Faking it in OMM.

[Obnoxious Dad]

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When students are going through OMM class it would seem that the people who don't really believe in OMM (or are actually afraid of it in the neck area) could just go through the motions and not really crack necks and backs.

Is faking it possible?

Is faking prevalent?

 

[ShyRem]

Depends on your school. At UNE, during second year you have to diagnose your partner (ACCURATELY - they check), and then fix three randomly chosen areas by the method your examiner chooses. If you do not effect a change, you can try again with a method of your choosing, but you only get half credit. Needless to say, you can only do this on one area per exam and still pass. And if you fail on the diagnosing part, you fail the exam. Lest you think you can just choose to examine those parts you are good at, if you don't have a sufficient number of areas diagnosed/examined, your examiner will find some for you to diagnose and fix.

so at UNE you can't "fake it" during second year. First year, yes. Second year, no.

 

[J1515]

There's nothing like trying to find something wrong with somebody who is perfectly healthy.

Yeah yeah, I know...everyone has dysfunctions

 

[Jamers]

When students are going through OMM class it would seem that the people who don't really believe in OMM (or are actually afraid of it in the neck area) could just go through the motions and not really crack necks and backs.

Is faking it possible?

Is faking prevalent?

DMU they check all of your diagnosis first and second year so you can't fake it.

 

[cyclohexanol]

When students are going through OMM class it would seem that the people who don't really believe in OMM (or are actually afraid of it in the neck area) could just go through the motions and not really crack necks and backs.

Is faking it possible?

Is faking prevalent?

Possible - yes
Prevalent - yes
(Relevant?) - no

Even if they check your 'diagnosis', they tend to ask first, then power of suggestion takes over so you are 'correct' 99% of the time. During cranial week, I stopped trying to feel things, and I'd just make up **** randomly, then low and behold the instructors would find the exact same made up **** that I did.

 

[jbp100]

Key to OMM practicals = confidence; if you are confident in your findings like the other posters said, they will agree with you 99% of the time (faculty graders, at least).

An asterisk to this rule is if you have some cocky "pre-doctoral fellow" grading you. At our school these are fellow students that could be as close as a year ahead of you. They seem to take pleasure in disagreeing with your diagnosis. Some sort of power trip I guess. I actually got into an argument with one once when diagnosing ASIS. Typically these are easy to diagnose, and I know that I was right and he was wrong, and I flat out told him that. My grade wasn't the best on that practical, but I still passed, and I don't know that I would have unless I had argued with him and made him doubt himself.

 

[Old_Mil]

Is faking it possible?

Yes.

Is faking prevalent?

Yes.

Especially during cranial.

OMM is a very subjective "science." The key to doing well is to look good diagnosing whatever it is you are trying to diagnose, and then pronounce your diagnosis with confidence and authority. There really is no right or wrong answer to this stuff.

 

[NontradICUdoc]

When it comes to the exams at UMDNJ, you have to Dx your partner in your first year and the professors will check. So there is no way to fake it unless you are luck. Then with the treatment, they will tell you what they want you to do. If you do not know it then you can try something else, but it will cost you some points.

In your second year, you are in a standardized patient laboratory with a "real patient" and you have to choose from 1 of 3 cards for evaluating a patient. then you have to treat the patient. All the while, you need to describe what you are doing. The professor is in the room as a fly on the wall with the grading sheet.

It is not easy to fake it at my school.

 

[brucecanbeatyou]

Possible - yes
Prevalent - yes
(Relevant?) - no

Even if they check your 'diagnosis', they tend to ask first, then power of suggestion takes over so you are 'correct' 99% of the time. During cranial week, I stopped trying to feel things, and I'd just make up **** randomly, then low and behold the instructors would find the exact same made up **** that I did.

Wow, what am I getting into?

 

[silas2642]

There's nothing like trying to find something wrong with somebody who is perfectly healthy.

Yeah yeah, I know...everyone has dysfunctions

Okay, now I don't get it. I thought manipulations were done on people who had problems. What, your schools wouldn't let you scrounge up some unsuspecting patients on the street? Just kidding with you guys, our school probably wouldn't let us do anything to a real patient either.

 

[24IdaFire]

I think we have all just made up a dysfunction on the fly.

More than once I've had to diagnose someone who has no dysfunction, and just spat out T3 - T5 RrSl.

And more than once I was surprised when the OMM prof said, "You're absolutely correct."

 

[Old_Mil]

Wow, what am I getting into?

Medical school, it just so happens that this one has a Department of Witch Doctory. Just consider it another hoop to jump through on your way to an OMM-free future as a physician.

Just do the exact opposite of what the people in that Dept tell you to do with your career and you'll be fine.

 

[zmeister22]

I have partners in class that are yoga people and are dysfunction free. The TAs and constantly trying to talk them selves into finding a dysfunction. "Well, she has no discomfort and the difference is nearly miniscule, but it is there." You know, if they want people to like OMM, they are going about it in entirely the wrong way.

 

[brucecanbeatyou]

Medical school, it just so happens that this one has a Department of Witch Doctory. Just consider it another hoop to jump through on your way to an OMM-free future as a physician.

Just do the exact opposite of what the people in that Dept tell you to do with your career and you'll be fine.

Haha, if OMM were called the Department of Witch Doctory, that would make me like it much more. OMM is now DWD.

 

[J1515]

The TAs and constantly trying to talk them selves into finding a dysfunction. "Well, she has no discomfort and the difference is nearly miniscule, but it is there."

It was funny calling over another doctor or TA and asking them the same question and seeing them give the exact opposite diagnosis.

 

[jbp100]

It was funny calling over another doctor or TA and asking them the same question and seeing them give the exact opposite diagnosis.

Very common happening for OMM and part of the reason we cannot get enough valid research put together to validate DWD (I like that!). The inter-examiner reliability is considered "good" if it approaches 80%.

 

[4Doc4]

Need an honest opinion here. I haven't started my training yet, but besides cranial - the other procedures must do some good..... right? I mean people have OMM all the time. Is it placebo? I'm just trying to wrap my mind around DWD I guess.

 

[ShyRem]

Personally, I think cranial is crap, but the rest of it has some really good uses and can be very helpful. Not placebo. Ask anyone who's ever had a rib out or tweaked their neck and had it put back in place. Definitely not placebo.

 

[Old_Mil]

Need an honest opinion here. I haven't started my training yet, but besides cranial - the other procedures must do some good..... right? I mean people have OMM all the time. Is it placebo? I'm just trying to wrap my mind around DWD I guess.

Depends. Soft tissue is basically like a massage wrapped in pseudo-medical terminology I'm sure that it has some physicial and psychological benefits but calling it "medicine" is a bit of a stretch. Stuff like HVLA is right up there with cranial.

In the end, the bottom line is that anyone whose shadow never darkened the door of any medical school can learn these exact techniques out of a book and set up a clinic dedicated to the practice of "musculoskeletal massage" and no one is going to get bent out of shape about it.

Try that if you're planning on taking out someone's appy or cardioverting them, and the police will be on their way.

 

[Hurricane95]

What are you trying to diagnose? What findings would you expect to elicit in a perfectly healthy individual? Please don't tell me you're feeling for energies, auras, or other intangible...qualities...

That would be something.

On a side (and related) note, the other day on my family medicine rotation I was paired up at clinic with a DO family doc. We were seeing patients the entire afternoon. We saw a man who had been told he was suffering from "cervical radiculopathy" of some sort. We weren't sure what level the lesion was at. He was complaining of vague neck pain and numbness all over the upper arm. The doc examined him, and then told me he would show me a trick that would improve the patient 50% at least and prevent him from needing surgery, at least for a while. He then proceeded to hold the patient by both sides of the mandible and briskly jerk his head 3 times towards the affected side, holding the position 30 seconds each time to "reset" the nerves (whatever that means). The patient screamed pretty loudly and afterward said his pain was twice as bad. The other attending scheduled imaging studies to be done the next week.

2 weeks later at the end of my rotation, I saw the same patient RTC and examined him. The pain was much worse than before and now the patient had wrist drop! BINGO - we now knew where to find the lesion (MRI of C spine was not yet read officially).

Amazing...OMM served very well as a diagnostic tool by accelerating the progress of the problem and further augmenting the injury. Otherwise, we would have been clueless until the MRI was reported.

 

[MossPoh]

OMM Burn!

 

[Brodiewankenobi]

What are you trying to diagnose? What findings would you expect to elicit in a perfectly healthy individual? Please don't tell me you're feeling for energies, auras, or other intangible...qualities...

That would be something.

On a side (and related) note, the other day on my family medicine rotation I was paired up at clinic with a DO family doc. We were seeing patients the entire afternoon. We saw a man who had been told he was suffering from "cervical radiculopathy" of some sort. We weren't sure what level the lesion was at. He was complaining of vague neck pain and numbness all over the upper arm. The doc examined him, and then told me he would show me a trick that would improve the patient 50% at least and prevent him from needing surgery, at least for a while. He then proceeded to hold the patient by both sides of the mandible and briskly jerk his head 3 times towards the affected side, holding the position 30 seconds each time to "reset" the nerves (whatever that means). The patient screamed pretty loudly and afterward said his pain was twice as bad. The other attending scheduled imaging studies to be done the next week.

2 weeks later at the end of my rotation, I saw the same patient RTC and examined him. The pain was much worse than before and now the patient had wrist drop! BINGO - we now knew where to find the lesion (MRI of C spine was not yet read officially).

Amazing...OMM served very well as a diagnostic tool by accelerating the progress of the problem and further augmenting the injury. Otherwise, we would have been clueless until the MRI was reported.

i hope the doc didn't bill for the OMM treatment...wow

 

[Old_Mil]

<I>
Amazing...OMM served very well as a diagnostic tool by accelerating the progress of the problem and further augmenting the injury...</I>

Not surprised in the least.

 

[DOinMS]

Medical school, it just so happens that this one has a Department of Witch Doctory. Just consider it another hoop to jump through on your way to an OMM-free future as a physician.

Just do the exact opposite of what the people in that Dept tell you to do with your career and you'll be fine.

I actually found this department listed in the catalog. The perplexing thing, however, is that all the faculty had WD, DO after their names. I suppose this is one more option to consider in the name-change debate.

 

[Bacchus]

I feel, if anything, OMM works with at least a placebo effect. Every instance I've seen used (through shadowing, not practice) has alleviated some pain. I found this thread the other day when I was looking around:

http://forums.studentdoctor.net/showthread.php?t=408247

It highlights OMM success stories.

 

[FutureDocDO]

Key to OMM practicals = confidence; if you are confident in your findings like the other posters said, they will agree with you 99% of the time (faculty graders, at least).

Agreed! Seriously, if you go through all the motions correctly when trying to diagnose, they will agree with you most of the time!

 

[Hurricane95]

Agreed! Seriously, if you go through all the motions correctly when trying to diagnose, they will agree with you most of the time!

Diagnose what?! What findings? Aren't your standardized patients healthy and well, or do they all have "findings"?

And how can they agree with you "most of the time" if you state any old finding with confidence?

That would be the equivalent of me examining a healthy patient and saying (with lots of confidence) that I can auscultate "lung cancer," and having the attending agree with me just because I said it "with confidence," even though I'm speaking complete BS. What are you looking for, seriously? Posts like this further cement the stigma that OMM practicioners are right up there with CAM users and snake oil salesmen.

I know a couple of DO's who are great docs, and it's NOT because of their judicious use of OMM. As a matter of fact they scoff at it and they themselves admit it was just a nonsense hoop they had to jump through to finish school.

 

[Old_Mil]

Diagnose what?! What findings? Aren't your standardized patients healthy and well, or do they all have "findings"?

And how can they agree with you "most of the time" if you state any old finding with confidence?

That would be the equivalent of me examining a healthy patient and saying (with lots of confidence) that I can auscultate "lung cancer," and having the attending agree with me just because I said it "with confidence," even though I'm speaking complete BS. What are you looking for, seriously? Posts like this further cement the stigma that OMM practicioners are right up there with CAM users and snake oil salesmen.

The thing is, you don't really understand the mindset of the true believer. They're more like chiropractors than real doctors. They truly believe that everyone has a dysfunction and that *all* disease causes musculoskeletal symptoms that can be palpated and corrected. Unfortunately, they have an inordinate amount of influence in the didactic years and at the AOA, so most of us learn to say the right things to keep them happy. I've heard of "energy diagnosis" being taught at some OMM workshops (thirdhand, because I avoid them like plague-infested sewers) where the practitioner is supposed to feel the dysfunction through energy from the body without actually touching the patient.

I know a couple of DO's who are great docs, and it's NOT because of their judicious use of OMM. As a matter of fact they scoff at it and they themselves admit it was just a nonsense hoop they had to jump through to finish school.

Yep.

 

[ShyRem]

Most folks have a rotated innominate (everyone I've ever looked at actually). Almost everyone has an AA dysfunction. Everyone I've ever looked at has a sacral dysfunction. And most folks have a rib or two out, they just never realized it. Are they healthy individuals? Sure they are. it's not like they have cancer or something.

Most people don't even realize they have these little dysfunctions until they've been fixed. Then they start paying attention and can often tell when something isn't right.

I don't know where y'all go to school or rotations, but none of my residents or attendings have told me what their findings were if they examined the pt first or asked me what my findings were if I examined first. And with a very few exceptions we've agreed after examination.

OMM is an ADJUNCT. It's another tool in your toolbelt, not a cure-all. But when you've got someone who has been constipated for a week on the biggest baddest bowel regimen ever and 20 minutes after OMT they finally poop, you gotta wonder. Or the asthmatic who has been on nebs in the ED whose respirations go down another 20% after OMT with a decrease in accessory muscle use and says they're breathing better when you're done. You get a woman with piriformis pain for a week who is pain-free for the first time after a 3 minute OMT treatment. It's an ADJUNCT. Not a cure-all.

It works for what it's meant for. An adjunct. There are folks who just suck at diagnosis. There are folks who are really good at it. I think most folks fall in the fair-suck category because it takes lots of practice and we just don't get enough.

 

[Brodiewankenobi]

Most folks have a rotated innominate (everyone I've ever looked at actually). Almost everyone has an AA dysfunction. Everyone I've ever looked at has a sacral dysfunction. And most folks have a rib or two out, they just never realized it. Are they healthy individuals? Sure they are. it's not like they have cancer or something....

Most people don't even realize they have these little dysfunctions until they've been fixed. Then they start paying attention and can often tell when something isn't right.

I am sorry, but as a scientist comments like this set off my BS detector. How is it a dysfunction if everyone has it???? How can you know proper function, if everyone has dysfunction? OMM maybe a valid treatment, I don't know b/c i haven't had much experience with it, making it impossible for me to comment on the specifics of it (criticize me all you want b/c of this). From a logical sense, you justification for treatment simply does not follow.

 

[homeboy]

I am sorry, but as a scientist comments like this set off my BS detector. How is it a dysfunction if everyone has it???? How can you know proper function, if everyone has dysfunction? OMM maybe a valid treatment, I don't know b/c i haven't had much experience with it, making it impossible for me to comment on the specifics of it (criticize me all you want b/c of this). From a logical sense, you justification for treatment simply does not follow.

one of the subtle ironies of OMM...

 

[scpod]

.... How is it a dysfunction if everyone has it???? How can you know proper function, if everyone has dysfunction?....

Those are things you'll realize once you've started to study OMM. All will come more clear in time. Why not hold your "observations" in check until then?

 

[Bacchus]

I am sorry, but as a scientist comments like this set off my BS detector. How is it a dysfunction if everyone has it???? How can you know proper function, if everyone has dysfunction? OMM maybe a valid treatment, I don't know b/c i haven't had much experience with it, making it impossible for me to comment on the specifics of it (criticize me all you want b/c of this). From a logical sense, you justification for treatment simply does not follow.

Well, since it can be corrected, I'd deduce from scientific reasoning that pre-OMM was the dysfunction and post-OMM was the correct function. Also, if you didn't take shyrem's post so seriously you'd realize that by everyone she more than likely means most. We're humans, but we are also machines. With time, machines break down or get misaligned. If you have old machines (a population) more than likely most of them are going to show some kind of wear.

 

[Brodiewankenobi]

Those are things you'll realize once you've started to study OMM. All will come more clear in time. Why not hold your "observations" in check until then?

Wasn't referring to the study of OMM. Also, my criticism was directed at the justification for the use of it. Just because I have not studied OMM, does not mean that I can't think about it critically. In the world of research, I am critically analyzed by people who are not experts in my narrow field of study (peer reviewers, grant reviewers) but can give insights on any flaws in my thinking. I am NOT making any claims about the validity or invalidity of OMM. Just stating that justification for any treatment must meet some logical standard. Saying everyone has dysfunction therefore everyone must receive OMM simply does not meet it.

 

[Bacchus]

I believe shy used the word ADJUNCT to describe OMM. No one (atleast in this thread) is claiming it replaces all other modalities.

 

[Brodiewankenobi]

I believe shy used the word ADJUNCT to describe OMM. No one (atleast in this thread) is claiming it replaces all other modalities.

Even an adjunct treatment needs justification.

 

[Bacchus]

If its not going to harm the patient (in most cases, when done properly) and possibly work, or even just induce a placebo effect, what's the problem?

 

[Brodiewankenobi]

If its not going to harm the patient (in most cases, when done properly) and possibly work, or even just induce a placebo effect, what's the problem?

Pascal's Wager (in the medical sense, not making any claims about the existence of god, this thread is controversial enough ). I do basic science research on products that can be described as nutriceuticals and I run into this line of thinking all of the time. It is very deceptive and I fall for it myself sometimes. As a scientist, i have to be VERY careful to believe only what I can justify and prove.

 

[Bacchus]

My story is anecdotal...but OMM worked for me. That's all I need to know, imo.

 

[Brodiewankenobi]

sorry to be such a rabble rouser in this forum, but I am just a skeptical person by nature. Full disclosure, I am going to an allopathic school next year, but i did interview at a ton of osteopathic schools this year. I found OMM intriguing (having a history of doing basic science on alternative therapies) and I am trying to ascertain how and if OMM works. Not being a troll or anything, just trying to ask some questions. Final point. As with any medical practice, the burden of proof for OMM lies on the practicers of OMM, not its critics. There will always be skeptics like me in the allopathic and osteopathic schools who need more than anecdotal evidence, and it is your job to convince us.

 

[ShyRem]

Saying everyone has dysfunction therefore everyone must receive OMM simply does not meet it.

I admit I'm tired today, but I don't recall anyone saying anything like the above in this discussion. I think the discussion revolved around exams. It is not practical to screen over one hundred people from general society when you have students you can pair up and work on each other. If anyone had said the quote from you above, I would not agree with it. Just because people have dysfunction does NOT mean everyone "must" receive OMM. That's like saying everyone with diabetes must receive injected insulin.

It's not my job to convince people who are already convinced. If you haven't learned it, haven't experienced it, and always argue against it, I can do nothing to change your mind. And if I could, it certainly isn't worth my time or energy while I'm post-call.

I'm reminded of the people who firmly believe that man never landed on the moon and it was all a hoax. But then again, as you've never experienced actually being on the moon and haven't seen unrefutable proof (photos can be mocked up you know), you may be one of those folks. Hmmmmm......

 

[Brodiewankenobi]

...But then again, as you've never experienced actually being on the moon and haven't seen unrefutable proof (photos can be mocked up you know), you may be one of those folks. Hmmmmm......

ad hominem arguments...great way to convince people. btw you could convince me that it is an effective treatment if you meet the following conditions. One, provide a logical reason for providing OMM. Two, show me controlled studies where OMM improved a condition compared to a sham treatment.

 

[psy]

ad hominem arguments...great way to convince people. btw you could convince me that it is an effective treatment if you meet the following conditions. One, provide a logical reason for providing OMM. Two, show me controlled studies where OMM improved a condition compared to a sham treatment.

Do you use pubmed much?
I found a study here.
I also found a study on horses as well. But I don't think it would fit your vs. sham treatment requirements since the horses wouldn't know what placebos were.

 

[Brodiewankenobi]

one could do a sham manipulation on an animal or person. We do sham surgeries on mice all of the time (ie just open and close them) as controls. Nice citation...it'll take a while to look over as it is a meta analysis!

 

[Bacchus]

If you look above I posted a link for a thread with about 40-50 stories of OMM working. Is it the broadest study or even a study? No. But it worked for them...unless their bodies just cured itself at that opportune time.

 

[meister]

This whole thread is . Why not just drop the pretense and get rid of OMM and leave that stuff for PTs and DCs?

Unite the profession and let's move on already. Not trolling but I honestly just don't understand...

 

[spicedmanna]

This whole thread is . Why not just drop the pretense and get rid of OMM and leave that stuff for PTs and DCs?

Unite the profession and let's move on already. Not trolling but I honestly just don't understand...

Why else? Don't you think there's money to be made from being separate and a certain amount of power/politics involved?

 

[DrMidlife]

Why else? Don't you think there's money to be made from being separate and a certain amount of power/politics involved?

Dogs marking territory comes to mind.

 

[ShyRem]

There's a reason Harvard has an OMT program that is packed with a waiting list every year with MDs trying to get training in the techniques.

 

[jbp100]

There's a reason Harvard has an OMT program that is packed with a waiting list every year with MDs trying to get training in the techniques.

Haha, ye$ there certainly are advantage$ to having other tool$ to work with in treating patient$.