12.12.2012 Visit of the NHS Osteopathic practice in Stockwell
I contacted the osteopath I observed, with the intension to visit his practice in Oakwood which is more local to me. He suggested however I would rather come and visit him in his NHS practice in Stockwell. I spend 4 hours observing (and in one case also helping) him. There seem to be a lot of benefits when working in the NHS as the referral for further investigation can be done directly by entering the request into the computer system of the NHS practice. The osteopath has also the access into the whole medical history of the patients, list of the drugs the patient uses or used to use, he also books his own appointments with the patients too. New patient appointment is 1 hour long and the returning patient gets 30 minutes appointment time. The osteopath I visited (VM) used to teach in the BSO as a clinic tutor and I met him in the access course when he taught us about the musculoskeletal system. This fact was convenient as i could see and compare what protocols we have at the BSO and how the experienced osteopath who worked for the BSO for 10 years, makes shortcuts in order to reduce the time spent by collection of the relevant case history. I felt very good in the practice that was larger than the rooms of the East street NHS practice. The patients I saw were all women from lower socio-economical class, one had COPD, another asthma and cared for her husband after stroke. One of the patients went into such a spasm (her QL, gluts on one side and ITB) that she was in the state of shock unable to more, shivering and crying in pain. VM offered to treat her with dry needling while i held her hands (as she asked for it - and yes, she was a bone crusher :-)) however this did not help so he arranged for the patient immediate appointment with a GP next door for a muscle relaxant medication. How convenient. The last patient of the day was treated by dry needling too and it helped her so much. Shame I did not enrol for dry needling course this weekend. That skill could come handy.
I was curious to find out more details about how to go about looking for a job in the NHS however until today (19.12.2012) I have not heard from VM neither he replied to my email in which I asked him to write a confirmation of the practice visit. Below is our conversation regarding the arrangement of the practice visit and my notes I took on the day.
I was curious to find out more details about how to go about looking for a job in the NHS however until today (19.12.2012) I have not heard from VM neither he replied to my email in which I asked him to write a confirmation of the practice visit. Below is our conversation regarding the arrangement of the practice visit and my notes I took on the day.
19.4.2013 - Visit to osteo clinic in Ware
Today I had a lovely trip to visit a 2008 BSO graduate, Laura. She is very pleasant lady that runs her own practice and employs another 3 associates, treating sports injuries, pregnant ladies and children. She uses a lot of cranial techniques and structural osteopathic concepts. Her treatment room is exactly a place i could imagine to work at. 4 roof windows allow a day light to come in and if it is too dark, she turns on very mild lamp in the corner, to allow the patient to stay relaxed. Her appointments are 30 mins returning and 45 mins new patients. She has one man band type of practice, no receptionist, she does all by herself. She keeps the record of the patients on the printed cards, she manages appointments, connects diaries of her associates and hers via google mail calendar.
She asked me to treat her neck and gave me quite a good feedback, however when i palpate the neck i should use a larger applicator and not only the fingertips. she gave me some tips on MET of suboccipitals - to ask the patient to look to either direction to reinforce the technique. I have observed her to treat a little 3 year old boy that had removed one testicle - she used cranio sacral techniques on him. And the patient afterwards was sixty year old guy with plantar fasciatis. she recommended to him to buy orthotics and wear them for 4 weeks to see what changes can occur. I was wondering if I could be so confident about advising orthotics at all... i dont have any knowledge about them at the moment. This would be another area I should look into before I graduate to understand what types are there and what are they used for plus what are pros and cons of using them and for what conditions are they used.
She asked me to treat her neck and gave me quite a good feedback, however when i palpate the neck i should use a larger applicator and not only the fingertips. she gave me some tips on MET of suboccipitals - to ask the patient to look to either direction to reinforce the technique. I have observed her to treat a little 3 year old boy that had removed one testicle - she used cranio sacral techniques on him. And the patient afterwards was sixty year old guy with plantar fasciatis. she recommended to him to buy orthotics and wear them for 4 weeks to see what changes can occur. I was wondering if I could be so confident about advising orthotics at all... i dont have any knowledge about them at the moment. This would be another area I should look into before I graduate to understand what types are there and what are they used for plus what are pros and cons of using them and for what conditions are they used.
20.4.2013 - Visit to osteo clinic in North London
The clinic i visited was so luxorious and glamorous i felt a little bit overwhelmed by all the glitter and shine... Receptionist welcomed me and offered tea or coffee. While I waited to see the osteopath, I have noticed a lot of advertising material in the waiting area regarding pilates classes, massages, osteopathic treatment and what it can be useful for. The practice was open for only 6 weeks previously with the osteopath having very busy patient list she created in her previous place. She told me she was going to invest money into her web site being one of the three top when searching for osteopath, so she can have more clients. The practice was equiped with disabled access and toilet, pilates studio and four treatment rooms. The osteopath regarded her business skills as essential for survival as an osteopath and making living and growing as the practice. I realised that I had very negative attitude towards the "money grabbing" health professionals as i do not consider profit as a main driving force for working as a health professional. I changed my attitude however next day after this practice visit when i spoke to my colleague about my impressions with the clinic and the osteopath, and he completely opened my eyes that actually it is very important for us to concentrate for running successful business and earning money as we need them to improve our skills, to pay for CPD courses and so on so we can be better and benefit by this our patients. Even though the impressions of the clinic visit were to start with quite negative, it helped me to realise with the help of my colleague that there is also a positive side of the thing and there is a balance needed. Balance between osteopathy and business.
The three clinic visits
I have been visiting as a patient and as a student observer the three clinic in Clapham common for over a year. I have learned that understanding how the body as whole functions is very important but also i have leaned that many issues start with the cranial problems and not feet. They approach was looking from the feet up. My problem was and still is from the top down. I can say that i have learn an amazing amount of stuff from guys working there. i liked the reminders they were sending me 2 days before the appointment. I liked that they had student discount. I liked that their passion led them to create educational activities targeted towards osteos and other MSK therapists. I liked that the involvement of the patient in getting better was so specific (exact exercises) and holistic approach in providing nutritional advice too. I realise that achieve that requires a lot of work and I know that people working there made lots of sacrifices but they love what they do.
Visit of a orthodontic practice and a TMJ specialist
My own issues with malocclusion and tmj pain led me to seek for help from orthodontist. firstly i visited an orthodontic practice in Hammersmith where despite advertising themselves on the internet as functional orthodontist, was targeted towards esthetically pleasing smile. I was told by the orthodontist that i have a small jaw and perhaps would need a surgery to make it bigger! what a nonsense. these "experts" were not ever able to assess the tmj issue, just malocclusion. I was disappointed. My next steps led into the wimpole street. The TMJ specialist examined my malocclusion and tmj and explained to me that the left condyle of the the mandible is sitting behind the fossa, pressing into the external auditory canal, causing me pain in the area, migraines, tinnitus, anxiety, balance issues and also high eye pressure. Due to this whole body addapted and thus i developed other issues in my neck, TSp, LSP, left hip, knee and foot. Knowing i was a student, the advised to me to read on many authors dealing with these issues and the latest research. I was pleased to understand and see on the models what was going on. The ttt offer price however was so high i could not afford it so i still suffer from all the problems as before.
however I spoke to my clinic tutor Mr Simpson about my experience and he advised me to read on cranial literarute by Souterland and Magoun. He was explaining to me about the position of the occiput and how it forms from 4 parts which later ossify. lots of neck issues originate in the malformation of the occiput either in utero, during birth of after. this also affects the position of the temporal bones which contain the condylar fossae for attachment of the mandible. temporal bones' axis of rotation in along the auditory canals. it they are not same, facial scoliosis can be noticed, this leads into imbalances in bite, malocclusion, and from there to postural changes.
I think this experience was of a very high value to me as i now look at the patient's faces very carefully and i examine the position of mastoid processes.
reading of the literature recommended by TMJ specialist and MR Simpson will have to wait until after the CCAs. interesting and exciting times ahead of me!
however I spoke to my clinic tutor Mr Simpson about my experience and he advised me to read on cranial literarute by Souterland and Magoun. He was explaining to me about the position of the occiput and how it forms from 4 parts which later ossify. lots of neck issues originate in the malformation of the occiput either in utero, during birth of after. this also affects the position of the temporal bones which contain the condylar fossae for attachment of the mandible. temporal bones' axis of rotation in along the auditory canals. it they are not same, facial scoliosis can be noticed, this leads into imbalances in bite, malocclusion, and from there to postural changes.
I think this experience was of a very high value to me as i now look at the patient's faces very carefully and i examine the position of mastoid processes.
reading of the literature recommended by TMJ specialist and MR Simpson will have to wait until after the CCAs. interesting and exciting times ahead of me!