What? An older female patient come in with pain around the thoracic region, and the patient showed a real conservative look as well as expressing concern for not only the pain, but the potential for “showing off too much skin”.

I offered the opportunity for a gown and explained that the removal of clothing is not necessary although very helpful.

So what? With this in mind I learnt the importance of not only how to deal with this situation, but how it may feel for the patient coming into practice expressing their feelings and always being considerate to individual’s preferences.

Now what? I will always check how my patients are feeling and ensure they are as comfortable as possible as this in turn will help them to relax and will provide them with a better experience.

Description – During my first term of year 3 I had a new patient who was elderly and hard of hearing. During my introductions and explanations of what to expect I found myself speaking quickly. The lady asked me to slow down and expressed her hearing made it difficult to keep up.

Feelings – As this was one of my first patients, I was nervous and did not initially adapt my communication style for my patient needs. I was grateful the lady asked me to slow down as this made me aware of the situation and was able to correct this quickly.

Evaluation – I began to slow my speech, face the patient to allow for lip reading and talk clearly all of which are to support in compensating for hearing loss (National Institute on Aging 2023). This had a positive impact on the patient, I could see they become more relaxed, and they thanked me for my patients.  

Analysis – it is natural to feel nervous when newly treating patients and is common for the pace of talking to increase. However, it taught me the importance of adapting my communication style for individual’s needs, and particularly those with hearing difficulties. Hearing loss is common amongst the adult population with one third living with hearing loss and the possibility of this becomes greater with age (National Institute on Aging 2023).  

Conclusion – Although I checked at different points, I could have asked the patient more throughout if the pace was suitable.

Action Plan – If I had another patient who was hard of hearing, I would ensure I actively considered my communication style and offered suitable communication supports such as a notepad and pen to write down important points as suggested by National Institute on Aging (2023).  

National Institute on Aging, 2023. Talking With Your Older Patients, Available at: https://www.nia.nih.gov/health/health-care-professionals-information/talking-your-older-patients#:~:text=Make%20sure%20your%20patient%20can,with%20letters%20that%20sound%20alike [Accessed: January 01, 2024]

What – When discussing testing, findings and treatments with patients I ensure I use laymen’s terms to avoid any confusion.

So what – Avoiding medical jargon helps to allow for clear communication and prevent misunderstanding and unnecessary worry or concern (Gotlieb et al. 2022).

Now what – it is important I keep this consistent throughout my career to avoid distressing patients.

Gotlieb, R., Praska, C., Hendrickson, M., Marmet, J., et al., 2022. Accuracy in Patient Understanding of Common Medical Phrases. JAMA Network, 5(11), pp. 1-9.

At the start and throughout all patients contact I ensure I obtain relevant consent verbally and document this on the case history and return forms.Gaining consent and appropriate documentation of consent is important to fulfil both legal and ethical requirements within the profession (GOsC N.D.).

I learnt early on in my academic journey that consent is an ongoing requirement throughout all aspects of patient care and is not a one-off occurrence. It is vital that patients are given all information to allow them to make an informed decision for consent to be valid (National Council for Osteopathic Research (NCOR) N.D) which is also documented on the clinic forms.

I have always understood the importance of gaining valid consent and is therefore something I will continue to obtain throughout my career.

GOsC, N.D.  A4. You Must Receive Valid Consent For All Aspects Of Examination And Treatment And Record This As Appropriate, Available at: https://standards.osteopathy.org.uk/standards/a4-you-must-receive-valid-consent-for-all-aspects-of-examination-and-treatment-and-record-this-as-appropriate/ (https://standards.osteopathy.org.uk/standards/a4-you-must-receive-valid-consent-for-all-aspects-of-examination-and-treatment-and-record-this-as-appropriate/)

[Accessed April 07, 2025]

National Council for Osteopathic Research (NCOR), N.D. Consent, Available at: https://ncor.org.uk/practitioners/practitioner-information-communicating-benefit-and-risk-in-osteopathy/consent/ (https://ncor.org.uk/practitioners/practitioner-information-communicating-benefit-and-risk-in-osteopathy/consent/)

[Accessed April 07, 2025]

Educating patients on their condition, providing and explaining benefits of home-exercises has been a key part of my role in supporting patients to self-manage and improve health outcomes. 

Educating patients plays a key role in patients understanding of their situation allowing them to make informed decisions and understanding their role in their own health and wellbeing allowing for a collaborative patient practitioner approach for better outcomes (Paterick et al, 2017).

I will continue to provide after treatment advise such as dietary advice, strengthening and stretching exercises if clinically indicated to support and promote patients health and wellbeing.

Paterick, T. E., Patel, N., Tajik, A. J. & Chandrasekaran, K., 2017. Improving Health Outcomes Through Patient Education And Partnerships With Patients. Baylor University Medical Center Proceedings, 30(1), pp.112-113

What – During clinic session I explain the reasons for asking patients to undress but always offer the option to keep clothes on to ensure the patient is comfortable. I advise to only undress the area being treated to maintain dignity and modesty.

So what – respecting patient dignity and modesty is key for building and maintaining a good patient professional relationship (National Institute for Health and Care Excellence (NICE) 2019).

Now what – I understand that everyone is different and have learnt the importance of understanding preferences and having options to ensure treatment is accessible to all.

National Institute for Health and Care Excellence (NICE), 2019. Patient Experience In Adult NHS Services, Available at: https://www.nice.org.uk/guidance/qs15/chapter/Quality-statement-1-Empathy-dignity-and-respect [Accessed February 03, 2025]

A patient of mine expressed they were of Muslim faith, during one of the sessions it was the month of Ramadan, my patient spoke about the religious celebration and the act of fasting from sunrise to sunset. I listened and took interest and recognised this was an important part of his identify.

Although I am personally not of Muslim faith, I respected his beliefs and treated him with respect. It is ethically, morally and legally important that all patients are treated with the same respect and quality care despite differences in values or beliefs such as sexual orientation, religion or age (GOsC N.D).

Going forward I will continue to be open to learning about different religions, values and beliefs to continue to grow as a practitioner.

GOsC, N.D. A7. You Must Make Sure Your Beliefs And Values Do Not Prejudice Your Patients’ Care, Available at: https://standards.osteopathy.org.uk/standards/a7-you-must-make-sure-your-beliefs-and-values-do-not-prejudice-your-patients-care/ [Accessed May 01, 2025]

Description- A patient of mine come in with pain radiating down from the buttock to the anterior thigh and leg. The patient also had a clear foot drop on that right side when walking into the treatment room.  

Feelings On initial thought, it was a shock as although in preparation in lectures for scenarios like this, it was the first I had seen this in person of a clear radiculopathy, and they were now under my responsibility to manage and take care of this patient.

Evaluation – This was a great learning experience for me as it allowed me to view something I had not before and see what worked and did not for this patient with a diagnose L5 radiculopathy. The bad is that I felt like the patient had been let down, as symptoms would not improve, even though the patient had been to see a consultant and was waiting on an operation for his radiculopathy.

Analysis – Having had this, I know how important it is to recommend the right pathway to release the nerve and therefore full function, as the prognosis for a full recover when left past 12 weeks is very slim.

Conclusion – Although the patient was on the waiting list for an operation, private may have been a better option as before coming to see me, the nerve damage was already left a significant amount of time and expressing the urgency may have change the outcome.

Action Plan – Express to the patient that time is extremely crucial and if the patient can afford, private would be the best option to manage the patient.

Description –  A patient come into the clinic with a new onset headache, although previously diagnosed with migraines. The patient was a middle-aged woman who was previously very active and was very career driven. This latest onset headache had been crippling her and was unable to function due to her symptoms. The tutor and I recommended a referral for an upright MRI to rule what was expected as either Chiari malformation or a cerebral spinal fluid leak.

Feelings –Due to this being in a specialist clinic, as well as one of my first experiences within this environment, it was came as a surprise and felt a little overwhelming for such a complex case.

Evaluation –This case gave me a lot of experience as even the tutor seemed concerned of how complex the case was. This for one of the first headache cases was quite overwhelming.

Analysis –This made for an extremely rare and great opportunity to learn from this patient, although potentially life altering for the patient.

Conclusion –This showed that I should have been more aware of different headache pathologies and causes.

Action Plan – This will be a case in which I will always remember, so signs and symptoms would be easier to notice in the future. I will also research more into possible headache red flags.

What - Throughout my time in clinic that have been numerous occasions a clinic tutor has asked me to go away and revise a particular topic/ condition/ treatment/ case.

So what – engaging in research and then talking it through with my tutor has helped to build my understanding and knowledge of different topics and therefore helped to support my clinical reasoning. 

Engaging in research is important as it helps to improve patient care and keep up to date with current findings (Gonzalez-Perez & Ramos-Remus 2025).

Now what – part of my ongoing professional commitment and responsibility is to engage with continued professional development in order to keep up to date with my skills and knowledge to inform my practice.

Gonzalez-Perez, O. & Ramos-Remus, C., 2025.  The Importance Of Physician Engagement In Medical Research. Frontiers In Medicine, 12, pp.1-4.

What? A previous bit of work was made, which was on Sub acromial pain syndrome.

So what? This piece of work allowed me to investigate the best test, what the patient will present with and description of the condition.

Now what? I will take this knowledge into practice and this will allow me to become more familiar and educated on the condition, therefore enhancing patient care.

Concrete Experience –A patient come to see me who was presenting with acute neck pain. 

Reflective Observation –In review, it was clear when treating, the choice of technique I used, seem to aggravate the patient.

Abstract Conceptualization –It was clear that I had not taken into consideration the extent of their pain.

Active Experimentation –This made me reconsider what technique to use, this then allowed the patient was able to relax more, and a better adapted treatment was applied.

What? Keeping a factual record of patient notes is vital to keeping the most accurate notes possible

So what? When testing, I try to write down as quickly as possible the finding as this keep the most accurate and most reflective of what is happing with the patients.

Now what? I will continue to keep factual records as well as improve on the time frame it takes to write down notes.

Description - There have been numerous times a tutor has requested to look at my clinic notes to review. Feelings – One of the first times this happened I have felt nervous and apprehensive as I was not sure what to expect and was unsure if they met the expected standard.

Evaluation – I found these experiences helpful as the tutor gave constructive feedback for example being more concise. Overall, the feedback was positive and offered a good learning experience.

Analysis - I learned the importance of clear, professional documentation and timely responses. Conclusion – I feel as this point in my learning as a student osteopath I feel as though there was nothing else I could have done and took on the feedback going forward. Action plan - Moving forward, I’ll consistently maintain detailed concise records, ensuring I can meet requests efficiently upholding professional standards.

What? One of my elderly patients come in for a routine appointment, but on taking information to catch up, he expressed that he had fallen and then got some rib pain.

So what? This was a red flag as upon testing, pain was present when doing anterior and posterior rib springing, percussions on and away from site as well as pain from the tuning fork away and near the site. This made me uncomfortable and felt it was needed to ensure safety to get an X-ray to confirm the patient was safe to treat. The patient received no treatment and was more than happy for this routine as it was explained with importance and professionalism.

Now what? This ensure the patient’s safety and any more harm could come from treatment.

Concrete Experience – It is important to keep a hygienic and clean working environment, which is something a health care practitioner should apply to every single session.

Reflective Observation – Having seen other rooms which has not taken this professional requirement on board and seeing practitioners not having blue roll or wiping the couches down, shows a lack of competence and thought for the patient.

Abstract Conceptualization – This reminds me to always keep a clean environment as there may be a venerable member of the patient’s family in which getting ill could be a serious consequence.  

Active Experimentation – Assuring blue roll and a clean surface is the first thing I do every appointment to assure the cleanliness and safety of my patient.

What? A 19 year old  patient coming in with neck, mid back and lower back pain. Upon testing it was clear to see that the posture of the patient was bad, with posterior pelvic tilt, increased kyphosis, and a flexed CD. Although working in retail stacking shelve can be heavy work, this pain will be a structural reason rather than degenerative and something as osteopathy can be very beneficial for.

So what? With treatment the patient had a little relief for a couple weeks but then the pain would slowly come back. This made me realise extra work out of the clinic and manual treatment was necessary, so recommendation for strengthening and engaging postural muscles to rectify the imbalances were given.

Now what? The patient now has longer periods in which treatment is needed as well as the pain is decreased significantly. It also allows the patient to self-manage symptoms as well as improve their posture.

What? Keeping integrity and honesty throughout the session in clinic is extremely important.

So what? Always explaining findings with honesty to the tutor as well as keeping the patient aware of what is going on is essential as it maintains patient and practitioner relationship (Hart 2022).

Now what?  To continue to be honest and keep integrity throughout my clinical career.

Hart, J., 2022. Deception, Honesty, And Professionalism: A Persistent Challenge In Modern Medicine. Current Opinion In Psychology, 47, p.1

What - Throughout all interactions with my patients, it has been important to discuss clients’ expectations and to be clear with what I can offer as a practitioner. During the initial meeting of patients, I ensure they are aware of clinic opening hours, how to contact the clinic with any concerns or queries. I do not give out any personal contact details and do not share any social media platforms or personal numbers in order to maintain contact through the clinic and therefore maintain professional boundaries ensuring clinic related work is managed within working hours.

So what - Clear communication is important when setting out professional boundaries from both the patient and practitioner to maintain safe practice (Healthcare and Professions Council (HCPC) 2014). Avoiding sharing of social media helps to keep professional and private life separate and prevents the lines being blurred between practitioner and patient relationships (HCPC 2014).

Now what - Going forward I will continue to be aware and conscious to set and maintain professional boundaries.

Healthcare and Professions Council (HCPC), 2014. Professionalism In Healthcare Professionals, Available at: https://www.hcpc-uk.org/globalassets/resources/reports/professionalism-in-healthcare-professionals.pdf (https://www.hcpc-uk.org/globalassets/resources/reports/professionalism-in-healthcare-professionals.pdf)

[Accessed April 10, 2025]

Description – When treating one of my patients a HVT was a treatment method chosen with clinical reasoning. I explained the treatment and possible side effects/ adverse reactions prior and the patient gave informed consent. As a result of the HVT the patient experienced an adverse reaction.

Feelings – I felt bad the patient had this negative reactions although I know it was not directly my fault, I felt some guilt as well as empathy towards the patient.

Evaluation – This was not my intention to impact the patient so negatively after treatment although it taught me that not every treatment is smooth.

Analysis – This re-highlighted that not every patient has the same reactions to the same treatment methods and the importance of explaining possible adverse reactions to ensure patients are aware of what they are consenting to.

Conclusion – I always take explaining the potential for reaction of this techniques and possible adverse effects of treatments seriously and this case has re-emphasised this.

Action Plan – I will always take time to explain possible side effects/ reactions to patients and give advice as needed on how to deal with the pain as well as help them manage after for continued care.

What? It is important that if an osteopath is not meeting osteopathic practice standards, a complaint from the patient can happen.

So what? Although not had a complaint personally, I understand that mistakes can be made or a patient may interpret something wrong.

Now what? It is important to keep as professional and up to standards as possible and recognise when off days could impact this.

GOV.UK, 2020. Duty Of Candour, Available at: https://www.gov.uk/government/publications/nhs-screening-programmes-duty-of-candour/duty-of-candour#:~:text=The%20intention%20of%20the%20duty,apology%20when%20things%20go%20wrong (https://www.gov.uk/government/publications/nhs-screening-programmes-duty-of-candour/duty-of-candour#:~:text=The%20intention%20of%20the%20duty,apology%20when%20things%20go%20wrong)

[Accessed May 01, 2025]

What? Keeping the patient’s personal information is extremely important.

So what? Within reflections, although gathering evidence of the patients who I have seen, redacting the personal information is not only professional but the legal obligation. This is shown in previous photos within this portfolio.

Now what? Continue to keep relevant information confidential and safe and in line with the information governance (NHS England N.D.).

NHS England, N.D. Information Governance, Available at: https://transform.england.nhs.uk/information-governance/ [Accessed May 10, 2025]

Concrete Experience – Having a patient that was female come into the clinic in which her preference was to be treated by a female practitioner.

Reflective Observation – Although a training clinic and observations are part of learning, this patient felt shy anxious about males present.

Abstract Conceptualization – This showed that we must take into consideration the patient’s preferences and not query their values.

Active Experimentation – Although routine, extra care when asking if observers whether male or female make the patient uncomfortable for what ever reason whether belief’s or values is important at all consultations.

What? Always Keeping a professional standard in and out of clinic is extremely important and is something I take very seriously.

So what? Keeping a clean and presentable appearance as well as a polite and approachable manner, every day is something hopefully is expressed day in day out. Tutors have also commented on my appearance within clinic and said I look professional, this shows that my efforts are acknowledged.

Now what? Keeping this standard is what I will take past the student life and uphold into my professional career as this will reflect on not only me as a practitioner but the practice I represent (Swick 2007).

Swick, H.M., 2007. Viewpoint: Professionalism And Humanism Beyond The Academic Health Center. Acad Med, 82(11), pp. 1022-1028.

Concrete Experience – A patient once tried to give me personally some money around the Christmas period.

Reflective Observation – This made me feel very uncomfortable as well as I knew that it was against the law.

Abstract Conceptualization – With this being done, I knew that this was wrong as this crossed the professional boundary and this shows my trust towards the clinic as well as the patient.

Active Experimentation – I know from experience that accepting money or gifts from patient’s I cannot take as this may cause a dilemma ethically (Zolkefli 2021).

Zolkefli, Y., 2021. Healthcare Dilemma Towards Gift Giving by Patients. The Malaysian Journal of Medical Sciences, 28(5), pp.137-141.

Description –With one of my colleagues suffering from migraines, it is important that other members of the team help when they are not up to standard of care with a patient.  

Feelings –Due to the unexpected illness and a patient sprung on me last minute, I was rushed and felt unorganised as I did not have time to read the patient notes properly, but maintained a professional.

Evaluation –The good part was that it showed even with little to no time to prepare, the patient was managed safely, although upon reflection, a better job could have been done.

Analysis –Within clinical practice, this is a part of the job and is a likely thing to happen more than once within my professional career, for example if a colleague has a surgery and their patients may need covering (McNary 2023).

Conclusion –I could have also explained to the patient about the situation better and even offered a reschedule if they would have liked.

Action Plan –I would explain there is an option to not have any treatment with me if they would not want it and wait for the regular practitioner.

McNary, A. L., 2023. Risk Management: “Covering” Your Bases: Managing Risk While Away From Your Practice Or Filling In For A Colleague. Innovations In Clinical Neuroscience, 20(1-3), pp. 76-77.

What-A patient of 74 come into the practice complaining of right shoulder pain, this had been the case for a while but could only remember causing it whilst gardening. Upon examining, the tear of the rotator cuff muscles was a serious concern.

So what- The next stage of management was a recommendation to get an MRI in which the patient had the choice of doing,

Now what- The patient ended up receiving an MRI on the shoulder, this showed the extent of the injuries of the shoulder which then the right plan of action could be applied and suitable  management for the patient.

An example of this is when I had the flu, this made me feel very fatigued and I would not be able to give the patient the care and attention needed. Also, the risk of spreading to them directly through treating.

This made me learn that it is sometimes the best option to avoid clinic when unwell due to the rapid infection rate and easily contagious setting (NHS England N.D)

NHS England, N.D. Chapter 1: Standard Infection Control Precautions (SICPs), Available at: https://www.england.nhs.uk/national-infection-prevention-and-control-manual-nipcm-for-england/chapter-1-standard-infection-control-precautions-sicps/ (https://www.england.nhs.uk/national-infection-prevention-and-control-manual-nipcm-for-england/chapter-1-standard-infection-control-precautions-sicps/)

[Accessed 01 May, 2025]

Within clinic, it is important to be as accurate as possible. Within the early stages of clinic, there was an incident where some information gathered was not correct from what the patient had initially explained.

This had me feeling anxious and concerned with regards to proper note taking.

This was a learning curve in which my tutor was understanding as this was an early stage of my career but also this could have potentially led to something harmful towards the patient if the tutor was not present (GOsC 2010).

This made me realise the importance of note taking and any concerns within the clinic setting to express to the tutor to build a strong trust within the profession.

GOsC, 2010. For The Record: Taking And Storing Osteopathic Notes, Available at: https://www.osteopathy.org.uk/news-and-resources/document-library/fitness-to-practise/ftp-ebulletin-2010-september/ (https://www.osteopathy.org.uk/news-and-resources/document-library/fitness-to-practise/ftp-ebulletin-2010-september/)

[Accessed April 19, 2025].

Harmon, A., 2024. Gibbs’ Reflective Cycle, Available at: https://www.ebsco.com/research-starters/education/gibbs-reflective-cycle (https://www.ebsco.com/research-starters/education/gibbs-reflective-cycle)

[Accessed April 03, 2025]

Kolbs experimental learning cycle:

Morris, T. H., 2018. Experiential Learning – A Systematic Review And Revision Of Kolb’s Model. Interactive Learning Environment, 28(8), pp.1064-1077

Driscoll model of reflection:

reene, J., 2024. Driscoll Model Of Reflection, Available at: https://www.ebsco.com/research-starters/health-and-medicine/driscoll-model-reflection#:~:text=The%20Driscoll%20model%20of%20reflection%20is%20a%20structured%20method%20of,providers'%20learning%20from%20clinical%20experiences (https://www.ebsco.com/research-starters/health-and-medicine/driscoll-model-reflection#:~:text=The%20Driscoll%20model%20of%20reflection%20is%20a%20structured%20method%20of,providers'%20learning%20from%20clinical%20experiences)

. [Accessed April 03, 2025]