Biomedical vs. Biopsychosocial Models: MD & DO Attitudes

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I do not know much about DO's and am becoming more interested in the approach (if my assumptions are correct). I've been learning about the advent and rise of the field of Health Psychology and think I may see some theoretical parallels with Osteopathic medicine.

Biomedical Model:
The model espoused within medicine and science over the past 300 years or so and has been a powerful in irradicating acute dusorders (flu, pneumonia) that were the top killers at the turn of the last century. It is a reductionist model that views disease as a cellular process. Disease is the focus, and is seen as a a deviation from the normal healthy state. Mind and body are seen as separate entities, with focus being on the body for disease repair.

Biopsychosocial Model (and Health Psych):
A model that began to gain prominence with a few WHO papers in the 50's or so as the prevalence of disease was moving from acute disorders (flu, pheumonia) to more chronic illnesses (cardiovascular, cancer). Health is seen as a combination of physical, mental, and social well-being. Health and disease are seen as being on a continuum, so that the focus is not merely on curing disease, but also on promoting health. Mind and body are seen as interdependent entities, one influencing the other.

An example:
I used to believe (before taking a few psych classes :) ) that everything had a physical cure and that we would someday have a medication to fix any and every ailment. This comes from the biomedical model that has become a part of our society's default beliefs.

Here is the example that began to change my mind. It has been shown in depressed patients that the same area of the brain is physically changed by both prozac and cognitive behavioral therapy (CBT). The difference is that CBT has longer lasting effects after being discontinued, likely because the patient has learned techniques to avoid relapse.

The most reasonable cure for depression would then seem to be (perhaps) anti-depressant medication to help jump-start recovery (in severe cases), along with therapy for more permanent results. However, most people I know who go to their doctor (assuming MD) with depression receive anti-depressants without much thought or advise to see a therapist. Would DO's handle this differently?

Note: I provide this as an example, and would prefer not to have debates about the validity of my example if there are minor flaws in it (I admit I'm not an expert on any of this). It is the general point I am interested in fleshing out:
1) Are DO's less likely to go straight for the prescription pad and try to promote a healthy life rather than to only combat a present illness?

My understanding of current attitudes (and more questions):
2) I've heard/read that MD practice has been slowly coming to see the value of mental/psychological and social factors in addressing patients' health needs, something which DO's have been doing for a long time. Is this true?

3) Anecdotally, I have two friends who go to DO's who say they are the best doctors they've had because they seemed to spend more time with them and get to know them. Is this generally true?

4) I am sincerely intereseted in the difference in attitudes between the two fields and whether the two may be converging. If they are converging, what should MD's borrow from DO's and vice versa?

5) Is DO really all that different than MD practice in the end? For example, every pre-med wants to save the world, but every M3 wants to match into a lifestyle residency. Similarly, do DO pre-meds think they are going to be providing higher-quality patient care, but in the end pump patients through to meet thier daily quota? In short, do the ideals of youth ;) translate into reality down the road?


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I'm just going to hit on a couple things here since I have two exams yet again this week. First, you will find that the field of osteopathic medicine is more similar to allopathic than you realize. When I entered med school I thought that I would come out knowing more about the differences between the two approaches, but the opposite has been true. Other than learning to effectively use manipulation, I could now tell you much more of the similarities of the two groups. After all, we take the same boards & have equal practice rights so therefore must have the same knowledge base.

Second, there have been studies (can't point you to them now) but DO's, on the whole, do spend more time w/ their patients. In this day & age, I would say that a FP MD & DO are going to treat patients more or less similarly. The only difference would come in personal preference. For example, I may see a patient w/ mild Htn & decide that I think they should really try diet & exercise to control it (the MD down the hall may do the same), but there are MD's & DO's both who would start a Beta-blocker or another first line drug while instructing an exercise regimen.

My whole point is that, in the end, you are going to practice how you want to practice. This may be shaped in large part by your medical education (MD or DO) but more likely to be shaped by whom you train under as a resident. Hope this helps.
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