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

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

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

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

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

Other OPS demonstrated in this reflection: A1., A2., A3., A5., B1., B2., B3., B4., C4., C6.

The following experience was reflected on using reflective model, Schön’s Reflective Practice Model (1983) demonstrating the OPS standards above.

Reflection-in-action

My 92 year old friend and next-door neighbour’s health deteriorated during, Sep ’24 quite alarmingly, beginning with an episode of dysphagia and an extremely productive amount of saliva of a thick, viscous nature [C6]. It was around 8pm just after getting a third through, his very small portion, evening meal and after trying to drink some water that he began to cough I was luckily there when it began as regularly called in on him, I quickly brought him a spitting bowl and a box of tissues. After realising this was not simply a ‘gone down the wrong hole’ situation [B1]. He agreed we should call 111, who requested a GP call back… however the on-call GP did not call until around midnight and did not arrive until 3am [B2]. I remained with my neighbour the whole-time as he does not have any family locally. He described in between choking episodes brought on by any attempt to sip some water. That it felt as strong as spider web. Not like normal saliva. He was producing and spitting out bowlfuls of it drinking any fluid seemed to simply create severe mucus production and consequential choking. I researched for advice, NHS suggests gargling with warm salt water to loosen mucus, I thought that gargling would be too risky as he would choke more if he swallowed it [B3]. I explained that he could try swishing the warm salt water around his mouth to then spit it out he gave it a go, we upgraded the cereal bowl that I had emptied 6 times to a larger vessel. He held and carefully swished the salt water in his mouth for longer periods of time, it began to break down the mucus and after an hour and half of almost constant coughing and producing mucus it calmed down after almost 2 hours of coughing and spitting his symptoms completely stopped and I lightened the atmosphere by pointing out that he will have a solid core after all that coughing [A5]. He did not want to attempt a sip of water whilst waiting for the GP call. The next episode occurred during that GP call when he was asked to take a sip of water so the GP could listen to his 'cough'. I had to take over the conversation with the GP from that point on as my neighbour was unable to speak, whilst being on guard again and preparing for the possibility of scooping the mucus film substance out of his oral cavity and CPR if required [C4]. Thankfully that did not happen as he managed to continue to find the energy to keep coughing and the warm saltwater swishing and remaining calm did the trick again after about half an hour the over-production eased again. When the GP arrived, he listened to my neighbour’s chest and confirmed that his lungs sounded clear. But advised him to go hospital as they have equipment that he doesn’t have at home that can help with choking episodes and they may want to put him on a drip for fluids, the GP described him as moderately dehydrated, I wondered what severe dehydration looked like if his was only moderate. I waited with my neighbour until the non-urgent ambulance that was called arrived at 7am. Although initially reluctant to go to A&E, Max understood the severity of his symptoms and eventually changed his mind agreeing with the GP for an ambulance to be called.

Reflection-on-action

I was able support my neighbour in his time of need, he didn’t initially want to go to hospital, as was awaiting possible spine kyphoplasty and didn’t want to jeopardise the possibility of that not happening, he was a stubborn individual and very scientifically minded [D6]. I told him that my opinion was that he needed to go into hospital, I asked how he proposes he can survive if he were to remain at home without being able to swallow? I also pointed out that the spinal kyphyoplasty operation would not be given a go ahead by the theatre team until this dysphagia situation is solved [A3, D3].

He agreed for me to call 111 to contact that appropriate medical professionals and in accordance with my neighbours wishes; not wanting to go to A&E. I spoke to advocate for my neighbour at the times that he was coughing unable to do so for himself, with him giving consent for them to speak to me, in between coughs, confirmed what I’d answered by nodding, declined by shaking his head and used hand gestures and a note pad and pen to jot things that came to mind down [A2].

After the event my neighbour was in hospital for a further 6 weeks during which time he contracted and fought covid, developed a UTI and also a blood infection from the IV nutrition, all of which he survived, he eventually lost all hope and refused all treatment as there was nothing, the hospital could do to find the cause of his dysphagia due to the inability to swallow any contrast fluids for imaging. Above all they were not prepared to risk surgery for the oesophageal stricture that they found on non-contrast imaging even if imaging was possible and positive for an epiglottis dysfunction there were no surgical options available. Sadly my neighbour passed away early November. Although the whole process was incredibly and overwhelmingly sad, I glad to have been able to help where I could and there was a great deal of honesty and integrity required when updating family members after visits to see him in hospital, breaking upsetting news to close, but not local family members was not easy. It was important to explain just how much their father's condition had deteriorated as they had to decide if they wanted or could make the journeys to visit [D1]. I had direct communication with nurses, consultants and his assigned speech and language therapist, at times helping to translate what he was trying to convey to them, advocating his wishes [D7 & D10].

This experience provided me with insight into urgent and palliative care processes, including how A&E and inpatient wards operate. It strengthened my understanding of healthcare system delays and limitations in both private and NHS care, the complexity of palliative care, and the importance of patient advocacy.

[A1 - demonstrated throughout the experience and B4 - demonstrated by this reflection]

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This reflection mainly encompasses OPS '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.'

'You should be aware of the risks to patients and to yourself of engaging in or developing social or commercial relationships with patients, and the challenges which this might present for the therapeutic relationship and to the expectations of both patient and professional. You should also be aware of the risk of patients developing an inappropriate dependency upon you, and be able to manage these situations appropriately, seeking advice from a colleague or professional body as necessary.'

Also includes the following OPS: A1, B4, C4, D1, D2, D3, D6, D7, D9, D10.

Kolb’s Experiential Learning Cycle (1984) was utilised.

1. Concrete Experience – Encountering a situation.

M Pt age 59, presented with neck pain, his pain had eased, and he recovered after 6 osteopathic treatments; during which he often spoke fondly of his wife. We agreed that he should continue with his exercises and to sign him off. At the end of the appointment, upon leaving I held the door open for him with my right foot, his folder and appointment notes held in my right arm, before going through, he told me how grateful he was to me for helping ease his neck pain [A1], that it’s really helped him sleep better then held his arms out, as I didn’t have my hand shaking arm free, my left arm rose to in response with a half-embrace/light pat on the back. The patient took the opportunity on his return to plant a kiss on my cheek! I brushed it off as a cultural/generational behaviour. But then, whilst approaching the top of the stairs he suggested meeting for a coffee in Maidstone, I laughed nervously and exclaimed “absolutely not, I couldn’t possibly go for a coffee with you, that would be professional misconduct, bye” [D2, D7].

2. Reflective Observation – Reviewing the experience.

It was unexpected, initially I had a surprised response, I wasn't quite sure what to make of it, found myself feeling slightly violated. I began reasoning and rationalising his actions perhaps he has French cultural links, perhaps it’s a generational glitch? [D1, D6] I acknowledged that he was being signed off for his CSP presentation, so I decided it was not worth saying anything directly to him or making it a big deal, but knew I had to put strategies in place to avoid such situations in future [B4, D2]. I did then clarify the patient practitioner boundaries after his request for coffee.

3. Abstract Conceptualisation – Learning from the experience.

Many questions arose during times of mental processing and reflection over the proceeding hours/days/weeks. Were there signs and signals that he was displaying in the treatment room during any previous treatment that I may have not noticed? Of which I could not pinpoint any obvious signs, however; we do not know our patient’s usual mannerisms. Was I, unintentionally, displaying any signs or signals that he may have misconstrued [B4]? I don’t believe I was, but I do have an overly expressive face. I acknowledged that this situation did not feel scary, however with a different patient it could become a scary and potentially dangerous one [C4, D1, D2].

4. Active Experimentation – Applying what was learned.

I quickly decided, no more patient farewells ‘cornered’ in doorways [C4, B4]. I am now always cautious to keep a safe space away from my patients, and try to be less 'smiley' especially to male patients, Of course we are in close contact when patient is on the treatment couch, however the dynamics are different because I’m in full control at those times. I must emit a high state of confidence and always have full control over my treatment room. I will ensure all folders and notes remain on the couch, so my hand is free to hold out at arm’s length to formally and professionally shake theirs to bid them farewell after being signed off [D2]. I will also let them open the door themselves to leave. At the end of the clinic session, I promptly e-mailed the Clinic Manager and Clinic Admin Team leader both were very supportive, I had a face to face discussion with the clinic manager and the admin team leader made it clear on the system that that patient was not to be booked back in with me [D3, C4, D9, D10].

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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.

Reflected upon using the Rolfe et al. (2001) model...

WHAT

Although quite perturbing this safeguarding training gave me a deeper awareness of the signs of threatening behaviour to look for when dealing with the general public.

SO WHAT

It focused on spotting and informing of any safeguarding issues relating to radicalisation, this is people who take extreme measures due to their beliefs to commit or plan violent attacks or groom people to carry out violent attacks on their behalf.

NOW WHAT

As medical professionals we must be able to identify and flag up any concerns if we see signs of radicalisation, if this should arise the practitioner must make a note of the details which led to raised concerns and ensure the appropriate authorities are informed accordingly.

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18 - OS746 - Patient Complaints Assignment, D4

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18 - OS746 - Patient Complaints Assignment, D4

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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.

OPS Mapping: A6, B4, C2, C6, A3, D1, D4, D10 & D12.

I used Rolfe et al. (2001) Reflective Model for this reflection.

What?
In my second year, we had to respond to a fictional patient complaint as part of an assignment. The scenario involved concerns raised by a parent regarding their child’s osteopathic treatment and communication during a consultation. I had to respond empathetically and professionally, while addressing clinical and ethical concerns clearly and supportively.

So what?
This experience helped me understand how essential it is to respond to complaints promptly, respectfully and in alignment with professional guidance [D4]. I also learned the importance of maintaining patient dignity [A6], ensuring clear and accurate documentation [C2], and communicating complex health information in a compassionate, non-judgmental way [A3], [D10].

Writing and re-writting the response several times helped me appreciate how poor communication, even if unintentional, can erode trust. A well-structured response, acknowledging patient concerns and offering transparent clinical reasoning, can restore confidence and build stronger therapeutic relationships [D1 & C6].

Now what?
I will ensure I am familiar with my clinic’s complaint procedures and proactively ensure there are feedback forms in the treatment room to encourage patients to voice concerns [D4]. I will reflect carefully on feedback, remain open to learning from any complaint or suggestion, and take all concerns seriously. Practising how to respond clearly and sensitively to complaints has helped me prepare for future employment interactions where empathy, professionalism, and transparency are crucial when addressing complaints [D12 & B4].

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The main OPS standard relating to this reflection is:

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.

Other OPS demonstrated in this reflection include: B4.

The OPS above are demonstrated in my reflection below, which used the Rolfe et al. (2001) model.

What?

I used the incorrect name for my patient throughout his second appointment.

So What?

The patient’s father pointed out at the end of the appointment that I was using the incorrect name, albeit similar. I felt embarrassed as instantly comprehended that I would not have optimal confidence in a healthcare practitioner who forgot my name! [A1] I also considered whether I‘d made the same mistake with other patients who may have kept quiet; to save the embarrassment and may not have had another person present to call attention to the mistake. [B4]

Now What?

I now write the patients name on the form prior to collecting them from the waiting area, I repeat the name three times in my head whilst doing this to reinforce it in my mind. [A1]

It is duly respectful and polite to address patients by the correct name. [B4}

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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.

My first patient(Pt), F 34, cleaner and mother of three, presented with low back pain and occasional hip pain I realised I am nowhere near as confident and able to swiftly recall information as I'd like to be. Felt flustered a couple of times, I didn't know how to do the quadrant test; my tutor suggested the test, and said "extend, sidebend and rotate". He asked if there's anything I wanted to ask him, at that unprocessed point there wasn't. After initial observation, AROM, PROM, palpation, LEx nuro screen, motor and reflexes, Beighton test for hypermobility, I was racking my brain but couldn't recall ever having covered a 'quadrant test' in a lecture my tutor, long gone by that point. Fortunately Nico was in the room observing I asked him if he remembers having learned it and he said he knew how to do it as has practiced it with a 4th year student. He verbally guided me through, I didn't think to ask my patient to cross her arms during the initial attempt, Nico reminded me to have her arms crossed, so then I had to re-test that side, I apologised to my patient, who was fine about it, a kind natured woman.

My patient experienced increased pain whilst laying prone and supine which limited the type of techniques I could utilise when formulating her treatment plan. I told my tutor that I was unsure exactly what I can do to treat this patient. The tutor was very kind and gently probed to gauge my understanding, leading me to the obvious conclusion that seated or side-lying techniques are my only options. Once I got into the swing of treatment, I was thinking of other tools in my technique toolbox and a few more ideas came to mind which I incorporated. Composed of gentle oscillation with my patients knees in contact with my thigh, whilst my hands were working on soft tissue performing inhibition of lumbar erector spinae, iliocostalis and longissimus.

I was praised by the tutor for good communication with the patient and ability to make the patient feel at ease despite feeling slightly nervous of my first patient encounter.

The days proceeding my first Pt encounter stirred some reflections using the Rolfe et al. (2001) model...

What?

From case history taking and examination, I found that my patient would not be comfortable with laying supine or prone. I struggled to remember any side-laying techniques and at the time could only think of seated mobilisations.

So What?

I discussed with my tutor who gave suggestions for side laying techniques allowing me to devise an appropriate treatment plan.

Now What?

I endeavour to practice with colleagues and expand on my current techniques inventory, ensuring I can derive a treatment plan and deliver appropriate care based on the individual patients needs.

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26 - OS746 - SPADE TOOL Ankylosing Spondylitis, B1

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26 - OS746 - SPADE TOOL Ankylosing Spondylitis, B1

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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.

25/09/2023 Term 1 - Year 3 using Rolfe et al.’s Reflective Model (2001).

WHAT?

Today a fantastic tutor brought to our knowledge the SPADE tool—a clinical screening method used to assist in the diagnosis of Axial Spondyloarthritis (AxSpA) in patients under 45 who have chronic back pain but no definitive radiographic evidence. The discussion highlighted the importance of recognising non-radiographic AxSpA, a diagnosis often missed in clinical settings.

SO WHAT?

This was a valuable learning moment. Previously, I believed diagnosis relied heavily on radiographic evidence. Learning about the SPADE tool challenged that assumption and expanded my clinical reasoning, particularly for patients presenting with persistent back pain and no visible structural changes on imaging. I recognised how easily this condition can be overlooked and how that could delay appropriate referral and treatment, compromising patient care. Furthermore, the symptoms described within the tool matched symptoms my son was displaying which prompted me to specifically request our GP refer him for rheumatological assessment. Due to my knowledge of this tool, we found the disease fairly early and my son was diagnosed with Axial Spondyloartritis and polyarthritis age 17 compared to the average diagnostic age of 24, this underscored the need for vigilance and a comprehensive diagnostic approach beyond imaging [OPS B1]

NOW WHAT?

Going forward, I will incorporate the SPADE tool into my clinical reasoning when assessing patients with chronic back pain, especially under the age of 45. I will also continue to seek out tools and evidence-informed practices that improve diagnostic accuracy and early identification of less obvious conditions.

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The SPADE tool has been designed to assist medical professionals define the probability of axial spondyloarthritis in a patient with chronic back pain, below the age of 45 with no definitive changes on X-ray

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The SPADE tool has been designed to assist medical professionals define the probability of axial spondyloarthritis in a patient with chronic back pain, below the age of 45 with no definitive changes on X-ray

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

Other OPS Mapping: C1, D1, A3, B2, D9 & C5

This reflection used Gibbs' Reflective Cycle (1988).

Description
I received a cover patient but struggled to read the previous student practitioner's handwritten notes. Important details such as diagnosis and treatment plan were unclear, delaying my ability to assess the patient confidently and safely.

Feelings
I felt frustrated by the lack of clarity, and concerned that poor record-keeping could compromise patient care. I was also annoyed at having to spend time finding a tutor who could help decipher the patients' notes - time that should've been spent assessing and treating [C1].

Evaluation
This experience highlighted how illegible and incomplete notes disrupt continuity of care. It also made me aware of the professional responsibility tied to accurate record-keeping and considered if those notes ever had to be used in legal proceedings they may not have provided enough evidence especially to the type of treatment provided [D1].

Analysis
Patient records are not just a formality; they are a legality, clinical tools that communicate critical information. Inadequate notes can reduce patient confidence, delay care, and lead to clinical errors [A3 & B2].

Conclusion
Clear, accurate, and timely documentation is essential to uphold safe practice and professional standards. This experience reinforced how much good record-keeping supports effective, ethical osteopathy.

Action Plan
I will take extra care to ensure all my records are clear, legible, and thorough. I will also raise any unclear notes with tutors to prevent future miscommunication [D9 & C5].

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The main OPS standard relating to this reflection:

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

Other OPS demonstrated in this reflection include: A2, A3, A5, B2, B3, B4, C1, C4, C6, D1, D2.

Using Johns' Model for Structured Reflection (1994)...

What were the significant issues in the experience?

M Pt Age 59, initially presented with neck pain however was deemed untreatable. We referred to his GP on the first appointment due to finding an undiagnosed cardiac arrhythmia upon checking blood pressure and pulse [C1, C4].

How did I feel and why?

Self-doubt. I checked twice and was almost certain I heard an arrhythmia and felt an irregular pulse, as had heard/felt one before. The patient was surprised by the findings, having not been picked up on in any previous medical appointments. I then began to doubt my ears and pulse palpation, so asked my tutor to come and check that I was hearing and feeling things properly, he checked my patients pulse and came to the same conclusion [B2, B4]. My patient was disappointed that he wasn't going to receive treatment. But accepted it with greater ease once my tutor had also confirmed. I next found myself on the delicate ground of carefully navigating patient expectations vs patient education, keeping mindful to minimise information overload [A2, A3]. He acknowledged the importance of following up with his GP and agreed for a letter of referral to his GP suggesting an onward referral to cardiology for their medical opinion on any other necessary tests such as for a 24h heart monitor. At first my patient was surprised, then disappointed, then guided. So hopefully left feeling somewhat supported to balance the disappointment of receiving no treatment [A5, C6].

What influenced my decision-making?

The findings blood pressure examination and pulse, my tutor confirmed my findings. Another consideration of his increased risk of a serious adverse effect (SAE) is high cholesterol. I suggested during the upcoming GP appointment he could explore the possibility of a medication review since it had been over 4 years since the last [C1, C6].

How could I respond differently?

By checking the pulse twice, I demonstrated a lack of confidence in my own ability to read the patient’s blood pressure, thus diminishing the patients trust in me as his practitioner [D1, D2]. I could and should trust my initial findings and only retest if the patient suggests it. Some exceptions to this rule, such as misheard tests due to an external disturbance, which, the patient will have heard too. [B4]

How does this impact future practice?

I will not have a tutor to hand to prove to my patient that my findings are true. By practicing more I will become more confident in my testing abilities and therefore trust the findings, my future patients will have greater confidence and trust in me. Which will encourage them to accept the fact of any disappointing outcome. [B3, D1]

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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.

Reflected upon using the Rolfe et al. (2001) model...

What?

I forgot to inform my patient of where the toilets are.

So What?

My patient would have ask if they need the toilet, polite manners may discourage some patients from asking, not wanting to interrupt the appointment, preferring to wait until after. This would inhibit effective treatment as the patient would feel less able to relax with a full bladder.

Now What?

It is considerate of patient dignity and shows attentiveness to patient comfort, to point out where the toilets are located on initial collection from waiting area. Whilst on the way to the treatment room [A1].

The days of recollection proceeding my first Pt encounter brought up a few reflections: (see one above)

'My first patient (Pt), F 34, cleaner and mother of three, presented with low back pain and occasional hip pain I realised I am nowhere near as confident and able to swiftly recall information as I'd like to be. Felt flustered a couple of times, I didn't know how to do the quadrant test; my tutor suggested the test, and said "extend, sidebend and rotate". He asked if there's anything I wanted to ask him, at that unprocessed point there wasn't. After initial observation, AROM, PROM, palpation, LEx nuro screen, motor and reflexes, Beighton test for hypermobility, I was racking my brain but couldn't recall ever having covered a 'quadrant test' in a lecture my tutor, long gone by that point. Fortunately Nico was in the room observing I asked him if he remembers having learned it and he said he knew how to do it as has practiced it with a 4th year student. He verbally guided me through, I didn't think to ask my patient to cross her arms during the initial attempt, Nico reminded me to have her arms crossed, so then I had to re-test that side, I apologised to my patient, who was fine about it, a kind natured woman.

My patient experienced increased pain whilst laying prone and supine which limited the type of techniques I could utilise when formulating her treatment plan. I told my tutor that I was unsure exactly what I can do to treat this patient. The tutor was very kind and gently probed to gauge my understanding, leading me to the obvious conclusion that seated or side-lying techniques are my only options. Once I got into the swing of treatment, I was thinking of other tools in my technique toolbox and a few more ideas came to mind which I incorporated. Composed of gentle oscillation with my patients knees in contact with my thigh, whilst my hands were working on soft tissue performing inhibition of lumbar erector spinae, iliocostalis and longissimus.

I was praised by the tutor for good communication with the patient and ability to make the patient feel at ease despite feeling slightly nervous of my first patient encounter. '

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11 - OS746 - An Accidental Data Breech, C3

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11 - OS746 - An Accidental Data Breech, C3

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

Other OPS demonstrated: D1, D5, A1 & C5

Reflected upon using the Rolfe et al. (2001) model...

What?
After clinic, I nearly took signed patient notes home on my clipboard instead of returning them to the file. I realised this when I got to my car and saw the patients appointment notes in my bag, whilst getting my keys out. I immediately returned to clinic and securely filed the documents.

So what?
This incident reminded me of the importance of safeguarding patient records and ensuring they are accessible when needed. Had I failed to realise and accidentally taken them home, the patient could have returned or a tutor requested them, I would have been unable to comply promptly [C3 & D1]. It also highlighted the need for vigilance when handling confidential data [D5].

Now what?
I will develop a routine of immediately filing notes after tutor sign-off and double-checking my clipboard before leaving clinic. This will ensure I respond effectively to documentation needs and maintain patient trust [A1 & C5].

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3 - OS746 - A Scary Situation, A1, A2, A3 & A5

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3 - OS746 - A Scary Situation, A1, A2, A3 & A5

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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.

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.

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

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

Relevant aspects relating to OPS 'communication and patient partnership' are highlighted.

Other OPS demonstrated in this reflection: B1., B2., B3., B4., C4., C6., D1., D3., D6., D7., D10.

The following experience was reflected on using reflective model, Schön’s Reflective Practice Model (1983).

Reflection-in-action

My 92 year old friend and next-door neighbour’s health deteriorated during, Sep ’24 quite alarmingly, beginning with an episode of dysphagia and an extremely productive amount of saliva of a thick, viscous nature [C6]. It was around 8pm just after getting a third through, his very small portion, evening meal and after trying to drink some water that he began to cough I was luckily there when it began as regularly called in on him, I quickly brought him a spitting bowl and a box of tissues. After realising this was not simply a ‘gone down the wrong hole’ situation [B1]. He agreed we should call 111, who requested a GP call back… however the on-call GP did not call until around midnight and did not arrive until 3am [B2]. I remained with my neighbour the whole-time as he does not have any family locally. He described in between choking episodes brought on by any attempt to sip some water. That it felt as strong as spider web. Not like normal saliva. He was producing and spitting out bowlfuls of it drinking any fluid seemed to simply create severe mucus production and consequential choking. I researched for advice, NHS suggests gargling with warm salt water to loosen mucus, I thought that gargling would be too risky as he would choke more if he swallowed it [B3]. I explained that he could try swishing the warm salt water around his mouth to then spit it out he gave it a go, we upgraded the cereal bowl that I had emptied 6 times to a larger vessel. He held and carefully swished the salt water in his mouth for longer periods of time, it began to break down the mucus and after an hour and half of almost constant coughing and producing mucus it calmed down. After almost two hours of coughing and spitting his symptoms completely stopped, I lightened the atmosphere by pointing out that he will have a solid core after all that coughing [A5]. He did not want to attempt a sip of water whilst waiting for the GP call. The next episode occurred during that GP call when he was asked to take a sip of water so the GP could listen to his 'cough'. I had to take over the conversation with the GP from that point on as my neighbour was unable to speak, whilst being on guard again and preparing for the possibility of scooping the mucus film substance out of his oral cavity and CPR if required [C4]. Thankfully that did not happen as he managed to continue to find the energy to keep coughing and the warm saltwater swishing and remaining calm did the trick again after about half an hour the over-production eased again. When the GP arrived, he listened to my neighbour’s chest and confirmed that his lungs sounded clear. But advised him to go hospital as they have equipment that he doesn’t have at home that can help with choking episodes and they may want to put him on a drip for fluids, the GP described him as moderately dehydrated, I wondered what severe dehydration looked like if his was only moderate. I waited with my neighbour until the non-urgent ambulance that was called arrived at 7am. Although initially reluctant to go to A&E, Max understood the severity of his symptoms and eventually changed his mind agreeing with the GP for an ambulance to be called.

Reflection-on-action

I was able support my neighbour in his time of need, he didn’t initially want to go to hospital, as was awaiting possible spine acromioplasty and didn’t want to jeopardise the possibility of that not happening, he was a generous and kind but stubborn individual and very scientifically minded [D6]. I told him that my opinion was that he needed to go into hospital, I asked how he proposes he can survive if he were to remain at home without being able to swallow? I also pointed out that the spinal kyphyoplasty operation would not be given the go ahead by the theatre team until this dysphagia situation is solved [A3, D3].

He agreed for me to call 111 to contact that appropriate medical professionals and in accordance with my neighbours wishes; not wanting to go to A&E. I spoke to advocate for my neighbour at the times that he was coughing unable to do so for himself, with him giving consent for them to speak to me, in between coughs, confirmed what I’d answered by nodding, declined by shaking his head and used hand gestures and a note pad and pen to jot things that came to mind down [A2].

After the event my neighbour was in hospital for a further 6 weeks during which time he contracted and fought covid, developed a UTI and also a blood infection from the IV nutrition, all of which he survived, he eventually lost all hope and refused all treatment as there was nothing, the hospital could do to find the cause of his dysphagia due to the inability to swallow any contrast fluids for imaging. Above all they were not prepared to risk surgery for the oesophageal stricture that they found on non-contrast imaging even if imaging was possible and positive for an epiglottis dysfunction there were no surgical options available. Sadly my neighbour passed away early November. Although the whole process was incredibly and overwhelmingly sad, I glad to have been able to help where I could and there was a great deal of honesty and integrity required when updating family members after visits to see max in hospital, breaking upsetting news to close but not local family members was not easy but it was important to explain just how much Max's condition had deteriorated as they had to decide if they wanted or could make the journeys to visit [D1]. I had direct communication with nurses, consultants and his assigned speech and language therapist, at times helping to translate what he was trying to convey to them, advocating his wishes [D7 & D10].

This experience provided me with insight into urgent and palliative care processes, including how A&E and inpatient wards operate. It strengthened my understanding of healthcare system delays and limitations in both private and NHS care, the complexity of palliative care, and the importance of patient advocacy.

[A1 - demonstrated throughout the crisis, I considerately and courteously treated my neighbour with compassion and sensitivity. B4 - demonstrated by this reflection]

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13 - OS746 - A Scary Situation C4 & C6. 

# data[].attributes.subject
13 - OS746 - A Scary Situation C4 & C6. 

# data[].attributes.body
C4. You must take action to keep patients from harm.

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

Other OPS demonstrated in this reflection: A1., A2., A3., A5., B1., B2., B3., B4, D1., D3., D6., D7. & D10.

The following experience was reflected on using reflective model, Schön’s Reflective Practice Model (1983) demonstrating the OPS standards above.

Reflection-in-action

My 92 year old friend and next-door neighbour’s health deteriorated during, Sep ’24 quite alarmingly, beginning with an episode of dysphagia and an extremely productive amount of saliva of a thick, viscous nature [C6]. It was around 8pm just after getting a third through, his very small portion, evening meal and after trying to drink some water that he began to cough I was luckily there when it began as regularly called in on him, I quickly brought him a spitting bowl and a box of tissues. After realising this was not simply a ‘gone down the wrong hole’ situation [B1]. He agreed we should call 111, who requested a GP call back… however the on-call GP did not call until around midnight and did not arrive until 3am [B2]. I remained with my neighbour the whole-time as he does not have any family locally. He described in between choking episodes brought on by any attempt to sip some water. That it felt as strong as spider web. Not like normal saliva. He was producing and spitting out bowlfuls of it drinking any fluid seemed to simply create severe mucus production and consequential choking. I researched for advice, NHS suggests gargling with warm salt water to loosen mucus, I thought that gargling would be too risky as he would choke more if he swallowed it [B3]. I explained that he could try swishing the warm salt water around his mouth to then spit it out he gave it a go, we upgraded the cereal bowl that I had emptied 6 times to a larger vessel. He held and carefully swished the salt water in his mouth for longer periods of time, it began to break down the mucus and after an hour and half of almost constant coughing and producing mucus it calmed down after almost 2 hours of coughing and spitting his symptoms completely stopped and I lightened the atmosphere by pointing out that he will have a solid core after all that coughing [A5]. He did not want to attempt a sip of water whilst waiting for the GP call. The next episode occurred during that GP call when he was asked to take a sip of water so the GP could listen to his 'cough'. I had to take over the conversation with the GP from that point on as my neighbour was unable to speak, whilst being on guard again and mentally preparing for the possibility of scooping the mucus film substance out of his oral cavity and CPR if required [C4]. Thankfully that was not needed as he managed to continue to find the energy to keep coughing and the warm saltwater swishing and remaining calm did the trick again after about half an hour the over-production eased again. When the GP arrived, he listened to my neighbour’s chest and confirmed that his lungs sounded clear. But advised him to go hospital as they have equipment that he doesn’t have at home that can help with choking episodes and they may want to put him on a drip for fluids, the GP described him as moderately dehydrated, I wondered what severe dehydration looked like if his was only moderate. I waited with my neighbour until the non-urgent ambulance that was called arrived at 7am. Although initially reluctant to go to A&E, Max understood the severity of his symptoms and eventually changed his mind agreeing with the GP for an ambulance to be called.

Reflection-on-action

I was able support my neighbour in his time of need, he didn’t initially want to go to hospital, as was awaiting possible spine acromioplasty and didn’t want to jeopardise the possibility of that not happening, he was a stubborn individual and very scientifically minded [D6]. I told him that my opinion was that he needed to go into hospital, I asked how he proposes he can survive if he were to remain at home without being able to swallow? I also pointed out that the spinal kyphyoplasty operation would not be given a go ahead by the theatre team until this dysphagia situation is solved [A3, D3].

He agreed for me to call 111 to contact that appropriate medical professionals and in accordance with my neighbours wishes; not wanting to go to A&E. I spoke to advocate for my neighbour at the times that he was coughing unable to do so for himself, with him giving consent for them to speak to me, in between coughs, confirmed what I’d answered by nodding, declined by shaking his head and used hand gestures and a note pad and pen to jot things that came to mind down [A2].

After the event my neighbour was in hospital for a further 6 weeks during which time he contracted and fought covid, developed a UTI and also a blood infection from the IV nutrition, all of which he survived, he eventually lost all hope and refused all treatment as there was nothing, the hospital could do to find the cause of his dysphagia due to the inability to swallow any contrast fluids for imaging. Above all they were not prepared to risk surgery for the oesophageal stricture that they found on non-contrast imaging even if imaging was possible and positive for an epiglottis dysfunction there were no surgical options available. Sadly my neighbour passed away early November. Although the whole process was incredibly and overwhelmingly sad, I glad to have been able to help where I could and there was a great deal of honesty and integrity required when updating family members after visits to see max in hospital, breaking upsetting news to close but not local family members was not easy but it was important to explain just how much Max's condition had deteriorated as they had to decide if they wanted or could make the journeys to visit [D1]. I had direct communication with nurses, consultants and his assigned speech and language therapist, at times helping to translate what he was trying to convey to them, advocating his wishes [D7 & D10].

This experience provided me with insight into urgent and palliative care processes, including how A&E and inpatient wards operate. It strengthened my understanding of healthcare system delays and limitations in both private and NHS care, the complexity of palliative care, and the importance of patient advocacy.

[A1 - demonstrated throughout the experience and B4 - demonstrated by this reflection]

# data[].attributes.body
Main OPS A4. You must receive valid consent for all aspects of examination and treatment and record this as appropriate.

Additionally features OPS: A1, A2, A3, A5, A7, B2, C2, C4, D4, D9, D10

Clinical reflection using Gibbs' Reflective Cycle

Description

My patient, a 54-year-old woman, presented with chronic low back pain and right lateral thigh pain. She had previously undergone a discectomy at L3/L4 and L5 after a traumatic injury while working as an air stewardess in 1994. She has been incontinent since the incident and wears an ankle-foot orthosis due to left-sided foot drop.

At her initial appointment, she was in significant distress, unable to sit or stand for long. I took her case history while she moved around the room, listening attentively and adapting my communication to her needs [A1, A2]. Examination revealed pelvic torsion and sacral dysfunction. My tutor demonstrated a sacral toggle technique, and I followed with lumbar decompression and soft tissue work. The patient reported reduced pain and was very pleased with the session. Her consent was obtained throughout, verbally and through explanation of each step [A4].

At the follow-up, the patient returned to clinic under a different tutor, who had a strongly exercise-based and educational approach to chronic pain. The tutor dismissed the previous sacral-focused diagnosis and directed that no manual therapy be used. Instead, the patient was encouraged to engage in core strengthening exercises and pain distraction techniques. She was not explicitly informed of this major shift in approach, nor was she given the opportunity to consent to it [A4, A1].

In the team room away from the patient, I tried to advocate for a blended approach but was instructed not to offer hands-on treatment. The tutor took the helm when we reentered the treatment room the patient reluctantly followed the exercises the tutor instructed her to do, whilst wincing and voicing discomfort. After my tutor left the session, she expressed concern to me about her ability to get out of the car once home due to pain, I asked if she had any neighbours, friends or family who could meet her at the car to offer support and encouraged ice or heat packs to help ease her pain. She later called the clinic, clearly distressed by the lack of treatment she had expected and consented to previously [D4, C4].

Feelings

Initially, I felt confident and satisfied with my patient care and communication. However, I became uncomfortable and conflicted in the follow-up session when the tutor enforced a new treatment approach without accommodating the patient's preferences or obtaining renewed consent. I felt it was not aligned with the patient's expectations or comfort [A4, A1].

Evaluation

The initial appointment was successful due to strong communication, tailored treatment, and continuous consent-seeking [A1–A4]. The second session lacked transparency. The shift in treatment philosophy was not properly explained or discussed with the patient, and no specific consent was sought for a radically different therapeutic approach. This led to distress and loss of trust [A4, D4].

Analysis

Consent is an ongoing, dynamic process. It is not a one-time agreement. The second tutor’s approach did not respect the need for informed, ongoing consent when changing treatment strategy. While exercise and pain education are evidence-informed, they should not replace collaborative discussion with the patient about treatment preferences. The situation highlighted how consent is not just procedural but relational, built on trust, clarity, and shared decision-making [A4, A2, A5].

Conclusion

This case illustrated how easily consent can be undermined when patient expectations are not managed and communication is overlooked. A treatment model, no matter how evidence-based, must still be tailored to the individual and agreed upon by the patient. I recognised the ethical and clinical importance of ensuring informed consent at every point of care [A4].

Action Plan

In future:

I will ensure that any significant change in treatment approach is clearly explained and that the patient’s consent is sought again [A4, A3].

I will advocate for patient understanding and choice, even when under supervision [B2, D10].

I will document not just verbal consent but also any expressions of discomfort or dissatisfaction [C2].

I will use my voice confidently when I feel patient autonomy is being compromised [A7, D9].

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5 - OS746 - Request for female practitioner, A6

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5 - OS746 - Request for female practitioner, A6

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

This reflection also incorporates OPS: A1, A2, A4, B4, C1 & D9.

A reflection about, my long-standing 'maintenance' patient a handover from a previous forth year, who is diagnosed with polymyalgia rheumatica. She feels uneasy being undressed with a male present and specifically requests a female practitioner for her thoracic spine and shoulder complaint.

I used Driscoll’s reflective model (1994) in the reflection below.

What?
Although I was able to accommodate being a female practitioner, no female tutors were present in clinic. I informed my patient of who my tutor was "Mr. (Tutor's name)." She appeared reluctant to undress, concerned the male tutor might enter. I reassured her she didn’t need to undress and could redress at any point, such as when my tutor enters. She agreed and was comfortable with this arrangement.

So what?
This situation made me reflect on the importance of recognising and respecting a patient’s modesty and cultural or personal preferences [A6]. By offering choice and reassurance, I preserved her autonomy and upheld her dignity [A1], [A2]. It also reminded me of the value of clear, sensitive communication and informed consent [A4].

Now what?
In future, I will continue to be responsive to non-verbal cues and patient preferences, especially around undressing or exposure. I will always clarify that undressing is optional and support patients in maintaining control of their environment [B4], [C1]. Where tutor presence may impact comfort, I will communicate and advocate appropriately [D9].

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14 - OS746 - Safeguarding Training FGM Awareness, C4

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14 - OS746 - Safeguarding Training FGM Awareness, C4

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A serious reflection about recognising and taking action on suspicion of female genital mutilation; relating to OPS: 'C4. You must take action to keep patients from harm.'

Other OPS demonstrated in this reflection are: A2, A3, B1, B4, C6, D1, D6.

I used Gibbs' Reflective Cycle (1988) to structure this reflection:

Description

During my first year of study, I completed safeguarding training on Female Genital Mutilation (FGM), which is a critical issue for primary healthcare professionals, including osteopaths. The training covered how to recognise signs of FGM, how to communicate sensitively with potential victims, and the steps required to report concerns. I learned that the current safeguarding lead at ESO is Natalie Pipe, and any suspicions should be reported to her [C4, D5].

Feelings

Initially, I felt somewhat anxious about approaching such a serious and sensitive subject, unsure how I would handle it in practice. However, the training made me feel more confident and prepared. I realised how important it is not to avoid difficult conversations when a patient's wellbeing may be at risk. [A2, D1]

Evaluation

The training was highly beneficial. It helped me understand both the clinical indicators of FGM and the legal and ethical responsibilities I have as a healthcare professional. It gave me practical tools on how to open up such discussions sensitively and non-judgementally. [B1, A3]

Analysis

Recognising FGM is not only a clinical responsibility but a legal and ethical one. I now understand the pathway for reporting concerns and the importance of acting promptly but respectfully. Communication must be culturally sensitive and non-threatening, while safeguarding remains a priority. [D6, C6]

Conclusion

I now feel better equipped to identify and respond to potential FGM cases. This training has enhanced my awareness of the indicators, improved my confidence in handling safeguarding conversations, and made clear the professional boundaries and legal duties involved. [B4]

Action Plan

If I suspect FGM in a future patient, I will follow safeguarding protocols by reporting concerns to the ESO safeguarding lead, Natalie Pipe, or to whomever the safeguarding lead in any prospective clinic may be. I will also continue developing my communication skills around sensitive topics and refresh safeguarding knowledge regularly [B3, C4].

# data[].attributes.body
B1. You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.

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

Other OPS also demonstrated: A1, C1, D9, D10.

My first patient (Pt) age 34, a cleaner and mother of three. Presented with low back pain and occasional hip pain. I realised I am unable to swiftly recall information; such as appropriate special tests, therefore am not as confident as I'd like to be. I felt flustered a couple of times, once when I didn't know how to do the quadrant test; my tutor suggested the test, and said "extend, sidebend and rotate", then asked if there is anything, I wanted to ask him, at that unprocessed point there wasn't; so I said no. After initial observation, AROM, PROM, palpation, LEx nuro screen, motor and reflexes, Beighton test for hypermobility, I was racking my brain but couldn't recall ever having covered a 'quadrant test' in a lecture my tutor, long gone by that point. Fortunately Nico was in the room observing I asked him if he remembers having learned it and he said he knew how to do it as has practiced it with a 4th year student. He verbally guided me through. I didn't think to ask my patient to cross her arms during the initial attempt, Nico reminded me to have her arms crossed, so then I had to re-test the original side. I apologised to my patient and asked to try again with arms crossed, she was happy to oblige, a pleasant natured woman.

Pre-treatment the tutor and I discussed limitations of treatment options available, due to my patient experiencing pain whilst laying prone and also laying supine so that and I struggled to formulate an appropriate treatment plan. I told my tutor that I was unsure exactly what I can do. The tutor was very kind and gently probed to gauge my understanding, leading me to the obvious conclusion that seated or side-lying techniques are my only options. Once I got into the swing of treatment, I was thinking of other tools in my technique toolbox and a few more ideas came to mind which I incorporated. Composed of gentle oscillation with my patients knees in contact with my thigh, whilst my hands were working on soft tissue performing inhibition of lumbar erector spinae, iliocostalis and longissimus.

I was praised by the tutor for good communication with the patient and ability to make the patient feel at ease despite feeling slightly nervous of my first patient encounter.

The days proceeding my first Pt encounter stirred some reflections using the Rolfe et al. (2001) model...

What?

I did not re-test after the treatment.

So What?

How can my patient or I gauge how well the treatment is working for them if we don't have a comparison?

Now What?

I must remember to re-test to enable comparison of progress, or to establish whether there is any increase in severity of symptoms. The patient is likely to feel confident in their practitioner and that they have received value for money, when they can see clear progressive results or transparency when it is beyond their Osteopath's scope of practice and they are signposted to appropriate continued care if symptoms do not improve [B1].

What?

I did not seek my tutor to ask for their advice relating to the quadrant test; instead, I'd relied on my colleague. I should have thought to have asked my tutor to stay and assess/correct my technique while performing the test, then would have utilised my tutor's knowledge at the appropriate time. After the clinic session I researched and learned that the arms do not have to be crossed during the extension and side-bending movement of the quadrant test and realised that I had not achieved full lumbar extension [B2].

So What?

The test is likely to have had false negatives as my technique was incorrect.

Now What?

Subsequently; this reflection however prompted me to ask during my next clinic session to check I performed the test correctly. I was glad to have checked with a tutor as I was not being as specific as required and was applying the vectors in a step by step fashion, rather than a fluid motion incorporating extension, side bending and rotation [D10, D9].

What?

I forgot to take the Pt's BP which should be included in every 1st patients examination routine [B2].

So What?

Hypertension, arrhythmia or any other cardiac pathology may have serious implications which would affect treatment choice. I cannot be sure my patient is safe to use certain techniques on, such as C-spine adjustments, unless I've taken their blood pressure along with a thorough case history.

Now What?

I promptly took Pt's BP at next follow up [C1]. To mitigate risk I will get into a habit of prioritising blood pressure reading above all other examination, for every new patient who is deemed safe to examine. Consideration of recent INR readings for any patients who may be taking anticoagulants such as warfarin should be taken into account before blood pressure is taken due to increased risk of haemorrhage. Between 2.0 and 3.0 is an effective therapeutic range for people taking meds such as warfarin. In people without health conditions, an INR of 1.1 or below is considered typical. While levels above 4.9 are considered critical (NICE 2025) [B2, C1].

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8 - OS746 - A Scary Situation, B1, B2, B3 & B4

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8 - OS746 - A Scary Situation, B1, B2, B3 & B4

# data[].attributes.body
B1. You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.

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

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

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

Other OPS Demonstrated in this reflection A1., A2., A3., A5., C4., C6., D1., D3., D6., D7., D10.

The following experience was reflected on using reflective model, Schön’s Reflective Practice Model (1983) demonstrating the OPS standards above.

Reflection-in-action

My 92 year old friend and next-door neighbour’s health deteriorated during, Sep ’24 quite alarmingly, beginning with an episode of dysphagia and an extremely productive amount of saliva of a thick, viscous nature [C6]. It was around 8pm just after getting a third through, his very small portion evening meal and after trying to drink some water. He began to cough and seemed to be choking on the over production of thick mucus saliva. After realising this was not simply a ‘gone down the wrong hole’ situation [B1]. I quickly brought him a spitting bowl and a box of tissues. He agreed we should call 111, who requested a GP call back… however the on-call GP did not call until around midnight and did not arrive until 3am [B2]. I remained with my neighbour the whole-time as he does not have any family locally. He described in between choking episodes brought on by any attempt to sip some water. That it felt as strong as spider web. Not like normal saliva. He was producing and spitting out bowlfuls of it drinking any fluid seemed to simply create severe mucus production and consequential choking. I researched for advice, NHS suggests gargling with warm salt water to loosen mucus, I thought that gargling would be too risky as he would choke more if he swallowed it [B3]. I explained that he could try swishing the warm salt water around his mouth to then spit it out he gave it a go, we upgraded the cereal bowl that I had emptied 6 times to a larger vessel. He held and carefully swished the salt water in his mouth for longer periods of time, it began to break down the mucus and after an hour and half of almost constant coughing and producing mucus it calmed down after almost 2 hours of coughing and spitting his symptoms completely stopped and I lightened the atmosphere by pointing out that he will have a solid core after all that coughing [A5]. He did not want to attempt a sip of water whilst waiting for the GP call. The next episode occurred during that GP call when he was asked to take a sip of water so the GP could listen to his 'cough'. I had to take over the conversation with the GP from that point on as my neighbour was unable to speak, whilst being on guard again and preparing for the possibility of scooping the mucus film substance out of his oral cavity and CPR if required [C4]. Thankfully that did not happen as he managed to continue to find the energy to keep coughing and the warm saltwater swishing and remaining calm did the trick again after about half an hour the over-production eased again. When the GP arrived, he listened to my neighbour’s chest and confirmed that his lungs sounded clear. But advised him to go hospital as they have equipment that he doesn’t have at home that can help with choking episodes and they may want to put him on a drip for fluids, the GP described him as moderately dehydrated, I wondered what severe dehydration looked like if his was only moderate. I waited with my neighbour until the non-urgent ambulance that was called arrived at 7am. Although initially reluctant to go to A&E, Max understood the severity of his symptoms and eventually changed his mind agreeing with the GP for an ambulance to be called.

Reflection-on-action

I was able support my neighbour in his time of need, he didn’t initially want to go to hospital, as was awaiting possible spine acromioplasty and didn’t want to jeopardise the possibility of that not happening, he was a stubborn individual and very scientifically minded [D6]. I told him that my opinion was that he needed to go into hospital, I asked how he proposes he can survive if he were to remain at home without being able to swallow? I also pointed out that the spinal kyphyoplasty operation would not be given a go ahead by the theatre team until this dysphagia situation is solved [A3, D3].

He agreed for me to call 111 to contact that appropriate medical professionals and in accordance with my neighbours wishes; not wanting to go to A&E. I spoke to advocate for my neighbour at the times that he was coughing unable to do so for himself, with him giving consent for them to speak to me, in between coughs, confirmed what I’d answered by nodding, declined by shaking his head and used hand gestures and a note pad and pen to jot things that came to mind down [A2].

After the event my neighbour was in hospital for a further 6 weeks during which time he contracted and fought covid, developed a UTI and also a blood infection from the IV nutrition, all of which he survived, he eventually lost all hope and refused all treatment as there was nothing, the hospital could do to find the cause of his dysphagia due to the inability to swallow any contrast fluids for imaging. Above all they were not prepared to risk surgery for the oesophageal stricture that they found on non-contrast imaging even if imaging was possible and positive for an epiglottis dysfunction there were no surgical options available. Sadly my neighbour passed away early November. Although the whole process was incredibly and overwhelmingly sad, I glad to have been able to help where I could and there was a great deal of honesty and integrity required when updating family members after visits to see max in hospital, breaking upsetting news to close but not local family members was not easy but it was important to explain just how much Max's condition had deteriorated as they had to decide if they wanted or could make the journeys to visit [D1]. I had direct communication with nurses, consultants and his assigned speech and language therapist, at times helping to translate what he was trying to convey to them, advocating his wishes [D7 & D10].

This experience provided me with insight into urgent and palliative care processes, including how A&E and inpatient wards operate. It strengthened my understanding of healthcare system delays and limitations in both private and NHS care, the complexity of palliative care, and the importance of patient advocacy.

[A1 - demonstrated throughout the experience and B4 - demonstrated by this reflection]

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6 - OS746 - An Insightful Tutor Led Conversation, A7

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6 - OS746 - An Insightful Tutor Led Conversation, A7

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

OPS also touched on: A1, A2, A6, B2, B4, D2, & D9

Reflected upon using Driscoll’s Model (1994) – ‘What?’ Model

What? During a tutor-led team discussion in clinic, we explored our professional obligation to provide care without discrimination, including treating patients regardless of gender, race, or personal history. The conversation deepened into an ethical debate about how we might respond if we discovered that a patient had a criminal history, such as a conviction for murder or sexual offences, even if they had served their sentence. One tutor shared a personal experience of discovering in a newspaper that a long-term patient of his had been convicted of rape, which brought this issue into real-life focus [A7 & D2].

So what?

This prompted me to reflect deeply on my own values, potential biases, and emotional responses. As osteopaths, we will inevitably encounter patients from all walks of life. It is essential that I examine how my personal feelings might affect the standard of care I deliver [A7].

While I believe I can treat all patients respectfully and without overt prejudice [A1], this discussion stirred strong emotional responses, especially around patients with histories of serious offences. I recognised that although I might act professionally on the surface, internal discomfort, such as fear, anxiety, or moral conflict, could subconsciously influence the quality of my patient interactions [B4].

This reflection reinforced the importance of recognising when my own values might conflict with my duty of care. It also helped me realise that non-judgemental care does not mean suppressing legitimate concerns, but managing them responsibly and ethically, including the option to refer [B2, D9].

Now what?

I will continue to provide respectful, inclusive care to all patients [A1, A2, A7]. However, if I recognise that my emotional or ethical boundaries may compromise safe or effective treatment, I will seek appropriate support and, if necessary, arrange for referral to a colleague who is better placed to offer unbiased care [B2 & D9].

I will also be proactive in reflecting on my values and assumptions, especially in ethically complex situations [B4 & A7]. I will refrain from discussing personal beliefs during treatment and remain focused on the patient’s health and wellbeing [A6 & A7].

Although I currently feel uncomfortable with the idea of offering services in prison settings, I acknowledge this may change with further professional maturity. Until then, I will avoid environments where I might be unable to maintain professional neutrality. Most importantly, I will continue developing ethical resilience and compassion, recognising that every patient deserves dignity, regardless of their background [A1, A7, D2].

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

Additional OPS mapping: C5, C6, D1, D4, D9 & D12.

Using Gibbs’ Reflective Cycle (1988)

Description
I was concerned about hygiene of the water dispensers; especially in light of a recent increase in norovirus cases, I raised a formal query with clinic management via email, asking when the dispensers were last professionally serviced or sanitised. I also suggested that if servicing hadn't occurred, students be temporarily allowed access to the staff kitchen for tap water, to ensure sanitary drinking water was available.

Feelings
I felt uneasy about the hygiene risk, particularly as the dispensers serve vulnerable individuals such as patients and stressed students. I also felt a sense of responsibility to speak up, even though I was unsure how management would respond. I hoped my query would be seen as constructive and in the interest of safety and compliance.

Evaluation
Raising the issue reflected positively on my awareness of professional standards and legal obligations around health and hygiene in the clinical environment [C5 & D1]. I recognised the tone needed to remain respectful, when addressing concerns about compliance and potential risk. My approach remained polite and evidence-based, and I felt it demonstrated initiative and accountability.

Analysis
Maintaining a hygienic clinical environment is not just a best practice—it is a legal and ethical requirement. As students and staff rely on shared water dispensers, their upkeep is essential to prevent illness and meet duty-of-care obligations [C5], [D4]. The issue also links to advocating for colleagues and patients [D9], and ensuring our practice setting aligns with public health expectations [C6].

Conclusion
This situation reinforced the importance of being proactive when identifying risks to hygiene and patient safety. It showed me that raising concerns can be done professionally and constructively, and that doing so is part of our obligation to uphold osteopathic standards and care quality.

Action Plan

In future, I will continue to observe environmental factors that could impact clinical safety and wellbeing. If I notice other compliance issues, I will again raise them through the appropriate channels. I will also monitor the clinic's response to this issue to assess whether it aligns with our standards and obligations [C5, D4, D12].

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19 - OS746 - The Importance of Client Confidentiality, D5

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19 - OS746 - The Importance of Client Confidentiality, D5

# data[].attributes.body
Although a multifaceted experience the OPS which best encapsulates the reflection below is: D5. You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively.

Other OPS also demonstrated in this reflection: A1, A2, A3, A7, B3, B4, D1, D2, D3, D6, D7, D10

Reflective model used, Kolb’s Experiential Learning Cycle (1984)

Concrete Experience

I am a massage therapist with a regular client base, including a mother and daughter who each attend sessions independently. During one appointment, the daughter disclosed a recent and unexpected cancer diagnosis following imaging intended to investigate hip bursitis. She asked me not to share this information with her mother, who lives next door and is also my client. The daughter expressed a desire to remain positive and continue with her long-distance running goals. [A1][A2][A3]

The following week, her mother came in for her regular massage. She appeared more agitated than usual and reported an increase in pain, tension, and blood pressure. I remained aware that I could not confirm or even imply anything regarding her daughter's condition [D1][D5]. Instead, I gently steered the conversation in a more neutral direction and provided care that met her physical and emotional needs at the time [A2][A3].

Reflective Observation.

This situation made me reflect on the emotional complexity of client interactions and the ethical responsibility to maintain confidentiality under all circumstances [D5]. I observed that although the mother seemed to be experiencing more stress, she did not mention her daughter’s condition, suggesting she was either unaware or choosing not to discuss it.

I became acutely aware of the trust each of them placed in me individually, and how easy it would be to damage that trust by a moment of assumption or an accidental comment [D1][D7]. It reinforced the importance of managing my own thoughts and responses professionally, even in emotionally charged or morally challenging situations [D2][D3].

Abstract Conceptualisation

This experience deepened my understanding of the boundaries between empathy and disclosure. While I felt empathy for both clients, I recognised that the therapeutic relationship must remain impartial and protected [D2]. Confidentiality is not just a legal obligation but a fundamental key of ethical practice across healthcare professions [D5].

I also recognised the importance of non-verbal communication and emotional regulation. Knowing how to remain supportive and composed without disclosing sensitive information is critical to maintaining professionalism [D1][A1][A7]. This is directly applicable to osteopathic practice, where building and maintaining trust is vital to effective care [D6][D7].

Active Experimentation

Moving forward, I will continue to respect confidentiality with vigilance and ensure I mentally prepare for situations where clients from the same family or social group attend treatment [D5]. I will revisit professional guidance (e.g. GOsC and GDPR on confidentiality) and apply similar principles in osteopathic practice when patients disclose sensitive information or when I encounter interrelated cases [B3][D10].

This experience has reaffirmed the importance of developing a strong internal framework for handling ethical situations, especially as I transition from massage therapy into osteopathy. I will also aim to practice reflective neutrality and emotional regulation, especially when two clients are indirectly connected by shared but unspoken concerns [B4][D7].

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

Using Schön’s Reflective Practice Model (1983)

Reflection-in-Action

During my initial formative practical assessment I recognised I was unprepared, especially in knowledge of detail such as grades of mobilisations, having got my amplitude and frequencies answer muddled up. This realisation coupled with the pressure of being among the first to be assessed, led to feelings of self-doubt which increased my anxiety. Despite this I maintained my professionalism, acknowledging my focus had lately been on the anatomy and pathophysiology exam prep. This self-awareness during the formative assessment exemplifies my ability to adapt and maintain composure under pressure, indicating a practical level of emotional intelligence.

Reflection-on-Action

Post assessment - during a resurgence of my massage therapy clients returning post-COVID. I recognised the need to limit client appointments to prioritise my studies and well-being. I identified the issues I was experiencing around time management and balancing academic responsibilities with personal and professional commitments as areas for improvement. My commitment to self-care demonstrated professional responsibility and autonomy to ensure my conduct supports the professions reputation.

Action Plan

I will implement a structured study timetable. I will set clear boundaries for massage client appointments to maintain academic focus. I will engage in regular self-reflection to monitor progress and adapt strategies such delegating household tasks to other members of the family to make time for study.

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Reflect model developed by Nick Butcher and Andy Whysall, through their work as trainers in their company Sherwood Training.

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

I utilised the REFLECT Model developed by Nick Butcher and Andy Whysall through their work as trainers in their company Sherwood Training.

R – Recalling the event
During a clinic session in early December, a regular patient who had attended several appointments offered me a £20 tip as a Christmas thank-you for my care and attentiveness over the term. She expressed genuine appreciation and insisted it was a gesture of gratitude. I was momentarily taken aback and unsure how to respond, especially as she handed it to me warmly and publicly.

E – Expressing emotions
I felt conflicted. On the one hand, I was touched and grateful for her appreciation. On the other hand, I felt uncomfortable because I knew that our student clinic had a clear policy that prohibits practitioners from accepting gifts or tips. I also worried that refusing the gesture might make the patient feel rejected or embarrassed.

F – Formulating the insight
This situation highlighted the delicate balance between professional boundaries and human kindness. It made me reflect on the importance of acting with integrity even in small decisions and maintaining trust in the profession by following institutional guidelines. It also made me consider how important communication is when navigating potentially awkward moments like this.

L – Learning from the experience
I respectfully thanked the patient for her kindness and explained that clinic policy didn’t allow me to accept personal financial gifts. I offered that a positive feedback form, or continued attendance was more than enough thanks. She smiled, seemed to understand, and eventually tucked the money back into her bag. The encounter reaffirmed my understanding of the importance of ethical clarity and gentle boundary-setting.

E – Exploring options for the future
If faced with a similar situation again, I would feel more prepared to acknowledge the patient’s generosity while still upholding professional expectations. I might also suggest to the clinic that we display a visible notice during festive seasons to help manage expectations around gifts.

C – Creating an action plan
Going forward, I will ensure I’m familiar with all relevant professional and clinic-specific policies regarding financial dealings and gifts [D8]. I’ll also practice ways of kindly declining gifts without causing offence. In future practice, I might explore whether patients could be directed to give donations to charity or leave written feedback instead.

T – Transforming practice
This experience has strengthened my resolve to act with transparency and honesty in all financial dealings, however minor they may seem.

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

OPS mapping: A3, B1 & C6.

Reflected upon using Rolfe et al.’s reflective model (2001)

What?
During cervical spine technique practice with peers, I achieved my first successful cavitation on a fellow student.

So what?
After an unsuccessful first attempt my colleague turned to me and advised, after setting up the vectors don't hesitate or set-up for too long. He told me to simply apply the thrust immediately at the bind. I did exactly what he said and it worked. This was a significant learning moment that boosted my confidence [A3]. The supportive environment and feedback from colleagues were key in refining my technique and ensuring it was performed safely [B1 & D9].

Now what?
I will continue practising safely with colleagues and contribute to a positive learning culture by offering encouragement and constructive feedback [D9 & C6].

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22 - OS746 - Barefoot talk with Carol Palmer, D9

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22 - OS746 - Barefoot talk with Carol Palmer, D9

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Mainly relates to OPS "D9. You must support colleagues and cooperate with them to enhance patient care."

Also incorporates OPS: A3, B1 & C6.

I utilised Rolfe et al.’s reflective model (2001) for this reflection.

What?
I attended Carol Palmer’s "Still's Technique" Barefoot Talk which included practical application of the techniques. I worked alongside colleagues, to learn to apply the correct force and vectors for the long lever techniques. We practised new approaches to musculoskeletal dysfunction in a supportive and collaborative environment.

So what?
Working with peers in a hands-on learning setting highlighted the importance of mutual support, shared learning, and constructive feedback [D9]. It improved not only my confidence in applying Still's techniques but also deepened my appreciation of collective skill development in clinical practice [C6]. The extra curricular talk, arranged by the student-led 'barefoot club' fostered a non-competitive atmosphere where I could ask questions and offer encouragement, enhancing both my competence and that of my colleagues [A3].

Now what?
I will actively seek further collaborative CPD opportunities in future and make space in clinic time to share new skills and techniques with colleagues. Continuing to nurture a team culture where learning and support are valued will contribute to better, more consistent care for patients [D9, B1].

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23 - OS746 - Yellow Flag, Hopeful for Husbands Return

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23 - OS746 - Yellow Flag, Hopeful for Husbands Return

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

Other relevant OPS in this reflection include: A2, A3, B1, B4, C4, D1, D6 & D10.

Reflected upon using - Gibbs' Reflective Cycle (1998) during the first term of the third year.

Description

My patient today was a 76-year-old woman who presented with a red, swollen, and painful right wrist, along with discomfort in her neck and shoulders. She also reported occasional low back pain. A few weeks prior, she had dismantled and moved parts of a sofa and had been undertaking various tasks at home, in preparation, hoping to gain approval for her husband's return from a care home. She mentioned this several times, highlighting the emotional and practical strain she was under [A2 & D6].

On case history taking, I was concerned there may have been a fracture due to the swelling. Or a possible thoracic compression fracture, due to her age and risk of osteoporosis [B1]. However, my tutor helped me reason through these possibilities, reminding me that the patient showed no typical signs of fracture, such as movement avoidance or significant pain and was able to continue her usual daily activities [B4].

The tutor explored alternative explanations such as contact dermatitis or insect bites, but these were ruled out. Ultimately, the patient was advised to consult her GP for further investigation and possible imaging. She agreed for a referral letter to be sent to her GP [D10 & A3].

Feelings

Initially, I felt concerned and uncertain about the cause of the wrist swelling. I was also aware of the responsibility of ensuring I didn’t miss a potentially serious pathology. I felt reassured by my tutor’s calm approach and valued the opportunity to learn from their clinical reasoning [D1].

Evaluation

This was a positive learning experience. I was able to work through my clinical suspicions logically, with support, and refer appropriately. I recognised the importance of considering the input of other healthcare professionals when something lies beyond my scope [C4 & D10].

Although I didn’t treat the patient’s wrist, I was able to deliver safe, effective care by focusing on thoracic mobility using GAT and soft tissue techniques, and gentle traction to the cervical spine [B1].

Analysis

This case highlighted the complexity of treating older patients, particularly those under physical and emotional strain. It reinforced the value of clinical reasoning, safety-first decision making, and involving other professionals where needed. I also saw the importance of communication, not only in speaking clearly, but in listening to emotional cues and respecting individual values and life circumstances [A2, A3, D6].

Conclusion

I better understand my scope of practice and when to seek collaborative input. While I was initially unsure, I managed the situation responsibly, putting the patient’s wellbeing first. I also developed greater empathy by understanding how the patient's personal situation influenced her health [D1 & B4].

Action Plan

I plan to strengthen my diagnostic reasoning and referral skills by reviewing red flags and note how experienced clinicians manage uncertainty. I will also continue to develop multidisciplinary awareness of other healthcare professions, ensuring I understand local referral pathways [B3 & D10].

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24 - OS746 - The Toughest Part of the Past Four Years, D11

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24 - OS746 - The Toughest Part of the Past Four Years, D11

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

Featuring OPS: C6, A6, D9 & D12.

Reflected upon using Gibbs’ Reflective Cycle (1988).

Description:
During the summer break, my father sadly passed away, his funeral was a week before my first clinic session. I returned to clinic as scheduled and was determined not to let this affect my clinical responsibilities or patient care. I informed the welfare officer, who responded compassionately and provided useful bereavement support information.

Feelings:
I felt deeply affected by the loss, but also proud of my ability to remain professional and grounded in clinic. I was also grateful to have someone to speak to within the school setting.

Evaluation:
Reaching out to the welfare officer was essential. I could have mistakenly believed I was coping well enough alone, but her guidance confirmed I was taking appropriate steps to protect patient care [D11].

Analysis:
Bereavement can impair focus and emotional resilience. By seeking support, I ensured an impartial assessment of any risk to patients, in line with GOsC expectations [D11 & C6]. Maintaining professional boundaries helped preserve my clinical competence [A6].

Conclusion:
Being open about personal difficulties with colleagues can feel vulnerable, but it is necessary for safeguarding patient care and my own wellbeing.

Action Plan:
I will continue to use welfare officer and supervisory support from my personal tutor proactively when facing personal difficulties, and encourage peers to do the same [D9, D12].

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25 - OS746 - Discussion on Self-Reporting Situ's to GOsC, D12

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25 - OS746 - Discussion on Self-Reporting Situ's to GOsC, D12

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Main OPS: 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.

The reflection below using Rolfe et al.’s reflective model (2001) Also Incorporates OPS: C5, C6 & D11.

What?
As part of a clinic team discussion, we explored scenarios where a practitioner might need to self-report to the GOsC, such as a criminal conviction, a serious health condition affecting fitness to practise, or a concern raised by a patient. The discussion prompted me to reflect on my responsibilities to maintain transparency with GOsC.

So what?
I realised that even if I believed an issue did not affect my competence or conduct, it is not my decision alone to make. The GOsC must be informed to independently assess the situation [D12]. This includes serious health conditions such as severe mental health disorders (e.g. psychosis, bipolar disorder with active symptoms), or neurological conditions (e.g. epilepsy with uncontrolled seizures) that could impair clinical judgment, motor function, or reliability. Failing to report such issues, even if under control in my view, could endanger patients and damage public trust [C5 & D11].

Now what?
I will familiarise myself with the GOsC’s guidance on when to self-report, and ensure I understand the types of events that trigger this responsibility. If ever in doubt, I will consult with a tutor, the welfare officer or any future clinic employer to seek clarification and act accordingly [D11, C6].

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

Using Gibbs’ Reflective Cycle (1988)

Description

A patient presented with transient dizziness, dysphagia, tremors, and headache, following a head injury a week earlier where she hit her head on a kitchen worktop. She had seen her GP, who suggested mild concussion. However, her symptoms raised concern, and I did not feel confident ruling out a vascular pathology. I discussed this with my tutor, who agreed that symptoms could indicate a potential brain haemorrhage especially as there is risk of slow bleeds for up to three months. We decided it would not be safe to examine her osteopathically. I wrote an emergency referral for A&E and documented the case thoroughly.

Feelings

I felt a strong sense of responsibility and some anxiety due to the potential seriousness of her symptoms. I also felt confident in pausing treatment and seeking guidance. Promptly completing an emergency referral form and ensuring all was documented on the patient's records made me feel I had achieved my duty of care.

Evaluation

The situation reinforced the importance of not overstepping clinical boundaries and recognising red flags. My decision not to examine the patient and refer immediately was appropriate. Documenting clearly and promptly helped ensure continuity of care and could have serious implications for her safety [C2].