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.

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.

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.

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?

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)

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)

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)

Key learning reflection: the study demonstrated three different areas of therapeutic approaches:

1. Technical osteopath focused on the practitioner and biomechanical approaches. They have a vested interest in knowledge and their own abilities at influencing the patient directly
2. Communicating osteopath is focused on ensuring that the patient has been listened to & understood. It involves sharing knowledge and is person-centred.
3. Educating osteopath also focuses on the patient but involves helping the patient understand themselves, empowers the patient and moves well beyond the physical elements of the patient. It involves a very holistic approach.

Not mentioned in the article – influences for type of osteopath (I believe that it’s not fixed, and depending on certain factors, I will switch between each of these styles):

1. temperament of the patient – more longstanding patterns & momentary states
2. my temperament – “...”
3. the nature of the patient/practitioner relationship
4. the patients understanding of their body & health
5. the patients wants/needs from a consultation at that point in time
6. time available
7. number of complaints
8. nature of the complaint