Do you buy into the principles of osteopathy?

[Tony1029]

I'm sure something like this has been asked before here, but what I'm not sure on is what kind of keywords I would use to search. I'm currently reading "The D.O.s: Osteopathic Medicine in America" by Norman Gevitz. The first few chapters deal with Dr. A.T. Still's background and how osteopathy got off the ground. The author mentions some of the other medical movements in the 19th century, such as homeopathy, hydropathy, and magnetic healing. He also mentions the challenges Dr. Still's theories faced once the germ theory became accepted in medicine.

I was wondering how one separates osteopathy from other movements like the ones above. Obviously osteopathy has survived better than those, but is that due to it actually working or just being popular? Some of the tactics Dr. Still used, traveling from town to town giving demonstrations on the back of his wagon in the town square make him sound like just another snake oil salesman. (Think about what your impression of osteopathy would be if it was being introduced today.)

Are you guys in osteopathic schools because you didn't get into your first choice MD school? Are you in one because you only applied to DO schools, in order to avoid more competition? In what ways do you think manipulative therapy can be effective, or better yet, in what ways has it shown to be effective?

My family physician is a DO, Philadelphia graduate from the 60s, but he has never performed any OMM on me or a family member. He'll usually just order a blood test or write a prescription. Is this a "lazy" doctor, or do most DOs today save OMM for school only?

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[TexasTriathlete]

Keep in mind that a lot of "standard medical practice" in Dr. Still's time was quackery. Still came at the forefront of the need for reform in the medical community, and while he may have just replaced old quackery with new quackery, in some cases, he still helped to point out a lot of the problems with medicine at that time. The Flexner Report would eventually make sweeping changes to medicine and medical education that, undoubtedly, Still would have found refreshing.

At least that's how I understand it.

 

[DrMidlife]

...some of the other medical movements in the 19th century, such as homeopathy, hydropathy, and magnetic healing. He also mentions the challenges Dr. Still's theories faced once the germ theory became accepted in medicine...I was wondering how one separates osteopathy from other movements like the ones above. Obviously osteopathy has survived better than those, but is that due to it actually working or just being popular? Some of the tactics Dr. Still used, traveling from town to town giving demonstrations on the back of his wagon in the town square make him sound like just another snake oil salesman. (Think about what your impression of osteopathy would be if it was being introduced today.)...

I won't take on your other questions, but to this one I've been giving some consideration. From my perspective, DOs survived and (relatively) thrived because they continually adopted therapies that work: first OMM, then drugs and surgery. DOs could have insisted that all ailments are curable through OMM; by not insisting on this, DOs kept (and added to) their credibility.

Let me elaborate on what I mean by "continually adopted therapies that work." If you go back 90 years, MDs had nothing, NOTHING on the influenza epidemic. No antibiotics, no lasix, nada. DOs had lymphatic flush, which was actually therapeutic against the (probable) cytokine storm. Too many MDs were being clowns at this point, dosing mercury for stomach aches, etc.

Move forward some years, good pharm shows up, MDs adopt it, and suddenly MDs have better tools. Suddenly surgery is survivable, troops in the field start coming home instead of dying of infections. Lymphatic flush couldn't compete with this. So DOs had to take on drugs and surgery, or become a sideline discipline. There was no reason to stop doing OMM as well. I would argue that chiropractors also had this opportunity, lost it, and are now trying to get it back.

The long-term downside for DOs is that we didn't (and largely don't) participate in the vast, rigorous peer-reviewed biomed research that pushed pharm and surgery forward. I don't think the current MD vs. DO status has anything to do with OMM: I think it's about DOs being largely destined for community medicine, because our academic & research contribution is weak. And we can either be satisfied with that, or not. Individual DOs who make it on faculty at MD schools aren't satisfied with that, and I doubt I'll be.

And really, though more studies on OMM would solidify our identity and help our case/status/prestige, I think that wider DO participation in biomed research would get more done against the remaining stigma.

My $.02.

 

[JaggerPlate]

I'm sure something like this has been asked before here, but what I'm not sure on is what kind of keywords I would use to search. I'm currently reading "The D.O.s: Osteopathic Medicine in America" by Norman Gevitz. The first few chapters deal with Dr. A.T. Still's background and how osteopathy got off the ground. The author mentions some of the other medical movements in the 19th century, such as homeopathy, hydropathy, and magnetic healing. He also mentions the challenges Dr. Still's theories faced once the germ theory became accepted in medicine.

I was wondering how one separates osteopathy from other movements like the ones above. Obviously osteopathy has survived better than those, but is that due to it actually working or just being popular? Some of the tactics Dr. Still used, traveling from town to town giving demonstrations on the back of his wagon in the town square make him sound like just another snake oil salesman. (Think about what your impression of osteopathy would be if it was being introduced today.)

Are you guys in osteopathic schools because you didn't get into your first choice MD school? Are you in one because you only applied to DO schools, in order to avoid more competition? In what ways do you think manipulative therapy can be effective, or better yet, in what ways has it shown to be effective?

My family physician is a DO, Philadelphia graduate from the 60s, but he has never performed any OMM on me or a family member. He'll usually just order a blood test or write a prescription. Is this a "lazy" doctor, or do most DOs today save OMM for school only?

Stupid post. The Osteopathic Physicians of today practice Western medicine just as MDs do. Like Tex said, a lot of medicine in Still's time was quackery and snake oil sales. DO schools today train doctors the exact same way as MD schools, but also provide an additional tool in OMM. You doc isn't lazy because he gives you a blood test or prescriptions .... he's a doctor because he does that.

 

[Tony1029]

Stupid post. The Osteopathic Physicians of today practice Western medicine just as MDs do. Like Tex said, a lot of medicine in Still's time was quackery and snake oil sales. DO schools today train doctors the exact same way as MD schools, but also provide an additional tool in OMM. You doc isn't lazy because he gives you a blood test or prescriptions .... he's a doctor because he does that.

Yes, I understand all of that. The question is does OMM serve a justifiable purpose?

 

[TexasTriathlete]

Sure it does. Not in every DO's practice though.

 

[jrf331]

First of all The principles of Osteopathy are principles that most if not all physicians practice

1. Structure and function are interrelated, if you compromise one the other is affected. A fractured bone will be detrimental to the function of that limb.
What physician does not believe this.

2. The body functions as a unit, each part of the body functions to maintain homeostasis.

3.The body has a unique ability to heal its self. What do we do as a physician that will heal a wound. We can prevent infection we can speed the healing process through innovative techniques like wound vacs etc...
But when it comes down to it, the body heals its self we just help it along a little.

4. For healing to occur there needs to be good blood flow and adequate lymphatic drainage. What doctor has not seen a gangrenous foot or wound of a diabetic patient due to inadequate blood flow to the foot.
Edematous patients unable to heal wounds in their lower extremities because of compromised lymph and blood flow.

Now tell me what of these principles do you not apply to your practice every day.

 

[JaggerPlate]

First of all The principles of Osteopathy are principles that most if not all physicians practice

1. Structure and function are interrelated, if you compromise one the other is affected. A fractured bone will be detrimental to the function of that limb.
What physician does not believe this.

2. The body functions as a unit, each part of the body functions to maintain homeostasis.

3.The body has a unique ability to heal its self. What do we do as a physician that will heal a wound. We can prevent infection we can speed the healing process through innovative techniques like wound vacs etc...
But when it comes down to it, the body heals its self we just help it along a little.

4. For healing to occur there needs to be good blood flow and adequate lymphatic drainage. What doctor has not seen a gangrenous foot or wound of a diabetic patient due to inadequate blood flow to the foot.
Edematous patients unable to heal wounds in their lower extremities because of compromised lymph and blood flow.

Now tell me what of these principles do you not apply to your practice every day.

quackery

 

[Lamborghini1315]

I'm sure something like this has been asked before here, but what I'm not sure on is what kind of keywords I would use to search. I'm currently reading "The D.O.s: Osteopathic Medicine in America" by Norman Gevitz. The first few chapters deal with Dr. A.T. Still's background and how osteopathy got off the ground. The author mentions some of the other medical movements in the 19th century, such as homeopathy, hydropathy, and magnetic healing. He also mentions the challenges Dr. Still's theories faced once the germ theory became accepted in medicine.

I was wondering how one separates osteopathy from other movements like the ones above. Obviously osteopathy has survived better than those, but is that due to it actually working or just being popular? Some of the tactics Dr. Still used, traveling from town to town giving demonstrations on the back of his wagon in the town square make him sound like just another snake oil salesman. (Think about what your impression of osteopathy would be if it was being introduced today.)

Are you guys in osteopathic schools because you didn't get into your first choice MD school? Are you in one because you only applied to DO schools, in order to avoid more competition? In what ways do you think manipulative therapy can be effective, or better yet, in what ways has it shown to be effective?

My family physician is a DO, Philadelphia graduate from the 60s, but he has never performed any OMM on me or a family member. He'll usually just order a blood test or write a prescription. Is this a "lazy" doctor, or do most DOs today save OMM for school only?

I am not the greatest expert on OMM to tell you why that's the reason but the DO's i know back in NY, jersey area don't ever use manipulation because they are all in specialities where manipulation might do more harm than good. Another reason why some DO's don't is simply because they haven't practiced enough or exposed them to more diagnostic situations..unless you treat a sick person your confidence won't grow. OMM is part of our training but there's no law that mandates a DO to do OMM to be able to practice..its a tool that can be taken advantage of, some do at a very proficient level. Although these guys tend to do more OMM than probably indicated for while some maintain a good balance. I pretty much described the type of DO's you might come across..but in my mind it would be wrong if you assume that a DO=OMM, in general DO's will be more comfortable to engage in physical contact with the patients and perform some basic musculoskeletal modalities but nothing too complicated that would be exclusively classified as OMM. My point is those who use OMM extensively are very devoted while those who don't are really more into other medical modalities. You make the judgement..and remember who are you to say which is better unless you are the patient and see something wrong! In regards to your comment DO's choosing to be DO's as an alternative to MD crap is overdone on these threads..just do a search and you will open your eyes to a broader mindset. FYI MD'S know nothing more than DO's and they both hold equal medical privileges...hope i enlightened you.

 

[TechnoViking]

The long-term downside for DOs is that we didn't (and largely don't) participate in the vast, rigorous peer-reviewed biomed research that pushed pharm and surgery forward. I don't think the current MD vs. DO status has anything to do with OMM: I think it's about DOs being largely destined for community medicine, because our academic & research contribution is weak. And we can either be satisfied with that, or not. Individual DOs who make it on faculty at MD schools aren't satisfied with that, and I doubt I'll be.

And really, though more studies on OMM would solidify our identity and help our case/status/prestige, I think that wider DO participation in biomed research would get more done against the remaining stigma.

My $.02.

I agree 100%.

 

[Non-TradTulsa]

I am not the greatest expert on OMM to tell you why that's the reason but the DO's i know back in NY, jersey area don't ever use manipulation because they are all in specialities where manipulation might do more harm than good. Another reason why some DO's don't is simply because they haven't practiced enough or exposed them to more diagnostic situations..unless you treat a sick person your confidence won't grow. OMM is part of our training but there's no law that mandates a DO to do OMM to be able to practice..its a tool that can be taken advantage of, some do at a very proficient level.

Well, as an ex-financial guy... I never managed a DO's practice - but I think part of the reason that OMM is often not used is because it takes time to do OMM, and it's generally not separately reimbursable as a procedure - unless the diagnosis code relates to something clearly musculoskeletal. I'm sure the reasons you site above are valid, but I think there is also the problem that doing OMM on many patients cuts down on the number of patients you can see in a day, and you won't get paid for it. It's a business reality.

 

[spicedmanna]

Well, I think any physician worth his or her weight in salt, and indeed anyone who has a good head on their shoulders, would agree that the principles of osteopathic medicine are common sense principles of medicine in general. I maintain that most of the distinction between allopathic and osteopathic medicine has been dissolved through the passage of time and with the rise of modern medicine. Pretty much the only distinction, besides perhaps a difference in focus, is the practice of OMM. The rest is simply medicine as we all have come to know it.

OMM is good as an adjunct/adjuvant therapy. I think it most useful when used in combination with other therapies, interventions, and modalities. If nothing else, it tends to improve a patient's experience. So, yes, I do think OMM has a place in medicine. Do most DO's use it? Unfortunately not. I am told that only a small percentage use it regularly.

 

[DRofO]

But it is a question from someone who probably hasn't experienced OMM. I thought I knew what Osteopathy was before starting med school, but I didn't. And to the post who said the principals quoted above are "quackery" says you don't know much about healing....everything is interconnected and anyone with experience in medicine knows that.
If you want to know if Osteopathy works, experience it. Find a physician who practices and go for a spin. I don't always understand the details of what I have been taught, I don't always understand exactly what is happening when I personally get treated or when I am treating at clinic, but after a couple years of seeing it work, having it called "magic" and "amazing" I have become a believer. I have been told to keep practicing and studying Osteopathy, and I will eventually understand, its just like every other subject I am learning, I will probably master it about the time I am dead. I am so damn busy studying for boards right now I can't spend as much time as I would like understanding everything...including the endocrine and renal systems...so like all subjects, I keep studying, keep practicing and eventually it will come. When I totally figure it out I will come back and try to explain it. Until then, best wishes.
FYI...I picked my school specifically for its location, I had no idea what I was getting into, but I couldn't be happier with where I am.

 

[Pansit]

I'm sure something like this has been asked before here, but what I'm not sure on is what kind of keywords I would use to search. I'm currently reading "The D.O.s: Osteopathic Medicine in America" by Norman Gevitz. The first few chapters deal with Dr. A.T. Still's background and how osteopathy got off the ground. The author mentions some of the other medical movements in the 19th century, such as homeopathy, hydropathy, and magnetic healing. He also mentions the challenges Dr. Still's theories faced once the germ theory became accepted in medicine.

I was wondering how one separates osteopathy from other movements like the ones above. Obviously osteopathy has survived better than those, but is that due to it actually working or just being popular? Some of the tactics Dr. Still used, traveling from town to town giving demonstrations on the back of his wagon in the town square make him sound like just another snake oil salesman. (Think about what your impression of osteopathy would be if it was being introduced today.)

Are you guys in osteopathic schools because you didn't get into your first choice MD school? Are you in one because you only applied to DO schools, in order to avoid more competition? In what ways do you think manipulative therapy can be effective, or better yet, in what ways has it shown to be effective?

My family physician is a DO, Philadelphia graduate from the 60s, but he has never performed any OMM on me or a family member. He'll usually just order a blood test or write a prescription. Is this a "lazy" doctor, or do most DOs today save OMM for school only?

You do realize that most of "osteopathic philosophy" is also part of allopathic right?...the whole structure related to function thing...an injury in one part of the body can affect another, treating the patient as a person, not a disease...these arent weird things...

 

[spicedmanna]

...it is a question from someone who probably hasn't experienced OMM....

Yup, I resonate with that.

If you want to know if Osteopathy works, experience it. Find a physician who practices and go for a spin.

Good advice.

 

[DO Anes]

I think a larger question is, do the adjuvant techniques of OMM justify the continued need for a separate profession? In Still's time, the differences were vast, in 2008 they are essentially non-existent. The American economy and health care system will face incredible challenges in the future. Maintaining two "separate but equal" systems of medical education, given the added cost and inefficiency does not make much sense. As the economy continues to deteriorate and the number of retirees entering the health care system increases, legislators will be debating the need for any physicians in medical care, much less the tired MD/DO issue.
So, is a consolidation inevitable and, if it is, do we physicians, MD and DO, plan and guide the consolidation, or do we wait for the government to dictate it?
Having worked in the MD and DO worlds for more than 20 years, I believe there is a difference, with DO's frequently (but not always) providing more compassionate and comprehensive care, but that seems to be more a result of the individuals selected or self-selected to DO schools, rather than by some magic OMM technique. Maybe life experience and a more nontraditional applicant make for a better physician, rather than the philosophy of his/her education. The allopaths are starting to realize this with a limited move of some of their schools to the nontraditional applicant.
Maybe the DO vs. MD-O, DOM, MD/DO, etc. degree debate is just a symptom of the problem of no need for a separate profession?

 

[It'sElectric]

Well, as an ex-financial guy... I never managed a DO's practice - but I think part of the reason that OMM is often not used is because it takes time to do OMM, and it's generally not separately reimbursable as a procedure - unless the diagnosis code relates to something clearly musculoskeletal. I'm sure the reasons you site above are valid, but I think there is also the problem that doing OMM on many patients cuts down on the number of patients you can see in a day, and you won't get paid for it. It's a business reality.

Correct me if I'm wrong, but OMM is billed as a separate, reimbursable procedure and it can be done very quickly. If I ended up going into family practice, I would be a fool NOT to use it, because there is in fact a lot of money to be made from it.

 

[spicedmanna]

Correct me if I'm wrong, but OMM is billed as a separate, reimbursable procedure and it can be done very quickly. If ended up going into family practice, I would be a fool NOT to use it, because there is in fact a lot of money to be made from it.

From a strictly financial perspective, I would agree.

 

[JaggerPlate]

And to the post who said the principals quoted above are "quackery" says you don't know much about healing....everything is interconnected and anyone with experience in medicine knows that.

If you were referring to my post ... you don't know much about sarcasm. I thought the laughing smiley face covered that .........

 

[spicedmanna]

I think a larger question is, do the adjuvant techniques of OMM justify the continued need for a separate profession?

That's a good question, Doc. The further I go along this path, the more I think not. I haven't reached a conclusion yet, however. I'm still a youngin', with much to experience.

 

[bth7]

Yes, I understand all of that. The question is does OMM serve a justifiable purpose?

I guess it depends on what you consider justifiable.

I had some pretty good luck with it with a few carpel tunnel patients. Of course, its nothing anyone couldn't learn how to do in about 10 minutes. It has its place. But it is definitely overemphasized.

There a lot of people/groups who for one reason or another need an answer to the question "What's the difference between a DO and an MD?" The most convenient answer is some propaganda laden speech about OMM. The most true answer is that nowadays, there really isn't one.

FYI - It's not osteopathy anymore. It's osteopathic medicine. Or better yet, medicine.


bth

 

[Pansit]

I guess it depends on what you consider justifiable.

I had some pretty good luck with it with a few carpel tunnel patients. Of course, its nothing anyone couldn't learn how to do in about 10 minutes. It has its place. But it is definitely overemphasized.

There a lot of people/groups who for one reason or another need an answer to the question "What's the difference between a DO and an MD?" The most convenient answer is some propaganda laden speech about OMM. The most true answer is that nowadays, there really isn't one.

FYI - It's not osteopathy anymore. It's osteopathic medicine. Or better yet, medicine.


bth

It's definitely overemphasized on the COMLEX...I mean, anatomy doesnt get it's own section, nor does biochem and we put just as much if not more time into studying and learning for those classes.

 

[Old_Mil]

The author mentions some of the other medical movements in the 19th century, such as homeopathy, hydropathy, and magnetic healing. He also mentions the challenges Dr. Still's theories faced once the germ theory became accepted in medicine.

I was wondering how one separates osteopathy from other movements like the ones above. Obviously osteopathy has survived better than those, but is that due to it actually working or just being popular?

Osteopathy has survived because it's graduates are licensed to practice modern evidenced based medicine (what they call 'allopathy'), and can prescribe, admit, and operate. Most DOs perform no OMM at all, the number is over 90%.

Are you guys in osteopathic schools because you didn't get into your first choice MD school?

For many, this is probably true. I know of no pre-med students who applied only to DO schools, though I'm sure there are a few out there.

Some OMM techniques, performed correctly, have the same effiicacy as a good massage. The majority are ineffective. Some are completely laughable.

 

[Lamborghini1315]

Osteopathy has survived because it's graduates are licensed to practice modern evidenced based medicine (what they call 'allopathy'), and can prescribe, admit, and operate. Most DOs perform no OMM at all, the number is over 90%.



For many, this is probably true. I know of no pre-med students who applied only to DO schools, though I'm sure there are a few out there.

Some OMM techniques, performed correctly, have the same effiicacy as a good massage. The majority are ineffective. Some are completely laughable.

Come on dude that's a bit of a stretch...i didn't and i have tons of DO friends who didn't either, you can pm me if you need more info on that..but i don't ever feel the need to argue your points because you have way more experience than i do and i am being neutral at this point. I personally have no intentions to make OMM a big part of my practice because i see no place for it in my field of interest but i certainly won't completely abandon it..i believe there will be times we can employ some manipulation to better treat our patients.

 

[aminoacid]

Osteopathy has survived because it's graduates are licensed to practice modern evidenced based medicine (what they call 'allopathy'), and can prescribe, admit, and operate. Most DOs perform no OMM at all, the number is over 90%.



For many, this is probably true. I know of no pre-med students who applied only to DO schools, though I'm sure there are a few out there.

Some OMM techniques, performed correctly, have the same effiicacy as a good massage. The majority are ineffective. Some are completely laughable.

When I was a pre-med, I only applied to DO schools because I was intrigued by OMT. There are many who only apply to DO schools because of the sincere interest in OMT. But I was also very naive in that I did not do enough research about the osteopathic clinical education model, as this information is not readily available. During clinicals, I became completely disillusioned with this profession.

There is absolutely no difference between "allopathic" and "osteopathic" medicine (both terms used loosely). The limited amount of OMT taught does not justify a separate medicial profession, a point underscored by the fact that most DO graduates pursue allopathic residencies. This is just propaganda ran by the AOA to justify keeping a select few in power.

While the AOA continues to purport that allopathic and osteopathic medicine are separate, they continue to exploit the allopathic profession by:
1. Farming out its medical students to predominately MD preceptors, and 2. Farming out its residents to ACGME programs.

Fact: Most DO students choose MD residencies, a point of contention within the AOA. The reality is that there are not enough DO residencies to support the number of DO graduates, so some of these DO grads will end up in MD residencies anyway.
Fact: The AOA does not allow MD graduates to enter their programs, in spite of the AOA's over-dependence on ACGME. A double-standard, at mininium. Discrimination? Well, let's see . . . they do not take MD students because of the whole OMT thing, but this can be learned very quickly (an OMT elective in 4th yr and a few months of OMT throughout the residency program). The only OMT I did was 3 hr/wk of lab during my 1st 2 yrs of DO school-this can be reasonably done during a residency (at least residents have the luxury of a clinical setting and not a lab, mind you). Fraud? Well, let's see . . . 3 hrs/wk of lab during my 1st 2 yrs (not 52 weeks/yr, either-more like 35 wks), and none during clinicals. Does this make me skilled enough to practice OMT? Of course not. Yet, AOA, COCA promises that its schools will make its graduates proficient in OMT-this is what the AOA says makes the DO "different." Everything else we do, our allopathic counterparts do.

Some OMT works, some does not, some is very questionable, and research will always be limited by the subjective nature of OMT. Most DO's practice evidenced-based medicine. So in this sense, most of us are more like our allopathic counterparts than not.

The point of my post is to underscore that there is no difference between MD and DO schools, regardless of why someone opted to attend a DO school. Most DO students are trained by MD's anyway, and most DO grads do not practice OMT. Medicine has continued to evolve, whether osteopahic or allopathic. The two schools of thought have now converged and those in charge of the osteopathic profession have to acknowledge this and stop living in the past.

 

[bth7]

Fraud?

My answer. Yes. Absolutely.