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

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

Experience

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

Reflection

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

Action

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

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

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

Experience

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

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

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

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

Reflection

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

Action

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

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

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

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

Experience

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

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

Reflection

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

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

Action

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

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

Experience

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

Reflection

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

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

Action

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

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

Experience

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

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

Reflection

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

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

Action

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

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

Experience

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

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

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

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

Reflection

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

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

Action

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

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

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

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

Experience

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

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

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

Reflection

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

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

Action

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

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

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

Experience

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

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

Reflection

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

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

Action

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

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

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

Experience

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

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

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

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

Reflection

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

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

Action

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

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

Experience

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

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

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

The report confirmed the suspected Morton’s neuroma.

Reflection

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

Action

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

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

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

Experience

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

Reflection

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

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

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

Action

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

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

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

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

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

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

Experience

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

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

Reflection

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

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

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

Action

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

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

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

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

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