Osteopathic Patient Care and Procedural Skills
Core concepts
Patient-care questions test a repeatable sequence: focused history, physical exam, problem list, differential diagnosis, diagnostic strategy, treatment, and follow-up. Know informed consent elements-capacity, disclosure of risks, benefits, and alternatives, voluntariness, and documentation-and remember that a signature alone is not consent. Demonstrate universal precautions, hand hygiene, sterile technique, and safe procedure setup. For common skills, know indications, contraindications, landmarks, complications, and aftercare: venipuncture, suturing, splinting, lumbar puncture, urinary catheterization, and airway management. Understand test characteristics and pretest probability before ordering studies; avoid shotgun testing. Traps include skipping the exam, ignoring contraindications, failing to obtain consent when the patient has capacity, misidentifying landmarks, and not documenting complications. In emergencies, implied consent may allow necessary treatment, but ask when possible. Also know when to escalate to a supervisor and how to write a procedure note.
Worked example
A febrile patient needs a lumbar puncture. Screen for increased intracranial pressure or coagulopathy, obtain consent if able, use sterile technique, and record opening pressure, cell counts, glucose, protein, and culture. Rule of thumb: for any procedure, state indication, contraindication check, consent, technique, and complication plan.