Really, what really is DO?

[peehdee]

Ok guys,

I'm sure this question has come up many times before so don't jump on my case.

I'm in an allopath school right now, but sometimes we usually talk about the difference b/w allo and osteol. Also, the convo sometimes come up with non-medical people.

So.. I need help in telling them the difference. I've heard that 'they practically get the same training except DO use "osteopathic manipulation" ". And that DO use 'whole body' approach to medicine. And usually that's what I say as well, since I'm not really that knowledgeable. What is this 'osteopathic manipulation' that is supposed to make the DO better/more qualified that the traditional MD? I'm a believer of the free enterprise/market system. That means that usually if something is 'better' then usually it gets more press or recognition. So if the DO are more qualified to treat 'whole body' or use some manipulation (which the MD obviously dont' get trained in) than the MD why isn't the market for DO stronger than the MD? One reason might be the sheer number of MD compared to DO. Another might be that DO don't really do those things. DO are just like MD except that to separate themselves from the MD, they make those claims?


Like I said don't start yelling at me. I actually want to know the 'real' differences. I'm one of those 'hard-core' science people so I need facts and evidence-based medicine. Stuff like acupuncture and herbal medicine may work for some 'small set' of people (with the caveat that the placebo effect is very powerful), but when it comes to large scale usuage, it does't stand a chance. Sure you hear stories about one of two people who had seen an MD about something that was not treatable who went to a non-MD person and got better; but these are in a very small minority. And by no means do I claim that MDs know everything, not possible. So, I would appreciate some intellectual exchange about what you guys think are the salient features of the DO that make it 'really' unique from MD.

Cheers

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[cmudan]

Great post and great question,

Unfortunately, I think you will get ripped apart by the wonderfully self-absorbed posters here, so be prepared.

 

[Ratch]

Stop by michigan state sometime, DO and MD take all first year classes together as far as basic sciences go, and second year we split apart for different approaches on systems based courses. then we go out to the hospitals and do the same thing, learn how to practice medicine.

aside from taking classes in osteopathic manipulation, and perhaps the big picture as far as how medicine is approached (ALLO: problem in a patient vs. OSTEO: patient with a problem), there isn't much difference. more non-traditional students in osteopathic programs, often a bit older with more diverse backgrounds (diversity in life experiences that is).

its medicine, you get out of it what you put into it. your personality is going to dictate alot more about what type of physician you are than the credential behind your name.

okay, i'd type more but i need to go study for my voodoo final tomorrow

 

[sophiejane]

What is this 'osteopathic manipulation' that is supposed to make the DO better/more qualified that the traditional MD?

I don't think that the majority of DOs believe that being able to use OMT (or anything else we learn that is different) makes us any better than MDs. It's just that we learn some different tools with OMT, and we tend to have more developed general palpation skills because of it. This does not make our education superior to that of allopathic schools. It just emphasizes different things. We get a lot of exposure to family medicine and primary care and have a long history of producing excellent primary care practitioners.

The other day, I was following an MD internist as he saw patients. One patient had AIDS, and a number of complaints, one of which was chronic low back pain. The MD never put his hands on the patient's back or asked the patient to demonstrate range of motion, and he approached all of the possible causes of his back pain from his labs and his subjective description. I was DYING to palpate his back and spine and felt confident I could find and treat some or all of his dysfunction, but I didn't dare speak up--after all, was just supposed to be "observing". The MD said that the problem would have to get worse before he could help him with it (with pain meds). The patient left with no treatment for his back pain.

Anyway, this MD was a very good doc at what he was trained in, it's just that his approach was different, and in this particular case, his training wasn't able to help him help his patient's back pain.

I think the best of all possible worlds is for MDs and DOs to work together and cooperate and use one another's strengths to the greatest benefit of the patient.

 

[Aaron Earles]

I don't think that the majority of DOs believe that being able to use OMT (or anything else we learn that is different) makes us any better than MDs. It's just that we learn some different tools with OMT, and we tend to have more developed general palpation skills because of it. This does not make our education superior to that of allopathic schools. It just emphasizes different things. We get a lot of exposure to family medicine and primary care and have a long history of producing excellent primary care practitioners.

The other day, I was following an MD internist as he saw patients. One patient had AIDS, and a number of complaints, one of which was chronic low back pain. The MD never put his hands on the patient's back or asked the patient to demonstrate range of motion, and he approached all of the possible causes of his back pain from his labs and his subjective description. I was DYING to palpate his back and spine and felt confident I could find and treat some or all of his dysfunction, but I didn't dare speak up--after all, was just supposed to be "observing". The MD said that the problem would have to get worse before he could help him with it (with pain meds). The patient left with no treatment for his back pain.

Anyway, this MD was a very good doc at what he was trained in, it's just that his approach was different, and in this particular case, his training wasn't able to help him help his patient's back pain.

I think the best of all possible worlds is for MDs and DOs to work together and cooperate and use one another's strengths to the greatest benefit of the patient.

Well stated sophiejane!

 

[sddoc]

I couldn't agree more, sophie. I love having OMT as a diagnostic and treatment tool, but it's not the only focus. Essentially, we have one extra subject to pass on the boards that enables us to look at a patient from one more angle. Hopefully, no one flames the OP. There's nothing wrong with asking a question, and it's a great opportunity to explain who we are and what we do!

 

[zenman]

Stuff like acupuncture and herbal medicine may work for some 'small set' of people (with the caveat that the placebo effect is very powerful), but when it comes to large scale usuage, it does't stand a chance. Sure you hear stories about one of two people who had seen an MD about something that was not treatable who went to a non-MD person and got better; but these are in a very small minority.

Since you are studying a lot and probably don't have time to keep up with the real world be aware that more visits and more out-of-pocket money is spent on "alternative" modalities than allopathic. The public is trying to say something here; is anyone listening?

 

[Robz]

Since you are studying a lot and probably don't have time to keep up with the real world be aware that more visits and more out-of-pocket money is spent on "alternative" modalities than allopathic. The public is trying to say something here; is anyone listening?

I dunno.

It could be legit and can could help...then again it could be quacks that require you to come back and back to "fix" the problem. I have heard that statement before about more being spent on "alternative" medicine but I think when it comes down to it...ask around, if you have had a heart attack and your sweaty, diaphoretic, thready racing pulse, and short of breath....would you want a physician or an alternative medical treatment?

That example may be pushing it but I think you get the point.

 

[cooldreams]

Quote:
"Stuff like acupuncture and herbal medicine may work for some 'small set' of people (with the caveat that the placebo effect is very powerful), but when it comes to large scale usuage, it does't stand a chance. Sure you hear stories about one of two people who had seen an MD about something that was not treatable who went to a non-MD person and got better; but these are in a very small minority."


Since you are studying a lot and probably don't have time to keep up with the real world be aware that more visits and more out-of-pocket money is spent on "alternative" modalities than allopathic. The public is trying to say something here; is anyone listening?

yea... like.. seriously man... TCM has something to it. just because your "hard science" cannot understand it doesnt mean that it doesnt work/exist. man we all have sooooooooooooooooooooooooooooo much to learn.......

just got back from a bushido camp this past weekend. it was using pressure points taught in kyusho-jitsu. totally amazing stuff. i actually got to knock somone out cold with a light strike to the face at a particular point. i asked the instructors several questions on how this works and why and basically it came down to they dont know why but were taught that it has something to do with your body's lifeforce/energy. i actually was demonstrated upon for a knockout. he never touched me..... he never touched me and knocked me out cold.... one minute i see him standing there with his hand near my face and the next thing i know im sitting on the mat with someone reviving me. i completely blacked out, they even video taped it and it shows he never touched me. now go ahead... explain that with your all knowing hard science...

dont turn your back on something just because you dont know how it works or "heard" that it is bunk...

 

[Robz]

I wanna try that! That would be cool!

 

[DORoe]

Since you are studying a lot and probably don't have time to keep up with the real world be aware that more visits and more out-of-pocket money is spent on "alternative" modalities than allopathic. The public is trying to say something here; is anyone listening?

The public also likes reality shows. That doesn't mean that they are better than reading a book. I don't think you should use the publics opinions/perception and anecdotal evidence to support the use of any "alternative" treatment. While it is true that everything cannot be explained there should at least be some sound scientific basis for what you are doing. I think that I read something the other day on here about a medicine man in some village likes to cut open live guinea pigs and look inside them to determine what is wrong with a patient. The patients swear by this method of diagnosis, but does that mean that we should all jump on the ripping open guinea pig bandwagon? I would say no, but that is only my opinion.

Edit: To the OP- Maybe you should check out some studies done on OMM and its effectiveness. That would probably give you a better idea about what OMM is and what it seeks to treat.

 

[zenman]

Posted by Robz: It could be legit and can could help...then again it could be quacks that require you to come back and back to "fix" the problem.

I agree we have quacks everywhere, including in the hospital. Two patients in the last few weeks have made it to surgery without a pre-op workup. One patient had a CABG and afterwards finally had that CXR where it was discovered her respiratory problem was due to lung cancer!

I have heard that statement before about more being spent on "alternative" medicine but I think when it comes down to it...ask around, if you have had a heart attack and your sweaty, diaphoretic, thready racing pulse, and short of breath....would you want a physician or an alternative medical treatment?

In an emergency situation, I want the best ER around. However, there are probably more emergency techniques in alternative medicine than you realize, including herbs to stop bleeding. I do Zen Shiatsu and treated a lady in Mexico during a medical mission for what the medical team thought was a heart attack. Course, no one bought nitro. The lady refused to go to the Mexican hospital (I don't blame her) so I worked her Heart and Pericardium meridians (Yea, I know they don't exist). Her pain went away and she followed me around the rest of the trip. The medical team just went, "What the hell?" We made a cute couple with her at least 4'5' frame next to my 6'3" one.

That example may be pushing it but I think you get the point.

Isn't that what the acupuncturist said? LOL.

 

[zenman]

Posted by Robz: I wanna try that! That would be cool!

It is cool. Some of the point strikes can be explained in western medicine terms such as the Stomach 9 point on the carotid artery. It only takes a light slap here and you know what happens next. Other points...I have no western explaination. The M.D.s in my instructor's school can also explain some things, but not all, according to their western framework. They include several Internal Medicine docs, Physical Med & Rehab docs, and a Chief of Orthopedic Surgery.

 

[zenman]

Posted by DORoe: I don't think you should use the publics opinions/perception and anecdotal evidence to support the use of any "alternative" treatment.

JAMA thought is was worth publishing. "Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey."

Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC.

If your office visits dropped off by 50% for example, would you listen to the public?

While it is true that everything cannot be explained there should at least be some sound scientific basis for what you are doing.

If if can't be explained, how is there to be sound scientific basis? Most empirical studies are flawed from the beginning because they do not take into account the role, and power of, the human brain (and mind). If anyone in a study, and that includes patients and healthcare team members, know that they are part of a study, it is null and void. If you look at any peer-reviewed medical journal, you probably see this statement: "Future studies should validate these findings; more evidence is required." In the meantime people are being harmed. Many reversals of popular medical opinion occur; this happens of course, after many thousands of people have been treated according to these empirically effective treatments or drugs. Statistics can never account for the effect of a particular therapy on an individual. Asian Medicine recognizes this and that is why 10 people who have a headache may each receive a different treatment. We use many medications, for example, but do not know how they work. Is this antedotal or empirical?

 

[cooldreams]

It is cool. Some of the point strikes can be explained in western medicine terms such as the Stomach 9 point on the carotid artery. It only takes a light slap here and you know what happens next. Other points...I have no western explaination. The M.D.s in my instructor's school can also explain some things, but not all, according to their western framework. They include several Internal Medicine docs, Physical Med & Rehab docs, and a Chief of Orthopedic Surgery.

yes, st9 is pretty dangerous, we were just using a setup on the wrist for the strike to st 5. thats cool you know about that, i think by our childrens generation that this stuff may be more mainstream, but right now it is just starting to emerge... what do you think??

 

[dcratamt]

Well stated sophiejane!

I agree also....with sophiejane that is.

 

[DrDavesWife]

Ok guys,

I'm sure this question has come up many times before so don't jump on my case.

I'm in an allopath school right now, but sometimes we usually talk about the difference b/w allo and osteol. Also, the convo sometimes come up with non-medical people.

So.. I need help in telling them the difference. I've heard that 'they practically get the same training except DO use "osteopathic manipulation" ". And that DO use 'whole body' approach to medicine. And usually that's what I say as well, since I'm not really that knowledgeable. What is this 'osteopathic manipulation' that is supposed to make the DO better/more qualified that the traditional MD? I'm a believer of the free enterprise/market system. That means that usually if something is 'better' then usually it gets more press or recognition. So if the DO are more qualified to treat 'whole body' or use some manipulation (which the MD obviously dont' get trained in) than the MD why isn't the market for DO stronger than the MD? One reason might be the sheer number of MD compared to DO. Another might be that DO don't really do those things. DO are just like MD except that to separate themselves from the MD, they make those claims?


Like I said don't start yelling at me. I actually want to know the 'real' differences. I'm one of those 'hard-core' science people so I need facts and evidence-based medicine. Stuff like acupuncture and herbal medicine may work for some 'small set' of people (with the caveat that the placebo effect is very powerful), but when it comes to large scale usuage, it does't stand a chance. Sure you hear stories about one of two people who had seen an MD about something that was not treatable who went to a non-MD person and got better; but these are in a very small minority. And by no means do I claim that MDs know everything, not possible. So, I would appreciate some intellectual exchange about what you guys think are the salient features of the DO that make it 'really' unique from MD.

Cheers

Hi there........although I'm NOT a DO (just the fiancee of a future DO), It didn't really seem as if anyone answered your question. Considering that I'm a patient, not a doctor, I thought perhaps my opinion might shed a different light for you......

Unfortunately, I've had to see many doctors in my 35-year life. I have a host of physical (and a few psych ) issues which has made it rather difficult for docs to diagnose me properly. Over the last 3 years, continued visits and a host a meds prescribed by MDs did me absolutely no good. The MDs seemed to want to target areas of complaint very specifically and band-aid pain. Finally, once I began seeing a DO in Erie (my fiancee is an MS I at LECOM), he along with a GI DO and an OB DO began putting 2-and-2 together and were able to not only relieve 3 years of pain, but solve my problems. What I really needed was a total-body approach; someone to look at ALL my symptoms and to perform a much more comprehensive history and physical. In addition, I gained an amazing amount of relief from osteopathic manipulation -- i was so locked up du to pain, anxiety, stress, weak muscles, etc.

Now, I feel wonderful, am on the proper type/dose of meds, issues were corrected surgically and am I on an exercise plan to keep my muscles strong, etc.

I feel as if seeing my primary DO is like seeing 3 or 4 MDs with better results.

Hope that helps a bit, albeit not a scientific explanation.

Best of luck.......
DrDavesWife

 

[jxu66]

http://www.osteopathic.org/index.cfm?PageID=ado_whatis

What is a Doctor of Osteopathic Medicine (D.O.)


If you're like most people, you've been going to a doctor since you were born and perhaps didn't know if you were seeing a D.O. (osteopathic physician) or an M.D. (allopathic physician). You may not even be aware that there are two types of complete physicians in the United States.

The fact is, both D.O.s and M.D.s are fully qualified physicians licensed to perform surgery and prescribe medication. Is there any difference between these two kinds of doctors? Yes. And no.

Read this brochure in Spanish: Que es un D.O.?




D.O.s bring something extra to medicine


Osteopathic medical schools emphasize training students to be primary care physicians.
D.O.s practice a "whole person" approach to medicine. Instead of just treating specific symptoms or illnesses, they regard your body as integrated whole.
Osteopathic physicians focus on preventive health care.
D.O.s receive extra training in the musculoskeletal system -- your body?s interconnected system of nerves, muscles and bones that make up two-thirds of its body mass. This training provides osteopathic physicians with a better understanding of the ways that an injury or illness in one part of your body can affect another.
Osteopathic manipulative treatment (OMT) is incorporated in the training and practice of osteopathic physicians. With OMT, osteopathic physicians use their hands to diagnose injury and illness and to encourage your body?s natural tendency toward good health. By combining all available medical procedures with OMT, D.O.s offer their patients the most comprehensive care available in medicine today.




More than a Century of Unique Care


Osteopathic medicine is a unique form of American medical care that was developed in 1874 by Dr. Andrew Taylor Still. Dr. Still was dissatisfied with the effectiveness of 19th Century medicine. He believed that many of the medications of his day were useless or even harmful. Dr. Still was one of the first in his time to study the attributes of good health so that he could better understand the process of disease.

In response, Dr. Still founded a philosophy of medicine based on ideas that date back to Hippocrates, the father of medicine. The philosophy focuses on the unity of all body parts. He identified the musculoskeletal system as a key element of health. He recognized the body?s ability to heal itself and stressed preventive medicine, eating properly and keeping fit.

Dr. Still pioneered the concept of "wellness" more than 125 years ago. In today's terms, personal health risks--such as smoking, high blood pressure, excessive cholesterol levels, stress and other lifestyle factors--are evaluated for each individual. In coordination with appropriate medical treatment, the osteopathic physician acts as a teacher to help patients take more responsibility for their own well-being and change unhealthy patterns.




21st Century Frontier Medicine

Just as Dr. Still pioneered osteopathic medicine on the Missouri frontier in 1874, today osteopathic physicians serve as modern day medical pioneers. They continue the tradition of bringing health care to areas of greatest need:
Approximately 65% of all osteopathic physicians practice in primary care areas such as pediatrics, family practice, obstetrics/gynecology and internal medicine.
Many D.O.s fill a critical need for doctors by practicing in rural and medically underserved areas.
Today osteopathic physicians continue to be on the cutting edge of modern medicine. D.O.s combine today's medical technology with their ears, to listen compassionately to their patients; their eyes, to see their patients as whole persons; and their hands, to diagnose and treat injury as well as illness.




D.O.s and M.D.s are alike in many ways:


Applicants to both D.O. and M.D. medical colleges typically have a four-year undergraduate degree with an emphasis on scientific courses.
Both D.O.s and M.D.s complete four years of basic medical education.
After medical school, both D.O.s and M.D.s can choose to practice in a specialty area of medicine -- such as surgery, family practice or psychiatry--after completing a residency program (typically two to six years of additional training).
Both D.O.s and M.D.s must pass comparable state licensing exams.
D.O.s and M.D.s both practice in fully accredited and licensed health care facilities.
D.O.s comprise a separate, yet equal branch of American medical care. Together, D.O.s and M.D.s enhance the state of care available in America. It is, however, the ways that D.O.s and M.D.s are different that bring an extra dimension to your family's health care.

Additional information may be found in these other Osteopathic.org Web pages:

Osteopathic Medicine

 

[Hernandez]

Hi, and thanks for the question.

The question you ask is really a difficult one to put into words and the posts above had done a great job of elucidating some of the differences. But here is my take on the whole thing.

It all boils down to the OMM, it does give us a chance to acquire palpation skills sooner and when we see patients we do have a tendency to palpate a more, i.e. just like the lower back pain story told before, OMM is a great technique for alleviating pain and other things.

And as for scientific, reproducible evidence-based medicine research for OMM, there is research out there, although still not in massive amounts it is underway, for instance one of our instructors (an MD to boot) had an article published about the benefits for Otits Media in infants recently. And another reason you may not see it is because the JAMA does seem to be a little reluctant to publish those articles, also be aware that there is still a lot of debate within even the Osteopathic community about the benefits of some techniques like cranial manipulation (please lets not go there)

But on a side note, I?m still not sure about the whole ?separate but equal? motto that is used quite a bit, OMM is just another tool that we have, not voodoo(once again please leave the cranial debate for another post) that only those daring enough to an Osteopathic school can achieve, MD?s can take the courses offered by the AAO if they want themselves.

 

[r90t]

http://www.mychiro.com/health/index.php?p=35

A quick article that my wife's boss wrote on acupuncture and radiation oncology. He became interested after a trial of acupunture worked on a trial set of pts by an eastern trained physician. He was a non-believing allopathic physician, now he has entwined it in his practice.

Look at manipulation. Medicare reimburses it. Added to a practice, you can generate an extra $2500/week with pts that is reimbursable. THe pts love the "hands on" care. Pts are happy.

As for differences in MDs and DOs. We have one more tool in our bag of tricks, o/w, both groups are held to the same standards of care in medicine.

 

[Tenesma]

a CABG without a CXR ---- yeah right... no surgeon would even do a sternotomy without a CXR hanging on the lightbox in the room... unless of course the CABG was done by a naturopath...