DO = bone doctor? ?

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MD's don't look into osteopathic residencies because they do not meet the requirement of attending / graduating from an osteopathic program. and therefore cannot apply to osteopathic residencies.
 
•••quote:•••Originally posted by migraineboy:
•MD's don't look into osteopathic residencies because they do not meet the requirement of attending / graduating from an osteopathic program. and therefore cannot apply to osteopathic residencies.•••••I have never met an MD-to-be that was interested, requirements or not. That is why they don't "look into" them.
 
Ask an MD that didn't match into his career choice if he would be interested in a DO residency in that specialty. You might find some. As an MS2 at an MD school,I know that if I don't get orthosurg, I would really want that option to get into a DO residency.
 
•••quote:•••Originally posted by Ice Man:
•Ask an MD that didn't match into his career choice if he would be interested in a DO residency in that specialty. You might find some. As an MS2 at an MD school,I know that if I don't get orthosurg, I would really want that option to get into a DO residency.•••••You make a valid point ice. Excuse my ignorance, but are there DO orthopedic surgery residencies?
 
There are DO residencies for virtually EVERY RESIDENCY!! From FP to neurosurgery! They tend to be more restrictive on location and amount of spots in the osteopathic residencies.
That is why many graduates, including myself, choose the ACGME route. Better funding, more flexibility in location, and in the case of EM, 1 year shorter! (requirement to do the traditional rotating internship in AOA residencies...not ACGME)

There is wide selection of opportunities for DO grads, you will always find a residency because of the ACGME and AOA options.
 
•••quote:•••Originally posted by Mr. happy clown guy:
•There are DO residencies for virtually EVERY RESIDENCY!! From FP to neurosurgery!•••••Ok, Ok, settle down. No need to get your panties in a twist. I wasn't aware that there was an abundance of orthosurg DO residencies out there. I guess that makes sense though, what with the chiropractor training you guys get and all...
 
•••quote:•••Originally posted by Mr. happy clown guy:
•????????

What are you like 12?•••••Man, you DOs are a touchy lot.

I thought my comments were pretty relevant. In retrospect, given your chiropractor training it does makes sense to me that there might be some Orthosurg residencys for DOs.

Just curious, do you manipulate during the surgery?
 
kurtz dude, whats your problem....are you a comedian? di you read everyones messages before writing back....did you not read that as a DO, i want to go do my residency at UCLA in psychiatry. i have already talked to them and they are already expecting my application...are you going to make fun of UCLA? are you now gonna say they are a weak med program...i think they are pretty top there no? i dont know if you are trying to act tough and make fun of my fellow peers cause we are gonna be DO's but i ll stand up to you cause i know you dont have the credentials in life that do...and i dont think you want to challenge me (go read my other posts) so just take a break and knock if off with the silly questions and us DO's, dont respond to this guys silly questions, you re just wasting your time....peace everyone...lets go nets!
 
Alright now, y'all...

Don't make me start sprinkling prozac dust around!

Missy :wink:
 
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•••quote:•••Originally posted by johndean11229:
•kurtz dude, whats your problem....are you a comedian? di you read everyones messages before writing back....did you not read that as a DO, i want to go do my residency at UCLA in psychiatry. i have already talked to them and they are already expecting my application...are you going to make fun of UCLA? are you now gonna say they are a weak med program...i think they are pretty top there no? i dont know if you are trying to act tough and make fun of my fellow peers cause we are gonna be DO's but i ll stand up to you cause i know you dont have the credentials in life that do...and i dont think you want to challenge me (go read my other posts) so just take a break and knock if off with the silly questions and us DO's, dont respond to this guys silly questions, you re just wasting your time....peace everyone...lets go nets!•••••Dude, relax. I'm sure UCLA psych will be happy to receive your application. And no, I am not looking to "challenge" you, ok?

My question was simply whether surgical DOs can manipulate during surgery. I mean, if OMM is more than placebo, the benefits of physical manipulation should be beneficial whether the patient is concious or not, right? Following this logic, there could conceivably be some manipulations that may best be done under anesthesia, no? Hence during a surgery - as an adjunctive treatment.
 
Research is currently underway concerning manipulative treatments under anesthesia, specifically for those suffering chronic backpain.

Manipulation would not be any more appropriate in most cases on the surgery table than would be performing surgery on an osteopathic treament table in a DO office. Post-op manip. treatment is a whole other story.

Manipulation is only one tool, not a cure-all, and we (DO's ) don't view it as a cure all. It is used appropriately in specific situations which may call for it.
 
That is very interesting. When is that NIH center that is supposed to investigate the effectiveness of OMM starting up? It will be interesting to see what comes of it.
 
Kurtz, you aren't even in Medical School are you?
Your overall lack of knowledge regarding anything and everything makes me wonder if you are wearing a Darth Maul T-shirt and have a DragonBall Z poster above your bunk beds.

The funny thing is that I have worked with MD students during my 3rd and 4th years of med school and none had the attitude that you have. Makes me think you are probably barely out if diapers.
 
•••quote:•••Originally posted by Kurtz:
• •••quote:•••Originally posted by johndean11229:
•kurtz dude, whats your problem....are you a comedian? di you read everyones messages before writing back....did you not read that as a DO, i want to go do my residency at UCLA in psychiatry. i have already talked to them and they are already expecting my application...are you going to make fun of UCLA? are you now gonna say they are a weak med program...i think they are pretty top there no? i dont know if you are trying to act tough and make fun of my fellow peers cause we are gonna be DO's but i ll stand up to you cause i know you dont have the credentials in life that do...and i dont think you want to challenge me (go read my other posts) so just take a break and knock if off with the silly questions and us DO's, dont respond to this guys silly questions, you re just wasting your time....peace everyone...lets go nets!•••••Dude, relax. I'm sure UCLA psych will be happy to receive your application. And no, I am not looking to "challenge" you, ok?

My question was simply whether surgical DOs can manipulate during surgery. I mean, if OMM is more than placebo, the benefits of physical manipulation should be beneficial whether the patient is concious or not, right? Following this logic, there could conceivably be some manipulations that may best be done under anesthesia, no? Hence during a surgery - as an adjunctive treatment.•••••Both MDs and DOs use manipulation during surgery. For example, for adhesive capsulitis, manipulation under anesthesia is *THE* recognized standard treatment of choice. DO's also use manipulation after surgery to help with post-op outcomes. Do a medline search using keywords "manipulation" and "surgery."

To learn more about the national osteopathic research center, follow this link. Go to "Research" and then "Osteopathic Research Center." It outlines the plan for development of the ORC and collaboration with the NIH.

<a href="http://www.hsc.unt.edu/departments/omm/default.cfm" target="_blank">http://www.hsc.unt.edu/departments/omm/default.cfm</a>
 
Kurtz,

The OTM research center is going to be located at the Texas College of Osteopathic Medicine. In addition, there are a couple of other studies, sponsored by the NIH, that are being performed on the efficacy of manipulation as an adjunctive treatment of pneumonia. The study is comparing hospital discharge times (do patients improve more quickly and get out earlier) if they recieve OTM (manipulation) in addition to traditional pharmacologic therapy or if they recieve pharmacologic therapy alone.

When the results are tabulated I'll post them here.

If you have any questions concerning OTM and its employment that are of a serious and intellectually driven nature please ask and I'll be happy to respond. By the way, OTM is not chiropractics, in fact, Dr. Palmer, followed A.T. Still by a number of years with his theories and actually attended a number of A.T. Stills lectures on OTM. In addition, D.O.'s aren't limited to correcting spinal mechanics, but, we can correct structural and functional problems anywhere in the body. I personally don't care if you call it chiropractic or anything else, however, others may find it offensive and I thought the nature of this web-page was to provide an opportunity for open intellectual dialog on a variety of topics.

I also agree that the studies coming from the OTM institute will be interesting and I look forward to good research coming out either proving or disproving the efficacy of various treatment modalities. Some things I think will work and work well while others may fall flat on their face. The net result is good for the profession and the general public as the profession will have solid evidence to point to and the public will benefit with improved care.

Sweaty Paul MS-II
KCOM
 
Another surgery-related point- knowing manipulation as a surgeon (especially ortho) provides you the opportunity to make the final pre-surgery check to see if anything else can be done. It is fairly routine for DO's to correct a variety of chronic pain, posture (ex: cases of functional scholiosis), and muscle problems (ex: pirformis syndrome) that are also commonly treated via surgery, and by knowing both treatment modalities you can catch the cases that can be treated by OMM before more invasive procedures are used. Most patients (and doctors) don't even know that such options exist. As a DO, even if you don't have the skill to treat, you should be able to diagnose what IS treatable by OMM and pass the patient along to a specialist.

Obviously there are many structural problems OMM will just not work on, but it is good to give patients the opportunity to avoid surgery where appropriate.
Of course, all of this also assumes you're willing to give up a few bucks to do whats right for the patient...

bones
 
Thanks Bones,

That is what I was getting at in my above post when I mentioned that it made sense in retrospect that DOs would have orthosurg residencies (sorry Happy Clown Guy I am not 12). It's nice to have an intelligent response. I wonder to what extent allo orthos deal in/consider manipulation (by referral or otherwise)?
 
•••quote:•••Originally posted by Mr. happy clown guy:
•Kurtz, you aren't even in Medical School are you?
Your overall lack of knowledge regarding anything and everything makes me wonder if you are wearing a Darth Maul T-shirt and have a DragonBall Z poster above your bunk beds.•••••It would appear that by my lack of knowledge regarding "anything and everything" you are in fact referring to my lack of knowledge concerning osteopathic medicine (which I readily admit to).

Well, I hate to break it to you but if you are this sensitive about people's misunderstandings regarding your profession you are in for a bumpy ride. I'm sure i'm not the first, and I promise you that I won't be the last person you come across that has no idea what Osteopathic medicine is. At my medical school (a top 20 allopathic institution) the vast majority of my classmates have little understanding - even awareness - of the DO profession. I'm not saying that this is a good thing - it's just a fact of life. At least I am trying to learn a bit about what the DO thing is all about.

As for Darth Maul & Dragon-whatever, I have nothing against them, though I can't claim to own their posters.

Cheers
 
Kurtz,

I'm glad you're trying to learn. I think you'll see that the the two professions aren't as far apart as you might think on most issues. Sure we have a few kooks who make far-fetched claims that make life difficult for the rest of us and cast a shadow over techniques that really work, however, you get that in every field (Dr. Susan Day from UCSF is one on the allopathic side of the field). The net is this; all medical students whether allopathic or osteopathic are, for the most part, interested in helping people and our future patients. Treatment paradigms aren't as different between the two professions as they once were and there will be fewer differences as time rolls on.

I personally don't think that osteopathy has the 'corner' on the holistic patient approach. Osteopathy may have been the first, but many allopathic schools are incorporating this methodolgy. What we do have that the allopathic schools don't have is the manipulation. Some of it is great, some of it is hooey (sp) (unless good research shows I'm wrong), some I may use and others I won't.

Again if you have questions post and I'll try to answer or direct you to the answer.

Sweaty Paul MS-II
KCOM
 
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•••quote:•••Originally posted by Kurtz:
•
I wonder to what extent allo orthos deal in/consider manipulation (by referral or otherwise)?•••••Actually, I was wondering the same thing myself. I'm in Maryland, so DO's are present around here but more scarce then in other states, and I've never seen an ad for a DO wanting referals for manipulation, so I think that most of the manipulation is done by chiropractors and PTs here. I am also ignorant in the studies proving or disproving OMM, but I do know that chiropractic manipulation has been shown to have some efficacy in treating short term back pain (not chronic back pain though). I asked the physician I was working with last summer, a cardiologist, if he would ever consider a chiropractic referal for a patient he had who had minor back pain and he said that he might if everything was ruled out and the patient expressed interest in pursuing it. He also told me that he had a brother in law who was a chiropractor, so I don't think that there was any bias against the field at all coming from him. I imagine it's the same way with referring to DOs, rule everything out, and if the patient expresses interest in being manipulated. I imagine that most MD's probably don't offer to refer patients for manipulation as a treatment option simply because they don't know very much about it. I'm just finishing my second year, and we've had a few lectures on alternative treatments, but manipulation has never come up.

Oh, and I have a good quote for you DO students as well that my physical dianosis preceptor told me (a GI, MD). He was teaching us how to present patients in rounds, and I happened to mention in the review of systems that the patient that I had interviewed complained about being depressed in addition to his physical symptoms. He says to me "Don't present that, nobody is going to care about that. I don't care about that sh(t, does it look like I have a DO behind my name?". <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />
 
•••quote:•••Originally posted by Sweaty Paul:
•Kurtz,

I'm glad you're trying to learn. I think you'll see that the the two professions aren't as far apart as you might think on most issues. Sure we have a few kooks who make far-fetched claims that make life difficult for the rest of us and cast a shadow over techniques that really work, however, you get that in every field (Dr. Susan Day from UCSF is one on the allopathic side of the field). •••••I think you are right - the differences have probably decreased dramatically over the last 15 years or so as Allopathic education has become more "holistic" - I think that this is a good thing. I suspect the DO philosophy probably had some influence in that. At the same time, I think DOs and OMM in general will probably benefit over the long term from a healthy dose of MD skepticism. For the time being, I see the two professions in a beneficial co-existance.

"I'm glad you're trying to learn"

Thanks- please bare (sp?) with me, as I am, by nature, a born-skeptic.

It does seem to me that within the next 20 years the differences will probably be zero - would any of you agree with that? If that happens I wonder if there will always be 2 degrees??

As for "kooks" in the MD field - some of the HIV-conspiracy mongerers come to mind immediately. But I always try to keep in mind that it is sometimes the "kooks" that move things forward (when they are right at least)
 
"I guess that makes sense though, what with the chiropractor training you guys get and all..."

Kurtz, since day one, you have had a poor attitude with virtually all of the comments regarding Osteopathic Training and Education. And now, you are the mature one? Please. At best these are back-handed compliments of poor taste. Congratulations at your "top 20 allopathic program"...you never know what letters may come after a future attendings last name, so I would recommend that you watch your snide remarks...they may get you in trouble, regardless of "top 20" school or not. Your comments sound very condesending, regardless of your intent.
 
I don't think we need the MD skepticism. I think there is already a healthy amount of skepticism over what works and what doesn't work, unfortunately, those who are most publicized are the 'kooks' with whom many D.O.'s have already written off (like the moral majority speaking for the Republican Party). The research that is being done will do the most to benefit the profession with respect to furthering the understanding and acceptance of OMM.

As a student, I am very skeptical concerning some of the claims made about the profession, however, I am not skeptical in how, when properly employed, it can relieve a variety of musculoskeletal problems (at least from the patients perspective, which is pretty important) which makes it hard to simply write the whole treatment paradigm off. Is it a placebo effect...possibly, however, when feeling the area that was causing the pain after the treatment the pain-inducing lesion was gone.

I think the biggest misunderstanding is that many allopaths think that all D.O.'s will do manipulation or that all D.O.'s would select manipulation as their primary treatment modality. This really isn't the case. My entire youth my Doc was a D.O., I had no clue, never once was I manipulated, Doc doesn't do it and he isn't ever going to do it. The point is that for many D.O.'s and many D.O. students see manipulation as another tool, just as drugs are a tool. Manipulation is one more skill that a D.O., if he/she chooses, can employ in an attempt to help patients.

I'll post results of the pneumonia study when it is completed, might be awhile, but I'll get it up when it's done. In the meantime if you have a specific question about the field or how manipulation is done let me know.

Sweaty Paul MS-II
KCOM
 
Again, this is all very simple-It boils down to this:

What do allopathic schools teach that osteopathic schools do not? NOTHING

What do osteopathic schools teach that allopathic schools do not? OMM

So why then is it soooo hard for MD students (or pre-MD students I suspect) to accept that DO students learn something more? Geez ppl get a grip-I can't help it you chose to go the old route. <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />
 
•••quote:•••Originally posted by Mr. happy clown guy:
•"I guess that makes sense though, what with the chiropractor training you guys get and all"•••••Hey Unhappy Clown Guy, I'm guessing that what has really got under your skin is that I referred to "OMM" as "chiropractor training."

Are you so above chiropractors that you find this insulting? I'm sorry but as far as i'm concerned they are both more or less the same so I tend to use the mainstream term for it.

It's like if MDs were trained in dentistry, yet called it Allopathic Tooth Correction or ATC - whatever, it's "dental training" to anyone outside the field.

Mention OMM to the Man on the Street and you are going to get some inquisitive looks. Are you going to get all puckered up with rage when your patients refer to your chiropractic treatments? Please.

Clearly, you have some issues to which you are pretty sensitive. But that is not my problem and I see no need to cater to your fragile ego.
 
Kurtz,
Osteopathy and chiropractics are 2 very different things. Maybe you need to do a little reading on the 2 becuase your statements seem to be very uneducated. But i know that you are probably very busy, and may not have the time. 🙄
Barb
 
•••quote:•••Originally posted by barbjs:
•Kurtz,
Osteopathy and chiropractics are 2 very different things. Maybe you need to do a little reading on the 2 becuase your statements seem to be very uneducated. But i know that you are probably very busy, and may not have the time. 🙄
Barb•••••Hi Barb, this may be! I really don't know. I have already confessed that, like most of my Allopathic peers, I know little about the DO profession. That is why I am here on your board - i'm trying to gain some insight.

I must confess, however, that everyone claims they are "very different" - but nobody ever says why.

Can you please tell me what is the difference between Chiropractic and Osteopathic manipulations?

So far, all I ever hear is that Dr. Somebody invented osteopathy before Chiropracty. That is just hair-splittting as far as I am concerned.

It seems that with a limited number of bodily motions, manipulation is by its very nature a limited field.

So, please help me learn what the real differences are.
 
•••quote:•••Originally posted by Sweaty Paul:
•I'll post results of the pneumonia study when it is completed, might be awhile, but I'll get it up when it's done. In the meantime if you have a specific question about the field or how manipulation is done let me know.

Sweaty Paul MS-II
KCOM•••••Hi Sweaty Paul, is the purpose of OMM in Pneumonia to improve breathing? The reason why I ask is that I remember being taught that there are some physical therapies that can aid in this.
Regardless, I'd be quite interested to check it out.
 
klutz,
Don't pin your own condesending replies on some "insecurity" play. Doesn't work...you know how you meant that statement. Much like your replies to SLINGBLADE...full of sarcasm and underclassman wit.
I reply to you based upon your smug responses.

Really, if it makes you feel superior for what ever reason, you can call me a chiropractor, just remember, this chiropractor scored rather well on two steps of the USMLE, and I would bet...better than you.
Good luck to you, you seem to get along with people oh so well.
 
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•••quote:•••Originally posted by Kurtz:
• •••quote:•••Originally posted by Slingblade the Surgeon:
•Again, this is all very simple-It boils down to this:

What do allopathic schools teach that osteopathic schools do not? NOTHING

What do osteopathic schools teach that allopathic schools do not? OMM

So why then is it soooo hard for MD students (or pre-MD students I suspect) to accept that DO students learn something more? Geez ppl get a grip-I can't help it you chose to go the old route. <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> •••••Hi Slingblade the Surgeon. Nobody claims that allopathic schools teach OMM. That is not an issue.

From my experience most MDs view manipulation skills as possibly effective in certain short-term circumstances but largely unproven and unsubstantiated. The unscientific nature of the field is what turns a lot of people off to it.

Geez, if you read the website of the Osteopathic Research Center you see at the top of the page:

"The Osteopathic Manipulative Medicine (OMM) research efforts of the osteopathic profession has suffered from a lack of focus and support services"

They are probably being polite when they say this - given that they are talking about their own profession. I would have thought they would have got the basic research on OMM right before running off and founding a new field based largely on it. Perhaps, that is just a by-product of my "Old" style Allopathic education.

It goes on to say,

"It is clear that definitive proof of the clinical efficacy of OMM (or lack thereof) will require repeated, prospective, randomized, placebo-controlled, double-blind, multi-center, clinical outcome studies with large subject sample size."

By the way, I did not add "(or lack thereof)" in the above quote. That is verbatim.

So, Slingblade, you are right - DO schools teach you extra clinical skills. Clinical skills not found in MD schools. Clinical skills for which there is currently no definitive proof of clinical efficacy.

Maybe i'm "old" school but that strikes me as odd.

Anyways, if a patient of mine is interested in manipulation I can always refer him/her to a chiropractor or DO, right?

So, if you are happy investing hundreds of hours studying a largely unproven field (omm) - more power to you, that's cool. I really have no problem with that. MDs on the other hand spend those hundreds of hours gaining more in-depth knowledge of the "Old" topics. You know, Pathology, Pharmacology, etc, that old dusty boring stuff. Perhaps that is why we score higher, on average, on our board scores?
:wink: •••••<a href="http://www.hsc.unt.edu/research/orc/aims.htm" target="_blank">Osteopathic Research Center</a> <a href="http://www.hsc.unt.edu/research/orc/aims.htm" target="_blank">Osteopathic Research Center</a>
 
You have just proven my case.

I would venture a guess you have a fairly significant "short man's syndrome" and you drive a Firebird don't you?
 
Unhappy,

Hehehe, I actually liked that 'Klutz' bit. Not too shabby.

•••quote:•••Originally posted by Mr. happy clown guy:
•
Really, if it makes you feel superior for what ever reason, you can call me a chiropractor, just remember, this chiropractor scored rather well on two steps of the USMLE, and I would bet...better than you.
Good luck to you, you seem to get along with people oh so well.•••••Hey man, I never called you a chiropractor. And I love the bit about "underclassman" wit.

Anyways, I'm glad you scored well on the USMLE. And if you scored in the top 10% you might have done better than me (Step 1 = 239 since you asked). If that's the case, i'm quite happy to be surpassed by such an excellent score. It is not a poor reflection on me that you did great. Congratz! :clap:
 
•••quote:•••Originally posted by Mr. happy clown guy:
•You have just proven my case.

I would venture a guess you have a fairly significant "short man's syndrome" and you drive a Firebird don't you?•••••Unhappy, I love the fact that you go on about my "immaturity" and "underclassman" sensibilities yet you are constantly throwing insults about my being a pre-med student, wearing darth maul t-shirts, collecting dragonball Z posters, driving a firebird (do you really care what car I drive??), and being short (actually i'm 6'2", not that it has any relevance to the discussion at hand).

Why are you so sensitive?
 
I have to admit that watching you two banter back and forth is rather amusing. You two dont even know eachother!! geez
 
Oh yeah, well I can bench more than you too...
HAHAHA, I am just kidding.

Many of your points are valid, just remember that many of our physical examination clinical tools are unproven. But yet, when applied, add significant information about the pathology.
When I was a physical therapist, manual muscle testing was the "cornerstone" of physical exam...yet there is a major subjective portion of such a test (with ALOT OF MONEY based upon the improving of such test). Despite my doubts upon the true objectiveness of this exam, I new it was vital AND the treatments to INCREASE the manual muscle testing resulted in improvement of pathology.
I would never treat cancer with manipulation...or for that matter, increasing strength. But as an additional clinical tool for the treatment of musculoskeletal problems, it proves quite effective!

And in the clinic/office/ED/field the additional tool ADDS to treatment options, patient satisfaction, and income. And for the vast majority of physicians in practice...this is FAR more significant than 10 additional points on the USMLE or any test!
 
kurtz,

No there are lot of areas in osteopathy that are unproven, however, traditional old boring medicine has its fair share too, most recently the revocation of Arava, the drug that was to replace methotrexate. It was to be the new standard and apparently after passing all the 'scientific' clinical studies it has been causing lots of CVA's. My point is that whether anyone likes it, osteopathic or allopathic, medicine is an art and a lot of unproven things are utilized everyday. Thalidomide is another that pops to mind, lung reduction on sufferers of severe emphysema (not FDA approved nor studied in a double-blinded fashion you purport all allopaths to follow but done daily b/c it seems to help greatly). I would caution taking the moral high ground on the superiority of all allopathic med research and practice.

The study on pneumonia is exactly what you thought, using manipulation to allow the musculoskeltel system to move more freely and increase airflow (esp.), bloodflow and lymphatic return to facilitate healing. The first study though very small (approx 80) showed release from the hospital 1 1/2 to 2 days early than pharmacotherapy alone. Perhaps this is why the NIH is funding this larger study.

Lastly, yeah we take time studying OTM, but, it isn't at the expense of hours in any of the old and more traditional areas of study. In fact at the school where I attend we have 240 hours of anatomy where the average osteopathic school has 170 and the average allopathic school has 140 (I don't think you can get any more basic or trad than anatomy). Would I like to have fewer hours, sure, but, I think I am learning a tool that in some situations will be efficacious and provide me with another treatment option.

Chiropractors are limited to manipulation of the axial skel. Osteopaths manipulate all structures of the body; axial skel and the periphery and many of the techniques are different both in setup and activating forces. Furthermore, many of the philosophies differ. In addition, Osteopathic physicans can do surg, write scripts, and do all other things our allopathic counter-parts do including all specializations, that is a significant difference from the chiropractor. We also go to school longer, more basic sciences, and have residency requirements.

Just a few thoughts.

More later,

Sweaty
KCOM
 
Let me also help out in this discussion...
Like Clown, I am also a former PT. When we discuss OMT, let us remember it is NOT just manipulation. It includes soft tissue techniques and stretching (very much like PT).
So when both clown and I say we use OMT in the clinic or ED or office or field, it is a far broader range of manual techniques than just the simple "rack and crack".
I am sure you have benefitted from stretching prior to exercise...eh? Well, take imagine the 50 year old weekend warrior who decides "today is the day we practice softball with daughter". You can guarantee that poor mobility is a deciding factor in his functional ability or disability. OMT in its various forms ajunctively (sp?) aids his recovery and future performance (along with rest NSAIDS {as appropriate}, ice etc).

In the pneumonia studies, I would bet the added benefit of lymphatic movement and increasing tidal volume has alot to do with recovery. Getting the patient "up and moving" would do wonders...but nursing surely wouldn't do it...and it is not considered "skilled" for therapy to cover it. Leading to a more manual approach to increasing lymphatic flow. I would (as my former PT training dictates) add exercises to be performed in bed for the patient to do independently.

Hope that helps.
 
Sweaty, HCG, & Freeedom! - you guys made some interesting points. Particularly regarding specifics of OMT. This is interesting and I want to get back to you on this but it will have to wait a couple hours while I tend to some work first.

Re: Benchpressing more than me - you are quite likely correct on that one. Never had much upper body strength!

Please stay tuned...
 
To Sweaty Paul,

As a chiropractor, soon to be Osteopath, I can tell you that they are not limited to just minipulation of the axial skeleton. I just took the California Ethics Exam for my Chiropractic license. The rule book states that chiropractor are limited to minipulation of the skeletal system both axial and appendicular, soft tissues, and we could use proprietary drugs(anything not stated in the Materia Medica)
Chiropractor believe or not could practice Physical therapy also, but they can't call it Physical therapy, but Physiotherapy.
They are very limited in what they can do in the medical field. They cover it up by saying that they don't want to blend with the medics because of their wonderful philosophy. I decided to apply for osteopathic school because I wanted a wider scope of practice. It's another 8-10 yrs of school, but I think it's very much worth it. doc2b34
 
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•••quote:•••Originally posted by Sweaty Paul:
•kurtz,

No there are lot of areas in osteopathy that are unproven, however, traditional old boring medicine has its fair share too, most recently the revocation of Arava, the drug that was to replace methotrexate. It was to be the new standard and apparently after passing all the 'scientific' clinical studies it has been causing lots of CVA's. •••••Hi Sweaty,

I'm not sure that your analogy is really appropriate in this instance. Arava was pulled due to the appearance of unforeseen side-effects. This is not unusual with new drugs. Some rarer, but possibly devastating, side-effects will never become apparant until they go into widespread use. Nevertheless, Arava passed its clinical trials because it was proven to be effective in its intended treatment.

My original point regarding OMT was that many aspects of this field have never even gotten over that basic hurdle. Efficacy has never been definitively proven. I think that this is pretty widely accepted knowledge.
 
•••quote:•••Originally posted by Sweaty Paul:
•Lastly, yeah we take time studying OTM, but, it isn't at the expense of hours in any of the old and more traditional areas of study. In fact at the school where I attend we have 240 hours of anatomy where the average osteopathic school has 170 and the average allopathic school has 140 (I don't think you can get any more basic or trad than anatomy).•••••I think I understand what you're saying here, Sweaty & I'm sure you get a solid education - especially at a top-notch DO school like KCOM (I understand it is one of the best). But my point was just that there are only so many hours in the day, days in the year, etc.

Given that MD & DO are both 4 year programs, if you study OMT for a couple hundred hours or more - that has to come at the expense of other pursuits. Clearly, there are arguments that this might be time well spent. However, I think it's fair to say that those hours that DOs spend on OMT classes represent time away from other areas.

Like everything else, its a trade off & what works best for any individual depends on their priorities/interests.
 
•••quote:•••Originally posted by Sweaty Paul:
•
Chiropractors are limited to manipulation of the axial skel. Osteopaths manipulate all structures of the body; axial skel and the periphery and many of the techniques are different both in setup and activating forces. Furthermore, many of the philosophies differ. In addition, Osteopathic physicans can do surg, write scripts, and do all other things our allopathic counter-parts do including all specializations, that is a significant difference from the chiropractor. We also go to school longer, more basic sciences, and have residency requirements.•••••I realize that DOs are much more than "just manipulators" but I guess what I am really interested to learn is what, if any, differences exist between Osteopathic Manipulation (OMT) and Chiropracty.

The above post by Barb is a good example of what I usually hear about how they are "very different" but I just can't seem to get a handle on what those differences are.

Perhaps, the above poster that is jumping from Chiropracty in Osteopathy could give us some insights. I'm really interested.
 
Another question for you guys:

How generally is insurance/medicare reimbursement for OMT techniques? Also, I imagine like PT, OMT must take some time, this has got to be tricky in a busy practice, no?
 
Kurtz:
The difference between allo and osteo lies in the philosophy, or lack thereof. To me the osteopathic philosophy is the search for the cause. In the late 19th century this concept by AT Still was radically different from the way medicine was practiced. Still happened to find the cause in the musculoskeletal system, which is not a new concept, but his manipulative approach is, or was. Thus OMM was originally formulated according to the osteopathic philosophy. Today, the search for the cause is not the sole property of DOs, but they are more likely to apply it in clinical situations because this is the way they are taught. And for those of us who use OMM, we have an added tool for treating the cause, or one of the causes, of disease.
 
As far as reimbursement goes, Medicare and many PPOs will pay for OMT codes, deepending on the number of areas you treat in a visit. In a specialist's office, you usually treat 5-6 areas in a visit lasting 20-60 minutes, and the Medicare reimbursement is $95. Not too bad if you are seeing two patients an hour. Most specialists in the CA area choose not to deal with insurance coverage. They typically charge about $150 for a visit, and let the patient go about getting reimbursed from their insurance at whatever rate they can get.

As far as time goes, it all depends on the type and depth of treatment you want to do. The most experienced osteopaths can give a full body treatment in 30-45 minutes. But in an acute situation such as a patient with a URI, 5 minutes of treatment can go a long way towards getting the patient on the road to health without antibiotics or other drugs.
 
•••quote:•••Originally posted by osteodoc13:
•Kurtz:
The difference between allo and osteo lies in the philosophy, or lack thereof. To me the osteopathic philosophy is the search for the cause. In the late 19th century this concept by AT Still was radically different from the way medicine was practiced.•••••Sure MDs were chasing a lot of symptoms in the 19th century but I think that it is pretty laughable to assume that "the search for the cause" is what seperates DOs from modern MDs. Just my 2 cents worth.
 
Kurtz,

Quote from Kurtz: Maybe one day I'll learn how to do that cool bold thing the rest of you do!!

"I think I understand what you're saying here, Sweaty & I'm sure you get a solid education - especially at a top-notch DO school like KCOM (I understand it is one of the best). But my point was just that there are only so many hours in the day, days in the year, etc.

"Given that MD & DO are both 4 year programs, if you study OMT for a couple hundred hours or more - that has to come at the expense of other pursuits. Clearly, there are arguments that this might be time well spent. However, I think it's fair to say that those hours that DOs spend on OMT classes represent time away from other areas.

Like everything else, its a trade off & what works best for any individual depends on their priorities/interests. "

================================================

The expense is sleep!! :wink: Most times, at least for me and many of my classmates our time in OMM lab is what we spend actually studying for the class. We may also read on some things for 4-6 hours (which is a lot of study time for OMM and this time decreases steadily after you have been in school a while) before an exam, but mostly that is time making sure you are able to understand the types of questions you might see. Now that I am in my second year study is lab, and a max of 2 hours before our exams since they are comprehensive and test your ability to understand a written diagnosis written in a case history form.

As to the issue of efficacy, OTM has been proven to be efficacious in reducing musculoskeletal pain, but, there are lots of other areas where it has yet to become proven. Unfortunately, people make the jump of: it works here so it must work everywhere; or they treated someone, the person did get better quickly, felt better after the treatment and they want to say it is efficacious without any solid scietific evidence. Both are flawed arguments for obvious reasons. There is a lot of anecdotal evidence for OTM helping people feel better and recover from illness, unfortunately it is anecdotal. Doesn't mean that OTM really didn't work to help cure the illness, however; and I may not be popular with some of my osteopathic comrades...it certainly doesn't prove that it did either.

My Arava example may not have been as good as I had hoped in light of your argument which I hadn't considered, but what about reducing lung vol in pts with COPD, not proven to be efficacious by multi-center studies, but still done, and done b/c a number of pts have said they 'felt' better after having the procedure done. In some ways it isn't any diff than OTM except that with the lung reduction you can point to a pile of tissue that is no longer in the person. However, with an osteopath, skilled in manipulation, who has felt an area of somatic dysfunction, treated it, and no longer can find the same dysfunction after a treatment, it is the same, except that there is no pile of tissue to point to.

Again many D.O. students may not ever use OTM or they may use it sparingly. It is a tool, for some it may be the tool of choice, but for many others it is going to be an adjunctive form of tx until better studies come out (assuming they'll use it at all). I have no reservations about its efficacy in helping to treat musculoskeletal pain, it is some of the other crazier stuff I can't accept until we get a good study to prove its efficacy (i.e. cranial manipulation, esp. on adults). The other thing is that many osteopathic students feel the same way, we need research to validate what we are doing or to show what doesn't work so we don't waste our time as students or more importantly, our patient's time, money, and health. In fact SOMA (Student Osteopathic Medical Association) recently passed a resolution calling for Evidenced-Based research on osteopathy, not outcome based research as has been the past expectations of the profession. Students know that evidence and reproducibility are critical and they are taking steps to force the profession in that direction.

"the search for the cause"

Kurtz, try to look at this from a historical perspective. You are right, now it does seem a somewhat laughable difference, but when A.T. Still lived/practiced germ theory wasn't employed and his predecessors and teachers (he was an MD) were still using heavy metals, bleeding anemics, and perscribing arsenic as cures. In this light he was one of the first to really "look for a cause" and in this light was an incredibly progressive thinker.

"Reimbursement"

I have no clue, the above posters seem to know a lot more.

Doc2b34

Sorry if my info on axial v. periph skel was incorrect concerning chiropractic tx. Not my intent to cause offense since hostility prevents open dialogue.

I guess that about wraps up this issue of Sweaty Paul and his many opinions. Tune in next week for his takes on Fung shwei (sp), Dog-walking, and child-rearing a 1 1/2 y.o. boy who thinks all structures exist to climb (including dogs, cats, and most recently kitchen cabinetry.

Sweaty
 
•••quote:•••Originally posted by Kurtz:
•••••Sure MDs were chasing a lot of symptoms in the 19th century but I think that it is pretty laughable to assume that "the search for the cause" is what seperates DOs from modern MDs. Just my 2 cents worth.•[/QUOTE]

As I stated in my post, I agree that many MDs have adopted the osteopathic philosophy. The point is that the osteopathic profession HAS a philosophy, whereas the allopathic profession has never had a guiding philosophy.
Today the key difference lies in the osteopathic profession's recognition of the role of the musculoskeletal system in somatic and visceral disease. There have been numerous instances over the past 100+ years of non-osteopathic researchers noting the interactions of viscero-somatic and somato-visceral reflexes in perpetuating disease, but the allopathic community in general has never paid much attention, preffering to be led by the pharmaceutical induatry towards chemical causes, and thus chemical remedies, for disease.
 
Sweaty Paul seems to be doing a great job answering the questions...

I really think it has little to do with philosophy and more to do with approaching a problem with some additional tools. OMT aids the treatment of some problems and does very little for others. Patients really respond well with the physical diagnosis style of many osteopathic physicians...the "not afraid to touch" approach. It really seemed to be the only difference that I noticed when I did rotations with many MD students...outside of the fact that THEY wanted to learn the simple "thrust" techniques.

As far as time and reimbursement...well many times reimbursement is cash(that is an entirely different issue)...and time is purely a scheduling issue. A thrust manipulation takes zero time and you get great patient satisfaction. The "osteopathic philosophy" should also include the awareness that other professionals like PT's should be utilized! We can't do everything, but we should utilize these professionals with greater frequency...especially after the "rack and crack".
 
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