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Osteopathic approaches (Clinical decision-making and therapeutic…

- - - - Practitioner centred - treater - body
        
        their application of specific osteopathic
        theories, knowledge and hands-on skills, suggesting a practitionercentred
        view of osteopathy:
        You need to keep pure to osteopathic philosophy. [and] the
        principles of osteopathy make me do what I do.
        
        A focus on technical rationality
        
        Practitioner-led
      - Collaborative - communicator - person
        
        Others valued working with patients so that decisions were
        made together (P3,4,7). These participants emphasised collaboration
        and partnership with patients, respecting them as equals:
        I don’t cure patients. Together we work out how come to a better
        state of health.
        
        Shared involvement
      - Empowerment - educator - patient
        
        Finally, some participants viewed osteopathy as a means by
        which they could facilitate patient empowerment (P6,9,10). These
        participants could not separate patient empowerment from their
        practise of osteopathy, and facilitating patient-learning was central
        to their treatment and management interventions:
        I really believe in patient autonomy, I think patients are responsible
        for themselves... it gives them control.
        
        A focus on professional artistry
        
        Patient-led
        
        Some participants (P6,9,10) adopted a patient-led approach to
        clinical decision-making and facilitated high-levels of patient
        involvement. These participants encouraged patients to take the
        lead in decision-making and educated patients so that they could
        make informed decisions:
        ...my process is “do you have any preference, what would you like,
        what do you think would help you most?” “Nowthat you’ve chosen,
        these are the side-effects. Are they acceptable?
  - - - Educational experience
        
        Student-centred, critically constructing knowledge
        Through reflection and time you begin to scrutinise
        things more and reject those fads and
      - Epistomology of practice knowledge
        
        Constructionist: listening and using language to develop an understanding
        of how patients’ made sense of their problem
        I seem to talk so much to patients, as I find that talking opens up a deeper
        level of understanding for them and me. (P3)
      - View of health and disease
        
        Biopsychosocial: considered patients’ problem in
        the context of their lives and their illness experience
        I like to see the other factors that would be influencing
        the way that they [the patient] experience
        their problem...it gives you a much rounder picture
        of the person you’re treating. (P6)
      - Theory-practice relationship
        
        Theories developed from practice: Though learning from, and reflecting on,
        practice they would develop their own personalised theories and
        practice models.
        I’m getting away from “I’ve got to get my hands on and get them better” to “right,
        this is the situation and this is how we can approach it; it’s your decision,
        what would you like to do?” So [my approach] has become much
        more collaborative. (P6)
      - Practitioner's perceived therapeutic role
        
        Patient autonomy: Patient as an active partner, views, knowledge
        and expectations exchanged and decisions negotiated
        By giving patients choice it treats them as an adult and gives them
        the autonomy. (P6)
    - - Professional artistry
        
        Educational experience
        
        Teacher-centred, uncritically accepting
        knowledge
        I still use the principles that I was taught
        as a student [and] they are still very relevant to me. (P1)
        
        Epistomology of practice knowledge
        
        Positivist-post-positivist: Focused on cause-effect
        relationships, knowledge is stable and factual
        If somebody’s got left-sided low back pain and
        their pelvis tilts down to the right then the structures
        will be more compressed on that left side. (P8)
        
        View of health and disease
        
        Biomedical: reduce patients’ problem
        down in a specific tissue or body structure
        and separates it from their social and
        emotional circumstances
        If you don’t have the basics like anatomy and
        physiology you are never going to get the
        right decision. (P12)
        
        Theory-practice relationship
        
        Theories applied to practice: view theory as separate
        from practice, apply existing theories (biomechanical
        and osteopathic theories) to practice.
        ...my practice is based on genuine biomechanical
        stuff [theories]. (P5)
        
        Practitioner's perceived therapeutic role
        
        Paternalism: assuming responsibility for
        the decision-making
        I am trying to get a little bit of mobility for him.
        To increase that range [of motion] for him,
        so that does not hold on to the joint so that
        he actually lets go of it. (P11)
- - - - The
        following analysis from participants viewpoints
        describes how traditional biomedical education
        forms an essential part of a holistic approach
        which, when combined together (in balanced
        emphasis), contributes to an integrated model of
        health care.