DO = bone doctor? ?

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Sweaty Paul,

I wasn't offended at all. Just presenting the facts and enjoying the debate between the two of you.

doc2b34

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Just a statement!!

There is a hell of a lot more to OMT than just manipulation.
Does everyone realize that???

Human touch therapy, read up on it....

Also without even using OMT, on your patients, you can use what you learned in your OMT class, to help you diagnose with your hands!!

The D.O. masters hands on palpation, percussion etc..... b/c s/he uses it so much, and is so comfortable doing it, b/c they use it soooo much!!!

My 2 cents...

IMO, OMT or just human touch can help not only diagnose a patient or relieve pain, but can also help heal a patient psychologically as well...

I feel that the more apropriate touching between doctor and patient, whether it be a handshake a hug or OMT, the more trust there will be in the relationship, the more open the pt. will be, and the more complete the treatment will be.

Mike

sorry I'm rambling, I'm tired, long runon sentences.....

good night!
 
•••quote:•••Originally posted by osteodoc13:
The point is that the osteopathic profession HAS a philosophy, whereas the allopathic profession has never had a guiding philosophy•••••Osteodoc, I think that is a pretty ignorant statement - sorry to be so blunt. Perhaps, you are confusing philosphies w/ slogans or gimmicks, because to state that Allopathic medical doctors lack a "philosophy" is just plain silly.

Let me help guide you here:

phi?los?o?phy
n. pl. phi?los?o?phies

A set of ideas or beliefs relating to a particular field or activity; an underlying theory: an original philosophy of advertising.

A system of values by which one lives: has an unusual philosophy of life.

~~~~~~~~~~

Let's consider for a moment the very basics, the Hippocratic oath for example.

But disregarding the obvious, your statement itself is an example of convoluted logic. You state that Allopaths "lack a philosophy" - yet you go on to say that we believe largely in chemical causes. If what you argue is true, that in and of itself would also be an example of such a philosophy.

Come on guys, THINK before you post.
 
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I would have to agree with the above statement...I am a D.O. newly graduated, and the absolute best clinical and academic teachers I have encountered have been M.D.'s. True, there is a supposed "defined" osteopathic philosophy, but it is important that we look beyond AOA gimmicks and catch phrases. As osteopathic physicians we should abide by the Hippocratic Oath as well.
 
If you had read my whole post, you would have seen that I was discussing the fact that Osteopathy was founded on a philosophy of medicine. That philosophy has been stated many times in many ways, but the basic idea is two-fold: 1) the body has an inherent healing capacity and produces all chemicals needed for health; 2) structure and function are inseparable, and disordered structure will lead to altered function and altered ability of the body to heal itself. Contrary to popular belief, OMM is not the basis of Osteopathy. It is simply an expression of the philosphy as applied by Dr. Still.

I challenge you to come up with an underlying philosophy for allopathic medicine.
 
it is really interesting to see how this topic has evolved :)
What a doctor told me (an MD)was that the difference between md/do is like the difference between an acura and a honda. One may have more bells and whistles, one may cost more or be seen as a "luxury" car, and owners of either may be quite proud of the fact that they drive one....but the underlying difference between the two is in the driver.
Our patients will both call us doctor, we will both be paid for our sevices, and we both go to school for a long time to make sure we don't screw up really bad when practicing.
I personally think that the only real differences exist in the pre-med world, once we are all practicing-- will it really matter what the acronyms of the person working next to you are as long as they do their job???
 
I wasn't going to say anything, but I really can't help it any longer. I have a couple of commments, and I hope I don't offend anyone in the process.

First and Foremost, KURTZ, I'm really surprised at the way you always lash out at DOs on this tread. But thats Okay. For your information OMT don't take away anytime or anything from other basic sciences course. If you don't know, you might want to check out the cirriculum at Duke (an allopathic) school. Their basic science is only done in a year. Duke Med students attend four years of Med school just like any other med school, but they still find an entire year to do just research. Well, Buddy thats the same way DO schools are able to incorporate OMT into their 4 year cirriculum.

TO EVERYONE ELSE ,
It makes me sad and sick to sit and watch you guys DOs and MDs argue about Osteopathic and Allopathic medicine. You guys are suppose to be professionals, come on people act like it. All of you involve in the argument sounds like rappers and Hip Hop musicians who are always fighting about who can rap the best, or who is sleeping with the others wives Eg..B.I.G and Tupac, Jay Z and Nas...etc. This people don't know any better. But You people are future Doctors, and are suppose to be some of the most educated people in society. How would your patients feel if they find out you argue like a bunch of 6-year-olds.
For God sake DOs and MDs are all Doctors, they all thave the same basic goal..to heal and help alleviate pains and sickness. It doesn't matter what other philosophies or techniques are used by the other.
Do you guys really think a sick person or someone on a dying bed really gives a damn if the Doctor who will be able to treat him/her is a freaking DO or MD?
You all sound like some kids arguing about who's bike is better or some kids in a pissing contest. The fact of the matter is, IT DOESN'T MATTER Whether one is a DO/MD or not. Us US citizens have so much of everything that we forget to appreciate things. In Third world countries like Africa, South Amreica...etc where there are severe shortages of doctors, DO YOU THINK THEY GIVE A DAMN WHO TREATS THE SICK. In America we have a wide range of choices, we are even blessed to have close to 200 schools of medicine. Off course some with a different philosophy. But hell all these schools contribute in making our health care system great. I wish one of you whinners will go leave in a third world country for a year or two, then you will appreciate the fact that the US has a lot of doctors, be it DOs or MDs.

AND FOR YOU DOs,
It's okay if people do not know about Osteopathic medicine. Just educate then about it. If you get tired, just print out "WHAT A DO IS" from the AOA page and hand it to people. It should be the AOA responsibility to educate the public, but if they are not doing it, you guys (future DOs) should do that. And please don't be hostile to everyone who ask you whether DOs are bone Doctors. Also don't pay attention to some Allopathic students that loves to bash on Osteopathic schools. Just don't sink to their level and You don't have to explain or prove didlle to anyone. YOU CAN PRACTICE MEDINCE IN ANY FIELD YOU WANT....that's all that matters. I would end with a question "If you are in a shower and a crazy mad man comes in and run off with you clothes, ARE YOU GOING TO RUN OUTSIDE AFTER THEM NAKED" NoPe, I didn't think so...Hence in the same way, don't sink so low to other med students who love to bash on other medical schools.
I'M VERY PROUD FOR CHOSING THE DO ROUTE, AT THE SAME TIME, I'M VERY PROUD OF MY BEST FRIEND WHO CHOSE THE MD ROUTE...WE ARE ALL GOING TO BE ABLE TO FUFIL OUR DREAM SOME DAY " HEAL AND TREAT THE SICK".
GOOD LUCK TO ALL OF YOU
 
•••quote:•••Originally posted by Dr. MAXY:
•First and Foremost, KURTZ, I'm really surprised at the way you always lash out at DOs on this tread. But thats Okay. For your information OMT don't take away anytime or anything from other basic sciences course. If you don't know, you might want to check out the cirriculum at Duke (an allopathic) school. Their basic science is only done in a year. Duke Med students attend four years of Med school just like any other med school, but they still find an entire year to do just research. Well, Buddy thats the same way DO schools are able to incorporate OMT into their 4 year cirriculum.•••••Hi there, buddy. Forget your meds today? (sorry, i couldn't resist - it's the wise ass in me)

I wasn't aware that I was "lashing out at DOs." Actually, i'm just telling you what most MDs I know think. Would you prefer I talk behind your back like so many others? No, I didn't think so. I have always believed that people should try to be as up-front as possible.

"For your information OMT don't take away anytime or anything from other basic sciences course."

Oh, I see. In DO-land, are there 34 hours in the day? No? OK, I didn't think so. 'Nuff said.

"If you don't know, you might want to check out the cirriculum at Duke (an allopathic) school."

I am more familiar with this than you might guess. Yes, Duke truncates it's didactic basic science curriculum (FYI - it's not spelled, "cirriculum"). However, it then supplements it with a year of research, seminars, and journal clubs. All basic science education. I see no correlation with OMM, sorry.

Listen Mr. Maxy, I am not trying to "lash out" at DOs. Rather, I am trying to figure out what exactly Osteopathy is and whether many of the unsubstantiated claims made by the profession are valid or not.
 
Hi Osteodoc,

"1) the body has an inherent healing capacity and produces all chemicals needed for health

2) structure and function are inseparable, and disordered structure will lead to altered function and altered ability of the body to heal itself."

If that's your "philosophy" of disease it seems like a bit of an over-simplification to me. The next time I treat a patient with a severe case of septicemia i'll be sure to inform him that his, "body already produces all chemicals needed for health" Sure makes my job easier, no need for those pesky antibiotics, right?

Look, I really don't need to re-post do I. Simply look about 2-3 posts above for my explanation of philosophy above (re-read it closely this time).

You see, allopathic philosophy has been evolving since the time of Hippocrates. Over the years it has changed enormously as the body of scientific knowledge has progressed. It is not a static thing. Some things remain constant, however. The importance of the doctor-patient relationship, confidentiality, and the commitment to always acting in the best interests of the patient.

If, however, you are interested in an allopathic approach to disease, I would refer you to your nearest copy of Harrison's.

Look, your argument about allopathic medicine lacking a philosophy is laughable. I think most people can see this. Did you read the definition of Philosophy that I posted?
 
•••quote:•••Originally posted by Dr. Nick:

If that's your "philosophy" of disease it seems like a bit of an over-simplification to me. The next time I treat a patient with a severe case of septicemia i'll be sure to inform him that his, "body already produces all chemicals needed for health" Sure makes my job easier, no need for those pesky antibiotics, right?•••••Sure, the underpinnings of our philosophy seem simplistic, but the key is that the philosophy provides a framework from which we view the patient. In the case of septicemia, no physician is going to withhold antibiotics, but the question which Osteopathy asks is "Why is this patient septic?" The human body is able to fight off bacteria on a regular basis. Everytime we brush our teeth we create a transient bacteremia, but the immune system prevents the bacteria from making us sick. But now this patient IS sick, and we need to find why. Osteopathic thinking would take into effect not only the common causes such as age, steroid use, fatigue, etc., but the effects of the ANS, specifically hypersympathetic tone, in altering the immune systems locally.


Look, I really don't need to re-post do I. Simply look about 2-3 posts above for my explanation of philosophy above (re-read it closely this time).

You see, allopathic philosophy has been evolving since the time of Hippocrates. Over the years it has changed enormously as the body of scientific knowledge has progressed. It is not a static thing. Some things remain constant, however. The importance of the doctor-patient relationship, confidentiality, and the commitment to always acting in the best interests of the patient.

Look, your argument about allopathic medicine lacking a philosophy is laughable. I think most people can see this. Did you read the definition of Philosophy that I posted?•[/QUOTE]

Yes, I did read the definition of philosophy, and I still haven't seen where you have given us :
"A set of ideas or beliefs relating to a particular field or activity; an underlying theory: an original philosophy of advertising. A system of values by which one lives"

I have explained, time and time again, the underlying theory and beliefs which relate to Osteopathy. All you have done is to tell me to read the Hippocratic Oath, followed by Harrisons. Give me the set of ideas or beliefs relating to allopathic medicine.

Osteopaths have shown, over the last 100 years and supported by scores of research by non-osteopathic researchers, that the musculoskeletal system has far-reaching influences on both the visceral and psychic systems, and thus, in conjunction with the use of pharmaceuticals, they continue to utilize manipulation to help the body return to it's optimal structure and thus optimal function. This is what is meant by Osteopathic philosophy.

BTW, most of us here DO think before we post, instead of just regurgitating incendiary statements intended to provoke hostile reactions.
 
•••quote:•••Originally posted by osteodoc13:
•but the question which Osteopathy asks is "Why is this patient septic?" The human body is able to fight off bacteria on a regular basis. Everytime we brush our teeth we create a transient bacteremia, but the immune system prevents the bacteria from making us sick. But now this patient IS sick, and we need to find why. Osteopathic thinking would take into effect not only the common causes such as age, steroid use, fatigue, etc., but the effects of the ANS, specifically hypersympathetic tone, in altering the immune systems locally. •••••Thank you, Osteodoc - you've made my day. These 2 are priceless:

"but the question which osteopathy asks is "Why is this patient septic?"

"Osteopathic thinking would take into effect not only the common causes such as age, steroid use, fatigue, etc., but the effects of the ANS, specifically hypersympathetic tone, in altering the immune systems locally."

Do you really believe this is unique to osteopathy? That is too funny. If you really think this is true, please tell my attendings ASAP, because they don't seem to agree. It's rhetoric like this that really hurts your profession's credibility.

You keep asking for an allopathic philosophy of medicine and disease. And I have already given you plenty of examples - one of which came from your own convoluted logic. Look, repetition will get us nowhere. If you wish to debate that these examples do not actually constitute philosophy - please post some evidence and we can go from there. That would be a refreshing change. All you have done so far is reject my examples with no logical explanation.
 
Well, its nice to see that we're all acting like professionals. :p

Dr. Nick, you clearly have a bit of truth behind your comments, but you also clearly intend to do more by them than "figure out" what osteopathy is. You proceed to ask for evidence without providing evidence of your own for your attacks on osteodoc. <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> All I read were a few vague references to your attendings. What have your experiences with attendings been like regarding these issues? give us specifics.

I myself know a good many competent MD's that 'search for the cause', as you say- so I don't doubt that some of your attendings are competent, but what seems like the majority of MD's I know are content to find the diagnosis, treat a few of the annoying symptoms and move on to the next patient- leaving their patients on drugs for the rest of their lives with no end to their condition in sight, and not even attempting to look for environmental, emotional or other physical causes that could be creating the symptoms presented.
Perhaps this is a product of being a power-hungry doctor that has lost sight of one's principles, rather than a product of one's educational background, I don't know. To be fair, there are many DO's that do the same- flying in the face of the philosophy that the AOA promotes.

This isn't a DO vs MD thing, its a good primary care physician vs. make a lot of money with as little effort as possible thing. Finding the true cause- "the health of the patient" should obviously be central to the philosophy of any good doctor- especially a primary care doc regardless of whether they are MD or DO. Not to say that you can always 'cure' patients, of course, but its always nice to see the effort- and if there IS a way to ultimately reverse a patient's condition, it is good to pursue that possibility. Perhaps since the DO education revolves around primary care- this thought process is strongly emphasized at many of the DO schools. Like I said, MD schools probably use this too, but some of my MD friends- and specifically one attending the University of Pennsylvania- a good MD school by all regards, considered this thought process as something he wasn't exposed to in his first year of training- and something he regretted not seeing. Perhaps this is just one area lacking at this particular school, but it is the type of thing that promotes the dualistic generalizations spouted by DO pamphlets.

Now, education doesn't always translate into a difference in practice down the road either- one's personal integrety and strength of character will ultimately do that. Lets hope that schools do a good job in selecting these factors in their applicants.

The DO education is clearly somewhat different than MD's (if for nothing else, the OMM), and whether its better or worse entirely depends on where you go and what you are looking for. The stronger DO schools -as I and several others on this thread have repeated- beat the extra OMM hours out of your sleep time. Of all my MD friends, I don't know of a single one that is getting only 4-5 hours average sleep per night- while it is pretty common around here-especially during the last month of every quarter (note I said 'average'- I got about one hour the night before last and about 3-4 most of this week- and I foresee little better through this wednesday). We'll be in class all summer as well :clap: I don't see that very often at MD schools either.

It does no good to make sweeping judgements about the quality of DO education due to OMM hours. Perhaps academics are weaker in some DO schools, but there are also weaker MD schools as well. There are even some MD schools that curve on a regular basis to keep some of the weaker students from failing (imagine that!).

All generalizations tend to fall flat on their face when brought under scrutiny <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> (LOVE the irony of that statement). So, we pick apart each others obvious generalizations and then spout our own back. Does that make any sense? please folks! lets bring the quality of discussion up a notch! Use specific examples and studies if you can. Explain your logic a little. Be HONEST with yourself for crying out loud.

While osteopathic medicine was founded on a 'holistic' philosophy- and &lt;in some cases&gt; preventative medicine is more central to diagnostics in osteopathic medicine (i.e. 'the search for the cause' argument mentioned earlier), this is clearly not always the case, and will vary by the school, by teachers within schools, and by student regardless of where they graduate.

why go DO then?

OMM is a particularly good tool for preventative medicine, since you can use it to catch a variety of chronic problems very early on, and perhaps even treat some of them. It is also used effectively for treating many of the acute structural problems that patients present with.

Other than these tools and the constant emphasis on finding the cause (which may indeed happen in many MD schools too)- there ISN'T a difference. Not in this day and age anyway.

Are the differences between MD and DO enough to constitute an entirely different profession? Now THIS is an interesting argument that I would like to hear some viewpoints on. I wonder if AT Still would promote a "DO degree" rather than award his students an MD today. Any thoughts?

enough. this is coming out of my sleep time. <img border="0" title="" alt="[Eek!]" src="eek.gif" /> back to the books...

peace,
bones
KCOM '05
 
Bones, excellent post. You brought some good points to the discussion.

I'm on limited time at the moment, but I want to just quickly follow-up a couple of things here.

•••quote:•••Originally posted by bones:
•Dr. Nick, you clearly have a bit of truth behind your comments, but you also clearly intend to do more by them than "figure out" what osteopathy is. You proceed to ask for evidence without providing evidence of your own for your attacks on osteodoc. <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> All I read were a few vague references to your attendings. What have your experiences with attendings been like regarding these issues? give us specifics.•••••Re:

"You proceed to ask for evidence without providing evidence of your own for your attacks on osteodoc."

You are missing something important here. I never refuted Osteodoc's claim that Osteopathic medicine has a philosophy (that would be absurd) - thus I don't feel that there is any "burden of proof" on my shoulders in this regard. What I disagreed with was the misguided claim that Allopaths lack a philosophy. To support my argument, I offered an accepted definition of philosophy and then proceeded to offer several good examples of such. I think I made a good argument. Osteodoc's response was simply that my examples "were not philosophies" - he rejected them without any evidence or rationale. Hence, my post above about pointless repetition, etc, etc...

Re:

"but you also clearly intend to do more by them than "figure out" what osteopathy is."

I disagree. I may not always believe what I am told and I may not always tell you what you wish to hear but I don't think I have any sinister motives. Actually, I do think I am learning something through this spirited discussion. In fact, I got in an argument the other day with a colleague that claimed DOs could only effectively practice primary care. Imagine that, Dr. Nick sticking up for the DOs! See, no sinister objectives here.

Re:

"All I read were a few vague references to your attendings. What have your experiences with attendings been like regarding these issues? give us specifics."

regarding septicemic patients specifically? OK, I doubt you are that interested in septicemia persay. I think I understand what what you are driving at here - at my school, and I can only really vouch for my school, we spend an inordinate amount of time and effort counseling our patients on the effects of all aspects of lifestyle on the prevention and cure of disease. Actually, a common complaint is that we spend way too much time on these aspects of modern medicine. Everything from exercise, stress levels, mental wellbeing, diet (especially diet!), family situation, broader social situation, substance use & abuse, smoking, to the potential effects (positive and negative) of "alternative" or "herbal" remedies are discussed with our patients in regard to their potential to effect their overall wellbeing. And all of this at a well-known allopathic institution. Believe it or not we don't simply rely on leeches and blood-letting anymore :D
 
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Wow, after reading all the posts from you people I feel like I live in the Gaza strip. Why do you keep shelling each other? Let me give all of you some real insight from the real world of medicine. Now I am not yet a physician, but I have probably practiced more real medicine than any one of you, even you residents. As a PA in family medicine, I have seen a huge shift in the trends among healthcare over the last decade. Patients now come in with their website printouts, "dietary supplements", and requests for referrals to alternative medicine providers ,and yes chiros top the list. Why do patients do such you ask? Because they are getting less than they desire from traditional medicine in many respects. As a PA, I was trained strictly in traditional medicine, but I have also seen its shortcomings. In treating musculoskeletal pain, we simply suck! Celebrex and Skelaxin are not adequate in most situations of back pain, and many MD's diagnose and treat these disorders without ever touching the patient (I have been plenty guilty of this). In my practice, we have MD's and DO's. They all work together as colleagues, but each has their own approach to treating patients. One DO did an allopathic FP residency and chooses not to perform any manipulation any longer because she feels she has forgotten it. Another DO uses OMM regularly and has a ton of extra patients because of it. As much as we in traditional medicine hate to talk about it, educated patients are wanting more options for their healthcare. And myself, I decided to go back to medical school, and was accepted to MD and DO schools. I ended up choosing the DO school because I felt like it would mold me slightly differently and prepare me just a tad bit more for the direction that medicine is heading. Most practicing MD's will tell you that they remember very little from medical school anyway and that much of it was esoteric BS based on what the PhD lecturers were researching that semester. They will also tell you that their residency is what made them physicians. So for DO and MD alike, there is very little difference once they are out of school except that a DO might remember a few more techniques to treat musculoskeletal pain. I do often feel a bit amazed why the AOA stands behind some of the more controversial things like cranial, and it constantly cracks me up how DO's act like their philosophy is so much more "whole person". I doubt many DO's use OMM to treat septicemia, and I doubt many MD's fail to consider what might be causing septicemia. So I guess you could call me a moderate in the world of liberal DO's and conservative MD's, because I have a bond to both and desire to use all tools possible to treat my patients. I don't think I will likely utilize OMM for anything but musculoskeletal back and neck pain, and I don't think I will ever be so holistic that I recommend Saw Palmetto over Flomax. But, I certainly hope to understand what it is my patient needs and wants just ever-so-more than some of the closed minded traditionalists that are out there in physician land. In 50 years the DO vs. MD argument will likely be a thing of the past, and we better start worrying more about all the allied health professions who desire to take over our jobs while we bicker over philosophy. The law says that a physician is a physician, MD or DO (hell even Podiatrists...another debate for sure if you ask me), so just respect each other and practice how you feel comfortable. Your patients will decide how competent you are, but your initials will not.
 
Dr. Nick:

I agree that it is stupid to keep repeating the same posts, so I will make one more comment and then get out:

If your attendings are looking to hyperactivity of the sympathetic nervous system producing localized immune defeciency as evidenced by changes in the musculoskeletal system, then they are simply practicing what Osteopaths practice. I agree that all of medicine is becoming more "holistic," but instead of seeing this as a refutation of Osteopathic philosophy, I see it as an acceptance, albeit unsaid. Thus for many GOOD physicians the difference lies in the use of the musculoskeletal system for diagnosis and treatment.

Bones:

When you state that many DOs practice allopathic medicine, I don't see this as a refutation of Osteopathy either. It is up to each DO to decide how much Osteopathy he/she chooses to use in their practice, but even if only 1% used it, the results would still be there.

I'm glad this has become such a lively discussion, let's keep it going.

As far as Still not giving a DO degree, he once said "Our house is only large enough for Osteopathy. For every bit of non-Osteopathy we take in, that amount of Osteopathy must leave." I don't think he would consider granting MD degrees at his schools.
 
QUOTE FROM MY BEST FRIEND AT KCOM: We have to face the fact that MD's and DO's are so very close to the same that AT still would probably reward the MD degree now days. I am an Allopathic MS-II, and today the DO philosophy is pretty much standard in medical schools (both MD and DO). They teach us to look for the causes of disease. OMM is the only difference that I see. My friend at KCOM gets less Biochem than I do but more anatomy and goes to class on average 2-3 hours more a week. I think it is only a matter of time before OMM is either validated or rejected by studies. At that time I think that each group (MD's and DO's) will react accordingly. MD schools will teach OMM or DO's will drop OMM. Because if OMM is rejected the insurance companies will not pay for treatments, placebo effect or not.
 
okay, lets put this to rest... :D

To clarify a few points made thus far:
1) Osteopathic Medicine has a philosophy

•••quote:•••Originally posted by Dr. Nick:
•I never refuted Osteodoc's claim that Osteopathic medicine has a philosophy (that would be absurd)
•••••Osteopathic medicine was founded on a philosophy of "holism" i.e. "the body is a unit". This is promoted in all the literature, and is taught (or at least espoused) at all of the DO schools so far as I know.

This philosophy is really rooted in homeopathy from the 1800's, and has since been borrowed by osteopathy, chiropractic, "allopathic" medicine, and virtually every other field of healthcare to greater or lesser degrees.

is the philosophy unique to osteopathic medicine? NO.

is this philosophy promoted in osteopathic medicine relative to allopathic medicine? YES (with reservation). you can argue that it is taught equally in some schools, yet you would be hard pressed to say that it is promoted in the same fashion since not all allopathic schools pay it any regard.

is this philosophy taught in osteopathic medical schools relative to allopathic schools and other branches of healthcare? MAYBE. This appears to vary considerably, but since the attempt has been made to promote this way of thought at all of the DO schools, and it is particularly applicable to primary care (which seems to be what many DO schools target in applicants)- it seems safe to say that this is a unifying philosophy adopted by osteopathic profession.
note: this would not be correctly called "osteopathic philosophy" since it clearly doesn't have osteopathic origins- but lest we bury ourselves in semantics, lets forgive those that use the term loosely.

2) Allopathic medicine has no philosophy
•••quote:••• Dr. Nick in regards to Osteodoc?s post: •
What I disagreed with was the misguided claim that Allopaths lack a philosophy. To support my argument, I offered an accepted definition of philosophy and then proceeded to offer several good examples of such. I think I made a good argument.
•••••....going back to your previous post....
•••quote:••• Dr. Nick in regards to Osteodoc?s OTHER post: •
phi?los?o?phy
n. pl. phi?los?o?phies
A set of ideas or beliefs relating to a particular field or activity; an underlying theory: an original philosophy of advertising.
A system of values by which one lives: has an unusual philosophy of life.
~~~~~~~~~~
Let's consider for a moment the very basics, the Hippocratic oath for example.
• ••••I would hardly call this an argument, but the hippocratic oath is indeed a place to start:
•••quote:•••
The Oath
By Hippocrates
Written 400 B.C.E
Translated by Francis Adams

I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!
•••••This indeed can loosely be called a philosophy, but it is by most regards closer to a system- there are few guiding principles and many rules (but we?ll disregard this). Some points are obviously still relevant, others are debatable (abortion and euthanasia), and others are clearly not (what about that bit swearing to Apollo or regarding one?s professor as a father and their children as brothers?). NO ?allopathic? physicians live their lives by this purely, but a few of the tenants are held dear. These very same tenets are also held dear to osteopaths, and I would challenge you to find any that principles held dear to ?allopaths? that are not shared by a similar contingent of osteopaths.

I would argue that the Hippocratic oath, if a philosophy, is a philosophy of medicine, and NOT of allopathic medicine. The holism principle is more specific, and thus can be claimed as a philosophy specific to the field of osteopathic medicine.

•••quote:•••Dr. Nick in regards to Osteodoc?s post:•
?You state that Allopaths "lack a philosophy" - yet you go on to say that we believe largely in chemical causes. If what you argue is true, that in and of itself would also be an example of such a philosophy.
••••• •••quote:••• Osteodoc?s post:•
?(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.)
•••••If you consider allopaths being led around by the pharmaceutical industry a unifying philosophy, then I?d believe you. :D This is indeed more a philosophy of apathy rather than a unifying principle for ?allopathic medicine?. I have yet to see a unifying philosophy for allopathic medicine that is specific for the field.
Hmm? well, I guess I figured it out. It was the enlightenment actually- those years of anti-non-science and the rise of the scientific method. I was about to say that allopaths only exist as a construct created by the medical tangential fields such as homeopaths and osteopaths, but this isn?t entirely true. While allopaths were attempting to weed out their homeopathic, herbal doctors, and snake oil salesman competition back in the day, they adopted the scientific method as their underlying philosophy- rational reductionism- it ain?t ?real? unless its proven in the lab- and they claimed to practice only that which was proven (though allopaths still often don?t live up to this).
Of course, allopaths only tested the stuff they themselves used and could turn a profit with (and there wasn?t funding to put common folk remedies to the test- since it would be tough to turn a profit with them). And thus, you also put it out of reach of the common person to understand, thus specializing the profession and getting yourselves (and now us osteopaths) more money today.

Guess you?ll like this Dr. Nick. This worked out well for allopaths, though this unifying philosophy has ultimately not been enforced in areas that you guys have historically had control over but had trouble testing (such as surgery and psychiatry).

Now, in the day, osteopaths only really did manipulative medicine and surgery (since ?medicine? sucked- just bloodletting and the like). With antibiotics and the scientific boom, OMM wasn?t adopted since few MD?s could do it, while surgery was adopted even though there was little scientific research outside of outcome-based studies to prove it worked (good outcomes must have been good enough- and they knew they could charge for it).

Since DO?s have adopted much the allopathic philosophy along with the tools of the MD trade for purposes of survival, this allopathic philosophy cannot be held as unique, however it is a common principle of all allopathic fields(at least theoretically), so it could rightly be regarded as a unifying principle of allopathic medicine.

I would also go so far as to say this may in part have led allopaths to inadvertently begin seeing their patients as test subjects rather than people- and hence the patch adams phenomena, the modern rise of alternative/integrative medicine backlash we see today (and the allopathic rush in some schools to over-emphasize the humanistic components of medicine). Many of the remedies and treatments back in the day that were left behind in the interests of funding may have been more effective and less costly, and patients see this. Osteopaths have always held this as well, and perhaps ?osteopathic philosophy? is the biproduct of the profession emphasizing values it has always held dear.

In any case- I just wanted to explore these lines logically to their ends to stop the endless wheel spinning and cut to the chase.

To sum up: THE PHILOSPHY ARGUMENTS ARE A WASTE OF TIME
give it a rest people.

DO pamphlets will continue to say we?re more holistic and better at caring for patients than allopaths.

Allopaths will maintain osteopaths aren?t as scientific as allopaths.

Both are generalizations and therefore bogus, but both are also grounded in a rich history of support and see enough support even in this day and age to propagate.
If one is to generalize, it should be in regards to specifics across schools (such as the average time in class teaching patient care-skills, average time in research methods classes, etc.) or outcome-based studies of patients with specific disorders that see DO?s vs. MD?s (some claim DO?s have better primary care outcomes but I have yet to see a worthy study).

I?d also like to see allopaths hold surgery to the same research standards they put to OMM before they decry how unscientific OMM is- since this is a field of patient treatment they understand. Both surgery and OMM are something of an art form, so they are inherently difficult to do anything but outcome-based research on. Even with outcome-based research, research is complicated because outcomes vary from one doctor to the next due to differences in skill and subtle differences in technique.

Both specialties can be performed skillfully with little knowledge of ?medicine? but both are clearly aided-especially in tough cases, by a broad pool of medical knowledge- and both take inherent skill, a huge knowledge base of anatomy (at least in the areas they work on the most), and many years of training to master.

Surgeons take extra years during residency rather than working them into the undergrad curriculum for all MD?s. DO?s put OMM right into the undergrad curriculum even for non-specialists (perhaps since it is less dangerous and a better adjunct to primary care). This, however, builds complications that all DO?s are aware of.

•••quote:•••From me: •
"but you also clearly intend to do more by them than "figure out" what osteopathy is."

From Dr. Nick:

I disagree. I may not always believe what I am told and I may not always tell you what you wish to hear but I don't think I have any sinister motives. Actually, I do think I am learning something through this spirited discussion. In fact, I got in an argument the other day with a colleague that claimed DOs could only effectively practice primary care. Imagine that, Dr. Nick sticking up for the DOs! See, no sinister objectives here.
•••••ahem, lets see?
List of gems by Dr. Nick:

Hi there, buddy. Forget your meds today?

"For your information OMT don't take away anytime or anything from other basic sciences course."
Oh, I see. In DO-land, are there 34 hours in the day? No? OK, I didn't think so. 'Nuff said.

FYI - it's not spelled, "cirriculum"

Listen Mr. Maxy, I am not trying to "lash out" at DOs. Rather, I am trying to figure out what exactly Osteopathy is and whether many of the unsubstantiated claims made by the profession are valid or not.

Thank you, Osteodoc - you've made my day. These 2 are priceless

Do you really believe this is unique to osteopathy? That is too funny.

Dr. Nick, do you see my point? You make comments like these and then expect rational answers? Although I am somewhat embarrassed at the defensiveness of my colleagues about their profession, and you do have courage coming onto a DO board and attacking us-your choice of words leaves little chance of rational debate. Remember that there are DO?s that would rather be in MD schools and are left with inferiority complexes. All they may have left is the DO propaganda to justify where they are (so they do not feel inferior to MD?s in ALL ways).

You need not attack these people (directly or indirectly) with your inflammatory statements to make a point. If all you want is information, I have plenty- is there a particular explanation you want?

My overall argument is that there is value to the DO education. Clearly those thinking of specializing in OMM have no other choice, but DO schools are also great choices for those desiring a career in family practice, peds, or OB/GYN with a focus on holistic medicine. You may get the holistic approach at some MD schools, but clearly not all, and OMM is a great adjunct to any of these specialties. I would even argue even that DO schools are great for surgeons since we have so many extra hours spent in anatomy (240 at KCOM vs. 140 at most MD schools)- and an extra 200 + hours of hands-on applied anatomy via OMM. By the time you?re cutting someone open you know EXACTLY what to expect- and the ambitious can even verify most diagnosis with their hands before they whip out the knife (perhaps saving a few lives or limbs down the road by catching mistakes). Of course, you?ll need to figure out how to get into a competitive residency coming from a DO school, but top students get these spots regularly and without difficulty from DO schools, so long as they have strong board scores and know some people in the field. Of course, nobody cares if you have a DO once you?re a neurosurgeon.

Regarding one of your earlier comments as Kurtz (assuming you?re the same person)- you kept regarding OMM as chiropractic (perhaps another attempt to raise some tempers for your amusement).

I will not put down chiropractors, as many are very skilled. Many use the holistic philosophy every bit as well as we do, and some can treat everything in their patients- from spine to stones. Most, also have in the neighborhood of 500 hours of hands on time in their training (vs. our 200). There are good ones and bad ones, like any other field.

So, what is the difference you ask? Are we a combo of a chiropractor and an MD? Well, history and other factors aside, we CAN do something neither of the other professions are fully qualified to do- diagnose with our hands. Anything from musculoskeletal problems to autonomic disturbances to virtually any trauma induced or chronic issue you can think of.
MD?s do rudimentary diagnosis with their hands, and chiropractors are taught some basic medical skills, but probably not enough to be accurate with many of the difficult cases we see regularly. Musculoskeletal problems (and a surprising variety of other things) can be treated effectively by OMM as well, and for things like tumors, patients can be quickly caught (think how much earlier a tumor can be found by a primary care doc that has their hands on a patient anyway? perhaps well before discomfort or other symptoms arise)

The ultimate counter to this that pops up-

Can DO?s using OMM really do what they claim?

Can surgeons? Patients come in with a massive debilitating complaint and they leave without it- never to come back. Hmm.. is that proof? No, I guess not. Does it happen often? Well, yes- it does with some of the good docs. Can diagnosed illnesses be cured via OMM? Well, it happens frequently, but we have very few if any studies. Is it all placebo? Well, is surgery? I know they did sham surgery experiment for one procedure back in the day that showed an equal and significant improvement for both real and sham surgeries. It would be great to do similar work with OMM to remove the questionable procedures- but keep in mind not all surgeries used today have been held up to this level of scrutiny- and think of how dangerous that is? the best that most do in surgery is outcome studies- and we have the same for much of what we do in OMM (perhaps not published in the best journals, but the work has been done).

Is the benefit of surgery all placebo? I doubt it. ?so long as the cause is removed. What if the cause is musculoskeletal and accessible via the hands? What if only the symptoms are musculoskeletal? At least in the latter case the symptoms can be relieved and the cause addressed via regular medicine. Now, think of how many illnesses and diseases there are with either a structural cause or structural/somatic symptoms that may be relieved via OMM. OMM is simple mechanics- there is no magic involved (okay, maybe a little...). If you know enough anatomy, why shouldn?t it be possible to fix messed up anatomy with your hands?

We have a pathetic base of research upon which to lay our claims, but everyone who uses OMM in their practice (and their patients) see the benefits. In the meantime, how can you justify studying something that isn?t proven? Do you wait until they ?prove? surgery works before you do it? I say, so long as the outcomes are good- do it, and keep doing the best you can as the research comes in- challenge everything you can, but discount nothing until it can be adequately challenged.

Tear anything and everything up that you want from this post- but if you want to keep me happy, please restrict your arguments to either disrupting my premises or my lines of reasoning, rather than the easy way out as has been used in the past :D I love hearing counterpoints, and my goal is to find the underlying truths of these matters rather than argue an agenda. If you have better ideas than those I posted- fill me in!!!

Ugh? back to work.

bones
KCOM '05
 
DO = bone doctor? YES! and muscle doctor and nerve doctor and skin doctor and general all around organ doctor. So Thar! Now drop it.

Don't you people remember the number line lesson in middle school math? How many times can you go half-way between two numbers? Or for a more salient application...how many times can you split this stupid hair? Let me help you...AN INFINITE NUMBER OF TIMES! These posts keep getting longer and longer and more philosophical ad nauseam. Less is more, so I offer my simple answer to the question-YES
 
<img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />

there you have it! all of the problems of the world resolved! :D

how many times can you split a hair? if you do it right the first time, thats all you need! :cool:
 
Bravo Bones!!!!

I wish I could be as articulate in my posts as you are. Perhaps I could have cut off some of the arguments by Dr. Nick?

The only "bone" I have to pick is when you say that DOs are basically MD + OMM. I know from your previous posts that you understand that the difference goes deeper than that.

Maybe the readers would be interested in another thread here, "What is Osteopathic Philosophy?" Stillfocused and I have been discussing the finer points of the philosophy, and some of the posts there are much more cogent than the ones I have posted here.

I feel that physicians can be "osteopathic" without ever using OMM. In the allopathic world, it is called being a good doctor, but if you look at what these physicians, such as Dr. Nick's attendings treating the hypothetical septicemic patient, are doing, it's really Osteopathy.
 
dah, can't sleep so here I am :p

thank you osteodoc for the complement.

I don?t know that I ever claimed that DO?s were nothing more than MD?s +OMM. I agree that the philosophy that DO?s use is critical in quality primary care. I did make the argument, however, that DO?s have no more claim on the holistic philosophy than MD?s do (though perhaps we are quite a bit more familiar with it). It is ultimately a homeopath/naturopath philosophy (if you are inclined to give it to some particular group) that happens to sit very well with what we do in our osteopathic practice. To say that good MD?s are using osteopathic philosophy is little different than saying osteopaths use MD science (even though it isn?t the MD?s that did most of the research, nor do they have sole claim on the use of the content).

No, I don?t think the ?osteopathic philosophy? is unique to osteopathic medicine- but I do think it is central to the type of medicine we practice, and it gives us VERY high patient satisfaction relative to doctors who don?t use it be they MD, DO or whatever else.
I also think that DO schools in general do a good job of teaching this philosophy relative to our MD counterparts, though I have been alerted that this isn?t the case for all schools. With a good foundation in this approach to medicine, you will be a good doctor no matter what specialty you want to be. I therefore agree that one does not need to use OMM in their practice to be a good DO- and in my DO surgeon example I left room for this possibility as well. I?d be happy to know if you catch me in an inconsistency, but I think I?ve been covering my bases. Have I forgotten anything? Do you disagree with any of the specifics I?ve mentioned?

Unfortunately- I will be buried in work for finals and exams for the next few days so there is no way I?ll be able to reply until at least Wednesday night or so.

As I?m tiring a little of this thread, (and it seems that you guys are too) I?m thinking I?ll start another with a little more life in it. Feel free to continue to comment on my posts here- add stuff I left out or rip apart things that don?t make sense or are inconsistent with studies you?ve found- but realize I can?t respond for a bit. I?d like to settle up this subject a little so everyone gets their viewpoint addressed ?we need a solid notion of what osteopathy really is before we know where to go with policy and education decisions.

The new thread will be in regards to this DO/MD merger idea I?ve been kicking around a little (I recently heard someone else came up with it first, so I wont take credit :rolleyes: ). Not that it is likely to happen anytime soon with politics in place, but I?d like to discuss the principles involved in such a move and hear some input. You had a good counter argument osteodoc and I?d like to see you post it again in the new thread.

cheers,
bones :cool:
KCOM '05
 
Lots of interesting points. I'm brand new to this network, but something was said earlier in the thread that made me curious. It has to be made absolutely clear. OMM DOES NOT INTERFERE WITH HOURS IN OTHER CLASSES.
 
(Ok, so I'm REALLY new at this posting thing.) Here's my evidence:

As it is currently finals time, I don't really have time to go through every single program, so I have chosen my osteopathic school, KCOM, and compared it with an allopathic program. I figured I'd choose Harvard. Units/Credits are difficult to compare from one school to another, so I've chosen contact hours.

Harvard Medical School, 2000-2001
First Year; # of contact hours = 825
(source = <a href="http://medcatalog.harvard.edu/calendars/cchp.html)" target="_blank">http://medcatalog.harvard.edu/calendars/cchp.html)</a>

Kirksville College of Osteopathic Medicine,2001-2002
First Year; # of contact hours BEFORE OTM = 1033
# of contact hours including OTM = 1146
(source = <a href="http://www.kcom.edu/newcatalog/program/curriculum.html)" target="_blank">http://www.kcom.edu/newcatalog/program/curriculum.html)</a>

Now, I agree that quantity never equals quality. And I don't want to argue whether DO programs are superior, inferior, or equal, because a case can be made for all three sides, and it probably comes down to individual programs.

As for KCOM, we have more contact hours than any school in the country (DO or MD). Our pass rate for COMLEX is 99.3%. Of those who take USMLE, we score on average in the 85th percentile. (Source = KCOM admissions & KCOM President's address, 2001) Our OTM hours are middle-of-the-road as DO programs go.

This does NOT mean we are better doctors. This does NOT mean we have a better program. These are just numbers.

But back to my original point. OTM hours do not interfere with other "traditional" class hours, at least here in the boonies of Missouri.
 
Please post on our What is Osteopathic philosophy thread, also!

I will inject one point here, however.

Contemporary, mainstream, evidence based allopathic medicine does have a predominant philosophical prespective. It is called biological reductionism.

Allopathy does an amazing job of breaking problems down into their constituent part; its not so good at looking at the greater whole.

Even though Engel's "Biopsychosocial" model is often invoked, in the everyday practice of allopathic medicine there is almost no room for a dialectical, interactionist, whole person approach to health and illness.

Patients lived experience is often treated as secondary to "the problem" of the moment.

Still's social reform movement of American medicine still has a place.
 
Wow! Looks like there has been some SERIOUS traffic here since I last visited. All good stuff.

Man, oh man, where to begin <img border="0" alt="[Wowie]" title="" src="graemlins/wowie.gif" />

First things first...

"ahem, lets see?

List of gems by Dr. Nick:

Hi there, buddy. Forget your meds today?

"For your information OMT don't take away anytime or anything from other basic sciences course."
Oh, I see. In DO-land, are there 34 hours in the day? No? OK, I didn't think so. 'Nuff said.

FYI - it's not spelled, "cirriculum"

Listen Mr. Maxy, I am not trying to "lash out" at DOs. Rather, I am trying to figure out what exactly Osteopathy is and whether many of the unsubstantiated claims made by the profession are valid or not.

Thank you, Osteodoc - you've made my day. These 2 are priceless

Do you really believe this is unique to osteopathy? That is too funny."

OK, OK, I am, by nature, a bit of a wise-ass. I have never denied that. But to be fair, some of these are best appreciated within their context (i.e. it takes 2 to tango) But to get back to the original point I don't think that I am here as a "troll," or whatever.

Apologies to whomsoever may have been offended - since I enjoy discussing with you guys, i'll try and keep it a bit more civil (though surely my sarcastic nature will get the better of me from time to time) :wink:
 
This has probably been the most frequently misunderstood point:

"OMM DOES NOT INTERFERE WITH HOURS IN OTHER CLASSES."

"Harvard Medical School, 2000-2001
First Year; # of contact hours = 825
(source = <a href="http://medcatalog.harvard.edu/calendars/cchp.html)" target="_blank">http://medcatalog.harvard.edu/calendars/cchp.html)</a>
Kirksville College of Osteopathic Medicine,2001-2002
First Year; # of contact hours BEFORE OTM = 1033
# of contact hours including OTM = 1146
(source = http://www.kcom.edu/newcatalog/program/curriculum.html)"

My original point here was a simple one. If you spend several hundred hours studying OMM, other subjects will receive less attention. This really has little to do with class hours because we all know medical students do the majority of their work outside of classes.

I simply do not buy the argument that DO students work harder - that is not to say that they work less. At my school, and I suspect the same applies to your DO schools, (most) people study to the breaking point - pushing the limits of sleep-deprivation. There just aren't any additional hours in the day. If we were to add OMM to our curriculum, something would have to give.
 
OK, Bones. You made some great points and your post reflects the effort that you put into it, but I saw a number of things that are problematic. I'll try to hit some highlights as time permits.

FIRST of all. In regards to:

"quote:
Dr. Nick in regards to Osteodoc?s OTHER post:
phi?los?o?phy
n. pl. phi?los?o?phies
A set of ideas or beliefs relating to a particular field or activity; an underlying theory: an original philosophy of advertising.
A system of values by which one lives: has an unusual philosophy of life.
~~~~~~~~~~
Let's consider for a moment the very basics, the Hippocratic oath for example.

I would hardly call this an argument, but the hippocratic oath is indeed a place to start:"


OK, maybe it is a brief argument but I would not attack the validity of claim here - and I will tell you why.

But first, I need to point out that you posted the original Hippocratic Oath for crying out loud! That is just not fair. In case you hadn't realized, it has changed over the last couple millenia.

Try this:

Hippocratic Oath -- Modern Version

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard- won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's
recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty.

Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care
adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter.

May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.


Now I ask you, does that comprise a philosophy? I think that yes, clearly, it fulfills the definition that I posted in my above argument - the one that you said was not an argument.
 
From Dr. Nick:
"I simply do not buy the argument that DO students work harder - that is not to say that they work less. At my school, and I suspect the same applies to your DO schools, (most) people study to the breaking point - pushing the limits of sleep-deprivation. There just aren't any additional hours in the day. If we were to add OMM to our curriculum, something would have to give."

And yet, osteopathic students are able to keep up with their allopathic comrades when it comes time for boards, rounds, residencies, etc. How is that?

One possible answer is that we (SOME osteopathic schools) have no summer break. Surely you can see that with no break, far more hours are spent studying.

Lots of other hours are spent in gross dissection, where osteopathic programs generally spend much more time than MD programs. I've heard that some schools don't even do dissection. (How can you be a physician if you haven't thoroughly dissected the human body? Its like never looking at any path/histo slides.)

Another possibility. We are all familiar with the concept that no matter how much crap we have to take, they seem to just keep piling it on. 50 more pages of notes to learn over the weekend? Another typical Saturday night. (That's ok. There isn't anything to do out here anyways.)

Additionally, OTM really provides a good anatomy review, so that, while our hands are "learning" how to diagnose/treat, our minds are going over things like: range of motion, ANS/somatic innervation, lymphatic drainage patterns, as well as being introduced to some basic internal medicine concepts.

And here's a little secret: Students don't spend a whole lot of time studying for the written exams. It's usually just a few hours the night before, b/c we've already had enough review in lab.

I have other theories as to how this is possible, but if you've read this far, you're probably bored by now.

So, to sum up: It is possible to add OTM to the curriculum without compromising on study time in other areas.
 
AviatorDoc,

I just don't buy into this - here's why.

If everything you say is true, why then do Allopathic students perform better on the USMLE Step I than Osteopathic students?

"In 1998, 1999, and 2000, the pass rates for first-time takers from US and Canadian allopathic medical schools were 95%, 94% and 93%, respectively."

"For the same time period, the pass rates for first-time takers from US osteopathic schools were 87%, 82%, and 77%, respectively"

<a href="http://www.usmle.org/news/medlic.htm" target="_blank">http://www.usmle.org/news/medlic.htm</a>

Why the big disparity?

Is it possible that allopathic students are smarter? That's a silly question - "smart" is a difficult concept to define.

Given the higher average entering stats of MD students, is it possible that Allopathic schools select for students with better test-taking skills?

Possibly, but probably not - just look at pass rates for the Step II, they are practically the same.

From the same site above:

During the August 16, 1999 - June 29, 2000 period 93% of Allopaths passed the Step II while 90% of DOs passed the Step II. While the difference in passing rates for that year's Step II was only 3% in favor of MDs during that year, the passing rates differed by 16% for the Step I during the same year.

This would lead me to believe that in terms of test-taking skills, both MD and DO students are probably similar.

So, why then is there such a significant difference between MD and DO Step I scores?

The evidence suggests that the basic science education at DOs schools does not prepare DO students as well as MD students. Whether this is due to time spent working on other areas, such as OMM, I have no idea. What I do know, is that at the end of the day, DO students just don't perform as well on the basic science intensive Step I.
 
Dr. Nick - I did not take the USMLE I, but many of my classmates did. Many of those who did had difficulty with many of the biostatistics and genetics questions, classes which are not taught at my osteopathic school. Perhaps that could at least contribute to the discrepancy in Step I scores between allopathic and osteopathic students. Just a thought.
As far as OMM/OMT taking time away from other areas of study, much of our OMM classwork was review of musculoskeletal anatomy and neurophysiology as well as "philosophy" of osteopathy, so it really does not take vast amounts of time to learn. Honestly, much of the material is common sense and does not require enormous study time. The only aspect of OMM that took any significant period of time was learning the manipulative techniques, and even that came quickly. So, overall, I would have to say that studying OMM/OMT didn't much if any time away from our other areas of study.
 
Usually I ignore the DO vs. MD debate...it is generally pointless.
But once again the "Why do DO students score worse on the USMLE" showed its ugly head.

Why should we and why would we???? We have the COMLEX...that is our licensure exam! We don't even have to GIVE our USMLE results if we chose not to... it means ZERO to graduate! The motivational factor is FAR FAR LESS. Also, the USMLE is likely to be taken near the COMLEX exam...leading to terrible burnout by the time we take it. Truth be told, I would rather do poorly on the USMLE (the test that means nothing to licensure) than the COMLEX...the one needed to pass.

I took USMLE 1 and 2. Passed em both, and did well. I prepared so that i would PEAK by the time COMLEX came around...the USMLE was a warmup!
 
•••quote:•••Originally posted by Mr. happy clown guy:
•Usually I ignore the DO vs. MD debate...it is generally pointless.
But once again the "Why do DO students score worse on the USMLE" showed its ugly head.

Why should we and why would we???? We have the COMLEX...that is our licensure exam! We don't even have to GIVE our USMLE results if we chose not to... it means ZERO to graduate! The motivational factor is FAR FAR LESS. Also, the USMLE is likely to be taken near the COMLEX exam...leading to terrible burnout by the time we take it. Truth be told, I would rather do poorly on the USMLE (the test that means nothing to licensure) than the COMLEX...the one needed to pass.

I took USMLE 1 and 2. Passed em both, and did well. I prepared so that i would PEAK by the time COMLEX came around...the USMLE was a warmup!•••••That is possible. However, I'm not sure that I would so casually dismiss these statistics.

Do DOs lack motivation when they take the Step I? Perhaps, some do. I would imagine, however, that many of those taking Step I are probably gunning for competitive allopathic residencies and are thus relying on good Step I scores to level the field with their allopathic competitors. Sure, it doesn't count towards licensure, but it might get you into that top-notch radiology residency. That seems pretty motivating to me.

Continuing this logic, it might also be true that many of those taking the USMLE are coming from the cream of the osteopathic crop. That being the case these figures might be artificially high.

Also, as Step II has nothing to do with licensure either, why little discrepancy there?
 
Hi Migraineboy,

Your school doesn't teach genetics? That's interesting. Biostat, is often not taught as a stand-alone course, but I have not yet heard of schools that were not teaching genetics. As for these subjects contributing to the disparity, that could be.

However, anyone, who has taken the USMLE can probably confirm that these subjects are not heavily tested (maybe a couple questions at most?)

"So, overall, I would have to say that studying OMM/OMT didn't much if any time away from our other areas of study."

Perhaps, genetics was passed over in favor of OMM/OMT? Just a thought.

Cheers
 
Osteodoc:

"I wish I could be as articulate in my posts as you are. Perhaps I could have cut off some of the arguments by Dr. Nick?"


Ahh, but I am not so easily thwarted.

"A clever explanation will never replace the truth." - Vietnamese proverb

Cheers,
Dr. Nick Riviera
Hollywood Upstairs Medical School
 
I agree with freedom...the COMLEX and USMLE are typically tested near the same time and the motivational factors for both are FAR FAR different.
We HAVE TO DO WELL on the COMLEX...but the USMLE...if you do well, then good...if not, don't report it. Not a ton of pressure there eh?

Dr. Nick, you are trying to find reasons to criticize...that is too bad. What next, making fun of a DO's haircut? Just another reason to justify some silly insecurity?
Whatever.
 
Mr happy clown guy......I sent you a PM....
 
It seemed as though my friends in MD schools had their curriculums geared toward doing well on the USMLE. My DO school seemed like they could care less whether we did well on the COMLEX or not. They taught us the basic sciences with the intent of educating us and learning the material as opposed to just learning the material to do well on a board exam. Just like during my clinical years, my rotation exams were not difficult and we barely got time off to study for step 2. My MD friends got time off during each rotation to study for their shelf exams and this in turn prepared them well for step 2. I just think that the mindset in the two different fields is different in regards to board exams. I'll admit, I did better on the COMLEX than the USMLE for step 1 but my USMLE step 2 was better than my COMLEX step 2. They were both good scores but they were different. Why? I couldn't tell ya. Maybe I studied harder for one than the other. I thought the COMLEX was a poor test with vague questions. The USMLE was only ~400 questions as compared to ~800 on the COMLEX. The two tests might cover the same material but the questions are presented somewhat differently. I personally don't think you can compare the two. Eight 50 quesiton blocks as compared to four 200 question blocks, one day compared to 2 days, one is paper and the other is computerized, and one has OMM and the other doesn't. Plus, honestly, you really think board scores are going to determine how good of a doctor you are going to be? Knowlege is great to have but you also need common sense, people skills, talent, technique, and good mentors to be good in any field of medicine. I had a friend in my class with an MCAT of 21. He got a 231 USMLE step 1. What does that tell you? Basically nothing. Scores are just scores. Its ridiculous how everyone puts so much emphasis on one exam rather that looking at the whole picture.
 
•••quote:•••Originally posted by Dr. Nick:
Osteodoc:

"I wish I could be as articulate in my posts as you are. Perhaps I could have cut off some of the arguments by Dr. Nick?"


Ahh, but I am not so easily thwarted.

"A clever explanation will never replace the truth." - Vietnamese proverb

Cheers,
Dr. Nick Riviera
Hollywood Upstairs Medical School•••••<img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> now now... I thought I told you- I can't take the time aside until wednesday to give an adequate thwarting! please reserve judgement about whether you'll be thwarted until then :D
j/k
I have no intention of thwarting you Dr. Nick. But I would like to iron out some of these confusions and conflicts everyone is having. And it is true- I do need to buckle down for a bit more- so I'll be signing off...

But to clear up one misconception before I do:
Last I heard, KCOM scored two standard deviations above the mean for MD's on the USMLE's -mind you, that WAS only 40% of the class taking the test, and possibly a somewhat above average cohort at that, but I think you'd be surprised how many from the bottom of the class take the USMLE's too- perhaps to give them more potential residency spots to choose from if they don't get into one of their favorites. Anyhow, it was enough to get some of the USMLE people out here asking what the heck we were doing to score so well. (cheating perhaps? we are a DO school after all... how could we do well on the USMLE? <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> ). In actuality I think its just that we're nerds and since cow tipping can only occupy you for so long, we have nothing better to do but study -plus, it ain't always easy to pass around here either- maybe we force all those that might bring down our scores to either fail out or flip out- studying around the clock and thus scoring better. who knows...

Remeber that many of the DO schools are still brand-spankin-new so they haven't had the time to develop an established system for doing well on standardized tests. Whether the fact they award DO's or have OMM hours has anything to do with this is still unsubstantiated. There are too many variables to make such generalizations with any hope of accuracy, so bugger off until I can give you a real response :)

Geez! I'm even wordy in my abreviated responses! <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />
bones :cool:
 
Bones posted,

"Last I heard, KCOM scored two standard deviations above the mean for MD's on the USMLE's"


Are you sure about this, Bones (feel free to reply after exams) ?? Because I'm having trouble believing that. Two standard deviations above the mean would be an average score of ~260!

If that is true, I salute you and your cohort! It would also give you the highest average USMLE score in the world with your average score being in the top 1% of all test takers.
 
A 260? Wow I want to go to your school. Seriously, was that an actual 2SD above the mean or theoretical (theoretical avg. is 200 with a SD of 15 according to Kaplan q-book). A 230 is very believable especially if the top 40% of the class is the one taking it. At my Allo school 92% pass every year, but the top 75% of those who pass score an average of 225. So, it is possible.
 
Happy Clown Guy,

"Dr. Nick, you are trying to find reasons to criticize...that is too bad. What next, making fun of a DO's haircut? Just another reason to justify some silly insecurity?
Whatever."

No. If you follow the thread back you will see that the discussion of the discrepancy in Step I scores was only brought up as an adjunct to a conversation as to whether or not OMM training comes at the expense of other courses in the pre-clinical years.

As the Step I measures competency in pre-clinical subjects and is the only standard measure used by both DOs and MDs, it was entirely appropriate to the discussion at hand.

Perhaps, your accusations of insecurity are misdirected.

~~~~~~~~~~~~~~

To the poster that brought up the fact that test scores are not everything and they do not determine your future worth as a doctor, I say that I couldn't agree more. You are absolutely correct.

If you follow this thread backwards you will realize that we were trying to compare the general differences bewteen DO and MD basic science curriculums. We were also discussing whether or not the several hundred OMM hours affected this in DO programs. As the only common measure between DO and MD pre-clinical studies, Step I scores are useful in this respect.
 
•••quote:•••Originally posted by Ice Man:
•A 260? Wow I want to go to your school. Seriously, was that an actual 2SD above the mean or theoretical (theoretical avg. is 200 with a SD of 15 according to Kaplan q-book). A 230 is very believable especially if the top 40% of the class is the one taking it. At my Allo school 92% pass every year, but the top 75% of those who pass score an average of 225. So, it is possible.•••••What's the difference between a theoretical and actual SD, Ice Man?

I took the Step I in 2000. I believe the mean that year was ~215 with a standard deviation of ~20. I scored 239, which we calculated on another thread to be approximately 89th percentile.

I'm no wizard at statistics but 2 SD above the mean would be ~255 or so and probably in the top 1%! And Bones says that's their average!

I know KCOM is a top-notch DO school - but damn. I'm not sure any school averages top 1%.
 
Dr. Nick and everyone else anxiously reading this thread,

O.K. here is the Poop, Bones is speaking without really having all of his facts straight, perhaps I can clear up a couple of his comments.

KCOM was not two standard deviations higher than all other allopathic schools, however, as a school during the (I believe, though I could have the wrong year) 2000 USMLE, scored in the 85%. This was significant, obviously, and the President of the NBME (the authors of the USMLE) came to Northeast MO to find out what we were doing in our education since our students were scoring so well compared to allopathic institutions.

That said, not everyone in the class took the USMLE, becaue as Happy Clown Guy pointed out there isn't any real motivation to take the USMLE. Arguements are made both ways on whether or not to take USMLE all the time, the benefits some think is that you will be a more competitive applicant at some programs, others argue that if you have a bad day it'll hurt you in the long-run, others think that if an allopathic residency won't take COMLEX they aren't DO friendly, others think that if you take the USMLE you show you aren't any diff...the arguements go on forever. As an older person who worked in the real world I really think that it comes down to "who you know" (i.e. how well you did on rotations, did you get along well with the staff, how did your interview go, or really who do you know at place that might have some 'juice' to help you out).

Sorry for the above digression, what I can say is that I know some of the class with that 85% score as their average and I know that several of the top academic performers didn't take the USMLE (they didn't see any academic/professional benefit). I also know that year they had only one person fail the COMLEX but, that person passed the USMLE. Does that make the USMLE easy or the COMLEX hard? No...both exams suck and both are very hard. Both are no fun to take, to prepare for, to pay for, or to worry about your results.

I have to agree with Clown too in that the motivation for USMLE isn't as great cause I don't need it to be graduated (Though haven't decided to take it yet either...I'm feeling very lazy my 33 y.o. butt is tired of wooden chairs).

Dr. Nick,

You haven't really read my post from before...but it comes down to this...OTM/OMM/OPP whatever you want to call it doesn't require lots of study time. You go to lab, you learn what you need there, what to feel, patterns of dysfunction etc. You practice on your classmates when they hurt and need a treatment. Our OTM lab time cuts into time that you might have free. While those who don't have OTM are out a couple hours earlier that time we spend in our OTM lab palpating backs, extremeties, tender points, trigger points,(craniums YIKES) necks, etc. Most important, there isn't really a good way to study since much of the exam is just if you know how a technique is setup, when you might use it, and the mechanics involved. The most important aspect for passing the course (at least at KCOM) is passing a practical exam where you find and treat somatic dysfunction on one of your classmates while one of our OTM faculty watches/critiques, checks for dx accuracy, and treatment efficacy. The net result is that it adds contact (contact/palpation get it...) (o.k. dumb joke) hours not study time.

O.K. my two pennies.

Hope this finds you all well.

Back to board study.

Sweaty Paul MS-II
KCOM
 
Hi Sweaty Paul,

I have read all of your posts. However, the reason that I feel as if I am beating my head against a brick wall is this:

"Our OTM lab time cuts into time that you might have free."

Why is that everybody here seems to think that the hours you spend on OTM, we spend watching TV and eating pork rinds? That implies you guys all work harder than us - a claim I simply do not believe and which I have already posted on ad nauseum.

On a completely radical tangent, I'd really like to know about your handle. Are you really that "sweaty"? I *do not* mean this as a flame. The reason I ask is that I've heard about botox being used for hyperhidrosis by derm specialists and it sounds interesting for those of us that hate to have big sweaty pits (like me!)

Cheers,
Dr. Nick
 
If 40% of your class took the USMLE and they scored, on average, at ~85% that is remarkably good. You and your classmates should be congratulated.

It sounds to me like they were pretty well motivated. Quite likely, they also were disproportionately representative of the "cream" of your class. All supportive of arguments that i've already made.
 
Right. The theoretical mean is what the NBME predicts the mean to be. The actual mean is what it really is, in your case 215. They try for 200 SD 15. Also, I would bet that the COMLEX and USMLE are slighty different style/content tests (correct me if I'm wrong). DO students (or current DO's) that I know say they get a little less biochem and a little more anatomy in their curriculum. Again I am not sure about that either, but I do know that on a percentage scale the COMLEX has less of the useless biochem and more of the useless anatomy.
 
Dr. Nick - so are you trying to imply that allopathic students never have any free time? You can't tell me that everyone heads right from class to the library 'til 2 AM everyday. I mean, everyone has to break for pork rinds now and then!
 
"O.K. here is the Poop, Bones is speaking without really having all of his facts straight, perhaps I can clear up a couple of his comments. "

Sweaty,

I was parroting what two of the people in the admissions committee told me when I was visiting during my interview for KCOM last year. Anyway, I -thought- I remembered them specifically stating that we were 2 standard deviations up on MD schools, and that the USMLE people had sent someone to us (maybe what I really heard has since been replaced by physiology and biochemistry). <img border="0" title="" alt="[Eek!]" src="eek.gif" />

Since I didn't know where to check the numbers and hadn't really questioned what I heard (I've heard many comments about how good our scores have been), I didn't look them up before posting -which I obviously should have found a way to do (thanks for making that so brutally clear). :p

..if you are right about the 85% figure, that does sound a little more realistic, and should still put us at around one standard deviation above the mean for test-takers (since it isn't a perfect bell-curve distribution, 84% was one SD in a previous year). Of course, we'd need to look at the statistics for the year in question to be sure. Do we have more recent statistics available? I would like to know if we continue to do that well or if that year was a bit of a fluke.

anyway, thanks for straightening things out,
:rolleyes:
bones
 
•••quote:•••Originally posted by osteodoc13:
•Dr. Nick:

If your attendings are looking to hyperactivity of the sympathetic nervous system producing localized immune defeciency as evidenced by changes in the musculoskeletal system, then they are simply practicing what Osteopaths practice. I agree that all of medicine is becoming more "holistic," but instead of seeing this as a refutation of Osteopathic philosophy, I see it as an acceptance, albeit unsaid. Thus for many GOOD physicians the difference lies in the use of the musculoskeletal system for diagnosis and treatment.
•••••Dr. Nick:

I'm still waiting for a reply to the above statement about what your attendings are looking for in terms of "causes" of septicemia...
 
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