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the AMA and the Campaing Unity Project

Discussion in 'Osteopathic' started by Matthew T Perry, Aug 20, 1999.

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  1. Matthew T Perry

    Matthew T Perry Junior Member

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    I got to thinking about the representation those of us who are members of both the AMA and the AOA are getting. Both organizations declare they are advocates of our concerns and interests and work to ensure we maximize our potentials as physicians and medical students. With this in mind, I am fully supportive of the AOA's effort to promote the osteopathic goals and philosophies through its Campaign Unity project. This is something that should have been done years ago, and if effective can greatly improve the public awareness of the osteopathic profession, which in turn will only help us.
    Now as a member of the AMA, I do not find it at all inappropriate to expect some type of support from them as well. As a matter of fact, every DO physician and student member should be fervently demanding they do their utmost to ensure the success of the Campaign Unity project. They should be actively engaged in promoting osteopathy. Their goals should be to make Andrew Still and the DO initials a breakfast conversation across America. After all, don't we pay the same dues as our allopathic colleagues?
    I would love to hear from others who support this idea. Also, if anyone can expound on this or has any useful comments regarding this please email me or post.

    Osteopathically yours,

    Matthew T. Perry
    Student Doctor
    UNTHSC-TCOM
  2. Doc777

    Doc777 Junior Member

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    Mr. Perry:

    Although I don't agree with you, I do admire your enthusiasm. I do not agree with the AOA's Unity Campaign at all, and I am against it to a certain degree. The AOA has consistantly defined the DO as a physician who utilizes manual medicine and OMM in their daily clinical practice, and claim that these techniques serve as an adjunct to traditional therapy. What the AOA doesn't say in their advertisments, and other PR related statements, is that OMM is practiced by less than 10 percent of board certified DOs, and that it is practically non-existant in the hospitals. Put simply, most osteopathic phyicians do not practice OMM, as the AOA claims. I have tremendous respect for OMM, and do consider it to be an essential asset in the realm of sports medicine and in the treatment muscoskeletal abnormalities, but it is NOT a defining characteristic of those who carry "DO" after their name. I have talked to many interns, residents, and attending physicians at all the major osteopathic hospitals in Michigan, and all of them say the same thing in regard to OMM: "We never do any of that here." With this in mind, why does the AOA continue to portray the DO as something he/she is not and never will be? Why do they stick a definition that is grossly out-dated? Why do they feel the need to continually separate osteopathic physicians from mainstream medicine? Times have changed; Doctors have changed; and medicine has changed. It's time for the AOA to change.

    The AOA should represent osteopathic medicine as a branch of mainstream medicine, which emphasizes a patient-centered approach to health care and primary and preventative care medicine. Using OMM as a defining criteria is misleading, and simply not true.
    An osteopathic physician my be the attending ER doc in a level-1 trauma center; he/she may be the neurosurgeon who is on call; he/she may be the forensic pyschiatrist testifying in a high-profile murder trial. We should be represented for what we are, not as what we were. If we are to improve our public image, we will do so by showing the public the competence and diversity of DOs, not by striving to have Andrew Taylor Still's name mentioned over a bowl of Frosted Flakes.

    MEDICALLY yours,
    Doc777
  3. MiracleDOhappen

    MiracleDOhappen Junior Member

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    Doc777 is right. OMM doesn't represent D.O.'s training, neither physical medicine represent M.D.'s traning. It will be an insult for M.D.'s, if we refer them as some sort of physical therapists, because they have physical medicine in their curriculum.
    The same game apply to DO's too, I will be definitely offended if some body refer me as a bonesetter, even though A. T. Still was once proud of himself as a bonesetter. I believe Doc777 represents a new breed of modern intellects who have the guts to say: you are wrong, my father.

    [This message has been edited by MiracleDOhappen (edited August 21, 1999).]
  4. MiracleDOhappen

    MiracleDOhappen Junior Member

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    D.O.'s are Medical Doctors....period. [​IMG]

    [This message has been edited by MiracleDOhappen (edited August 21, 1999).]
  5. turtleboard

    turtleboard SDN Advisor

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    Doc777,

    How else are osteopathic physicians unique if not for their education in OMT and osteopathic approach to patient care?

    What exactly is the osteopathic approach? Is it the same as "patient-centered, preventive" medicine? I'm not sure if I can agree with you that DOs have a monopoly on this particular approach to their patients since, as reported in a number of medical periodicals, MDs in certain specialties have the same approach. Just check out the video the AAFP sends out to interested medical students on what an FP physician does.

    If I read you correctly, and the DOs renounce their training in OMT and discard the osteopathic philosophy (which is, very generally, the interrelationship between systems within the body), what makes a DO different from an MD? I can tell you now that it's not patient-centered care -- it's not absolutely unique.

    I'm a big fan of osteopathic medicine and DOs, but the osteopathic profession needs focus. It can't justify its existence without promoting its own philosophy and its unique therapeutic modality (OMT). Too many DOs today practice as MD-wannabes and have all but abandoned their faith in their school of medicine.


    Tim of New York City.

    [This message has been edited by turtleboard (edited August 22, 1999).]
  6. turtleboard

    turtleboard SDN Advisor

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    MiracleDOhappen,

    I'm not sure your osteopathic colleagues would whole-heartedly agree. Osteopathic physicians are trained to utilize a whole bunch of things, including the stuff the allopathic physicians are taught, but the DO is not the same as a medical doctor (MD).

    Representing yourself (an osteopathic medical student) and your profession (osteopathic medicine) in a way which confuses the issue of differences between DOs and MDs does a great disservice to your profession.

    If you believe DOs are medical doctors, why did you choose to be a DO student rather than an MD student? DOs are doctors of osteopathic medicine, and that represents a whole lot more than just an MD without the MD.

    Tim of New York City.
  7. turtleboard

    turtleboard SDN Advisor

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    The Unity Campaign is the AOA's attempt to increase awareness of osteopathic medicine and philosophy within the public, as well as to reintroduce DOs to osteopathic medicine.
    From my understanding it is not necessarily a vehicle through which the AOA and its DO leaders hope to make the DO a household name.

    The AMA has a responsibility to all physicians, MD and DO alike, and is not in the business of promoting the interests of MDs over DOs or DOs over MDs. The issue of osteopathic medicine's public obscurity and what must be done to reverse it is entirely the responsibility of the osteopathic profession, which the last time I checked, was independent of medicine (allopathic medicine) as a profession. Do you, as an osteopathic medical student, really want a group of MDs to lead the country's perception of osteopathic medicine? Of course not. If you want the job done right, do it yourself!


    Tim of New York City.
    (MESSAGE REPOSTED FROM ALLO. MEDSTUDENTS)
  8. dragonking

    dragonking Member

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    Doc777,

    You are damn right about what you said.
  9. dragonking

    dragonking Member

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    ?????

    [This message has been edited by dragonking (edited August 22, 1999).]
  10. dragonking

    dragonking Member

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    .......

    [This message has been edited by dragonking (edited August 22, 1999).]
  11. Henry

    Henry Senior Member

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    I believe DOs need to be unified but maybe not apply to the current strategy of AOA.



    [This message has been edited by Henry (edited August 22, 1999).]
  12. OldManDave

    OldManDave Fossil Bouncer Emeritus Moderator Emeritus

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    The philosophy, patient-centered approach and our training emphasis to be aware of more than a mere set of symptoms was and is a hallmark of the DO profession. More and more, this is also being incorporated and emphasized in allopathic training as well, as it should be. You are correct in that the "patient centered focus" is no longer a DO exclusive...however, it never should have been ours alone.

    ALL physicians should be aware of much than lab values and chemical reactions--->we are treating people. We [Docs] were, and still are, people before we were ever healers...despite all of the rhetoric to the contrary.

    I definitely believe we should maintain our [DOs] professional identity...our sense of uniqueness. But, it should NOT be done at the cost of the budding collaborative atmosphere we have with our allopathic collegues. The most important thing we all [MD and DO alike] MUST remember is that we are collegues, not adversaries. We are not in competition like a bunch of pre-meds. We are all striving to provide the best care we are capable of delivering to the patients with which we are charged.

    For me, the committment I have made to my future patients doesn't have a damned thing to do with the initials behind my sig. I am VERY proud to know I will be a DO. I chose to enter this profession...yes, I had the option to go elsewhere. But this was "my best fit". However, remember and respect that what works best for ourselves does not necessarily hold true for someone else.

    On the case of the AOA painting us all as prolific users of OMT...I strongly disagree with it. How can you possibly adopt something used so scarcely as our "defining characteristic"? This is foolhardy and potentially paints the profession into a corner. Public perception is a very malleable & tenuous thing---->VERY easy damaged and a BITCH to repair!

    I have met DOs who feel OMT should be the txn for all maladies and others who feel it has limited applicability at best. As with most issues, the answer most likely lies somewhere on a continuum. The mix each of us will chose will be a personal and experential matter. Myself, I am a born skeptic...but I will maintain an open mind and see what lies ahead.

    My thoughts...

    ------------------
    'Old Man Dave'
    KCOM, Class of '03


  13. MiracleDOhappen

    MiracleDOhappen Junior Member

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    Medical doctor= D.A.(Doctor of Allopathic Medicine) + D.O.(Doctor of Osteopathic Medicine)
    Medical doctor does not belong to D.A.
    My school is a medical school.
    If anybody ask me what D.O. is, my explanation simply is D.O. is a Legal licensed Medical Doctor. No further explanation will be given.... Period.
    I want to become a medical doctor who is legally licensed to practice medicine. I do not care which type, D.A.(Doctor of Allopathic Medicine) or D.O.(Doctor of Osteopathic Medicine) [​IMG] La.La.La....
  14. Gregory Gulick

    Gregory Gulick Senior Member

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    You Wrote: On the case of the AOA painting us all as prolific users of OMT...I strongly disagree with it. How can you possibly adopt something used so scarcely as our "defining characteristic"? This is foolhardy and potentially paints the profession into a corner. Public perception is a very malleable & tenuous thing---->VERY easy damaged and a BITCH to repair!

    Where is the AOA making such claims? I just passed an AOA unity campaign poster in the hallway of my medical school today, and nowhere on the poster did it say anything about OMM. I just don't see the AOA throwing OMM in the face of the health care consumer. So where are you guys seeing it?

    [​IMG]
  15. Matthew T Perry

    Matthew T Perry Junior Member

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    Thank you all for your comments. I am pleased to see such a good responce, but I will interupt this discourse to try to redirect this discussion back to its original point. I am wondering whether I am alone in thinking that the AMA should help (not dictate, take over, or lead) the Unity Project, since it represents both DOs and MDs. My reason for offering this consideration is the low public awareness of osteopathic medicine, which I am pretty sure would be a major issue for allopaths and the AMA if the misperceptions were reversed.
    Also, I would greatly appreciate any comments concerning the defense of osteoapthic medicine against allopathic medicine be refrained from this post. There is no need to defend something that is not under attack. Thank you OldManDave for your maturity (The most important thing we all [MD and DO alike] MUST remember is that we are collegues, not adversaries). Thanks.
  16. drusso

    drusso Moderator Emeritus Lifetime Donor

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    The AMA's weekly newspaper--the American Medical News--did run a story about the Unity Campaign on page 19 of the August 16 issue that cast the AOA's efforts in a positive light. I'll put a copy of it up on the "Unity Board" in Med Ed I, Matthew.

    I think that it is very unlikely that the AMA would back an osteopathic unity campaign in any substantial way. The AMA recognizes DO's largely for their similarities to MD's and not their differences (or "distinctiveness" [​IMG]). Remember, the AMA's founding mission was to limit medical competition and create a monopoly for MD's. While that overt point of view may no longer be as prevalent, I think that the sentiment is still there among AMA leaders. Since they grudgingly accepted DO's into their ranks in the early 1960's, (in a move akin to throwing up one's hands and saying, "If you can't beat'em, join'em.") they've focused their efforts on keeping tight control over PA's, NP's, nurse-anesthetists, optometrists, chiropractors, and others.

    I wouldn't be surprised if the AMA launches its own unity campaign of sorts (of course they won't call it that) to rally AMA members around the new AMA physicians' union. Stay tuned.

    --dave
  17. Matthew T Perry

    Matthew T Perry Junior Member

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    Dave, thanks for the reply. I read the AMANews article on the Unity Campaign. It was very benign. {Please put the article up in Med Ed 1, I think it is a great idea}. But my question still remains. If the AMA is our advocate, why can't we strongly suggest that they represent us in this, along side the AOA. If they support their own literature and feel we are equal to our allopathic colleagues they should have no problem with this idea. I am sure you are familiar with the BSMG survey results (if not I will gladly post them for you, or anyone interested in them). With their membership down to around 30%, they have a vested interest to do whatever they can to make friends around the medical communities. I'm all for letting bygones be bygones, and chalking the past up to a bunch of bad choices by both the AMA and the osteopathic physicians. But, I strongly believe in the osteopathic approach to patient care. I believe that the more patients know the better decisions they can make. It seems like we are missing The Big Picture here. Egos aside, the only reason why anyone of us is in medical school is to serve our patients. This isn't about who gets credit for what. The AOA and the AMA are both in this business to better serve the interest of the physicians who join their ranks. By helping the doctors, they help the patients.
  18. OldManDave

    OldManDave Fossil Bouncer Emeritus Moderator Emeritus

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    Greg,

    You are correct in that I can not allude or cite any specific AOA publication that defines DOs as prolific users of OMT. My statement was more of an inference from experiences thus far in my osteopathic education and encounters with other persons within the profession. I am not condemning the AOA...I agree the public must be made more aware of who we are and what we are capable of doing for them. However, in doing so I feel it is unwise to extract a single class of tools from our vast armamentarium and use it as a defining characteristic. IMHO, it would be akin to referring to MDs as the antibioticists. There is far more to what we can do than OMT. I concede that OMT promises to be a highly valuable tool within it's limits of applicability. But, when I explain what a DO is, I do not use it as the key point of difference. I will be a physician...irrespective of the initials I tack onto my sig.

    ------------------
    'Old Man Dave'
    KCOM, Class of '03


  19. turtleboard

    turtleboard SDN Advisor

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    OldManDave (and everyone),

    I'm not trying to turn this into an MD vs. DO issue, but rather trying to discern for myself and for whoever else may be confused, as to what you identify as your profession's unique characteristic.

    You note that allopathic training has only recently begun to incorporate a whole-person approach to patient care, while osteopathic training has been doing this since 1874. From all sources I can recall at the moment, you are probably correct in your assumption.

    With that said you still haven't defined for me what the distinct marker of osteopathic medicine is. In 1994 there was a report released by the Josiah Macy, Jr., Foundation on osteopathic medicine which spoke in brief of the profession's justification for existence. There were two things that were concluded, I believe: 1) Osteopathic Medicine and its physicians have the training to perform Osteopathic Manipulative Treatment (OMT), for whatever it's worth and 2) Osteopathic Medicine and its physicians have a very strong committment to primary care and care in underserved communities (e.g., rural).

    Now I ask you and anyone else who may be interested in throwing their hat into the ring. Were the findings of the Macy Foundaiton report correct? Do you, as an osteopathic medical student, believe that these are the characterisitics which make your profession distinct from the allopathic profession? If you do NOT agree, then what separates DOs from MDs beyond the different letters?

    To MiracleDOhappen,

    I'm not sure what the AOA's stand on this is, but as someone who has done much research into the osteopathic profession, representing yourself as a "Medical Doctor," is not entirely correct. You may be trained similarly to a Medical Doctor and you may do everything a Medical Doctor does, but you are technically an Osteopathic Medical Doctor.

    What does this mean? Well before anyone gets himself all sweaty and hot under the collar, it signifies that there are two distinct professions in the realm of medical practice. There are DOs and MDs; neither of which is better than the other.

    Miracle, you're an osteopathic medical student, have you given any consideration to what that means? You say a medical doctor can be either a DO or a DA (which you define to be a Doctor of Allopathic Medicine, the MD), but even in that instance you've made a distinction between the osteopathic and allopathic physician. What does that mean? What do you believe are the differences? Do you believe in OMT, by the way? If a patient or any lay person inquires as to what a DO is, and you give your answer, you're not giving them the entire picture. In effect you're reversing all the AOA and its Unity Campaign are trying to do, and that is to increase public awareness of osteopathic medicine. I can bet that their message is NOT that osteopathic medicine = traditional medicine.

    Does anybody else out there agree with Miracle's statements?

    Tim of New York City.
  20. MiracleDOhappen

    MiracleDOhappen Junior Member

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    D.A.(M.D.) and D.O. mimic Bipartisanship in the political world.
    If you believe D.A.(M.D.)=Traditional Medicine, due to its massive size. D.O., on the other hand, does not equal to traditional Medicine.
    Now, may I ask you, do you agree that Republicans = Traditional American Political Party, due to its mighty force, on the other hand, the Democratic party doesn't belong to Traditional Amerian Political Party due to its relative small size. I bet nobody will agree with you, because BOTH parties are traditional political partis, and Public has no problem to accept it. Why on earth we, DO's, disqualify ourselves as Traditional Medical Doctors, but secretly believe that we are the Traditional Medical Doctors who can do all the D.A.(M.D.) can do in addition to OMM. The message we sent out has confused the Public for hundreds of years. It is not our job to distinguish ourselves from traditional medicine. If D.A.(M.D.) think there is a need to distinguish themselves from D.O.'s, let them take over the burden's proof of their profession. We, however, enjoy the glory of legal Medicine with no reason to explain ourselves to anybody except legal regime, we are not criminals, we are not obligated to take those burdens of proof.
    I will be a proud Medical Doctor (D.O. Type).... Period [​IMG]
  21. drusso

    drusso Moderator Emeritus Lifetime Donor

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    ...a couple of thoughts for Tim (of New York City)

    1) The Macy Foundations conferences were productive, but not the end all and be all of DO/MD relations. Many things were left unsaid, many points of view unappreciated. It was only a starting place.

    2) Osteopathic medicine was founded as a reform movement in medicine. A.T. did not intend to create a separate branch of medicine; he believed that when his ideas saw the light of day all medical schools in the country would become osteopathic medical schools. The reform, as invisioned by Still, was not simply the addition of a new treatment modality to the physician's armamentarium, but the inclusion of a philosophy of healing, based upon scientific precepts, in medical education as a means to provide physicians with...a lens, a metaphor, a point of view, etc, etc...through which to view the physician-patient relationship. The fact that allopathic medical education also tries to provide this to their students does not diminish the osteopathic approach to patient care. Being a DO means many different things to different people. I'm sure it's the same for MD's. Here's an excerpt from an essay I've been tinkering with on the subject:

    ****
    Some might argue that this hand wringing about ?reform? and ?philosophy? begs this question: Hasn?t evidence-based medicine singly reduced all competing philosophies of patient care to a handful of common factors? Put differently, Do the way physicians? understand the meaning of illness in patients' lives, or their appreciation for the distinction that some patients draw between being cured of disease and being healed from illness measurably affect the way that they practice medicine?

    Data from research examining the patient-physician relationship establish that indeed such philosophical understanding and appreciation does (4,5,6). Also, these data demonstrate that American physicians and their patients aren?t as connected as they used to be. That kind of connection, a hallmark of many indigenous healing traditions, and the keystone of generalist medical training, used to be a bridge between the technical knowledge that physicians possess and the patient?s day to day experience of living with pain and disease. Such a shared understanding addresses not only why a person is sick, but also helps patients cope with what it means to be sick. As Arthur Klienman explains in The Illness Narratives (1988): "Nothing so concentrates experience and clarifies the central conditions of living as serious illness [does]. The study of the process by which meaning is created in illness brings us into the everyday reality of individuals like ourselves, who must deal with exigent life circumstances created by suffering, disability, difficult loss, and the threat of death."

    The physician-poet Williams Carlos Williams also writes about how patients? inherent vulnerability, combined with medicine?s lack of an experiential language of healing thwarted efforts to relieve human suffering. In his short story, ?The Practice? (1951), he hammers home the message that physicians, even in their role as healers, still miss opportunities to engage others in ways typically outside the realm of everyday experience: "Do we not see that we are inarticulate? That is what defeats us. It is our inability to communicate to another how we are locked within ourselves, unable to say the simplest things of importance to one another, any of us, even the most valuable, that makes our lives like those of a litter of kittens in a wood-pile. That gives the physician?his opportunity?a wonderful opportunity to actually witness words being born."

    American medical schools have long struggled to help students ?witness words being born.? That is, they have struggled to teach their students a framework, a worldview, a way of thinking to help them understand their patients? experiences. All medical schools introduce students to Engel?s biopsychosocial model of patient care. However, according to many medical educators, the model is a tough sell outside the classroom. It demands from students a degree of psychological-mindedness and an understanding of sociological ideas not emphasized in traditional premedical or medical curricula. Frankly, some medical students dismiss the model?s expectations as too ?touchy-feely? and too at odds with the conventional expectations of how a physician should behave.

    Before Engel, the Canadian physician William Osler worked to provide medical students a viable conceptual framework for the foundation of a modern medical. He too knew that language and communication are an essential part of a physician?s work, "There is no more difficult art to acquire than the art of observation, and for some men it is quite as difficult to record an observation in brief and plain language." Widely known for his rigorous approach to medical education, he demanded that his students take exhaustive histories and perform meticulous physical examinations. Almost single-handedly he moved medical education from the lecture hall and laboratory to the bedside. Sadly, today?s technology has robbed physicians of all but the most perfunctory opportunity to engage in this close work. Careful palpation, observation, and auscultation have largely been replaced with sophisticated imaging and laboratory diagnosis. Many fundamental physical diagnostic skills, along with the larger ideals of Oslerian medicine, have been virtually forgotten in the modern hustle of managed care.

    ...It is a connection to healing that I argue osteopathic medicine emphasizes in its approach to patient care; laying hands on patients reaches back to the most ancient healing traditions, it builds trust, affirms human relationships, and when applied therapeutically, it heals. Holism is only another expression for total care of the mind, body, and soul. Related structure and function is a scientific principle that is the foundation of modern physiology. Prevention of disease is sine qua non of good primary care. When these four ideas are packaged together and shared between doctor and patient what is communicated is tantamount to the tenets of osteopathic medicine.

    The obvious convergence of these ideas reminds me of a comment I heard a DO make during a conversation at a recent conference. In introducing his colleague he said, "I practice with Jim who is an MD,? and then quickly added, ?but he practices osteopathically.? That after-thought says it all. It highlights the fact that all medicine and the fruits of its labor?technological, philosophical, and intellectual?ultimately exist in the public domain. If taken seriously it is a sentiment that begs all physicians to focus less upon turf and guild issues in medicine and more upon bringing osteopathic ideals out of the closet to share with colleagues, nurses, managed care organizations, and most importantly, the patients who seek our care.
    *****

    3) This topic reminds me of an article I read about the merger of an osteopathic hospital and catholic charity hospital up in Ohio a while back. The author, a nun with a MBA in health care financing (take a moment to consider that!), wrote about the challenges of brokering the merger. The osteopathic hospital wanted to retain its "osteopathic identity" in the deal, but had a difficult time saying exactly what that meant specifically. After hours and hours of meetings she said that she finally had an epiphany when she understood that a dedication to osteopathic principles did not so much reflect specific "things" or procedures that DO's do as much as it reflects a "feeling about the meaning" of your work. I know that sounds kind of woo-woo, but I think that captures it. In essence, the osteopathic group wanted to make sure that the newly-merged group's mission retained certain convictions about the practice of medicine: Strong generalist-physician participation in hospital activities and committees (usually specialists call the shots), the retention of an OMM service, maintaining strong ties to the community, etc.

    Ideas, philosophy, and abstractions are slippery things, which is why the profession has this conundrum in the first place.


    [This message has been edited by drusso (edited August 24, 1999).]
  22. OldManDave

    OldManDave Fossil Bouncer Emeritus Moderator Emeritus

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    >>>Ideas, philosophy, and abstractions are slippery things, which is why the profession has this conundrum in the first place.<<<

    Very well said Mr. Russo!




    ------------------
    'Old Man Dave'
    KCOM, Class of '03


  23. Matthews

    Matthews Member

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    Matthew, I think it is very naive to think that the AMA would support or want anything to do with the UNITY campaign for the AOA.

    You are definitely motivated but I don't think this is something you should spend time on. Who needs them anyway?

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