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Definitions

Discussion in 'Medical Students - DO' started by DOPhD student, Jan 9, 1999.

  1. DOPhD student

    DOPhD student Senior Member
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    Allow me to play the Devil's Advocate for I'm a bit confused. What is meant by "treating the patient" vs. "treating the disease"? Please define these phrases in unequivocal terms.
     
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  3. Deb

    Deb Senior Member
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    Are you guys REALLY not receiving this info in school? I'll give you the
    benefit of a doubt and assume that for whatever reason, you aren't. The
    following is a quote from "Foundations for Osteopathic Medicine", Chapter 1,
    pg 10. "In caring for the whole person, the well-grounded osteopathic
    physician goes beyond the presenting complaint, beyond relief of symptoms,
    beyond identification of the disease and treatment of the impaired organ,
    malfunction, or pathology, important as they are to total care. The
    osteopathic physician also explores those factors in the person and the
    person's life that may have contributed to the illness and that, appropriately
    modified, compensated, or eliminated, would favor recovery, prevent recurrence,
    and improve health in general. The possible factors include such categories
    as the biological (genetic, nutritional), psychological, behavioral (use,
    neglect, or abuse of body and mind), sociocultural, occupational, and
    environmental. As A.T. Still often said, "To find health should be the
    object of the doctor. Anyone can find disease."
     
  4. Deb

    Deb Senior Member
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    I just wanted to add that while many MD's now believe in this approach
    to patient care, it's origins are strictly Osteopathic. I realize the
    differences between MD's and DO's are quickly fading, however, I take
    great pride in the fact that DO's understood these relationships long
    before MD's would even acknowledge their existance. I'm proud to be a
    student DO...so shoot me!


    [This message has been edited by Deb (edited 01-11-99).]
     
  5. StillBorn

    StillBorn Member
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    Oh, we're given the propoganda in school just like you. Your quote from Foundations is found in most general medical text, except they call it "a complete history and physical." (I might suggest you read chapter 1 of Mosby's guide to physical exam, which says pretty much the same thing as Foundations) Since I don't know you , I will give you the benefit of the doubt and assume that you are just young and impressionable. My school has not "taught" me a philosophy of medicine; my philosophy of medicine, i.e. how patients should be treated and care delivered, was formed before I set foot on campus. I chose osteopathic medicine because the philosophy they espouse most closely intersected my own. A philosophy formed while working for MDs. If, as you say, osteopathic med is treating the whole person, I would have practiced "osteopathic" medicine no matter what my degree was. To say that this approach to patient care is "strictly osteopathic" and that "DO's understood these relationships long before MD's" is ridiculous. I imagine that there have been thousands of MDs that practiced that way for years. They just called it good medicine, and didn't feel the need to write it down, although I grant you that the majority of MDs probably have not historically practiced this way.

    Make no mistake, just because I see few differences doesn't mean I am not proud of being at AZCOM, or am ashamed of being a DO. It simply means that I will always see myself as a physician that happens to have his degree from an osteopathic school, rather than as some ambiguous philosophical construct "the osteopathic physician."

    [This message has been edited by StillBorn (edited 01-11-99).]
     
  6. DOPhD student

    DOPhD student Senior Member
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    Deb, I don't understand your hostility. Thank you for clarifying the definition nevertheless, and indeed I've not learned that particular definition, or I might have but forgotten since it's such an obvious characteristic of being a competent physician. I don't believe that your definition applies to all DOs however. I know quite a few DOs who are pill pushers who could care less about anything else but symptomology and treatment plans. On the other hand, my mother, M.D. ob/gyn, when she was treating patients, took into account many social, biological, spiritual factors aforementioned that could affect her patients. I guess she was being "osteopathic" unintentionally. Unfortunately then, you've not succeeded in defining terms that are unequivocally, and EXCLUSIVELY osteopathic and so I thank you for your input, but most of what you say, I dare assert, is rhetorics. As a side note, my disagreement in no way implies that I'm not proud of becoming a DO because after all, we've all chosen this less travelled path instead of the well-worn one, but we do need to really understand ourselves if others are to understand us.
     
  7. UHS2002

    UHS2002 Senior Member
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    StillBorn

    you make an interesting argument, but could clarify what you mean by

    " I chose osteopathic medicine because the philosophy they espouse most closely intersected my own. A philosophy formed while working for MDs "

    In this statement you seem to be implying that you found SOME PHILOSOPHICAL IDEAS in osteopathic medicine that are entuned with your own, but couldn't you have found the same ideas in alopathic medicine, since their were formed while you were working for MDs? Is there something philosophically unique in osteopathic medicine which is lacking in alopathic medicine??? Your statement quoted above seems to imply so. Obviously it is not the "caring for the whole person" because you already clearly stated that this is not an exclusively osteopathic concept. So what is it?????
     
  8. StillBorn

    StillBorn Member
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    I should more clearly have stated that I chose osteopathic medicine because it focused on the same type of medicine that I was focused on--i.e. clinical primary care, wellness, etc. Do these ideas exist at MD schools? certainly, although I don't think that allopathic schools FOCUS on those ideals. Would I personally have been a significantly different physician if I had chosen to attend an MD school, very unlikely.

    As an undergrad I had a philosophy prof who used to say, "only stupid people are "taught" philosophy; intelligent people observe, study, and form philosophy of their own. My focus and "philosophy" of med was not taught to me by MDs; it was formed while I worked for a family practice by watching the way those docs practiced medicine; a very "osteopathic" practice if we are to use the definitions that are flying around here.

    My point in the above post is very simply: just because a group writes down a mission statement, or a philosophy, does not mean that everyone in the group (or even the majority) adheres to that mission statement.

    To answer your question more directly: Is there something philosophically unique about osteopathic medicine? It doesn't matter; what matters is how physicians practice medicine. The question I have been concerned with is "is there something PRACTICALLY unique about DOs (or osteopathic medicine) and the answer again, is no.
     
  9. jwpelley

    jwpelley Member
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    Allow me to play the Devil's Advocate for I'm a bit confused. What is meant by "treating the patient" vs. "treating the disease"? Please define these phrases in unequivocal terms.
    --------------
    I think an article written by Francis Peabody would be useful in addressing the different definitions you are seeking. JAMA has it on-line at http://www.ama-assn.org/sci-pubs/msjama/articles/vol_280/no_13/peabody.htm . It doesn't have the unequivocal definitions you are looking for, but it gives an answer that Patch Adams might have given you. It also fits the description that Deb submitted.

    [This message has been edited by jwpelley (edited 01-12-99).]
     
  10. DOPhD student

    DOPhD student Senior Member
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    jwpelley, thank you for providing the address to the very interesting article. I've read it with thorough enjoyment and agree with the critical point that medical school provides you a knowledge base of a physician but it does not guarantees to provide one with a personality to be a good physician. I'm reminded of a saying by which I will try to live by (when opportunity arises) - patients don't care what you know until they know that you care. How true! Regardless of whether one is an DO or an MD, beginning a practice or retiring, skilled or not so skilled, the first thing one ought to do is care since ultimately, medicine is a caring profession.
     
  11. Deb

    Deb Senior Member
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    DOPhD Student

    I must apologize, my "attitude" was not directed towards you. If I am passionate
    about this issue, it is because I speak, not from the observations of a medical
    student, but from the experiences of a patient. After over a dozen operations,
    plus "too numberous to count" proceedures, I am sorry to report that maybe only
    1/3 of the MD's I encountered practiced anything resembling "holistic" care. I
    don't mean to imply they were uncaring individuals (the majority were very nice
    people), just that they were either unaware of or not appreciative of this
    approach. Was I just unluck? Maybe (my experiences cannot be extrapolated to
    include the entire allopathic community). I have also seen evidence of this from
    my friends in MD school who tell me the subject is given little more than "lip
    service" (of course this information as well cannot be extrapolated to include the
    curricula of all allopathic medical schools). Are a greater percentage of DO's
    practicing "holistic care"? I don't know, but my theory is that since we are all,
    to some extent, products of our environment, then being educated in an environment
    that nurtures and encourages this type of approach would, in theory, produce a
    greater number of physicians that practice "whole person" care. Anyway, I am
    interested in this subject and am considering a research project to test my
    theory. If any of you have any ideas for questions that might be used in such a
    study please let me know (serious respondents only please).

    [This message has been edited by Deb (edited 01-14-99).]
     
  12. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    I think that people are getting caught up in semantics and losing sight of why there is a profession like osteopathic medicine in the first place.

    Remember, osteopathic medicine's whole impetus was as a reform movement centered in the midwestern United States in response what was believed to be negligent medical practice of the time. The fact that many DO's and MD's practice similarly today speaks more to the advances made over the years in technological medicine and biomedical science than it does to the failure of some bizarre attempt to indoctrinate hapless students with osteopathic propaganda as was implied in a previous post. It also demonstrates that no one has taken the time to honestly compare practice patterns among MD's and DO's with respect to patient satisfaction, clinical outcomes, or cost effectiveness. It's not rocket science. These comparisons have been made before such as those comparing physicians versus PA's or NP's. On some important dimensions, allied healthcare providers out perform physicians. We should take notice.

    Of course, there also exists very real political reasons as to why the AOA seeks to distinguish itself from the AMA, LCME, and ACGME. If you think that these political issues between the two guilds will be resolved overnight, then you are naive.

    Finally, to the extent that osteopathic medicine is still in touch with its reformist roots is a question open for debate. I believe that the time is right for DO's to re-assert themselves as more complete providers of medical care. Patients marvel at all of the wizz-bang technology and gadgetry that we employ to make them well and simultaneously complain about being fed up with a health care system that runs on 12 minute appointments and values pill-pushing/"yes-man" doctors who will--at the expense of patients' lives, values, and integrity--cave in to the pressures of managed "care" and HMO executives in order to keep making payments on their shiny Lexus. Patients are clammoring for a brand of medicine that is built upon something more sacred than the bottom line of a financial report. DO's have an entire corpus of philosophical thought to offer up, what do the MD's have? Maybe a little Osler or a tongue-waggling idea called the "biopsychosocial model?"

    A debate about "holism" versus "reductionism" or hypocrisy in any medical arena (on either side of the practice pathway) is nothing but cheap claptrap designed to raise the passions of those who don't know better and abuse the common sense of those who do.

    I like to remind those who take so much pleasure in bemoaning the sad state of affairs they find themselves in that if you're not part of the solution, then you must be part of the...


    [This message has been edited by drusso (edited 01-15-99).]
     
  13. edgar

    edgar Senior Member
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    jwpelley and friends,

    Thank you Dr. Pelley for the link to the JAMA article, it is the best one I've seen in recent times. It is amazing to me that the article was written in 1927 and is especially relevant to the sad state of affairs of medicine in general and managed care.

    On the subject on "holistic" or "distinctively osteopathic medical care", the article that Dr. Pelley has referred us to precisely documents what is happening today in medicine. Medicine is currently too narrowly focused on strictly medical/surgical diagnosis and treatment modalities. With today's managed care environment, I doubt that MDs or DOs have the time to truly consider all their patients needs (spiritual, emotional, familial, etc.) during the 10 minutes they have allocated to each patient. Unless the physician wants to be miserable and wants to go home at 10pm from his office every night. From my limited experience, both my MD and DO mentors are very caring and "holistic" physicians, but they have so many patients and such little time to treat patients holistically. I'd appreciate any further comments on this issue.

    EDGAR
     

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