Does Panda Bear love the DOs?

[spicedmanna]

...and down the rabbit hole we went.

---

Members don't see this ad.

 

[Dr JPH]

I say “still taught” because there is little or no good evidence that manipulation does anything other than make the patient feel subjectively better.

And of course that statement is completely false.

But someone reads that on a website somewhere and suddenly it becomes a standard part of their argument. "There is no research."

I hear it all the time from DO students telling me why they dont take OMM more seriously. They say "if there was research in OMM..."

When I tell them there is they are shocked. And the ones who take the time to do a literature search are really suprised how much is out there.

And then people say "there are no randomized trials". Again, false.

"No control groups." False

"Small patient populations." False.

The great majority of people in this world base their opinions on something someone else said instead of looking to the facts. Individuality fails to exist in someone who can only quote an opinion of another.

 

[8744]

And of course that statement is completely false.

But someone reads that on a website somewhere and suddenly it becomes a standard part of their argument. "There is no research."

I hear it all the time from DO students telling me why they dont take OMM more seriously. They say "if there was research in OMM..."

When I tell them there is they are shocked. And the ones who take the time to do a literature search are really suprised how much is out there.

And then people say "there are no randomized trials". Again, false.

"No control groups." False

"Small patient populations." False.

The great majority of people in this world base their opinions on something someone else said instead of looking to the facts. Individuality fails to exist in someone who can only quote an opinion of another.

"Good" evidence. You're reading what you want to read and constructing a straw man. I never said there was no research, just that it is underwhelming.

 

[8744]

Maybe spicedmanna can help here. I think there's something just really wrong with this comment. Does "subjectively better" lead to "objectively better?"

No. You can feel great about your lung cancer but it's still going to kill you.

Sorry. Maybe I wasn't clear that I'm a real doctor treating real diseases and not nebulous spiritual imbalance problems.

 

[spicedmanna]

No. You can feel great about your lung cancer but it's still going to kill you.

True. I don't think any sane person, especially one who is going to be a future physician, would argue that as a physician you shouldn't use whatever "evidence-based" treatment for lung cancer that is approved, indicated, and available to you. Obviously, you should.

I think, however, it is wise to not forego the less "objective" elements of medical care, either. I mean, aren't we at a juncture in our understanding of the nature of wellbeing that we at least have some hint that it is intimately related to how we feel "subjectively?" That there is feedback between how we feel, our mental state, and the intricate physiological mechanisms underneath? Just saying...

 

[Dr JPH]

"Good" evidence. You're reading what you want to read and constructing a straw man. I never said there was no research, just that it is underwhelming.

Underwhelming how? What more are people looking for? More trials looking at the same clinical outcome?

I'm doing my part in this whole issue. On a daily basis I work with DO students who tell me there isnt enough research...yet none of them have once tried to get involved with any projects. And none of them are aware of the literature out there.

In order to say that the research is underwhelming you need to know what is out there, not just rely on the "I have never seen it in JAMA" argument.

 

[Mung]

I am a very structurally oriented person when it comes to OMT. If you cannot show me the anatomy, physiology and understand the biochemical/biomechanical workings then Im not going to even attempt to treat a patient with that technique. Basically if YOU dont understand what is happening and YOU are the one "treating" the patient...well, in my opinion that borders on malpractice and fraud.

I dont like to hear "I dont know how or why it works but patients seem to get better so thats why I do it."

That doesnt sit well with me and it shouldnt sit well with any physician.

So if none of your explainable and proven treatments are working, and the patient is still suffering, then is it better to let them continue to suffer and to tell them tough titty, than to offer some type of therapy that may have anecdotelally helped people but it has not been proven (yet) by the sources you trust?

In the case of a patient whose life is not in immediate danger is it more ethical to only suggest therapies and procedures that are proven first even if they may involve substantial risk to the patient, when perhaps there may be less risky options that may help but the research has not "discovered" it has helped yet?

Just because you do not know or can not explain how something works does not mean it does not work. Many centuries of using gravity before Newton started breakin' it down with his phat beats.

It seem some things become evident with big revelations and other things in bit and pieces. The more money to be made if you can explain it, own it and patent it then the more minds, money and effort are directed to this end.

 

[Taus]

So if none of your explainable and proven treatments are working, and the patient is still suffering, then is it better to let them continue to suffer and to tell them tough titty, than to offer some type of therapy that may have anecdotelally helped people but it has not been proven (yet) by the sources you trust?

In the case of a patient whose life is not in immediate danger is it more ethical to only suggest therapies and procedures that are proven first even if they may involve substantial risk to the patient, when perhaps there may be less risky options that may help but the research has not "discovered" it has helped yet?

Just because you do not know or can not explain how something works does not mean it does not work. Many centuries of using gravity before Newton started breakin' it down with his phat beats.

It seem some things become evident with big revelations and other things in bit and pieces. The more money to be made if you can explain it, own it and patent it then the more minds, money and effort are directed to this end.

hehe....while I don't completely disagree w/ you.....when you are taught cranial you'll see what he's talking about.....its bad enough to make >95% of my class of relatively highly educated individuals laugh/roll their eyes....its actually quite embarrassing to listen to IMO

The real problem stems from lumping all OMT into the same category and the in-fighting that occurs b/w DO students who feel this way vs. the very vocal minority who feel that this stuff is the cornerstone of our profession and think people like me and JP aren't proud to be DO's (or something to that effect) when that couldn't be further from the truth...

hows that for a run-on sentance?

 

[DragonWell]

Underwhelming how? What more are people looking for? More trials looking at the same clinical outcome?

I'm doing my part in this whole issue. On a daily basis I work with DO students who tell me there isnt enough research...yet none of them have once tried to get involved with any projects. And none of them are aware of the literature out there.

In order to say that the research is underwhelming you need to know what is out there, not just rely on the "I have never seen it in JAMA" argument.

IMO, this is where the Panda articles (DO & CAM) are weak and the Fox news comparison is actually very accurate. I can't help feeling that only enough research went into the articles to confirm whatever stereotype is being presented - ie. OMT has no research, CAM is a bunch of quackery, etc.

Remember those questions you had to do in 5th grade when you had to read something and then decide if it is fact or opinion - think back real hard and then decide which this is...

 

[Mung]

hehe....while I don't completely disagree w/ you.....when you are taught cranial you'll see what he's talking about.....

This is not in regards to cranial or any other type of therapy in particular.

It seems to me the problem with many "alternative" therapies is that they can be very practitioner dependent to get desired results.

This is very problematic, because then this instills trust in an individual not so much the therapy utilized by that individual.

But when someone is suffering and evidenced based medicine has nothing else to offer, many of those suffering are going to continue to seek relief.

Perhaps they will go to CAM providers and perhaps they will spend their money and time and not get results, but remember they did not get results or is some cases were made worse by evidenced based medicine. Maybe they will find relief. Sure there are charlatans that are stealing and plundering hope and money, but there are CAM providers that actually do get results and who are not crooks.

Does it not make sense to find out who these effective practitioners are, refer to them, learn from them?

Just as some folks have posted that OMT (excluding cranial and non MSK indications for simplification) takes much practice, much sensitivity and effort to stick with it to turn it into something real.

Just because there are people practicing OMT techniques and not getting anticipated results is it because OMT dosn't work? Or is it the lack of skill of the pracitioner?

It would seem the more carefully failures and successes were observed and what has been gleaned from this a catalyst to update training and provide guidance so that those that really want to learn can learn more quickly and be more effective.

 

[Mung]

http://www.nytimes.com/2007/05/09/business/09anemia.html?_r=1&th&emc=th&oref=slogin

 

[spicedmanna]

http://www.nytimes.com/2007/05/09/business/09anemia.html?_r=1&th&emc=th&oref=slogin

Interesting read; thanks. It is as I had suspected; nothing new here, just another example of economics winning over the actual care of the patient. Further evidence, albeit anecdotal, that doctors are being taken away from their role as the patient's central healthcare advocate due to economic and business pressures and incentives, created in part by pharmaceutical and insurance companies, that aren't related directly to the actual benefit of the patient. Scary stuff.

 

[8744]

True. I don't think any sane person, especially one who is going to be a future physician, would argue that as a physician you shouldn't use whatever "evidence-based" treatment for lung cancer that is approved, indicated, and available to you. Obviously, you should.

I think, however, it is wise to not forego the less "objective" elements of medical care, either. I mean, aren't we at a juncture in our understanding of the nature of wellbeing that we at least have some hint that it is intimately related to how we feel "subjectively?" That there is feedback between how we feel, our mental state, and the intricate physiological mechanisms underneath? Just saying...

Naw. We're talking about real medicine here where a patient presents with a complaint, we come up with a diagnosis and a plan of treatment. Wellbeing is a personal problem. Healthy people feel well. Unhealthy people don't. I sometimes wonder if you guys have ever seen any real patients other than the standardized kind. Some of those mother****ers are sick. Sick as stink. Almost every day I see somebody who I can use a new benchmark for horrendously sick. Just when you think you've seen it all some guy comes in with COPD, CRF, CAD, PVD, GERD, CHF, DM and then raises you something like icthyosis or the CREST syndrome.

So you'll forgive my lack of faith in spine cracking.

 

[8744]

I mean, really. What are you guys thinking?

 

[spicedmanna]

Naw. We're talking about real medicine here where a patient presents with a complaint, we come up with a diagnosis and a plan of treatment. Wellbeing is a personal problem. Healthy people feel well. Unhealthy people don't. I sometimes wonder if you guys have ever seen any real patients other than the standardized kind. Some of those mother****ers are sick. Sick as stink. Almost every day I see somebody who I can use a new benchmark for horrendously sick. Just when you think you've seen it all some guy comes in with COPD, CRF, CAD, PVD, GERD, CHF, DM and then raises you something like icthyosis or the CREST syndrome.

So you'll forgive my lack of faith in spine cracking.

Yeah, I've been around very sick people before. I've been in situations where there wasn't anything I could do personally, with my limited skillset, but try to be a calming presence for a woman in her late 80's, let's say, having a stroke right in front of me as we took her to the stroke team. I've seen end stage COPD and seen how horrible it looks and how much the patients suffer. I've been around people with CHF exacerbation, etc., etc., in the wards. That's not the issue. Of course people in need of emergent care should receive it. I'm for that in every way. My experience tells that this is the appropriate treatment.

However, what I mean to say is that perhaps we wouldn't have so many people in the ED and in the ICU with all those disorders, some end stage, if PCP's got more involved in preventive care and what you would consider personal problems like the maintainance of wellbeing. Just my undereducated 2 cents.

 

[8744]

Yeah, I've been around very sick people before. I've been in situations where there wasn't anything I could do personally, with my limited skillset, but try to be a calming presence for a woman in her late 80's, let's say, having a stroke right in front of me as we took her to the stroke team. I've seen end stage COPD and seen how horrible it looks and how much the patients suffer. I've been around people with CHF exacerbation, etc., etc., in the wards. That's not the issue. Of course people in need of emergent care should receive it. I'm for that in every way. My experience tells that this is the appropriate treatment.

However, what I mean to say is that perhaps we wouldn't have so many people in the ED and in the ICU with all those disorders, some end stage, if PCP's got more involved in preventive care and what you would consider personal problems like the maintainance of wellbeing. Just my undereducated 2 cents.

"Wellbeing" as it is a combination of personality, financial situation, work, relationships, and self-esteem is far, far, out of your scope of practice as a physician. You can pay it lip service, of course, but unless you view the job of a physician as a cheerleader and full-time ass wiper you'll find that there is not enough time in the day to do much but react to the patient's health problems. No need to go chasing after their personality which cannot be changed in the brief time you have with the patient.

You get jiggy with the standardized patients and explore their personal problems in detail but you will not have this kind of time in real life. And if you did it wouldn't do much good based on effort expened versus change ellicited.

So sorry.

 

[8744]

Yeah, I've been around very sick people before. I've been in situations where there wasn't anything I could do personally, with my limited skillset, but try to be a calming presence for a woman in her late 80's, let's say, having a stroke right in front of me as we took her to the stroke team. I've seen end stage COPD and seen how horrible it looks and how much the patients suffer. I've been around people with CHF exacerbation, etc., etc., in the wards. That's not the issue. Of course people in need of emergent care should receive it. I'm for that in every way. My experience tells that this is the appropriate treatment.

However, what I mean to say is that perhaps we wouldn't have so many people in the ED and in the ICU with all those disorders, some end stage, if PCP's got more involved in preventive care and what you would consider personal problems like the maintainance of wellbeing. Just my undereducated 2 cents.

Being a calming presence is a part of good bedside manner but calm or not, the lady is going to have her stroke just the same and the neurological damage will progress how it's going to progress. I bet she'd rather be in the hands of some malignant neurosurgeon with some skill rather than a bunch of well-wishers.

Seriously, this "wellbeing" stuff is more for the doctor (or medical student) to make them feel good about themselves.

 

[8744]

Yeah, I've been around very sick people before. I've been in situations where there wasn't anything I could do personally, with my limited skillset, but try to be a calming presence for a woman in her late 80's, let's say, having a stroke right in front of me as we took her to the stroke team. I've seen end stage COPD and seen how horrible it looks and how much the patients suffer. I've been around people with CHF exacerbation, etc., etc., in the wards. That's not the issue. Of course people in need of emergent care should receive it. I'm for that in every way. My experience tells that this is the appropriate treatment.

However, what I mean to say is that perhaps we wouldn't have so many people in the ED and in the ICU with all those disorders, some end stage, if PCP's got more involved in preventive care and what you would consider personal problems like the maintainance of wellbeing. Just my undereducated 2 cents.

Preventative care is a legitimate medical endeavor and has nothing to do with "wellbeing" or other emotional masturbation. Did I say I was agin' primary care? I don't think I did.

One of my patients asked me last night if stress was contributing to her COPD. Maybe it was but the 150 pack-year history had something to do with it too.

 

[Mung]

Naw. We're talking about real medicine here where a patient presents with a complaint, we come up with a diagnosis and a plan of treatment. Wellbeing is a personal problem. Healthy people feel well. Unhealthy people don't.

Thank you for what you do.

So diabetes only matters when its time for the amputations?

Impossible for everyone put obtainable for many, is not the ideal for the doctor to strive to keep people well?

 

[DragonWell]

Naw. We're talking about real medicine here where a patient presents with a complaint, we come up with a diagnosis and a plan of treatment. Wellbeing is a personal problem. Healthy people feel well. Unhealthy people don't. I sometimes wonder if you guys have ever seen any real patients other than the standardized kind. Some of those mother****ers are sick. Sick as stink. Almost every day I see somebody who I can use a new benchmark for horrendously sick. Just when you think you've seen it all some guy comes in with COPD, CRF, CAD, PVD, GERD, CHF, DM and then raises you something like icthyosis or the CREST syndrome.

So you'll forgive my lack of faith in spine cracking.

Obviously, there will always be the train wreck patients, but that doesn't change the fact that the goal of medicine should be to intervene before the patient is seriously ill, indeed, before the patient even shows a symptom of illness. Subjective feeling is a valuable, but imperfect measure of the state of one's health, tools like nutrigenomics will open up many more possibilities. The idea that prevention is not "real medicine" is part of what is bankrupting our health system and creating dissatisified patients who are flocking to see anyone but doctors with their health problems.

 

[DragonWell]

Preventative care is a legitimate medical endeavor and has nothing to do with "wellbeing" or other emotional masturbation. Did I say I was agin' primary care? I don't think I did.

One of my patients asked me last night if stress was contributing to her COPD. Maybe it was but the 150 pack-year history had something to do with it too.

From what I have seen, most physicians view preventive medicine as synonymous with "early disease detection". From this extremely limited perspective I understand your point that wellbeing doesn't matter. Unfortunately, this view fails to integrate the mounting evidence that suggests that disease risk can be modulated by interventions to lifestyle and diet.

 

[Mung]

"Wellbeing" as it is a combination of personality, financial situation, work, relationships, and self-esteem is far, far, out of your scope of practice as a physician. You can pay it lip service, of course, but unless you view the job of a physician as a cheerleader and full-time ass wiper you'll find that there is not enough time in the day to do much but react to the patient's health problems. No need to go chasing after their personality which cannot be changed in the brief time you have with the patient.

So sorry.

So as more and more people are getting more and more sick you will have less and less time. Then what?

 

[Mung]

Panda Bear Panda Bear What do you see?

I see a bankrupt nation of one legged diabetics, end stage kidney failure, and alzheimers patients begging the world to remember how great we were sailing by me.

 

[spicedmanna]

Come now, Panda, this is an age old debate. I'm obviously not talking about "lovey-dovey" over-emotional stuff when I'm talking about wellbeing. I've been exposed to enough real medical emergencies to understand a little about what is effective and what is not. I'm not as experienced as you, not by a long shot, but I do have some baseline knowledge. Please give me some credit.

What I am saying is that it is possible to make preventive, palliative, and other types of interventions that aren't related to emergent care. Obviously what you do is vital. I'm not dissing that, or you. As a former EMT-B, I think what you do is awesome. However, I think there is a role for the types of care I mentioned. It might not always be clear cut, but medicine is not always clear cut. I will do what I think will help my patients. Of course, ultimately it's up to the patient to help themselves, but who says I can't help with that? "There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy." (Hamlet, Act 1, Scene V).

Obviously patient care has gotten to the point where there is little time. I will offer what I can and give the highest quality of care I can in that limited time. I think the quality of my presence is crucial. Naturally, I'm going to follow the medical model, but that doesn't mean I have to be an ass about it. There are many ways to be present with the patient. I will attempt to cultivate their wellness in as many ways as I can, to address the patient as completely as I can, and of course I will engage my diagnostic mind, too. I love the diagnostic process; if anything, I engage much more in intellectual masturbation than emotional, but whatever.

I'm not faulting what you do, or the way that you do it. What you do works for you. I guess I have some idea of how I want to get my results and the manner in which I wish to approach it. I'm going to modify and adjust my approach as I mature in my experience. You are definitely at an advantage in that arena. I respect you highly for that. No doubt about it. But just as there is much science to medicine, there is as much judgment, deep listening, and personal touch. Maybe not in all the specialties, but definitely in the ones I'm considering.

Oh well, you are delightfully bitter. You are who you are. I appreciate that. I have no doubt that you are a very good EM doc.

Cheers.

 

[MaximusD]

Preventative care is a legitimate medical endeavor and has nothing to do with "wellbeing" or other emotional masturbation. Did I say I was agin' primary care? I don't think I did.

One of my patients asked me last night if stress was contributing to her COPD. Maybe it was but the 150 pack-year history had something to do with it too.

OK, I have been trying to stay out of this discussion because I do not think that I have the experience or the know-how to contribute.

Panda, you're no-BS style is refreshing. It's probably the result of real-world experience rather than idealistic and self-aggrandizing views that many pre-meds and medical students hold. Please do not, when fielding questions and comments, feel as though many of these pre-DO opinions are representative of the vast majority of DOs out there.

That said, I must agree with you on one primary issue. When one's actually a physician, it is not difficult to imagine that there is VERY LITTLE time for doctor-patient interaction. With that little time that you actually get, it is incredibly unlikely to actually impact their "mind & spirit". What is the job of the physician? As the name of the profession implies, it's the body -- first and foremost. While it is nice to use the biopsychosocial model, it is naive to think that the two latter parts of that word (psycho-social) can be dealt with in any large-scale and thorough approach. Not only is it impractical, but Joe Schmoe, DO, Family Physician, lows little to nothing about psychiatry or psychology to making psychological evaluations.

To a certain extent, I think that the same thing can be said for osteopathic manipulation. While it would be ideal for the physician to treat muscular problems, there is no-doubt VERY LITTLE time. What am I saying? I am saying that for musculoskeletal manipulation to be exercised properly it is only logical that the physician must be highly and thoroughly efficient with its administration. I am unsure as of yet (MS-0) whether there will be sufficient training for me to practice it regularly. Individuals like JP who have gone through extensive training as an OMM fellow no-doubt represent individuals who know how to effectively use it as an excellent adjunct to their practice.

Additionally, I fail to see how OMM can be effectively evaluated with a blinded study. Maybe someone can explain (cough, JP, cough) how you can blind for something like HVLA when there is a distinct "pop" or "crack" during treatment that an indvidual can feel and hear.

Ultimately, I feel like naysayers like to oversimplify. MD students don't learn OMM as an adjunct to their practice. Out of fear of what they don't understand, it is easier to oversimplify and claim "it's not EBM" and "there are no controlled studies" when, in fact, there may be a plethora of said studies and OMM may be completely effective. The real negative to the whole situation is that these individuals are highly unlikely to even consider looking into the actual facts of the situation. Likewise, DO students, defensive about their degree, are also unlikely to actually look up the truth behind OMM, because they fear that it may undermine their career choice. Bottom line is everyone is insecure --

I just rambled for a long time... hopefully someone can pull some good from my awful argument which had no purpose..

 

[spicedmanna]

What is the job of the physician? As the name of the profession implies, it's the body -- first and foremost.

This is a "chicken or the egg" question. Where does the mind end and the body begin?

 

[DragonWell]

Panda Bear Panda Bear What do you see?

I see a bankrupt nation of one legged diabetics, end stage kidney failure, and alzheimers patients begging the world to remember how great we were sailing by me.

The irony that the system is set up to reimburse a doc for dialysis and amputations but not for spending time educating a diabetic about how to eat and manage their meds .

 

[spicedmanna]

The irony that the system is set up to reimburse a doc for dialysis and amputations but not for spending time educating a diabetic about how to eat and manage their meds .

Yeah, that is a problem.

 

[Dr JPH]

So if none of your explainable and proven treatments are working, and the patient is still suffering, then is it better to let them continue to suffer and to tell them tough titty, than to offer some type of therapy that may have anecdotelally helped people but it has not been proven (yet) by the sources you trust?

In the case of a patient whose life is not in immediate danger is it more ethical to only suggest therapies and procedures that are proven first even if they may involve substantial risk to the patient, when perhaps there may be less risky options that may help but the research has not "discovered" it has helped yet?

Just because you do not know or can not explain how something works does not mean it does not work. Many centuries of using gravity before Newton started breakin' it down with his phat beats.

It seem some things become evident with big revelations and other things in bit and pieces. The more money to be made if you can explain it, own it and patent it then the more minds, money and effort are directed to this end.

Youre reaching.

I would never recommend a therapy or treatment unless I had complete faith and trust in it. No voodoo consults for me.

Explain to me why the studies DISproving cranial (that were designed initially to prove it was effective) never make it to print? Or better yet...explain to me why they never leave the authors desk?

I have seen the busted studies first hand. They arent published because these people KNOW it doesnt work...they dont want the rest of the world to know it too.

 

[San_Juan_Sun]

The irony that the system is set up to reimburse a doc for dialysis and amputations but not for spending time educating a diabetic about how to eat and manage their meds .

Ironic in an Alanis Morissette kind of way, in that it isn't ironic at all.

Ask any amputated, CRF'n diabetic about the education they've received on DM. The vast majority will tell you they've known about their diabetes for years, but they never did anything about it until it was time to lop off a foot, because PEOPLE ARE LAZY.

I'm continually amazed at the dedication primary docs devote to diabetes education. And they are reimbursed for it (although if it's worth it financially is open to debate). It's easy to blame The System and The Man, but I think it's critical to emphasize that education cannot do anything about inaction.

 

[MaximusD]

This is a "chicken or the egg" question. Where does the mind end and the body begin?

To add to that thought... from what I've read, it seems as though the separation between neurology and endocrinology are arbitrary at best--

 

[spicedmanna]

I think it's critical to emphasize that education cannot do anything about inaction.

True. However, I think you might be confusing talking to someone and the process of education, which comes from the latin, "educare," meaning to "draw out." Paying lip service to having a better diet, etc., is just a waste of time. That's not the same as actually educating the patient. The patient already knows that he's fcuked if doesn't have a good diet, but what is it that he doesn't know that he doesn't know? What is causing the inaction; what is at the root of the ignorance? Have we become so apathetic that we don't want to help the patient to get to the bottom of the problem any more, but only care to treat him when he's critical or already presenting signs and symptions?

Yes, people are lazy, but why and how are they actively engaged in killing themselves? How can they address these issues right now? Of course, we can't solve their problems for them, but if I can be a positive force that assists them in facing their issues and help them to take responsibility for their wellness, then maybe I've done some good, even if you can't really quantify it. Yes, this means I will have to see my patients regularly and actually talk with them and get to know them.

I don't know. Whatever. I guess I'm idealistic. Maybe I'll become bitter like some of you folks and be like, "here's your script, have a nice day." I doubt it, but you never know.

 

[MaximusD]

True. However, I think you might be confusing talking to someone and the process of education, which comes from the latin, "educare," meaning to "draw out." Paying lip service to having a better diet, etc., is just a waste of time. That's not the same as actually educating the patient. The patient already knows that he's fcuked if doesn't have a good diet, but what is it that he doesn't know that he doesn't know? What is causing the inaction; what is at the root of the ignorance? Have we become so apathetic that we don't want to help the patient to get to the bottom of the problem any more, but only treat him when he's critical or already presenting signs and symptions?

Yes, people are lazy, but why are they actively engaged in killing themselves? How can they address these issues right now? Of course, we can't solve their problems for them, but if I can be a positive force that helps them face their issues and helps them take responsibility for their wellness, then maybe I've done some good even if you can't quantify it. Yes, this means I will have to see my patients regularly and actually talk with them and get to know them.

I don't know. Whatever. I guess I'm idealistic. Maybe I'll become bitter like some of you folks and be like, "here's your script, have a nice day." I doubt it, but you never know.

That's not a fair generalization, spiced. If you met me, you'd know why. I just don't think that unbridled optimism is a positive thing.. And I don't think that doctors, on the whole, are like that either.

The pediatrician that I shadowed and sort-of idolize always follows up with his patients and knows most of his patient's names. If I become a PCP or the like (where you get repeat patients) I hope to be this sort of physician.

 

[spicedmanna]

That's not a fair generalization, spiced. If you met me, you'd know why. I just don't think that unbridled optimism is a positive thing..

I didn't mean to come off as an a$$. I apologize. You're right, however, it is an unfair generalization. I have a straw man I've created. I just get a little frustrated with medicine limited to just fixing something or someone. That's all. I think we can play a bigger role than managing a problem.

I agree with you that unbridled optimism is just as bad as dark cynicism. I'm seeking some sort of balance. Perhaps I got a little lost along the way.

 

[Mung]

​

Excerpt from Job's Body by Deane Juhan
​

The Dilemma Today​

Job hurts. He is confused in his pain, he even feels betrayed by the body that gives it to him, because by and large his affairs have been as well ordered as he could possibly imagine. As far as he understands matters, he has omitted no safeguard to his health and has committed no glaringly self-destructive act; he has done nothing to deserve the retributions he feels descending without warning on his chest, his bowels, his joints, his back, his feet. To be the best of his lights and abilities, he has worked hard for success and tried to be “perfect and upright, and the one that feared God and eschewed evil.” And yet, at the height of his prosperity, his productivity is curtailed and his rewards are taxed by pains.
Job’s appeal to the experts on his condition often yields no improvements, nor even satisfactory answers about what is going wrong. Too frequently they can only mouth the established opinions of the current authorities, declaring that his symptoms are his disease, that his suffering itself proves that he is somewhere, somehow pathologically flawed, and that any questioning of these opinions is irrational. “Miserable comforters are ye all,” he broods as he leaves their examinations, contemplating such cures as they can offer.
Paradoxically, our material existence has never been so fruitful, our authorities so learned. The practical application of the physical laws unearthed by modern science has given us a dominion over the nature that would confound our great-grandfathers, let alone biblical Job. We now have salves and procedures by the thousands for his aches and pains, and legions of specialists to decide which one to use in every case.
And yet it has to be admitted that our understanding of our bodies and our minds is still a tenuous thing, leaving malfunctions many fronts on which to exercise their disruptive tyranny. Most of us have no more control over our internal bodily processes than did primitive sorcerers over the weather, the crops, or the coming and going of the moon-possibly less. Our scientific skills have indeed helped to substantially eliminate scores of external threats-parasites, germs, viruses, toxins-only to have them replaces by a growing list of equally catastrophic functional disorders, heart failure, brain stroke, ulcers, high blood pressure, hardening of the arteries, head ache, back pain, weakened immune systems, cancer-diseases generated not by filth and want, but evidently by prosperity itself.
These sorrows appear to visit us as inevitably and capriciously as the rain, and in spite of the fact that an orderly empiricism promises that all will one day be logically explained, their comings and goings look very much to us like the vagaries of blind Fate. Most of us do not know why it should be us that hurts, and when we try to find out, we are told that we are frightfully complex and fragile collection of tissues and chemical exchanges whose interlocking ramifications are comprehensible only to the experts. So we adopt the same attitudes toward our physical conditions that mankind has usually adopted toward an inscrutable Fate: paranoia, fond hopes, consultations with the established oracles, and acceptance of the inevitable. And we revere the experts as the sole mediaries between fate and ourselves.
Job not only hurts physically; Job suffers emotionally as well. He has acute anxieties that compound his pain because it has been made clear to him that his well-being is largely out of his hands, that he is surrounded by arbitrary forces which dwarf his capabilities….

 

[JayneCobb]

Underwhelming how? What more are people looking for? More trials looking at the same clinical outcome?

I'm doing my part in this whole issue. On a daily basis I work with DO students who tell me there isnt enough research...yet none of them have once tried to get involved with any projects. And none of them are aware of the literature out there.

In order to say that the research is underwhelming you need to know what is out there, not just rely on the "I have never seen it in JAMA" argument.

As someone who's read Kuchera/Kuchera and looked up more than a few of the quoted references in it. As well has annotated, proofed and edited a published OMT guide. I have no problems saying that I'm underwhelmed by the research out there.

 

[DragonWell]

... unless you view the job of a physician as a cheerleader and full-time ass wiper you'll find that there is not enough time in the day to do much but react to the patient's health problems.

I'm continually amazed at the dedication primary docs devote to diabetes education.

Interesting juxtaposition.

 

[Mung]

Youre reaching.

I would never recommend a therapy or treatment unless I had complete faith and trust in it. No voodoo consults for me.

Explain to me why the studies DISproving cranial (that were designed initially to prove it was effective) never make it to print? Or better yet...explain to me why they never leave the authors desk?

I have seen the busted studies first hand. They arent published because these people KNOW it doesnt work...they dont want the rest of the world to know it too.

Again I do not know about cranial. And I have no ideas about those studies. I know that so many people are suffering from chronic conditions that their doctors either don't have time for or offer no remedies. I know that many of these people (not all by a long shot) but enough to make a difference in the quality of someones life and their families life are helped with some sort of "voodoo". How flat was the earth before it was round?

You do not have to make any voodoo refferals the suffering will go looking and hopefully find some relief on their own. Ironically many of these are members of the conventional health care field that know and fear what EBM would have in store for them.

 

[Dr JPH]

As someone who's read Kuchera/Kuchera and looked up more than a few of the quoted references in it. As well has annotated, proofed and edited a published OMT guide. I have no problems saying that I'm underwhelmed by the research out there.

Where is your contribution to research?

At the click of a button I can find 500 papers on OMT.

And as someone who works with Kuchera on a daily basis I can tell you that the research is being built up every day, and the legs its standing on arent as shaky as peopel think.

 

[Dr JPH]

The irony that the system is set up to reimburse a doc for dialysis and amputations but not for spending time educating a diabetic about how to eat and manage their meds .

You can bill for diabetes education.

 

[Mung]

In the city of Asheville NC, the city was losing so much money to diabetic and asthamtic employees that they took it upon themselves to do what the insurance companies and their doctors would not:

http://www.ncpharmacists.org/associations/4188/files/ashevilleProjCarole.pdf

http://www.healthycarolinians.org/OunceOfPrevention/(John_Miall)_Asheville Project.ppt

 

[Dr JPH]

Again I do not know about cranial. And I have no ideas about those studies. I know that so many people are suffering from chronic conditions that their doctors either don't have time for or offer no remedies. I know that many of these people (not all by a long shot) but enough to make a difference in the quality of someones life and their families life are helped with some sort of "voodoo". How flat was the earth before it was round?

You do not have to make any voodoo refferals the suffering will go looking and hopefully find some relief on their own. Ironically many of these are members of the conventional health care field that know and fear what EBM would have in store for them.

When you take desperate patients and offer them something they will believe anything. Power of suggestion.

Ever wonder why these alternative "miracle cures" cost so much? Because the "practitioners" know they can take advantage of people willing to do anything.

Homeopathy, cranial, rolfing, reiki. Show me the science or Im not showing you my patients.

 

[DragonWell]

You can bill for diabetes education.

I stand corrected. Just curious JP, if your experience is also that adequate education is provided but patients are generally unwilling to act on it?

 

[Tanner82]

anybody read this article....

http://www.quackwatch.org/04ConsumerEducation/QA/osteo.html

A subtle, negative slant toward the whole osteopathic system and philosophy yet it may be the most representative of the physician population....

I still think there is no difference, and the point that they try to make such a difference kinda annoys me, but I'm still DO all the way

 

[Mung]

When you take desperate patients and offer them something they will believe anything. Power of suggestion.

Ever wonder why these alternative "miracle cures" cost so much? Because the "practitioners" know they can take advantage of people willing to do anything.

Homeopathy, cranial, rolfing, reiki. Show me the science or Im not showing you my patients.

Charge so much? Compared to what?

Cost of homeopathic remedies compared to pharmaceuticals?

A CAM pracitioner compared to a DO?

Rolfing interesting that you threw that into the above mix. But it seems that what Ida Rolf came up with and has been co-opted by the powers that be is now called myofascial therapy which until a few years ago when it was lumped in with manual therapies even had its own cpt code.

 

[DragonWell]

anybody read this article....

http://www.quackwatch.org/04ConsumerEducation/QA/osteo.html

A subtle, negative slant toward the whole osteopathic system and philosophy yet it may be the most representative of the physician population....

I still think there is no difference, and the point that they try to make such a difference kinda annoys me, but I'm still DO all the way

I wouldn't say subtle.

Talking about DO students,"Those who diligently apply themselves can emerge as competent."

Maybe that should be the new AOA slogan - "DOs...striving for competence."

I don't even know where to start w/ that article.

 

[Bleurberry]

Preventative care is a legitimate medical endeavor and has nothing to do with "wellbeing" or other emotional masturbation. Did I say I was agin' primary care? I don't think I did.

One of my patients asked me last night if stress was contributing to her COPD. Maybe it was but the 150 pack-year history had something to do with it too.

Is that condescension or compassion you're expressing toward your COPD patient? The 150 pack-year history was then, this is now. I had a pulmonary specialist who thought he was a funny guy tell my grandmother about a year ago after looking at her chart for a bronchial infection with COPD complications, "You believe in God?" She said "yeah...?" and he shrugged at her and walked out of the room.

There's good reason to theorize that MD's today, including you, would probably have had some form of Osteopathic Muscular Manipulation in your academic curricula hadn't many MD's in the 19th century and arguably longer felt it impugned their dignity and was beneath them to administer treatment with their hands (Gevitz 31).


I'd like to calmly reiterate if only to myself that OMT is an integrative technique, not a stand alone cure-all for the woe's of the world. Last time I checked, there weren't any silver bullets to be found in any department of medicine. Dain Tasker, D.O. "...In order to be truly scientific we must love truth better than we love our preconceived ideas of what truth is" (Gevitz 65).


Gevitz, Norman. The D.O.'s: Osteopathic Medicine in America. Baltimore: The Johns Hopkins Univ. Press, 1982.

 

[spicedmanna]

If you wish to select an osteopathic physician as your primary-care provider, your best bet is to seek one who: (a) has undergone residency training at a medical hospital. . .

 

[DragonWell]

Charge so much? Compared to what?

Cost of homeopathic remedies compared to pharmaceuticals?

A CAM pracitioner compared to a DO?

Rolfing interesting that you threw that into the above mix. But it seems that what Ida Rolf came up with and has been co-opted by the powers that be is now called myofascial therapy which until a few years ago when it was lumped in with manual therapies even had its own cpt code.

Actually, supposedly Ida Rolf learned much of what later became Rolfing from a DO. Admittedly she also drew on her doctorate in physics, yoga background and god knows what else.

Although Rolfing uses MFR, it actually has a pretty specific intention which is significantly different than the way most PTs, DOs or LMTs use MFR.

 

[Dr JPH]

Ida Rolf disguised much of what she does as "myofascial therapy" and tried to group it under the umbrella of manual therapy in order to gain credibility.

Technically all massage, therapeutic or otherwise, is "myofascial" as you are working the fascia and muscle. So calling it "myofascial" doesnt add any credibility nor is it a good descriptor.

Thats like saying a medication is "biochemical." No $hit.