Throughout my two years at the teaching clinic, I have experienced many different personalities and unique characteristics within my patients. This process requires practitioners to respect and uphold their individual concerns and identify the patients’ preferences. 

Practitioners use active listening to be empathic and gain a better understand of the patient in front of them. This helps the practitioner to develop an effective and concise treatment and management plan, unique to each patient. Therefore, if there are two patients sharing a common differential diagnosis (i.e., Non-specific lower back pain), the respective treatment and management will differ to suit the individual. 

This is beneficial to me as my future career requires me to be adapt to the patients’ requirements and expectations. Attached below is a poster about the benefits for adults and older adults. This highlights how being active (walking, jogging, swimming, dancing, and Tai Chi) which is very beneficial for those diagnosed with diabetes, cardiovascular disease along with joint and back pain. Furthermore, provides improvement in sleep quality, helps to manage stress and improving the quality of life. 

This is something to consider when prescribing exercise and rehabilitation programmes. 

Selecting exercises and activities which the patient enjoys, means the patient is more likely to adhere and perform even after treatment has come to a natural conclusion. 

Experiences like this in clinic has brought to my attention as this can take a lot for a patient to talk to someone and ultimately receive treatment from a practitioner. Not everyone is comfortable within their own skin and having a potentially serious issue can really affect a patient’s mental state. 

Having realised the importance of the certain phrases and language we use in day-to-day practice; I can now appreciate what it means to be adaptable and communicate effectively. This can be done by listening to the patient, clarify what they would like from the appointment and what can be done about it. 

From this, I have investigated what is needed to have good and effective communication. This entails – Tailoring to the patient’s understanding, in terms of contact and pace of delivery, checking the patient’s understanding, picking up on verbal and non-verbal cues and active listen to the patient. This has been proven to develop a solid practitioner-patient relationship, develop shared decision making and empowering the patient which aids recovery. 

To develop this skill further, I will take time to make sure my body language is open and invest time into the patient. Identifying and respect their individual ideologies and communicating in a way they can understand.  

This helped to solidify the patient’s understanding after diagnosing FSCS the session before. It provides a useful summary of FSCS along with its aetiology, epidemiology, treatment and possible interventions and rehabilitation. However, a possible implication could be that it possible may scare the patient. It may be too much information all at once, especially with all the interventions available. Fortunately, the patient was very accommodating, and we built a strong rapport from the first session. 

This experience was extremely valuable for me because it demonstrated how my language and demeanour was interpreted by a patient and developed a good rapport, which built up this sense of trust and belief in what I had said. 

This will be helpful outside the teaching clinic as this will help the clinic to attract potential patients and contemporaneously enhancing my skills as a practitioner. 

Studying at the ESO has given me the opportunity to treat a range of different patients and conditions, via a multitude of techniques (IVM, BLT, BMT, MET and visceral). We are very fortunate to have a designated children’s clinic and module, which is often a CPD course or learnt post-grad. 

Mothers’ willing bring in their newly born infants to the teaching clinic, knowing a student will be treating their new addition to the family. Meaning they must place a lot of trust in a stranger, which for them can be very scary. 

Therefore, when dealing with an infant patient, demonstrating a high level of understanding and empathy will enable to build a therapeutic relationship. The consent and shared decision making took place between myself and the mother. This was vital as this enabled me to 1) perform a full neurologically/osteopathic/orthopaedic screen 2) handle a newly born infant and 3) establish myself as a practitioner and someone the mother could trust. 

From this experience, this has highlighted the importance of informed consent, as this enables practitioner to maintain clear professional boundaries. Whilst simultaneously demonstrating your knowledge and understanding of the situation and how it can be addressed. 

Children's clinic is not an area I would specialise in; however, it has offered experience which is not found anywhere else. However, has given me an insight into pregnancy, delivery and being responsible for an infant. 

This was sent after a treatment session in year 3. I did not have enough time to demonstrate the exercises and explain the appropriate cues. A possible implication of this could lead to incorrect form when performing the exercises, leading to imbalances and possible issues further down the line. 

However, I had anticipated this may happen, so to combat this I had found YouTube video which helped the patient to understand and execute the movement.  

This will be beneficial in the future as the patient will gain a better understanding of the movement pattern. Furthermore, if this injury is to occur again, they have the tools necessary to correct it themselves, creating patient responsibility. 

 

This reminded me of my first practical session at university. It was during the very first lecture, going over the human body, the lecture said “Okay, now in pairs identify the anatomical structures”. I remember thoughts of insecurity and feeling uneasy; thus, I can empathise with patients who haven’t been to an osteopath before. 

Having remember these feelings of insecurity, I can understand what thoughts and feelings the patients must go through. 

This is mentioned in the first piece of dialogue within the initial consultation. I often say, “This may require yourself dressing down appropriately, so I can examine the area in question – is this something you are comfortable doing?”. This is usually not an issue, yet in some cases the gowns are implemented, or a suggestion may include bring sporting or active attire for the next appointment. 

There are many factors which can influence an individual to experience cognitive biases. Usually, it is a combination of learned behaviours and value sets, originating from the individual’s social, cultural, and personal settings.  

Therefore, this can impact us as practitioners in clinic. The practitioner can interpret events and facts which are based on their own set of beliefs, and experiences which lead to deviation from a normal rationale. Ultimately, leading to flaws in reasoning which in turn leads to misinterpretation of information.
  

Practitioners’ cognitive bias can be impacted by the information we receive and learn. Such as Anchoring – a tendency to over rely on base decisions; Confirmation bias – a tendency to look for evidence to confirm a diagnostic hypothesis and therefore give weight to evidence that is supportive of the diagnosis and ignoring evidence which may dispute it; Search satisfaction – a tendency to stop decision on recent encounters; Diagnosis momentum – a tendency to expect and continue initial diagnosis without sufficient scepticism. 

Being able to see and appreciate these different types of bias in this way is extremely valuable to me as it will allow me to be a more developed and well-rounded practitioner. 

This will be beneficial to me as practitioner as this will help future my career and different between similar clinical presentations. 

 

This has reminded me of the idea that osteopathy is unique in the way it identifies and treats certain conditions and musculoskeletal problems. 

This has helped me to develop my practical skills, which will put myself at an advantage compared to other students, at different universities. 

However, it is required by GOsC to carry out 30 hours of CPD courses, which keeps every practitioner up to a certain standard. Further increasing their knowledge base, improving their techniques, and learning from other professionals. 

This experience was during my first consultation during children’s clinic. The presenting complaint (Tongue tie and subsequent feeding difficulties) was a common presentation within the teaching clinic; however, it was brought to my attention, the psychological distress and anguish the mother had to confront during a global pandemic. 

The symptoms which were displayed prompted the mother to arrange an appointment. Within the initial consultation, it was clear that the mother was concerned about her situation, this was possible amplified by a range of intrinsic and extrinsic factors. As the patient’s symptoms improved, the mother’s confidence was increasing. She was able to express the feelings she had been experienced during a national lockdown, giving birth, and how it came somewhat of a lonely experience due to the restrictions in place. 

As osteopaths, we are in a unique position that allows us to establish a rapport with patients and identify possible issues which had not been noticed previously. By establishing this rapport, we can better understand the patient and provide with the support they need (D10). 

Realising the importance of these implications, I can now understand how a multidisciplinary team of professionals, can enhance, and be well adapted to increase the patient’s overall experience and well-being.   

This has reminded me of the idea that updating our knowledge base frequently, enables us as practitioners to optimise our treatment and management plans, we deliver to patients. 

Furthermore, from the dissertations we write in the beginning of fourth year, we are now able to identify biases in research articles and simultaneously identify articles which would score highly in Sackett’s hierarchy of evidence.  

This knowledge and skill will help to develop my skills and interpret data in the right way within being misled. 

This CEX was conducted on a patient with frozen shoulder contracture syndrome (FSCS or adhesive capsulitis). FSCS has an idiopathic aetiology and can be a frustrating diagnosis especially for the patient. This patient had previously seen numerous practitioners and tutors – which had led to different ideologies and treatment styles. 

A possible implication of this includes the patient becoming disheartened by the diagnosis and the realistic timeline of recovery. 

This was an extremely valuable experience as this allowed me to follow the course of a patient with frozen shoulder. This also helped me develop a succinct and slick assessment routine and a useful treatment plan. 

Therefore, by the time I see a new patient with FSCS, I will have a calculated and well thought, realistic short term and long-term goals. 

From the case history and subsequent questioning, this led to a succinct and well-informed assessment, composed of the following: Observation, Palpation, Active and Passive movement of the lumbar spine and hips, Neurological screen, relevant orthopaedic tests (SLR, Slump, FABER, FADDIR, Quadrant test and Laslett cluster). 

An assessment routine is used to provoke and recreate the patient’s presenting compliant. Testing can help a practitioner to identify the pain causing structures, whilst ruling out any serious pathology.
 

Therefore, from this assessment, I was able to decipher an appropriate diagnosis (Facet joint syndrome), and treatment plan. Simultaneously, being able to decide on short- and long-term goals and outcome, relevant to the patient. 

The feedback I received (see below) was very positive and demonstrated I was able to swiftly decide on an accurate evaluation and perform adequately. 

No one has permission to retain any patient records, as this goes against the GDPR (General Data Protection Regulation). The GDPR’s purpose is to provide a set of standardised data protection laws across all the members countries. This should make it easier for EU citizen to understand their data is being used, and raise any complaints, even if they are not in the country where its located. However, I am unsure how this will be altered due to the departure of the UK from the European union. 

Furthermore, by making sure patient records are comprehensive, accurate and legible, this not only maintains the standard of note taking clinic, but also providing sufficient evidence in a court of law. This is particularly important when checked and recording the patients understand and consent. There are multiple sections on the case history forms, about informed consent and obtaining consent. 

Often in clinic, tutors have made remarks about the neatness of my notes, and how they are easy to read. This is important in the teaching clinic as patient’s get passed on from student to the next. Thus, comprehensive, and legible notes make the person reading the patient’s record easier and gain a better understand of the patient. 

This is an example of a referral letter, which was made up for a patient with unremitting symptoms. In the document attached, the name of the patient has been deleted and is referred to as “patient X”. 

The case presentation was rather usual. This patient was the first case after the teaching clinic had reopened since the national lockdown. The patient presented with bilaterally anaesthesia into the palmar and dorsal aspects on both hands. The anaesthesia, spread down the arm into all the digits on both hands, however it was not dermatomal pattern. The anaesthesia was only exacerbated by extension of the neck, yet the patient was in no pain. The patient had been experiencing these symptoms for almost a year. 

Therefore, after several treatments at the teaching clinic, trying different treatment modalities, there was no improvement in symptomology. Subsequently, there was a joint decision made to type up a referral letter to the GP. This was to request an x-ray of the patient’s cervical spine, as I had suspected possible signs of early radiological changes (such as osteophytes or reduction in disc height). 

Before we can start to write a referral letter, we need to gain consent for the letter itself. This is done via a separate consent from – consent for a referral letter. 

This was beneficial to me as this may be required of me in future practice when something out of my scope is detected. 

For several months, the ESO teaching clinic was unable to open until the summer. A risk assessment was performed before we were allowed to return to practice. 

The following changes at clinic were as followed: 

-       Smaller clinic groups

-       One-way systems within the teaching clinic and campus 

-       Mask and PPE were used to minimise the spread of COVID-19

-       Two receptions were open, to reduce the amount of footfall through one building 

-       Spacing of treatments to allow for adequate cleaning and preparation between appointments 

-       A swap from tunic to polos were implemented 

All students were required to take two lateral flow tests before returning to clinic and practise at the university campus. 

This is a unique experience for us as osteopaths and has highlighted the importance of keeping the practice at a clean and disinfected.  

When booking an initial appointment at the clinic, the receptionist ask a list of triage questions, to clarify 1) the patient understands the rules in place at the teaching clinic, 2) the patient is indeed safe, and 3) the patient is not putting other patients at risk. 

Then upon arrival at the clinic, the patient’s temperature is checked and asked the following questions a) Have you suffered from any change in taste or smell? b) Have you suffered from any sort of cough in the last several weeks? c) Has anyone in the household experienced or had COVID-19 symptoms, and additionally I have added d) Have you had the vaccination? If so, how many doses? 

This can help us identify potential asymptotic cases which could risk infecting the clinic. 

Each practitioner must don and doff between each patient, sanitising their hands frequently. Then after every patient, the room is cleaned thoroughly, and the used PPE is placed into bags and put into designated waste bins.

This is in accordance with COVID-19 rules and regulations which allows us to remain open and practice. This has been a rather surreal experience, filled with lots of anxiety when returning to clinic, yet exciting to get back into practice life and returning to some sort of normality. 

Osteopathy works on the principle that with structure governs function, implying that the body works as a unit, as they are reciprocally interrelated. We specialise in providing different manual therapy modalities, identifying osteopathic lesions by understanding the body’s biomechanics. However, what sets us apart is the amount of time spent with the patient, and due to this time, practitioners can establish a good rapport. 

During treatment sessions, we can offer advice about certain musculoskeletal conditions and diseases. Amongst other lifestyle changes which can enhance the patient’s quality of life. 

From talking to the patient, practitioner can pick up on the verbal and non-verbal language given off by a patient. Potentially, the patient may suffer from a mental health disorder, and this is something out of our scope of practice. However, by helping to identify these potential qualities, we can start to get the help they need.  

Similarly, patients are sent to an osteopath from GPs, physiotherapists, and other professionals as we can help due to our specialist training. Although the reverse can occur, for example physiotherapists have a superior rehabilitation repertoire. Therefore, we will send them to a physiotherapist if it enhances patient care. 

This is something I realised at multiple parts throughout the course. When you begin to research into a certain topic, the more realise how little you know in that chosen field. Which is why we have specialists and refer to other professions. Ultimately the patient’s health both mental and physical is of the upmost importance. 

These experiences from the teaching clinic, as previously mentioned, we act as a frontline worker, screening patients for serious pathology then using our osteopathic knowledge to treat accordingly. A possible implication of a lack of knowledge could lead to the practitioner being unsafe and putting the patient’s health at risk. 

Therefore, we need this information to make an informed decision. By understanding a certain condition, or pathology, we can then address it appropriately. Providing accurate advice when discussing short term and long-term outcomes. I believe this is very important as this influences our honesty and integrity within clinic. 

Thus, demonstrating the correct and sufficient knowledge, this will ultimately help the patient but contemporaneously building a strong therapeutic relationship. 

However, the therapeutic relationship should have clear, professional boundaries from the initial consultation and maintained both in and out of clinic. This can be done by using certain language and refraining from being over friendly, chose of vocabulary and sharing personal information.

I believe that a therapeutic relationship relies on the practitioner being open and honest. Therefore, it only seems natural that the patient develops some form of attachment. There will be general conversation after the compliant has been dealt with and must be professional. 

This highlights why is it important to be careful with the verbal and non-verbal language used when having a discussion. 

This can be broken down into four categories. 

Present – Being present: Reflects therapists and patient’s intention and abilities to be in the moment or embodied in the time and space. 

Genuine – To be real or convert sincerity in the present. Being genuine in a therapeutic relationship has three aspects 1) being yourself, 2) being honest and 3) investing in personal, both the person and situation. 

Receptive – parties involved must enter interaction with 1) an open attitude to negotiate appropriate treatment plan, 2) focuses receptivity to identify salient issues and needs. 

Committed – To be engaged, therapists and patient must be committed to their roles within the therapeutic relationship. The points considered, there are two aspects that characterise being committed 1) committed to understand and 2) committed to action. 

By creating a therapeutic relationship, it can enable us to create an open and honest environment. I believe, those who decide to embark on any sort of health care profession have certain characteristics which allow them to be caring and communicate effectively. 

This research paper has identified the subtle signals that can be interpreted when creating a therapeutic relationship. Especially how you are as a practitioner is almost as important as your practical skills. 

This webpage is the location where patients will make any suggestions (positive or negative), whilst also making a formal complain to GOsC if needed. 

On the webpage it states, “On occasion, we may not meet an individual’s level of satisfaction and if you are concerned about the care or service you have received from us, we would like to know.”

To date, I believe my current cohort of students have not received any negative feedback or formal complaints to GOsC.