Prep for clinic:

For those of you who are going into clinic later in summer I thought I would give a heads up. It is scary but valuable. Things to do:

• Learn your anatomy, it is vital to be up to speed on it. (this is from experience, well lack of knowledge).
• Learn the dermatomes, myotomes and cardio/respiratory exams. They use them often.
• Be bold - get to know the 3rd years. This helps you see more patients and learn more easily.
• They will encourage you to take continuations and new patients - do so when you are ready only. We have lots of time and there is so much to learn - this is advice from Johnathan Eddis.
• I have some useful hand outs I have collected, I will scan in next weekend fo us all.

Hope everyone is having a lovely holiday. margaret x

Yet more info for clinic

A few notes for those yet to start:

Taking a history for a new patient.

• You should take 30 minutes to take a new patient's history, although for the first week or two the tutors might allow you to get away with running over.
• Some people have a photocopied list of questions to ask -- here's an online version.
• Say to the patient that you "hope to have time for treatment today" or similar -- if the history takes a long time then you may not have time for treatment, and it's good to have the patient prepared for this.
• The "patient presents with" part of the form is obviously the main meat of the history. Here's an acronym that helps me take a history: "SOCRATES"

Taking a continuation -- a returning patient

• The contination forms are simpler than those for new patients, but the process is very similar. A detailed case history is not taken; instead, the process concentrates on changes since the last appointment.
• Questions you will probably want to ask:
  • How did the last treatment feel?
  • Any change in symptoms since last appointment?
  • Anything new?
• When presenting to the tutor, focus on:
  • Name, age, gender.
  • How they are feeling since last time, and any changes or new symptoms.
  • Diagnosis and treatment plan.
  • If they haven't commented by then, say "Today I will..." followed by your plan.
• The form has 5 headers at the top of it, making the acronym SOAPI. It's all spelled out on the form, but here's the detail:

Red flags

You need to know these! Here's a list of the red flags that I've encountered so far, and the questions that the tutor will expect you to have asked:

Hypotheses

• There is an acrostic on the form: V.I.N.D.I.C.A.T.E.R. This stands for: vascular; inflammation; neoplasm; degeneration; infection; congential; autoimmune; trauma; endocrine; rheumatological (with some variations, depending on who you ask). This is a useful checklist to run through when thinking of the "tissue causing symptoms", or the "cause" of the patient's presentation. (This doesn't feel very osteopathic to me.... but there it is).
• The tutors tend to ask you to find positive findings that support each hypothesis. An alternative model is to disprove each hypothesis you come up with, which might be a more scientific approach. However this is very time consuming..... your choice!

Documentation

• There are three forms: a new patient form for third years; a new patient form for fourth years; and a form for returning patients. These forms should be available in the Team Points, but you may have to grab a bunch from reception.
• Patient records seem to go missing quite easily, either in their entirety or in part. Check for the patient files first thing in the morning, and immediately after lunch. If they're missing, ask at reception. You will need to give them any pertinent details e.g. new patient; patient from yesterday; file not in a folder; etc. so they can find the file easily.
• At the beginning of the day, all files for the day's patients are placed in folders in the Team Points. At the end of the day, the files are collected from the Team Points. Any files which are unsatisfactory (incomplete; lacking tutor signature; etc) are returned to the Team Point next day with a note stapled to the front, explaining what needs completing.
• Those circle diagram things on the forms:
  • Very handy! You can use them for active and passive movement notation of:
    • The back, label it GSp -- general spine.
    • The neck, label it CSp -- cervical spine.
    • The shoulders, label it GH.
    • The hips... and so on.

Other bits and bobs

• Don't ask the patient how they are while you're in the waiting room or corridors. They may say "you really hurt me last time" in front of other patients!
• "Page 4". The back page of a new history form contains a complete summary of the history, examination, treatment, and advice. If you take a new patient history, you will have to fill this in. Get someone to talk you through it -- you'll have a tutorial on it in the first week. It can take quite a while, and the tutor will want to have it completed and signed before they leave at 5:45pm or 6pm, so try to keep some time free to complete it. Don't take a new patient in the last time-slot in the afternoon!
• The clinic computer system is a bit outdated. There are two tabs that you need to know about: "Arrivals" and "Departures". Click "arrivals" to see people who are booked but who have not yet arrived in the waiting room. Click "departures" to see people who are waiting in the reception area, and are ready for you to collect.

Routine 

• A good order for most routines is:
  • Active movements.
  • Passive movements.
  • Special tests i.e. orthopaedic, neurological exam, etc.
  • Resisted movements.
• This allows you to start with the patient standing, then progress to the plinth, without getting the patient on and off the plinth.

Team Four 

• The Thursday team seem very keen on setting homework, which they ask you to demonstrate the following week. So far, we've been asked to perform a full cardiovascular exam, and this week they've asked for a full respiratory exam.