalføringen består af to dele: Informationen og samtykket. Informationen skal journalføres i nødvendigt omfang. Samtykket skal altid journalføres, medmindre samtykket er stiltiende. I så fald skal samtykket kun journalføres, hvis det er nødvendigt i den konkrete sammenhæng.

Der er ingen formkrav til, hvordan et informeret samtykke skal formuleres i journalen, men oplysningerne og omfanget af dem skal tilpasses den enkelte behandling og omstændighederne.

Husk at

kravet til journalføringen af informationen stiger, jo mere kompleks og indgribende en behandling er, og jo større risiko der er for at udvikle komplikationer og bivirkninger.

hvis du bruger standardfraser til at journalføre det informerede samtykke, så tilpas dem altid til den konkrete behandling.

Du kan læse mere om journalføring af det informerede samtykke i vejledningen.

Undtagelser fra journalføringspligten

To situationer er undtaget fra journalføringspligten:

Hvis du yder førstehjælp, fordi du tilfældigt er til stede.

Hvis du har meldt dig til at behandle patienter ved et arrangement, fx en festival, en spejderlejr, et fodboldstævne eller lignende, og der er tale om at afhjælpe en ukompliceret tilstand, eller du sender patienten videre til andre sundhedspersoner, fx egen læge eller ambulancepersonale.

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Journalføring for osteopater - Styrelsen for Patientsikkerhed

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Når du arbejder som osteopat, skal du dokumentere dine behandlinger i den sundhedsfaglige journal. Journalføring er vigtig, fordi den sikrer den faglige kommunikation mellem dig og dine sundhedsfaglige kolleger om den enkelte patients sundhed og dokumentation af dit arbejde.

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

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

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It is important that my patients feel welcome and safe. They must get the necessary time to tell me about their concerns and preferences. I am aware that they may use other expressions than me, as they are not familiar with professional words. It is my responsibility to make sure that we understand each other.

I found a useful danish homepage about a guide for the positive communication between the patient and the healthcare provider. https://www.sundhed.dk/content/cms/63/136563_guide_dialogsamtale_a4.pdf

A patient told me today that it was a pleasure for her to come to me. Her first experience with another physiotherapist was terrible for her. She appreciated my way of welcoming her, listening to her, asking her and explaining her what I found, my thougths, considerations and plan. She got an understanding and felt that she was treated with respect and real interest. That reminds me about the importance of explaining and to ensure that the patient has understood.

Wondered why my patient with severe shoulder pain did not consider to take painkillers as recommanded by the GP. When I explained him the advantage of painkillers in his situation, he was thanking me. The GP had not explained him anything and therefore he was against medication. Now, it made sense to him, and he understood that it is only a few days medication.

feedback from year 2 examination

Found a great picture of a spine showing different pathology of the spine. My patients find it very useful when I show and explain them.

Interesting discussion in ESO teaching about how a patient/student can experience something. Ethical discussion about when someone crosses a personal boarder of somebody. Discussion how important it is to explain a patient what we are going to do for minimizing the risc of misunderstandings. Eventually make some physical distance with using a pillow between chest of patient and therapist. '

A well-known patient suffering from Parkinson’s contacted me for another reason after she fell on her head. Now, she suffers from a lot of pain in her neck muscles and tension headache. She was seen by her GP, who revised her to me with her “neck pain”. The patient was in an MR scanner, and the GP told her nothing had happened to her cervical spine. She got three treatments with soft tissue techniques for it, but without any effect. However, I decided to send her back to her GP and neurologist as I am not able to help her. Because of her Parkinson's, I cannot find out whether it is her increased muscle tone causing neck pain or if something else is going on. I asked the patient if she wanted me to contact her GP. She was happy with that, and therefore, I was. We never found out what was wrong, but happily, the pain decreased after some weeks. It was frustrating for me that I could not help my patient and I still wonder what has been wrong with her.

I bought a model of a female pelvic which helps my patients to understand the anatomy of the pelvic and pelvic floor and the organs in it.

I am always aware of having eye contact with the patient to make sure that I can see the patients reaction to my words and treatment. It is also important for building up a good relationship with the patient.

Use the biopsychosocial model to explain a chronic pain patient how emotions (her fear and anxiety) affects her pain. She was very happy about that and understood that she has influence on her pain level.

Based on the examen feedback I received during the ESO years, I am disappointed with the marks I received for my patient communication.

It took me a while to understand that UK osteopaths ask for much more consent than we do in Denmark. I also know that I am incredibly nervous in an examination situation. Therefore, my patient handling is insufficient, giving me a lower mark than expected in actual practice. I am nervous, speak a foreign language, and must focus on a “patient” and the censor…

I know this is a game, so I accept the feedback as it is. However, I know that I have to pass an exam to become an osteopath, so I work on my nerves. Among others, I train in front of the mirror or a camera. Afterwards, I analyse how I manage the situation. I also asked some of my student colleagues for feedback, and they told me what I could improve for the exam. It is still tricky, but it helps.

During pediatrics modul in ESO year 4 learned that communication of baby must include the family. I have not considered before that a stressed mother can influence a baby in a negative way. It is my job to help the mother to understand how her behaviour/feelings affect her child. That is not always a easy job.

Complaints: In my many years working as a physiotherapist I have not received many complaints. But when it happens - it hurts. Had an patient with osteoporoses who wanted to follow my osteopores course with exercises. After second time participation she send me an e-mail where she wrote that she got lots of pain after the exercises. I gave her a call and asked for further details about her thoughts. Of course, I know that there is always a risk that something can get worse due to treatment. Therefore, I also asked if she has been seen by a GP. Which was the case. Luckily, it seemed "only" to be a muscular condition and not a fracture. I listened to her and was aware that she was afraid. I offered her some manual therapy treatments for her back pain. But she was not able to listen to me and she was too afraid to do anything else then lying in her bed. I tried to explain that it would be better to be at least a little bit active. It was frustrating, that I was not able to connect better with her.

A few patients have complained that they think the treatment lasted too short. I never promise a patient an exact time of how long a treatment lasts. My consultation are typically about 30 minutes. Sometimes, patients need more or less time. But it irritates me when somebody watches the clock when I finish my job and tells me I stopped 2 minutes too early. I answer them in a friendly way so that the treatment's aim is received, and now, the tissue needs no more input. I try to let them understand and feel in their body that the last two minutes don’t make any further change. And they are not entitled to get more like at the haircutter. When the work is done, then it’s done. Some understand it, while others do not. However, it makes me feel sad that some people are like that. I know I have done a good job; the patient can feel it, but I still focus on, in my opinion, irrelevant things.

I have many elderly patients (age> 75 years). In Denmark, everything is based on the internet and digital. Most Danes are familiar with gathering information online, video consultation for follow-up (for example, exercises I gave my patient), communicating with my clinic by e-mail, or patient log-in to book appointments in my clinic. But I am aware that some patients are not able to do that. Here, I take my time to give them a phone call. Or if I want them to read something about their condition, I cannot advise a homepage to them, but have to print the relevant information and handle it.

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

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

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https://www.patientkommunikation.dk/siteassets/medier-til-varktojer---patientkommunikation/folder-tal-med-patienten/w_talmedpatienten_0000000194.pdf

https://patientsikkerhed.dk/content/uploads/2015/12/kvalitativ_rapport__patienters_oplevede_barrierer_i_kommunikationen_med_personalet.pdf

https://danskepatienter.dk/vibis/om-brugerinddragelse

Talking with a patient who had lost her first child because of diabetes. She contacted me three weeks ago because of shoulder pain. But as soon as she knows me, she opens up and tells me about her worries. It helps her a lot to talk about it and have me listen. She feels how her body relaxes.

I have experienced several times since my summer holidays that my patients thank me for a good explanation. They felt heard and that I answered their questions. Since the last summer seminar at ESO, I have asked my patients more often (compared to before) if they understand what I say or have further questions or concerns. It made a massive difference for a part of my patients.

A patient was so happy with my explanation about pain in arthroses. She was so afraid that an operation was required. And so relieved when I explained her what treatment plan will be: exercises for strenghtening and osteopathic techniques for pain relief

A patient asked for advice about the "correct" exercises when she is training in the gym. As I do not know how she is training in the machines I can only give general advice. However, she was very happy that I told her that she should listen to her body. And trust her body. That made much more sense for her, than eg. telling her to exercise with 10 kg.

Male patient who has a rotator cuff tear. He loves playing badminton which is not possible because of the shoulder problem. Explained him with graphs how treatment will influence his healing. How he can do progression with his shoulder exercises and how treatment will help his healing. It was very important for his motivation to get a deadline for when he can expect to return to badminton. It made him very happy and optimistic to know that in about two months he should be able to return to badminton when he is following the instructions.

Experience: Saw a patient with knee arthrosis for the second time after the X-mas holiday. He was very negative when entering the room and telling me he still has a lot of pain. I first saw him a few days before the Christmas holiday. We did an examination; I explained his condition, prognoses, what he must do and the working plan. He lives very unhealthy with smoking, no exercising, ... The patient was referred by his GP to my physiotherapy clinic for knee arthrosis exercises. I must do what the GP ordinates, but I always also integrate some osteopathy with manual techniques. Usually, my first appointment is an examination, explaining the condition and giving some exercises (aim: patient can start working with his health). Unless the patient has severe pain and is not able to do exercising before we did manual treatment, this was not the case with him.

My reflection: I felt slightly angry and disappointed because I knew I had explained and treated him very nicely and in a friendly and professional manner the first time. I asked him if he understood, if things made sense, and if he had any questions. I remembered that he was frustrated and that I needed to take the time to explain again. It ended up with a good consultation with further exercises, no manual treatment (because he came 10 minutes too late, which gave us only 15 minutes left), and he asked for a new appointment. That made me reflect that he was just frustrated because he came too late, had not done the exercises, was a little too stressed and did not listen to me the first time. Action: Being open-minded, curious, and understanding is, in most cases, the best thing to do when dealing with a frustrated patient.

Communicating with a child patient requires a more straightforward, more engaging approach, using age-appropriate language and visual aids to ensure understanding. Unlike adults, children may struggle to express their symptoms clearly, so asking creative, open-ended questions and using play can help gather important information. Building trust through a friendly and reassuring tone is crucial, as children may feel more anxious in medical settings than adults. One of our lecturers told us that she always has a Teddy bear in her clinic and shows the child how she will treat the Teddy bear before she treats the child. For that reason, I decided also to have a Teddy bear in my clinic. Until yet, I have not used it because my clinic has not many children below 10 years.

I had a patient with headache. During patient history taking it became clear that headache was caused by too little sleeping. It took some time to get the patient to understand that. She was sure that it must be something else. But finally, when she understood and stopped looking on her Iphone during the night she experienced that her headache stopped.

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

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

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I always ask the patient during treatments if they understand or might have further questions. And I inform them that they always are allowed to ask me again next time, if some questions should come up later.

Thanks to the internet. It is easy for my to find information on relevant homepages. Very often I advice patients to those pages to they can obtain more knowledge about their condition. I think it is very important, especiallly in chronic conditions. For example, the official Danish osteoporses homepage gives information about the condition, food, medication, exercises, risk factors, ....

https://www.osteoporose-f.dk

Most patients really appreciate it. Some are already aware of that, but many are not.

I realize that I ask the patient much more often if they understand and accept what I am doing, than I did before.

My patients always receive an e-mail with text and video for their home exercises.

A mother with her 14 years daughter had a lots of question about her daughters heel. It helped her so much that I showed and explained on a foot model.

feedback from ESO year 2 examen:

"Seated assessment, good interaction with the patient, couch was a little low."

AND

"Manner professional and respectful to patient throughout."

Useful to get feedback from another as I cannot evaluate myself.

A patient came with her journal about her hip after an x-ray. She was scared because she could not understand what the x-ray showed. Because I saw how unsafe she felt, I knew it was important for her to understand what was written in her papers. We took some time, and I explained to her what the doctor had written. She had several questions and realised that her condition was not severe. It always surprises me that five minutes of listening to a patient’s fear and thoughts can be powerful and make life much easier for the patient.

During the education, I also learned how important it is to ask about the patient’s expectations. Unfortunately, what patients want is not always obvious. Some are very clear about what they want,  some expect me to decide, and the maybe most “difficult” ones are those where I have to read between the lines. However, I am aware that I am responsible for asking in a way that helps the patient to answer me. Luckily, I have learned coaching techniques and cognitive behaviour therapy, which gives me valuable tools.

I have one patient with sclerosis who challenges my patience. Of course, I know it is probably a part of her disease. And I do my best to help her. Therefore, I researched communication with patients with scleroses and found a helpful article: Improving communication with multiple sclerosis patients (Raed A. Alroughani, Neurosciences Journal April 2015,  20 (2) 95-97; DOI: https://doi.org/10.17712/nsj.2015.2.20140441, accessed on https://nsj.org.sa/content/20/2/95.short

)

The main points are:

·       "a) Gesture: Engagement is key to a successful relationship. Body language and eye contact are pillars when initiating an interaction.

·       b) Effective listening: Listening to reasons why patients seek doctors’ opinions is crucial, since interrupting the patients may break the order of thinking resulting in patient frustration.

·       c) Information and breaking “bad” news: It is important to set the level of information that is given to the patients and caregivers at the first encounter. Any chronic diagnosis is usually considered “bad” by patients, so a stepped approach is advised. Patients and caregivers are interested in receiving the diagnosis, so hampering them with other information may not be effectively registered. Additional family members may be needed to be present when breaking “bad” news.

·       d) Empathy: Physicians are advised to be compassionate and empathic, as most patients are aware of the disability label and social stigma attached to the condition.

·       e) Hope: patients often seek medical opinions looking for a cure, so it is imperative that optimism should be dominating the final comments of the meeting. It is shown that greater hope is associated with better adjustment and coping.2

·       f) Next meeting: Physicians may ask patients to prepare and write down their questions and bring them to the next visit. It is preferred that patients are accompanied by family members to improve the registration of new facts and to provide support and empathy."

The most surprising thing was e). When I started to talk about that, she started crying, and we had a positive dialogue. She had no hope and was scared; I could give her hope. That was a game changer for our work and made our lives much more manageable.

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Velkommen til Osteoporoseforeningens hjemmeside. Læs om symptomer, fakta, tal og statistik. Og hvad du kan gøre for at mindske risikoen for at få knogleskørhed.

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

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

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Before I start any treatment I explain the patient my considerations. Further, I explain what I can offer and let them decide.

Feedback from year 2 examination:

"IVM introduced self and set some expectation. Moved the couch a lot good. Prepared herself with grounding. Honest and took shoes off. Very nice set up for palpation and knew why she was doing it- very good. Very polite to patient. SBS hold was on the sphenoid- good but did have the other bones- will confused. Moved patient to other side because she didn’t like the face hole- very good. Interesting and realistic explanation of a BMT, knew the process, did a good release."

In Denmark it is mandatory to receive consent for the treatment plan. https://stps.dk/sundhedsfaglig/ansvar-og-retningslinjer/sundhedsfaglig-vejledning/journalfoering/journalfoering-for-fysioterapeuter

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

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

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Had some elderly patients where I was concerned if they drink enough water, tea, ... during the day, as their skin was very dry. Asked them and told them why I ask, and why it is important to drink during the day. And gave them some ideas how they can measure how much they drink.

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

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

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I am very much aware that some patients are very easy to communicate with.

While others are more shy and have difficulties expressing themselv.

There are patients from other cultures, which I maybe know nothing about.

People with Alzheimer.

Babies and smal children

people with disabilities (death, blind, physical disabilities)

people with mental diseases

There should always be a way for a good and respectful relationship. Words are not the only way to show respect. Respect is also shown in face- and bodylanguage.

First consultation with an elderly woman. She did not know why her GP send her to me. She did not expect me to be able to help her. Took some time to listen to her considerations and asked her if we should try to find out if I can do anything for her. At the end she was very happy with my examination and explanation and treatment plan. Her GP did not listen to her, but just send her to me. That was the reason for why she did not believe that I could help her.

During ESO modul we had a real patient. Student X and me had to examine a female patient. X was the one who did to take the patient history, examination and treatment. I was the observer. During the patient history taking student X became iritated on the patient, which I could hear in his voice and see on his attitude. After patient history taking we have to leave the room and discus our next step, and discus it with out teacher.

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

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

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13 th October 2022

The GP send a patient to me and recommended shockwave. My clinic doesn´t have shockwave and therefore I informed my new patient that I cannot offer shockwave. My clinic does not offer shockwave because I think there are other opportunities for treatment. I wanted to give the patient the opportunity to stop or continue treatment with me. What I didn´t expext was following answer: "I am so happy to hear that you do not have shockwave. I was so scared and could not understand why my GP recommended shockwave. I did research and I am not convienced that shockwave will help me, and it seems to be painful." The GP did not involve the patient in opportunities. I told the patient what I would do and she agreed, and after 2 treatments she is almost healthy again.

5 th April 2024

In my clinic we produce insoles. Whenever a patient asks me about insoles I tell them that there are lots of solutions: standardized and individually produced. I explain the patient why I have the individually insole in my clinic. And also tell them that I know patients who have advantage of standard insoles.

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

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

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Looking up on official homepages when in doubt about diseases or symptoms. I only use homepages, which are designed for healthcare professionals or offer counseling for patients and have healthcare professionals in their team (eg. The danish "Gigtforeningen").

https://www.sundhed.dk

https://www.gigtforeningen.dk

https://netdoktor.dk

Yesterday, in my physiotherapy clinic, I had a very interesting patient with "classic"  lateral epicondylitis. But after a few minutes it became clear to me, that I have to think "out of the box". My patient has been with a physiotherapist last year, and with limited succes. Then he got three steroid injections with a rheumatologist, with no succes. Therefore, no reason just to treat in the classic way with the danish national guidelines with exercises. I startet to think osteopathy. The patient had a serious accident with the hand 6 months before the lateral epicondylitis startet. I told him my considerations about the connection of fascia, nerves, muscles .... from hand to albow. As I work as a physiotherapist in a physiotherapy clinic I must make sure, that patients accept me to work with osteopathic techniques.

30 th September 2022

First day in second ESO year. Learning new stuff about cranio and about science.

1st October 2022

ESO cranio module: We were divided in two groups in cranio class today. First as a model, afterwards as a therapist. Very interesting to experience so many different therapist hands on my cranium. And very enriching to work and feel som many different craniums in short time.

January 2025

Soon I am an osteopath. Last teaching modul several students and me discussed: "Whats next for you?. I am one of the oldest students in our class. I have done so many courses in physiotherapy every year, a MSc in Physiotherapy, acupuncture, coaching education, Mindfulness, ... and driven a physiotherapy clinic since 2004. Also in my clinic we do at least 4 training sessions every year. It is in my DNA continue learning. And I will continue until I die, because I love my work.

16 th November 2022

Did some reading about MET on neck and had a whiplash patient in mind. Found some interesting testing and treatment of sternocleidomastoideus and scalenes. Practiced it the day after on my patient with great succes.

15 th February 2023: excellent results in two eldery shoulder patients with decreased AROM in shoulder with treatment of the elbow (techniques learned in last ESO seminar for shoulder, elbow and hand). Very surprising for me (because I had so much focus on the shouler) and great for my patients. Treating the shoulder did help, but treating the elbow gave fantastic result!

29 th April 2023: Spend time on Science Direct to research for up-to-date knowledge.

5 th Maj 2023: Refreshing my knowledge about cervical spine on ESO classes. It is always useful to listen to somebody else teaching. And to practice with other physiotherapists and osteopath students, where I get feedback.

3 rd June 2023: Three days with osteopathic teaching at ESO. Lots of useful MET techniques. New knowledge for TMJ, which is very new for me during my physiotherapy career.

25 th June 2023: peer to peer training during ESO module (patient history and examination). Very useful to discuss with teachers and ESO students about how to diagnose, considerations, DD, examinate and treat.

7 th October 2023: useful seminar about pain. And how pain and psychology work together. Inspiration by Bud Craig (book): How do you feel? An interoceptive moment with your neurobiological self". Excellent knowledge which also helps my patients to understand and hopefully also cope with pain.

4 th November 2023: A great teaching weekend with ESO in Copenhagen. Training in diagnoses, differential diagnoses, red flags. As a physiotherapist I am not used to measure bloodpressure, because patients come from the GP. I did not know that blood pressure always should be taken on left side. Didn´t know that.

15 th November 2023: starting to find my research question for the master. Searching on Cochrane, Google scholar, ....

December 2023: continue with reading articles for my master.

Contacted two professionals (an osteopath and a physiotherapist) with strong knowledge for the female pelvic floor.

6 th January 2024: Learned a lot about pelvic floor hypertonicty during my research for the Master protocol. Also contacted three physiotherapists and osteopaths who were specialised in women health.

12 th May 2024: ESO seminar about Osteopathy in sports patients. Very useful to discus cases with other osteopath students and teachers. Get some understanding about the psychological aspects. Further, how for example clothe can influence an athlete. We discussed a real case where a too smal swim suit for openwater longdistance swimmer caused a shoulder problem.

15 th September 2024: year 4 ESO seminar: learned how to handle a baby and treatment in peadiatrics modul. I never managed babies before and always adviced to experienced colleagues. That was an interesting experience. However, we only trained on a doll. Therefore, I would not feel save to treat a real baby.

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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. 

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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. 

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I found it very useful to be in a study group with other osteopat students during the year. They can give me feedback about my handhold, communication and techniques.

3rd February 2023

ESO seminar with a teacher who focus very much on the five models. Asking all the time what is affected when X happens. What else? What to do.

Very good to repeat and reflect on own knowledge.

5 June 2023: Very interesting discussion with a ESO teacher about concerning neckpain and how loss of hear or sight may influence balance.

August 2023: feedback from ESO year 2 examination:

"Wrist osteopathic examination routine - slow to complete, observation routine appropriate, active and passvie assessment applied, included some palpation and medical screening, review understanding and relevance. Carpel Tunnel Syndrome - appropriate tests and range demonstrated, review nerve distribution that you are testing, review knowledge and understanding of the tests, practice tests, appropriate understanding of carpal tunnel. Wrist Articulation techniques - knowledge of carpal bones appropriate but revise them all, correct set up of techniques, practice articulation technique to be more fluid and review how you

use your own body to be more effective, review your explanation of articulation to include descripton of mobility, aims and objectives. HVT C5 Rot L - Supine position, good use of bench height, adequate communication and offered some contraindications for HVT, slow to set up the technique, needs practice to support head and neck more effectively, did not apply correct vectors, force or levarage, review the difference between sidebending and sideshift, review how

to locate C5 effectively - technique was not effective and needs practice. MET Pirifomis - practice set up for Piriformis muscle, review hand holds and leg position, review motion barrier, leverage and force applied. Relax shoulders and review how you use your own body position to improve effectiveness, but appropriate technique demonstated. Generally - need to consider the best position for your self and patient when settin up technique, review focus, force and

leverage when setting up techniques, and locate anatomical landmarks correctly e.g. HVT C5, carpal tunnel"

I realized that I was very stressed during the examination and did a lot of mistakes. In my daily work I would consider myself as a specialist in hand and elbow treatments and therefore I was surprised how affected my nervesystem was during the examination. I forgot my techniques, names, ....

2nd December 2023: Learn to use https://ichd-3.org/ for classification and improve my patient journal.

5 th December 2023: Bought 3 books about differential diagnoses.

2 nd April 2024: Have a young physiotherapist collegue and enjoy her questions about patient treatments. Important to discuss with a collegue and to explain examination and treatment techniques.

January 2025

I am very nervous for the practical examination. And to be honest the feedback is not always useful. I do not recognize my patient handling as it is written in some of the feedback. I acknowledge that my patient handling in a stressful exam situation is not the best. But, I know that I have a positive and empathic patient handling in real situations. Therefore, this feedback does not help me. Some of the censors are friendly, while others have a not-friendly attitude. It does not mean that they are not friendly, but our brain interpret what we see.

Actually, I had a very interesting experience last year when preparing for the examination. Everybody got 15 min "examination training". For the feedback process I asked the censor, who I feel not save with, if I might record the feedback. That was okay with the censor. While I received the feedback and saw the censor in front of me, I got the feeling that I have done so many mistakes and everything was wrong. But later, when I listened to the record with the feedback and without the censors face infront of me, the critique did sound much better. Of course, there were some mistakes, but actually also positive feedback. That surprised me very much and reminds me how powerful our visual impression is, much stronger than what we hear.

(Mayo, L. & Heilig, M. 2019. In the face of stress: Interpreting individual differences in stress-induced facial expressions.

Neurobiol Stress, 20(10):100166. doi: 10.1016/j.ynstr.2019.100166. PMID: 31193535; PMCID: PMC6535645.

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The International Classification of Headache Disorders 3rd edition On behalf of the Classification Committee of The International Headache Society I am proud to present the third edition of the International Classification of Headache Disorders

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

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

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As my data always are in the patient journal system it only takes a few minutes to access them, when I am at work. In case of holiday, there will be an "out of office" answer in my e-mail and patients and insurances will know when I am back again.

In Danmark it is obligatory to write a journal for every treatment.

Patients have the right to see their journal any time they wish.

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

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

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When I have patients where I am seriously concerned for their mental health (stress), I always give them a call at the end of the day to hear how they are. I also advised them to contact a doctor if I could see that they were very stressed.

I was contacted by a patient who asked for treatment with me after a very complicated TMJ operation. I told her that I had no experience with that area. However, she wished for therapy with me. We agreed in case of no improvement after at least three sessions; we would stop treatment with me. However, it worked. Before the appointment, I refreshed my anatomy for the TMJ and muscles around. I also read her journal, giving me more details about the operation.

In my clinic, we sell orthotics. We guarantee satisfaction with the product for 30 days. During that time, we follow up with our patients. When patients are unhappy with the orthotics, we offer correction or a return without discussing it.

Elderly persons with impaired vision or hearing: I follow them closely to ensure they do not fall or walk into tricky corners in my clinic.

Had a patient with non-specific lower back pain. Her reaction to my treatment was not expected. She also told me that her stool has changed in the last few months. She did not think about it and never mentioned it to her GP. It asked her to contact her GP and got her to agree to write to her GP. We made no further appointments, and she will inform me what her GP plans.

Had a patient with too high blood pressure. He has a very stressful job as an accountant, which means that the end of the year is a very stressful period. He contacted me because of a headache and neck-shoulder pain. I was worried about his health and advised him to go to his GP. First, he did not want to listen. Therefore, I started telling him a story from my study time in the neurologic hospital department, where I saw many middle-aged men with strokes. That helped him to understand that high blood pressure can be hazardous. He thanked me and went to the GP. The GP did not order him medication but did a follow-up in the following months. The GP and I made some lifestyle suggestions, hopefully enough to normalise the blood pressure. The patient was not in risc of doing harm to anybody in the clinic, but he could be dangerous when driving a car and be a reason for a car accident.

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

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

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I have agreement with a cleaning company, which does daily cleaning due to a written contract. The company is specialised in healthcare system and knows how cleaning should be done. We have an annual meeting to review if work is done as it should be.

Whenever a couch is used, I use paper to ly on and desinfection of it immediatly after treatment. My patients can always see that desinfection is done.

During Corona (Covid 19) I was very much aware of the changing updates done.

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

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

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I do my best to inform my patients what they seem to miss to achieve better health and wellbeing.

Keep myself update with information. During the last months the Danish Health Authority is doing campaigns for strenght exercising in adult population. As a physiotherapist and osteopath student I inform patients and tell them where they can read more about that. Further, I help them actively to find a suitable solution for them.

https://www.sst.dk/da/nyheder/2023/Styrketraening-er-vigtigt-for-aeldre

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Med alderen får man svagere muskler. Derfor er styrketræning særlig vigtigt, når man kommer op i alderen, så man har kræfter til at klare hverdagens opgaver.

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

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

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I always try to be empathic and friendly. I never make or accept private invitations. When patients ask for my opinion I always do my best to be neutral. And I make it clear that some issues are my personal opinion, and NOT is the same than saying that it is true. I only give my personal opinion in issues which cannot harm. "E.g. I would not run in short pants when it is cold outside because I think it is not healthy for the knees. But it is up to you what you believe."

I try to mirror the patient to "match" the treatment. A sensitiv patient ("pleaser") needs to be safe and built up. Therefore it is important that I am calm and friendly. While a dominant patient in most cases needs a "dominant" therapist. At least in the beginning to make them believing in me.

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

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

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Realized that a patient booked online for treatment of incontinens. When I saw it I gave her a call and informed her that I am not educated in treatment for incontinens and recommanded her to contact a specialist.

in general:

When I have a patient, where I am in doubt and I cannot find a diagnose I always tell and explain my patient. I always offer to write to their GP with my findings and my missing links. This helps my patient hopefully to find another health professional who can help.

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

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

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7 th December 2022 Had a patient who was not satisfied with some orthotics I recommended and sold in my clinic. I listen to the arguments and complaints a few minutes. Make sure that the patient had followed my instructions, which was the case. Accept that the orthotics don´t fit and give money back to the patient. Everybody is happy and we can continue treatment without bad feelings.

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

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

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This is something required from the Danish Healthcaresystem. On my clinics homepage information is given to patients. The homepage includes links to relevant homepages where the patient can read about their rights.

https://www.stpk.dk/borgere/

Building a respectful relationship with a patient is fundamental, ensuring privacy and confidentiality and providing ethical care. I must always handle patient information and data carefully, ensure its protection and share only when necessary and accepted by the patient.

https://gdpr-info.eu

https://standards.osteopathy.org.uk/themes/professionalism/

Furthermore, all clients of the clinic receive a brochure during their first consultation where the information is given, too.

5 th December 2022

A new patient came to me in the waiting area. He was very stressed and talking very loud about his problem. He was not aware that others in the waiting area did response negative by his behaviour. Also for the patients´ private live I got him out from the waiting area into a room where he could talk to me without others could listen to our communication. Even if the patient did not realise what happened, I found it important to ensure his privacy.

6 th January 2024

We had an interesting discussion in ESO teaching about how a patient/student can experience something. Ethical discussion about when someone crosses a personal boarder of somebody. And again I was reminded how important it is to explain the patient what we are going to do for minimizing the risc of misunderstandings.

For example I am very much aware when treating male patients as a woman. I do not like the techniques where my chest is in contact with the patient, like in dok technice for the thoracic spine. Here I ensure a physical distance with using a pillow between my chest and the patients´ body.

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

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

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I enjoy meeting different people. When patients talk in a way without respect for others, then I ask them to change the issue because I do not agree with them. I always avoid talking about politics, religion, sexual orientation and race as it normally is not relevant for the treatment.

11 th February 2024: In my clinic I do writing on the social medias. One of our patients with a physical disability wrote: "You all are so nice and friendly. You always smile. All of you know my name and say Hello to me. I never felt as a number in your clinic." A few days later I met her in the waiting area and had a little chat with her. I thanked her for sharing her experience with our clinic. She told me that it means a lot to her. That made me very happy. To smile is free, but can make another persons so much better. (She was the only patient sitting in the waiting area.)

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

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

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1.4.2023

In my clinic we sell orthotics. We have a satisfaction-guarantee of 30 days on the product. We follow up with our patients in that period. In the cases when the patient is not happy with the orthotics we offer correction or return without discussing.

1.4.2023

It is important to consider my words when doing advertisement in brochures, SOME, ....

https://www.osteopathy.org.uk/standards/guidance-for-osteopaths/advertising/

As osteopath/physiotherapist I am entrusted with the health and well-being of my patients.

Therfore, I have to be aware of my words and actions both in the clinic, but also in other places. For example, how I reflect and talk about my work and clients. I have to be aware to protect the privacy of patients.

I also have to ensure that I keep informed and engaged with current practice and research. Last week I followed a online webinar about osteoporoses. Although I have been working with osteoporoses for many years I decided to participate, because of being aware not to just do routine work. I am a generalist, while the speaker was a specialist and therefore there was a chance that I could learn something new. And actually I became updatet with some medication.

I had some interesting discussions with a rheumatologist I am working very close with. He is interested in the work of the osteopaths and therefore it is nice to discuss different management conditions for certain diseases.

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

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

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Prices for treatments are available on my clinics homepage and in the waiting area.

Furthermore, all new patients receive written information about prices and how to cancel appointments.

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Osteopaths must act with honesty and integrity and uphold high standards of professional and personal conduct to ensure public trust and confidence in the profession. The standards in this theme deal with such issues and behaviours, including the establishment of clear professional boundaries with patients, the duty of candour, and the confidential management of patient information.

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

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

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All my colleagues are aware of patients sitting in the waiting area. Even when we do not know a person, we notice if somebody looks or behaves unusually. Actions, which are taken (of course in relevance to the person’s need): contacting the relevant therapist, offering a glass of water, calling a taxi, ....

Since my osteopathic studies, I have learned about reflection models. My clinic has a monthly meeting where we start reflecting in a group. Some of us present a patient case built on a reflective thinking model. Everybody is urged to enhance their reflective thinking. This is an exciting experience for everybody.

Presented this article to my collegues:

"Reflective practice enhances osteopathic clinical reasoning"

https://www.mendeley.com/catalogue/0d36cb2e-9d11-3f48-b072-41041e171fd1/?ref=raven&dgcid=raven_md_suggest_email&dgcid=raven_md_suggest_mie_email

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Abstract

Background: There has been extensive research of clinical reasoning in health professions, and reflective practice is widely used. However, in the field of osteopathy, clinical reasoning is largely under-researched and the use of structured reflective practice at its early stages. Objective: To understand the broad role of reflective practice on osteopathic clinical reasoning during active delivery of patient care. Method: Using an ethnographic method, the diagnostic and reasoning processes of one osteopath were recorded as they arose. These notes were then expanded to give a description of the interaction with the patient during the clinical encounter. Using autoethnography and reflective practice, the descriptions of the clinical encounters were developed into reflective narratives which were then analysed using elements originating from grounded theory. Results: Reflective practice helps the practitioner become aware of their moment-by-moment osteopathic practice, it triggers the questioning of a practitioner's clinical reasoning, and creates change of practice. Conclusion: This novel study highlights the relevance of reflective practice as a means of monitoring the thinking and reasoning processes in osteopathy. An increase in awareness of clinical reasoning processes could help prevent cognitive and affective biases and possible clinical error. We would argue that reflective practice is a critical tool in maintaining professional competence in osteopathy across a practice lifetime.

Cite

McIntyre, C., Lathlean, J., & Esteves, J. E. (2019). Reflective practice enhances osteopathic clinical reasoning. International Journal of Osteopathic Medicine, 33- 34, 8-15. https://doi.org/10.1016/j.ijosm.2019.07.002

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Reflective practice enhances osteopathic clinical reasoning

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(2019) McIntyre et al. International Journal of Osteopathic Medicine. Background: There has been extensive research of clinical reasoning in health professions, and reflective practice is widely us…

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

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

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My clinic shares rooms with two reumatologists. We have daily discussions about specific conditions. Whenever, we share a patient we also discuss if there a problems (of course, always with the patients consent).

I work a lot with concussion. Cases with eye problems I recommand to contact a neurooptometrist. Cases with Tinnitus I recommand to contact a hearing center specialised in Tinnitus.

In general, I always offer my patients to contact relevant professionals when relevant. In Denmark the patient has to give consent before I am allowed to share information with others. In most cases the patient agree, because they know that it is for optimizing help.

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

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

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Covid 19- time was a time when I realised how vulnerable many elderly and people with chronic diseases are.

In my daily practice, I work close with four physiotherapists, one nurse and two reumathologists. Supporting Health and Well-being in the Workplace

We function as a strong and supportive team, not only in patient care but also in looking out for one another. We check in and offer support if someone appears unwell, whether exhausted or stressed.

As the owner of a physiotherapy clinic, I am particularly mindful of my staff’s well-being. I actively encourage them to take the necessary time to recover when ill. Sometimes, I even suggest an extra day off to ensure they return fully rested. They do the same for me. This creates a positive and reassuring environment where no one feels pressured to return to work too soon. Knowing that our team values health and mutual care fosters a trusting workplace culture.

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

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

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I work in Denmark where the Danish Patient Safety Authority which "authorizes health care professionals, supervise Danish health care professionals and organizations. They also offer health professional and legal advice to authorities and work with learning activities for the Danish health care sector.

Supervision of healthcare facilities

The Danish Patient Safety Authority carries out risk-based supervision of healthcare facilities and elderly care in Denmark. Healthcare facilities can be selected for supervision based on samples among different types of facilities. We also carry out inspections based on specific concerns about healthcare facilities. Supervision of healthcare facilities focuses on the organizations’ ability to ensure patient safety, not individual health professionals.

If we determine that there are risks to patient safety in a healthcare facility, we will take measures proportional to the severity of the risk against the safety of patients.  "

https://en.stps.dk/health-professionals-and-authorities/supervision

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The Osteopathic Practice Standards set out the standards of conduct, ethics and competence required of osteopaths to ensure high-quality care for patients.

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The information you provide to patients on your website, in practice literature, and via social media, service directories and marketing material must comply with the Osteopathic Practice Standards.

In April 2021, we issued a joint message with the Advertising Standards Authority (ASA) and the Committee of Advertising Practice (CAP) to all osteopaths, to reaffirm the standards expected when advertising osteopathy to ensure the protection of patients and the public. Read our joint message

The Advertising Standards Authority

In the UK, all advertising is governed by the ASA. Osteopaths must comply with the ASA's requirements, as set out in the British Code of Advertising, Sales Promotion and Direct Marketing (CAP Code).

What the Osteopathic Practice Standards say

The guidance to Standard D1 of the Osteopathic Practice Standards says:

'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)'.

Guidance on the Committee for Advertising Practice website

CAP produces the advertising code that all UK advertisers must adhere to. The ASA ensures that advertisers comply with the CAP Code.

As an osteopath and a regulated health professional, it is your responsibility to ensure your marketing information, including website content, entries in service directories, posters, practice leaflets and social media promotions, all conform with the ASA's standards.

What can I say on my website?

If you are developing a practice website you need to be aware of the guidance in paragraph 2, standard D1 of the Osteopathic Practice Standards, which is about advertising and publicity. This advises that information on your website needs to meet the requirements of the ASA, including the UK Code of Non-broadcast Advertising, Sales Promotion and Direct Marketing (CAP code).

In particular, the ASA sets out the conditions which it believes osteopaths may say they can help and not adhering to this guidance may give rise to complaints about your website or other patient information being made to the ASA by members of the public.

Standard D1, guidance paragraph 2 also says: 'The information you provide about your professional qualifications, practice arrangements and the services you provide is of a high standard and factually accurate'.

Evidence

Osteopaths should ensure they have a good understanding of the evidence that underpins the advice they give patients. The National Council for Osteopathic Research (NCOR) website is a rich resource of information regarding evidence relating to osteopathic practice and includes evidence summaries. Osteopaths also have free access to a range of research journals in the IJOM Plus package.

ASA guidance on advertising claims about treating babies, children and pregnant women

The ASA has been working closely with the osteopathic profession to produce new guidance about advertising claims that relate to the treatment of babies, children and pregnant women. The guidance - Osteopathy: ASA Review and Guidance for Marketing Claims for Pregnant Women, Children and Babies - has been sent by the GOsC to all osteopaths on the UK Register.

Registrants have been strongly advised to review the information provided on practice websites and other publicity material to ensure their advertising complies with the ASA standards.

Read the ASA guidance and joint letter to osteopaths from the GOsC and ASA/CAP.

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The information you provide to patients on your website, in practice literature, and via social media, service directories and marketing material must comply with the Osteopathic Practice Standards. In April 2021, we issued a joint message with the Advertising Standards Authority (ASA) and the Committee of Advertising Practice (CAP) to all osteopaths, to reaffirm the standards expected when advertising osteopathy to ensure the protection of patients and the public.

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The International Classification of Headache Disorders 3rd edition On behalf of the Classification Committee of The International Headache Society I am proud to present the third edition of the International Classification of Headache Disorders

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Cochrane is a global independent network of researchers, professionals, patients, carers and people interested in health.

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Womens´ health

Pediatrics seminar september 2024

Lecturer teached in the treatment of pregnant women and post-pregnancy as their problems. That was very useful, because there were lots of things I have not been aware before. For example, such as how a birth proces can be a traumatic experience later in a womens live. Especially, when it has been stressful, painful and feeling not to get enough help.

December 2024

Did a lot of reading in physiotherapy book "Der Beckenboden - Funktion, Anpassung und Therapie" R, Tanzberger 2019. The book was recommended to me by a German physiotherapist who is specialised in women´s health. I call or write to her when I have patients with pelvic floor problems, which are not too severe.

5th January 2025 (ERA cycle)

Experience: For the first time, I agreed to see a patient who had been referred to my clinic with urge incontinence and low back pain following surgery for uterine prolapse.

Reflection: Earlier, I did not feel comfortable treating a patient like her and would have recommended her to visit a physiotherapist specialised in pelvic floor disorders. However, the ESO sessions in women's health convinced me that I can offer useful management of the woman's problems with osteopathy.

Action: Before seeing the patient, I re-read my ESO papers (year 4) and discussed them with a study colleague. We talked about how the pelvic floor influences the lower back and the viscera. Additionally, we discussed the importance of the woman having a well-functioning GIT and respiratory/circulatory system to reduce the impact on her pelvic floor. Nonetheless, I still feel I do not know enough when seeing the patient. If my treatment doesn’t help, I will, of course, advise her to consult an expert.

7 th January 2025 (Kolbs experiential model)

Saw the patient mentioned above. However, the patient explained me that she "feels heavy in whole her body when sitting and lying down". Incontinence was not a issue for her anymore.

Reflective observation: I had to forget about many of the examinations and considerations I had done, as her problem actually was something else.

Abstract conceptualization: I asked her to explain me what she experienced in her body. And because things did not make really sense in the beginning, I decided to do an active listening and she was "circeling round", her chest was very tight. Although she seemed to be calm, I realized her breathing was not. She also told me that she felt the sensation of being suffocated. She cannot speak for long time, she cannot sing anymore. She had been seen by plenty of specialist doctors. Everything took a new and unexpected turn. I have been working with trauma during several years and started to consider that with her. I asked her if something had happen or if she felt stressed. She started talking about that she had moved at that time .... I did not force her more that day. However, we had a good communication, her body relaxed during the examination and she left the clinic with a smile.

Active experimentation: It is not sure that there is a big trauma, but also small experiences can affect our live for long time. I explained her that I suggest working with her breathing to calm her nerve system down. We will also work with Craniosacral techniques, and balance exercises and strenghtening exercises. I still wonder what happened to her voice as she said that she cannot sing anymore. Her voice sound very normal. However, something is going on. I will discus with some osteopath collegues in near future. And try to read up in some books. Is it psychologically or is there something pathologic? Due to a specialist in ear-nose-neck doctor nothing is wrong.

In pediatrics seminar with Kok Wim Lem I learned how pregnancy, giving birth, breast feeding, emotions, having a baby influences the mothers body and health.

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Paediatrics

I have been working as a physiotherapist for many years and have established my physiotherapy clinic and routine with adults. In Denmark, it is standard procedure for GPS to refer patients to a physiotherapist specialising in a specific area. Consequently, my clinic was not often contacted by parents seeking treatment. However, when we were contacted, we always referred babies to a specialist, as neither my colleagues nor I had training in the management of infants.

I have never been interested in working with babies, and it is not my plan for the future. However, the pediatric models during the ESO study provided me with valuable insights into how pregnancy, birth, and having a baby can impact a mother’s body and life. It gave me a basic knowledge, but we were not allowed to have a real baby patient. And I never treated a baby before. Therefore, I cannot reflect on a treatment.

However, I still learned a lot. Among other things, I learned how specific issues in adults may originate from their birth, as many problems can take years to manifest and be recognized as such. For example, a difficult pregnancy or birth can impact the baby and later emerge as issues in adulthood. Previously, I was unaware that a birth involving a ventouse or forceps could be a reason for headaches in adulthood. The baby's cranium is soft and vulnerable to any incoming pressure.

During the study, I had fascinating discussions with an osteopath colleague who works with infants. It is intriguing to hear how she approaches treatment. Management involves not only the baby but also the parents and various environmental conditions surrounding the baby.

I treat a few children aged 5+ during the year in my clinic. They come for issues like ankle sprains, fractures, or muscular pain. Children with severe diseases or traumas are referred to children’s hospitals. That is fine with me, but it is not my favorite patient group. However, after the pediatrics course, I learned that some bones (cranium, os sacrum, fibula, clavicula, ...) in children mature at different ages. For example, cranial nerves in the foramen magnum are very vulnerable in a small baby. Therefore, torticollis could indicate a problem with cranial nerve development. As a therapist, one must be aware of the soft spots in the cranium and when they should close. This knowledge can aid me during patient history taking and provide another perspective on the patients’ problems. I do not feel safe treating a baby due to a lack of routine, but I am more aware and have gained knowledge that advises me to refer to a more competent colleague.

I do not have children; therefore, I am probably not very aware of how small children influence adults’ lives. Although I believe I understand how busy life with kids must be, hearing it again was a very useful reminder for me. That gave me a better understanding of the parents I treat. Lack of sleep, sickness, or colic of their baby will affect the parents’ mood, stress, and health. Moreover, the pediatric session was beneficial because I learned more about growth, delicate structures, birth traumas, a baby's needs, feeding difficulties, and guidance for parents.

Although I am not interested in the treatment of infants, I loved the pediatric modules because the teachers were so passionate.

And I wrote the following sentences, which I consider relevant for both children and adults:

·      See and listen, and acknowledge the unsaid things.

·      How does the baby react in place?

·      Which mood are the mother/parents?

·      I must be aware that the baby cannot talk; therefore, it’s important for the parents to explain. However, parents do not always know what information is relevant, which means that I need to understand the pertinent questions. (However, I am not familiar with what to expect, and therefore, I do not feel qualified enough.)

It was wonderful to observe how the teachers managed the babies and parents. This reminds me that one must be passionate about what we do. Regarding osteopaths who are very passionate about working with infants, it highlights that working with infants is not my interest. Furthermore, it is important to update knowledge through further education. Since I am not interested in pediatrics, I would not be updated regularly, as I wish to focus on other fields of interest. However, I was pleased to gain some basic knowledge during the sessions.

Kok Weng Lim was an amazing teacher. He has a routine to evaluate when something is not normal and colleagues he can supervise. But I do not have a routine and no colleagues to discuss with. Given my lack of interest in that area and the absence of a routine and colleagues, I consider it safer for both the patient and me not to treat but to refer to a specialist.

I have worked as a physiotherapist for many years, and I have enough experience to understand that every therapist has a personality that attracts a specific type of patient based on who we are. My strengths (and interests) do not lie in caring for babies and small children—and they never will.

But I respect all humans, and I am passionate about helping. Therefore, I am responsible for advising a patient to the therapist best qualified to help.

www.osteopathy1000.org

www.coursera.org

https://cranialacademy.org

https://www.researchgate.net/profile/Kunaal-Shinde-2/publication/318782529_Factors_influencing_the_likelihood_of_vacuum_delivery_success/links/5ba790cf45851574f7e01dff/Factors-influencing-the-likelihood-of-vacuum-delivery-success.pdf

https://www.stanfordchildrens.org/en/topic/default?id=anatomy-of-the-newborn-skull-90-P01840

https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/healthy-baby/art-20045964

https://www.pregnancybirthbaby.org.au/about-the-fontanelle

https://www.mdpi.com/2227-9032/11/18/2600

https://www.mdpi.com/2227-9032/10/8/1525

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For the year 4 examination, I had to do a poster on a long-term condition. I decided to choose osteoporosis. During the process, I became increasingly aware of how much awareness it requires to write useful and relevant information for patients with osteoporosis.

There were a lot of options and considerations:

Is it for women, for men, or both?

Postmenopause or elderly population?

Patients with other diseases, such as RA? Those patients have a risk of osteoporosis due to medication.   https://pmc.ncbi.nlm.nih.gov/articles/PMC7687316/

Which state of osteoporosis should I address? (osteopenia, osteoporosis)

There are lots of ways to focus on the topic of osteoporosis. I realised that I can be very specific for a population group.

Osteoporosis is one condition, but I learned that it can affect people differently. For example, a younger woman with good balance and mobility has other possibilities for being active than an older woman walking with a rollator.

When creating the poster, I was aware of the terminology I used. Since the poster is intended for patients, I must consider what is important to them, which language they use and understand. This shaped my entire approach.

I enjoyed the process of creating a poster, and I will continue creating posters for my clinic. My patients like this kind of information, which surprised me a lot.

This process reminded me that I take my knowledge for granted: Just because I am familiar with the information, it does not mean everyone else is.

https://www.osteoporose.dk  (Danish homepage for osteoporosis)

https://www.nogg.org.uk/full-guideline (CLINICAL GUIDELINE FOR THE PREVENTION AND TREATMENT OF OSTEOPOROSIS)

https://pubmed.ncbi.nlm.nih.gov/35378630/

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www.osteopathy1000.org

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www.coursera.org

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A patient often asks for my opinion about a specific treatment (e.g., acupuncture, operation, etc.). I can tell what I know from my own experience and ongoing research. I make it clear to the patient when there could be a conflict from my experience and research, for example, with CranioSacral Therapy.

I also inform my patients when my knowledge and experience are limited. In those cases, I always recommend that they do their own research on official homepages or contact relevant healthcare providers. The patient must have the opportunity to get as much relevant information as possible. For example, in surgery cases for non-life-threatening conditions, the patient must decide based on information from different healthcare providers, clinical guidelines, and relevant patient information homepages. For example: https://www.nhs.uk/conditions/osteoarthritis/treatment/

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Sports patient

During year 3, I had to produce a Powerpoint presentation about a sporting patient. It was a very useful process. I saw the patient several times, and I realised that I spent more time on research because of the Powerpoint presentation. That helped me to learn and refresh my knowledge. As a physiotherapist, I have seen plenty of sports patients, and when considering the body and its functions, it is simple. However, when viewing a patient through the 5 osteopathic models, it becomes more exciting and meaningful. For me, it makes sense to have a holistic view of a patient, and my experience is that patients appreciate this. Creating the Powerpoint to visualise the different aspects was beneficial.

In my patient case, I chose a 69-year-old man with rotator cuff tears. I became aware that he still saw himself as a young man. He did not consider that his age influenced his healing process. But when I read about sarcopenia in the elderly, I was able to provide relevant and updated information to him.

It was also useful to discuss the case with some of my osteopath student colleagues. Particularly, one colleague who is very interested in sports patients was new to me: She reminded me of the importance of considering the mental aspect, such as being part of a community when training together with others.

I found it interesting to create the Powerpoint and the presentation. It was a rewarding experience to present it and discuss it with the assessor. This also inspires me for the future to conduct webinars for patients with information about various conditions and how to manage them. I was proud of the feedback I received because I conducted extensive research. I was very pleased with my marks, as I was not afraid of the assessor. I could concentrate on my presentation and had a great discussion experience.

References

SST, Danish Health Authority. 2023. Available at:  https://www.sst.dk/-/media/Udgivelser/2023/Sarkopeni/Tab-af-muskelfunktion-og-muskelmasse-sarkopeni-og-effekten-af-fysisk-traening.ashx

https://www.degruyterbrill.com/document/doi/10.1515/jom-2023-0145/html

https://www.osteoworks.com.au/the-role-of-osteopathy-in-sports-medicine/

https://journals.sagepub.com/doi/abs/10.1177/28.suppl_5.s-10

https://www.sportsfysioterapi.dk/fagligt/fagligt-katalog/skulder/supraspinatus-ruptur/