Health promotion is really important and action aims at reducing differences in current health status and ensuring equal opportunities and resources for everyone. All this includes a secure foundation in a supportive environment, access to information, life skills and opportunities. People have to be able to take control of those things which determine their health. This must be equally to women and men. 

It determines that the health sector is not the only responsible of health promotion. It requires coordination between the government, economic sectors, voluntary organizations and local authorities among other organizations. Although health professionals have a major responsibility to mediate between the interests in society for the pursuit of health. 

Health promotion goes beyond health care and Ottawa charter makes reference to the strategies and programmes which should be adapted to the local and international needs, take into account social and cultural differences and economic systems. 

1.       The boundaries between practice and research 

2.       Basic ethical principles, which includes: 

2.1.   Respect for persons 

2.2.   Beneficence 

2.3.   Justice 

3.       Applications 

3.1.   Informed consent 

3.2.   Assessment of risk and benefits 

3.3.   Selection of subjects 

Although Belmont Report talks about Ethical Principles and Guidelines for the Protection of Human Subjects of Research, from my point of view, these principles should be put into practice with any medical activity or health care procedure and not only in research. 

In addition to the ethical principles and clinical guidelines mentioned in Belmont Report, we must know that all people, regardless of their nationality or their culture or social status, have human rights which can never be violated. That is why as health professionals, we must know and respect human rights in all our health care procedures. Some of the most known human rights are the respect for people and their dignity, the right to self-determination, protection and anonymity, right to be informed of everything related his health status and give their approval for all types of clinical practice as well as the right to refuse treatment without that supposing any inconvenience for him and his health. 

During the case history, the tutor came inside the room for 5 minutes observing the patient and when we discussed about the possible differential diagnosis, he knew what the patient had just by looking at the patient feet’s and integrating the different pathologies the patient presented: fungus on the toenails, dermatitis on one of his ankles, black nails, man fat distribution in the abdomen and the pathology for which he was in clinic today; A sprain ankle that does not improve within 3 months of evolution.

The differential diagnosis was a great probability that the patient suffered from type 2 diabetes and sensory poly-neuropathology. All this based on the observation of the patient and relate some aspects that he explained about his lifestyle. At the time of testing, the patient presented a clear lack of proprioception, vibration and soft touch of the feet’s, and a slight deficit of balance, that could confirm the poly-neuropathology.

Although the tutor told the practitioner not to tell the patient the possibility of suffering from type 2 diabetes and a poly-neuropathology, they did so and the patient started to worry more than necessary. The tutor took part to explain that it’s just a possibility, that they could not prove it but that he could go to his GP and have a Blood test to rule it out. 

At this time I began to think how important is the knowledge about pathologies and different risk factors, at least the most common in society, such as diabetes. Knowing how to make a good observation and having the ability to integrate what you observe, will make a big difference when it becomes to make the diagnosis. That will make all the treatment and outcomes really simple and will reduce the risk of complications. Regarding the fact that the practitioner told the patient that could suffer from type 2 diabetes and sensory poly-neuropathology, I think it was a bit risky because we have no way to prove it. This could completely change the patient's lifestyle and lead to excessive worry about something that may not be the truth. 

Because of my background in physiotherapy and two years of work, I had similar experiences and I think the best way to manage these situations  would be to let the patient know what could be going on and advice to visit the GP and have a Blood test. Will also be necessary to clarify that the fact of suffering from diabetes could have a direct relation with the actual delay on the healing of the sprain ankle, but may not have any relation. That’s why will be necessary to encourage the patient to continue with the treatment and see if it improves. 

There are lots of different reflective cycles like Gibbs cycle which are more complex, but from my personal experience I found that if we have to make the reflexion during a situation or immediately after is easier and more effective having 3 questions and respond them instead of start doing a complex thinking process with lots of questions. 

This reflective cycle is very important for us as osteopaths because it make us to integrate all the information we have related to the situation, try to clarify what is required from us and make a learning process with the observation and analysis of the results. 

There are lots of different reflective cycles like Gibbs cycle which are more complex, but from my personal experience I found that if we have to make the reflexion during a situation or immediately after is easier and more effective having 3 questions and respond them instead of start doing a complex thinking process with lots of questions. 

This reflective cycle is very important for us as osteopaths because it make us to integrate all the information we have related to the situation, try to clarify what is required from us and make a learning process with the observation and analysis of the results.