Shared Decision-Making at The Health Equation

At The Health Equation, shared decision-making is an essential part of every diagnostic consultation and treatment plan. It means working collaboratively with each patient so that clinical decisions reflect not only the available evidence, but also the patient’s individual circumstances, priorities, concerns and preferences.

Patients receive clear explanations of the potential benefits, limitations and risks of any proposed investigation, referral or treatment, together with the reasonable alternatives—including, where appropriate, the option of taking no immediate action. This allows patients to make properly informed choices about their care.

All consultations and treatments are undertaken by Mr Gerry Gajadharsingh DO, Osteopath & Diagnostic Consultant in Integrated Medicine, with almost 40 years of clinical experience in the assessment and management of complex and persistent health problems.

What Shared Decision-Making Means

Shared decision-making brings together two equally important forms of knowledge: the clinician’s experience and understanding of the available evidence, and the patient’s own experience of their symptoms, health priorities and personal circumstances.

It is a collaborative process in which:

  • the clinical problem and any areas of uncertainty are explained clearly;
  • the available options are discussed, including their potential benefits, limitations and risks;
  • the patient has the opportunity to ask questions and express any concerns;
  • personal preferences, previous experiences and practical circumstances are considered; and
  • an agreed plan is developed, reviewed and adjusted where necessary.

Shared decision-making does not mean that responsibility is transferred entirely to the patient. Gerry provides clinical guidance and recommendations, while ensuring that the patient understands the reasoning behind them and remains actively involved in deciding what happens next.

The Purpose and Benefits of Clinical Assessment

Clinical Examination

A clinical examination helps to identify relevant patterns, distinguish functional problems from possible pathology and determine whether further investigation or referral may be required. The examination is individually tailored and may include assessment of:

  • Musculoskeletal function — posture, movement, joint mobility, muscle function and palpation
  • Cardiovascular function — blood pressure, pulse and cardiac auscultation where appropriate
  • Respiratory function — breathing pattern, spirometry, capnometry and oxygen saturation
  • Neurological function — reflexes, sensation, coordination and muscle power

Depending on the presenting problem, patients may be asked to remove some clothing so that the relevant area can be examined accurately. This will always be explained beforehand and undertaken with respect for the patient’s dignity and consent. Towels are available, and patients may request a chaperone or bring a trusted companion.

Relevant parts of the examination may be repeated during follow-up consultations to assess progress and guide any changes to the management plan.

Diagnostic Investigations

When clinically appropriate, Gerry may recommend further investigations to clarify the diagnosis, exclude significant pathology or provide a more detailed understanding of the factors contributing to a patient’s symptoms.

These may include:

  • Laboratory investigations — blood, urine or stool testing, interpreted using established medical reference ranges alongside a broader functional and physiological assessment
  • Diagnostic imaging — X-ray, ultrasound, MRI or CT scanning where clinically indicated
  • Physiological assessment — including capnometry, heart rate variability, spirometry and other relevant measurements

The reason for recommending an investigation will be explained, together with its potential benefits, limitations, costs and any relevant risks. Patients may accept, defer or decline a proposed test. Where an investigation falls outside Gerry’s professional scope, referral will be made to an appropriate GP, medical consultant or other regulated healthcare professional.

Osteopathic Assessment and Manual Treatment

Where appropriate, osteopathic manual treatment may form part of the agreed management plan. Its purpose is to improve mobility, reduce unnecessary muscular and fascial tension, support more efficient movement and help manage pain or other functional symptoms.

Treatment is individually selected and may include:

  • soft-tissue and fascial techniques;
  • gentle joint articulation and mobilisation;
  • functional and indirect techniques;
  • visceral techniques;
  • cranial and involuntary-mechanism approaches; and
  • high-velocity, low-amplitude thrust techniques where clinically appropriate.

The proposed technique, its intended purpose and any reasonable alternatives will be explained before treatment. Consent is an ongoing process: patients may ask questions, request a different approach or withdraw consent at any time. No particular technique is used automatically, and treatment is adapted to the patient’s clinical findings, preferences and individual risk profile.

Additional Management Options

Depending on the findings of the diagnostic consultation, the agreed management plan may also include:

  • Exercise and rehabilitation — individually selected strategies to improve mobility, strength, coordination and physical resilience
  • Nutrition and biochemistry — practical dietary guidance and, where appropriate, carefully selected nutritional supplementation
  • Breathwork and breathing re-training — assessment and retraining of dysfunctional breathing patterns to support respiratory efficiency, physiological regulation and neural balance
  • Lifestyle and mind–body support — consideration of sleep, stress, recovery, activity and the interaction between emotional and physical health
  • Further investigation or specialist referral — referral to an appropriate GP, medical consultant or allied healthcare professional when additional expertise is required

These options are not applied as a standard package. Recommendations are based on the individual patient’s clinical findings, priorities and circumstances, and each element can be discussed, modified, deferred or declined.

Understanding Potential Risks

Patient safety is central to clinical decision-making at The Health Equation. Although most examinations, investigations and treatments involve negligible or minimal risk, no healthcare intervention can be described as entirely risk-free.

Any risks that are relevant to the individual patient will be considered in relation to their age, health, medical history, current medication, clinical findings and the proposed intervention. Where a particular technique, investigation or treatment carries a material risk, this will be explained in understandable terms before consent is obtained.

The discussion will also consider:

  • the likelihood and possible seriousness of an adverse effect;
  • the expected benefit of the proposed intervention;
  • reasonable alternatives;
  • the potential consequences of delaying or declining treatment; and
  • any steps that can be taken to reduce risk.

This allows decisions to be based on the balance of potential benefit and risk for the individual patient, rather than on risk figures alone.

Clinical Examination

Most elements of clinical examination carry negligible risk. Some physical tests or movements may temporarily reproduce a patient’s familiar pain, stiffness, dizziness or other symptoms because they are designed to assess the structures or physiological responses involved.

Each examination procedure will be explained and adapted to the patient’s presentation. Patients should tell Gerry immediately if they experience unexpected discomfort or do not wish a particular test to continue. Any examination can be paused, modified or declined.

Laboratory Investigations

Urine and stool sample collection carries negligible risk.

Blood sampling is generally a low-risk procedure but may occasionally cause:

  • temporary discomfort at the needle site;
  • minor bleeding or bruising;
  • light-headedness or fainting;
  • local irritation; or
  • very rarely, infection or injury to a nearby structure.

Blood samples at The Health Equation are taken by an appropriately qualified phlebotomist. Patients should disclose any history of fainting during blood tests, difficulty obtaining samples, bleeding disorders or use of anticoagulant medication before the procedure. They may accept or decline any recommended laboratory investigation.

Diagnostic Imaging

The benefits, limitations and risks of diagnostic imaging depend upon the type of investigation being considered:

  • X-rays and CT scans use ionising radiation. Exposure is carefully controlled and should only be recommended when the anticipated clinical benefit justifies it.
  • MRI scans do not use ionising radiation but may be unsuitable for some patients with particular implants, medical devices or metallic foreign bodies. Some people also find the enclosed scanner uncomfortable.
  • Ultrasound scans do not use ionising radiation and are generally regarded as carrying negligible risk.

Some investigations may require a contrast agent, which introduces additional considerations such as allergy or impaired kidney function. These will be assessed and explained by the imaging provider.

Gerry holds IR(ME)R certification in relation to the Ionising Radiation (Medical Exposure) Regulations. This supports the appropriate clinical justification of imaging referrals involving ionising radiation, including consideration of whether the anticipated diagnostic benefit outweighs the radiation exposure.

The purpose of any proposed scan, suitable alternatives and the possible effect of the result on clinical management will be discussed before referral. Imaging is not recommended routinely where it is unlikely to contribute meaningfully to diagnosis or alter clinical decision-making.

Osteopathic Manual Treatment

Most patients tolerate osteopathic manual treatment well. Some may experience a temporary response lasting approximately 24–48 hours, such as:

  • local soreness or stiffness;
  • a temporary increase in familiar symptoms;
  • fatigue;
  • mild headache; or
  • transient light-headedness.

More significant adverse events are uncommon, but the nature of the risk varies according to the technique used, the area being treated and the patient’s individual health profile. High-velocity, low-amplitude thrust techniques require particular consideration because rare but potentially serious complications have been reported, including fracture, aggravation of a disc injury, nerve irritation and vascular injury associated with treatment of the neck.

Before using these techniques, Gerry considers the patient’s history, examination findings, medication, bone health, neurological or vascular symptoms and any other relevant risk factors. The reason for proposing the technique, its expected benefit and suitable alternatives will be explained beforehand.

Patients are never obliged to accept manipulation. Gentler manual approaches or non-manual management may be selected instead, and consent may be withdrawn at any stage.

Other Management Interventions

Other elements of an agreed management plan are generally low risk when appropriately selected and monitored, but individual responses can vary.

  • Exercise and rehabilitation may temporarily increase muscular soreness, fatigue or familiar symptoms. Programmes are therefore tailored and progressed according to the patient’s ability and response.
  • Breathwork and breathing re-training may occasionally produce temporary light-headedness, breath awareness or anxiety, particularly when established breathing patterns begin to change. Exercises are introduced gradually and monitored where appropriate.
  • Nutritional guidance and supplementation may cause intolerance, digestive symptoms or interactions with medication or existing medical conditions. Recommendations take account of the patient’s history, current medication and available laboratory findings.
  • Lifestyle and mind–body approaches may bring attention to sensitive personal or emotional issues. Patients decide what they are comfortable discussing and may decline any particular approach.

Patients should report any unexpected or persistent reaction. Recommendations can then be reviewed, modified or discontinued as part of the shared decision-making process.

Considering the Alternatives

Patients remain in control of the decisions made about their healthcare. Before proceeding, reasonable alternatives to a proposed investigation or treatment will be discussed where relevant.

These may include:

  • choosing a different form of examination, investigation or treatment;
  • adopting a gentler or more conservative management approach;
  • seeking an opinion from a GP, medical consultant or another healthcare professional;
  • monitoring the problem before deciding whether to intervene;
  • deferring a decision while obtaining further information;
  • declining part of a proposed management plan; or
  • choosing no investigation or treatment at that time.

Choosing not to proceed is itself a valid healthcare decision. Where delaying or declining an intervention could carry a significant risk, this will be explained clearly so that the patient understands the possible consequences.

A decision made at one consultation is not permanent. It can be reconsidered as symptoms, circumstances, clinical findings or personal priorities change.

Shared Decision-Making Within an Integrated Approach

At The Health Equation, shared decision-making is embedded within the Integrated Regulatory Systems Framework (IRSF). This provides a structured way of considering how the respiratory, neural, circulatory, endocrine, immune and inflammatory, metabolic and musculoskeletal systems may interact in patients with complex or persistent symptoms.

The framework does not replace established medical diagnosis or appropriate specialist care. It helps organise clinical information, identify potentially relevant physiological relationships and determine which findings require treatment, monitoring, further investigation or referral.

During a Diagnostic Consultation, Gerry explains:

  • what is known from the history, examination and available investigations;
  • which findings appear clinically important;
  • where uncertainty remains;
  • the possible relationships between symptoms and regulatory systems;
  • which further investigations or referrals may be justified; and
  • the available management options and their relative priorities.

The aim is to develop a coherent and proportionate plan that the patient understands and feels able to follow, while remaining clear about the limits of current knowledge and Gerry’s professional scope of practice.

Consent Is an Ongoing Process

Consent is not a single signature or a decision made only at the beginning of care. It is an ongoing conversation throughout examination, investigation and treatment.

Before proceeding, patients are encouraged to:

  • ask questions;
  • request further explanation;
  • discuss any concerns or previous adverse experiences;
  • take additional time to consider their options where appropriate;
  • involve a trusted relative, friend or other healthcare professional; and
  • say if they would prefer an alternative approach.

Gerry will check that the patient understands the proposed plan and is comfortable proceeding. Consent may be limited to a particular part of an examination or treatment and can be withdrawn at any time, without affecting the patient’s right to respectful clinical care.

Where a patient lacks the capacity to make a particular decision, or where capacity may be impaired or fluctuate, decisions will be approached in accordance with the relevant legal and professional requirements.

Discussing Your Healthcare Options

If you have persistent or complex symptoms and would like a clearer understanding of your findings, available options and appropriate next steps, book a Diagnostic Consultation with Gerry Gajadharsingh.

The consultation provides time to review your clinical history, previous investigations and current concerns, undertake an appropriate examination and develop an individual plan through shared decision-making.