Keeping a diary improves your clinical decision making!

This paper presents an interesting and relevant topic for contemporary osteopathic practice, namely that keeping a diary has been shown to improve clinical reasoning skills.  The key take home message is that by keeping a diary osteopaths can deepen their reflective skill set, and thereby gain a deeper engagement with their clinical decision making.

There is a convincing review from other healthcare professions where this form of reflective practice is more common place, and is considered a valuable tool to help with clinical reasoning.  Examples of embedded reflective practice are to be found in nursing, physiotherapy, occupational therapy and medicine.  Within these professions it is considered a valuable tool and practitioners are given help to structure this process.  In essence reflective practice requires practitioners to “actively write and question one’s own actions and thoughts”.  Sharing these thoughts in a peer group or with a supervisor deepens this process.  It has been shown that this helps to focus on what is actually being done during the treatment, not what practitioners think they are doing.  This process enhances healthcare provision.  This is clearly relevant to us as osteopaths as it opens up the possibility of improving our interactions with patients.  This will not only help those we treat but also improve out understanding of our interactions and deepen our learning around the therapeutic encounter.

For those interested in research methodology the authors utilise a qualitative method where they analyse data from the lead researcher’s use of diary keeping, in combination with discussions with peers and supervisors.  They, therefore, present a real life case of an osteopath using this method.

The results section is full of interesting and rich data.  For example, there is a realisation from the main researcher that she has relied on the biomechanical model and tended to exclude psychosocial factors. This emerges from a meeting with her supervisor who suggests she may be over relying on pattern recognition and intuition.  On reflection she realises that she feels untrained to deal with psychological issues.  This leads her to read around the subject and revisit some earlier psychology training material.

This is a very relevant paper for our profession, if we can develop some form of reflection into our practice this will enhance our therapeutic interactions for both parties.  The way to incorporate this process into practice requires the practitioner to write regularly about their experiences and then seek feedback from peers and/or a supervisor.  I can speak from my experience as a psychotherapist where supervision is normal, that the ability to discuss patients in a safe and supportive environment is both challenging and rewarding. It can highlight our blind spots and show where we need to seek further training.  I would strongly advocate some form of supervision for the osteopathic profession.  This paper provides compelling evidence that deepening our clinical reflective capacity improves our clinical decision making, and keeping a diary is an important tool in this process.

McIntyre C, Lathlean J and Esteves J E (2019) Reflective practice enhances osteopathic clinical reasoning, International Journal of Osteopathic Medicine, 33-34; 8-15

Robert Shaw PhD

January 2021

Robert has worked as an osteopath for over 30 years and a psychotherapist for over 25 years. He obtained his PhD in 2000 exploring the concept of embodiment within the therapeutic encounter. He has written many journal articles, a book, and lectured throughout Europe on the subject.

He has a specialised training in dealing with the physical and psychological aspects of post traumatic stress disorder. He moved to Sweden in 2010 and currently has a private practice as an osteopath, integrative psychotherapist, and supervisor, and is the program leader for the Skandinaviska Osteopathögskolan.

He is on the international editorial board for The International Journal of Osteopathic Medicine, and a member of the European School of Osteopathy International faculty. He is an Honorary Research Fellow at University of Technology Sidney (ATS), Australia, which has organised the first International Osteopathy Research Leadership and Capacity Building Program for osteopathy.