Experience

A 36 year old female came to see me for neck pain. The clinical history revealed PTSD and previous physical abuse, which affected the patient’s life through ‘flashbacks’ as reported by herself. She suffered with widespread pain sometimes which she could not describe. Physical examination revealed increased sensitivity to light pressure (allodynia) and, because I did not have encountered symptoms like this before, I did not suspect fibromyalgia. The tutor on the day suggested to test the common pain points and the patient had 14 points positive out of 18.

Reflection

I felt discouraged about the fact that I didn’t suspect fibromyalgia from the start, however, I decided to revise the condition again and prepare for the next time the patient came in.

Fibromyalgia is a complex and often misunderstood condition that presents with a range of symptoms, including widespread pain and allodynia. It is commonly associated with psychological conditions such as PTSD, which can complicate diagnosis and treatment. The challenge in recognizing fibromyalgia, particularly in patients with a history of trauma, underscores the importance of thorough clinical assessment and familiarity with its diagnostic criteria (Wolfe et al., 2010).

Action

I revised fibromyalgia again and I gave the patient the correct advice, gave her the required referral letter and she started having the correct investigations.

During a CEX (clinic exam) I had a patient with fibromyalgia and the tutor’s feedback was positive.

Wolfe, F., Clauw, D.J., Fitzcharles, M.A., Goldenberg, D.L., Katz, R.S., Mease, P., Russell, A.S., Russell, I.J., Winfield, J.B. and Yunus, M.B., 2010. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis care & research, 62(5), pp.600-610.

Experience

Being an osteopath involves taking accurate notes during the consultation, form the clinical history taking to examination, to treatment and final reflections.

At the beginning I tried to fight my neurodivergence and tried to write what I thought it was concise notes.

Some tutors are ok to sign the notes even when we write ’NAD’ for cardiovascular questionnaire, or any systemic category.   One day, an intense tutor asked me: what questions did you asked for the systemics? I answered all of them, I just wrote NAD, as patient did not report any palpitations, SOB etc. Then the tutor asked me: if you receive a complaint, how can you prove you asked those questions?

Reflection

I started to understand straight away that I had to find a way to be thorough, short and concise at the same time, but my notes became much elaborated and I could not keep with time anymore. I also understood SOCRATES model does not work for me, as I was taking too many questions and not obtaining the DDX.

Maintaining comprehensive, accurate, and legible patient records is a fundamental aspect of safe and effective osteopathic practice. Proper documentation ensures continuity of care, legal protection, and facilitates communication among healthcare providers. Inadequate or incomplete records can lead to miscommunication, missed diagnoses, and potential legal consequences. Research underscores the importance of thorough documentation, especially in multidisciplinary and high-stress environments, where the risk of errors can be heightened by factors such as neurodivergence or time constraints (Clayton et al., 2017; Jefferies et al., 2018). Implementing strategies that balance thoroughness with efficiency, such as tailoring the use of clinical note templates and abbreviations to individual needs, can improve both the quality and efficiency of record-keeping.

Action

I asked all the tutors to give me advice on how to write good notes and also to read my colleagues’ ones. Slowly I started improving the layout and conciseness, without compromising on the quality of the notes and keeping up the time.

Jefferies, D., Johnson, M. and Griffiths, R., 2010. A meta‐study of the essentials of quality nursing documentation. International journal of nursing practice, 16(2), pp.112-124.

Experience

The learning experience is not always smooth and I tried to cut the corners by writing suggestions for the patients to take to their GP, like blood tests etc, on the clinic slip notes.

It worked for a while, but a tutor observed me and he told me to write proper referral letters from now on, which took way longer.

Reflection

Being an osteopath is not about being fast, but thorough and professional, even in writing the notes and any written material. The written material has legal importance and can make a big difference in a legal action. I also found out that, once you wrote the notes, even if they are untidy, you cannot make new ones.

In clinical practice, the importance of thorough and accurate documentation, including referral letters, cannot be overstated. Properly written referral letters are not only a critical aspect of patient care coordination but also serve as a legal document that can protect both the patient and the practitioner in the event of a dispute. The temptation to cut corners in documentation, such as by providing informal notes instead of formal referral letters, can lead to significant risks, including miscommunication and potential legal liabilities. Research highlights that effective referral letters should clearly convey the clinical findings, the rationale for the referral, and any specific recommendations for further investigation or management (Grol et al., 2013). Developing and practicing the skill of writing concise yet comprehensive referral letters is essential for ensuring high standards of care and maintaining legal and professional integrity.

Action

Practicing ow to write referral letters helped me become faster and now I am assured the patients receive the best service and also I am legally covered if any complaint should happen.

Grol, R., Wensing, M., Eccles, M. and Davis, D. eds., 2013. Improving patient care: the implementation of change in health care. John Wiley & Sons.

Experience

During the first academic year I attended the safeguarding course, which was very disturbing and upsetting, as I was taught about female genital mutilation, a horrible practice around the world, that affects young females, as young as 3 years old. My daughter was 3 years old when I started this course, so I felt really affected by this.

Reflection

The consequences of FGM are terrible, including early death of infection or later in childbirth, bleeding etc, but the ones we need to be able to spot are difficulty to urinate, the girl may have difficulty walking, standing, or sitting, being anxious.

Female genital mutilation (FGM) is a deeply traumatic practice with severe physical and psychological consequences. It can lead to immediate complications such as severe pain, bleeding, and infection, as well as long-term issues including chronic pain, childbirth complications, and psychological trauma. The ability of healthcare professionals to recognize the signs and symptoms of FGM, such as difficulty in urination, walking, or sitting, as well as anxiety and behavioral changes, is crucial for early intervention and support. However, prevention remains the most critical aspect, as stopping FGM before it occurs can save countless girls from suffering (Elmamin et al., 2020). Raising awareness and supporting survivors who work towards preventing FGM, as portrayed in the documentary "Desert Flower," is essential in combating this practice.

Action

Being able to see the signs and symptoms of FGM is very important, however, I believe what is more important- is to help with prevention. I watched the ‘Desert Flower’ movie on Youtube and I found out there are strong women that have suffered the procedure that are helping prevent it.

Elamin, W. and Mason-Jones, A.J., 2020. Female genital mutilation/cutting: A systematic review and meta-ethnography exploring women’s views of why it exists and persists. International Journal of Sexual Health, 32(1), pp.1-21.

Reflection Using Jasper's Reflective Model

Experience

Before I joined this course during the COVID pandemic in 2020, I already had a veterinary business open since 2016.

Because of the operative theatre strict hygiene rules, I learned about how easily bacteria and viruses can infiltrate and cause harm, also how to implement strict hygiene rules.

The COVID hygiene rules were also very strict, so hygiene practice at the ESO was very controlled, as well as the clinic.

Reflection

The disinfecting and personal protection material must be widely available, even if COVID rules do not exist anymore. This hard period taught us all a lesson on how fragile the vulnerable patients can really be. This has cemented even more my previous knowledge about cross contamination, but helped me to see patients with different eyes.

Maintaining a safe, clean, and hygienic clinical environment is a critical aspect of healthcare practice, not only for patient safety but also for the protection of healthcare providers. The COVID-19 pandemic has heightened awareness of the importance of stringent hygiene protocols, emphasizing the need for consistent disinfection practices. In osteopathic practice, where hands-on treatment and close physical contact are routine, the risk of cross-contamination is significant. Recent research underscores that even in controlled environments like medical school labs, disinfection practices often fall short, particularly in high-touch areas such as examination tables (Patrizio et al., 2023). This highlights the necessity of ongoing vigilance and adherence to robust disinfection protocols to prevent healthcare-associated infections (HAIs) and ensure a safe practice environment.

Action

I always wear a mask if I have a cold or a virus and I spray the couch and disinfect hands in between patients, I even ask patients to wear a mask if I see them being unwell, because protection needs to be both ways. If I don’t take care of myself and I fall ill, I need to cancel the appointments my patients booked, therefore denying them the care they need.

Patrizio, H.A., Phyu, R., Boyle, T. and Schachter, T., 2023. The effectiveness of disinfection protocols in medical school osteopathic manipulative medicine labs. Journal of Osteopathic Medicine, 123(9), pp.435-441.

Experience

The children’s clinic at the ESO has been a great learning environment. Being in contact with new mothers can be a calm experience, but also moving, as some of them can have physical and/or mental difficulties. From sleep patterns to breastfeeding issues, stress caused by other family members etc, osteopaths must identify and try to help with the cause and prevention.

Reflection

Working in the children’s clinic as a mother myself has helped me understand the struggles of new mothers. I have also seen the pattern of some women that get caught up in the situation, and they forget completely they exist, or that their wellbeing is important.

I was that new mother myself once, and having my patients in front of me going through the same situation, has given me the opportunity to give advice on their wellbeing.

The babies are feeling all the energy around, and their connection to their mother makes them feel all their emotions. If the mum is stressed, the baby is stressed too, if the mum is calm, the baby is calm as well.

In reflecting on the holistic approach required in osteopathic practice, I have come to appreciate the significance of viewing both the mother and child as interconnected beings, rather than isolated patients. According to Fahlgren et al. (2015), osteopathic philosophy aligns closely with the biopsychosocial model, emphasizing the importance of addressing the physical, mental, and spiritual aspects of health. This perspective has influenced how I approach treatment, recognizing that supporting a mother’s mental and emotional wellbeing is crucial for the child’s health as well. By adopting a person-centered approach, I am better equipped to provide advice and support that goes beyond mere physical interventions, helping new mothers foster resilience and well-being in both themselves and their children. This holistic perspective has allowed me to develop a deeper connection with my patients, empowering them to achieve a more harmonious balance in their lives, which is reflected in the positive outcomes observed in their infants' behavior.

Action

Although the osteopathic treatment has been proved to help newborn babies and new mothers, I believe that the anxious mothers would benefit from finding ways to unwind and relax, nurturing themselves, even if there is no one around to help much. When the mother is more relaxed, the baby sleeps better and more, so she gets more time for herself. I have given this advice to minimum 3 new mums and they both told me that the babies were more relaxed and content, latching and feeding better.

Fahlgren, E., Nima, A.A., Archer, T. and Garcia, D., 2015. Person-centered osteopathic practice: patients’ personality (body, mind, and soul) and health (ill-being and well-being). PeerJ, 3, p.e1349.