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Hi I was just wondering if OMM is used in rotations and if so, how often?? Does it depend on your preceptor or is it never used?? Thanks!!
For D.O.'s: Do you use OMM in rotations??
- Thread starter skicu
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Usually only on FP rotations - or if you are with a doc that is really into OMM.
For example, we have an internal medicine doc here who is into it and is currently doing research on its use with pneumonia patients (Dr. Noll - he's published several things on OMM with respect to Internal medicine).
You also use it, obviously, when you set up an OMM rotation. That's about it. Of course, there are other things that could be available - sports medicine, for example.
The amount you do depends on the doc. I was with an MD who really didn't encourage it on his patients...but let me do a few things when it was an obvious musculoskeletal problem. However, most of my OMM was performed on the MD that month! He loved the manipulation!! I was also with a DO for another FP rotation and he had people that made appointments JUST to get manipulated. So, it's out there - just find out what docs do it and which ones have gotten out of it. Just ask around, depending on what you want.
For example, we have an internal medicine doc here who is into it and is currently doing research on its use with pneumonia patients (Dr. Noll - he's published several things on OMM with respect to Internal medicine).
You also use it, obviously, when you set up an OMM rotation. That's about it. Of course, there are other things that could be available - sports medicine, for example.
The amount you do depends on the doc. I was with an MD who really didn't encourage it on his patients...but let me do a few things when it was an obvious musculoskeletal problem. However, most of my OMM was performed on the MD that month! He loved the manipulation!! I was also with a DO for another FP rotation and he had people that made appointments JUST to get manipulated. So, it's out there - just find out what docs do it and which ones have gotten out of it. Just ask around, depending on what you want.
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The amount of OMM used does depend on your preceptor. I only used it during my FP rotations. One of the FP docs I was with had me do the OMM on his patients if they asked for it because "I was better at it." 😱 One of the other FP rotations I did had an OMT clinic - it was awesome 👍
Unfortunately, most DO's don't do too much OMT.
Unfortunately, most DO's don't do too much OMT.
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Yep, definitely used OMM on family rotations and have fixed my preceptors (both DO and MD) on several occasions. I'll use it on other rotations when the appropriate situations arise. Most patients love it and all the MD's that I've worked on liked it as well. I thnk you can use it about as much or as little as you like.
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I used it the most on my ENT rotation. Can you believe that? My preceptor was a DO and recognized that a lot of "sinus" and "ear" pain was actually musculoskeletal in nature. He also said that he actually gets reimbursed for it when he is being consulted vs most FPs who don't get reimbursed for it. He was good at it, too. I was also happy to brush up on my skills.
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I have used it at least once a week, either for dx or rx
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skicu said:
I was put in an MD's office for family practice. Therefore, no OMT. With a DO for OB/Gyn right now and the most 'osteopathic' thing I've seen thus far is his diagnosis of a G1P1 patient with "sacral dysfunction". Rx: Flexeril.
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Completed Ob/Gyn, Ambulatory Peds, Surg1 and Psych...the only rotation that I used it on was Pediatrics - on two separate occasions!! Two teenage patients one with some neck pain and another with a pelvic dysfunction. On both, they came in with acute pain, attending was going to give them some NSAIDS or send them home with nothing at all....I did a quick assessment and fixed them right up. They ended up not even needing the meds! The best part about it was the attending was an MD...he loved it. The parents were pretty shocked too...
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So far, I have only been able to use OMT in FP rotations. By the end of the month, patients were requesting time with me after their regular appointment with the doc, because they were happy with my "work". I had one patient in particular with parathesias in his arm x 3 months. After 3 sessions, he had regained full mobility and the tingling in his arm had completely resolved. I enjoyed the hands on rotation so much, I am going back for one of my electives! It is a lot of fun to put OMT into practice!!! Now, if I could find someone to work on me!!!
I have used OMM on almost every rotation-including psych, and have had many MD attendings. I feel there are a few problems w/ lack of OMM on rotations:
1) little formal encouragement/curric. that integrates OMM in years 3/4 on the part of schools/hosp. (rare exceptions)
2) students who are not that confident in their skills and are then all too easily persuaded to not use OMM
3) students with good skills who are not aggressive enough
My experience in rotations has been that if you present somewhat formally a diff. dx., that the tech. is safe, and a clear plan-almost no attending will say no. I had a FP rotation at a MD residency program where two DO Residents, including a chief resident said "we have no DO attendings so we dont use it-but we'd like to" Baloney! With attending consent a did more OMT in a week than both of them combined in their whole residency-b/c I made a good sales pitch to my attending and advocated for my pt.
1) little formal encouragement/curric. that integrates OMM in years 3/4 on the part of schools/hosp. (rare exceptions)
2) students who are not that confident in their skills and are then all too easily persuaded to not use OMM
3) students with good skills who are not aggressive enough
My experience in rotations has been that if you present somewhat formally a diff. dx., that the tech. is safe, and a clear plan-almost no attending will say no. I had a FP rotation at a MD residency program where two DO Residents, including a chief resident said "we have no DO attendings so we dont use it-but we'd like to" Baloney! With attending consent a did more OMT in a week than both of them combined in their whole residency-b/c I made a good sales pitch to my attending and advocated for my pt.
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During my Family Med rotation, I manipulated about 30% of the patients per day. My doc was an OMM fellow back in the day, so that made life a little easier. I used it a ton for MS pain/dysfunction, but also for ENT, vestibular disorders, CAP, and for COPD. I used it less in IM mainly because my attendings were MDs with little OMM experience. They had no trouble letting me do treatments, but each time I had to explain nearly every thing that I was doing so my patience wore a little thin. Actually, the biggest problem I found with OMM in inpatient setting is the damn bed and all the other crap in the room.
I also wanted to ask if anyone else does an OMM grand rounds during their didactic times. We have a program in our hospital where anyone on an inpatient service has to present an OMM teaching case (for example, little old Mrs. Smith in 103A with acute exac. of COPD) and then we discuss the manipulation options for those patients. After that, we actually go round on those patients and perform the OMT and write notes on them. We do this about once a month. It has been a great help to some of my more OMM- hesitant classmates as well as to those of us less hesitant folks.
I also wanted to ask if anyone else does an OMM grand rounds during their didactic times. We have a program in our hospital where anyone on an inpatient service has to present an OMM teaching case (for example, little old Mrs. Smith in 103A with acute exac. of COPD) and then we discuss the manipulation options for those patients. After that, we actually go round on those patients and perform the OMT and write notes on them. We do this about once a month. It has been a great help to some of my more OMM- hesitant classmates as well as to those of us less hesitant folks.
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One patient on my third year FP rotation who had LBP.
One post-trauma patient in the Surgery Clinic...did some Counterstrain on his arm which he said helped, but I didn't dare mention to my MD attending that I did that. I don't know what his reaction would have been but I imagine it would include laughter.
Two patients on one of my IM rotations (my attending was a DO and never did it, just let students do it from time to time).
OMM rotation my third year of course included some and I am scheduled to do an OMM rotation instead of FP my fourth year, which will be 99% OMM and 95% of it will be HVLA! 🙂
I don't think its stressed enough on clinical rotations so I even question the usefulness once we graduate, because not many students practice it like we did our first two years on each other.
I won't need it much anyway, as long as I match into Rads.
COME ON INTERVIEW INVITES!!!
One post-trauma patient in the Surgery Clinic...did some Counterstrain on his arm which he said helped, but I didn't dare mention to my MD attending that I did that. I don't know what his reaction would have been but I imagine it would include laughter.
Two patients on one of my IM rotations (my attending was a DO and never did it, just let students do it from time to time).
OMM rotation my third year of course included some and I am scheduled to do an OMM rotation instead of FP my fourth year, which will be 99% OMM and 95% of it will be HVLA! 🙂
I don't think its stressed enough on clinical rotations so I even question the usefulness once we graduate, because not many students practice it like we did our first two years on each other.
I won't need it much anyway, as long as I match into Rads.
COME ON INTERVIEW INVITES!!!
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So far I've had 2 months of Peds (with MDs) and 2 months of FP (with DOs). In the Peds rotation, I did a ton of OMT. Everything from the hurt teenage cheerleader/football player all the way down to a 3 day old in the nursery. Basically, I just waited until I knew I could fix something that would look like a miracle so the preceptor couldn't have anything to question. When the first girl I treated came in on crutches and left jumping....my MD preceptor was setting appointments up for me for just OMT. Pretty sweet....except for doing cranial on the 18 year old and making her throw up and then wet her pants.....preceptor gave me a very wierd look as I went to find a gown for the girl...
In my FP rotation I did quite a bit as well. Since I was with DO, sometimes they wanted to do the OMT, so I didn't get to do it as much as I would have liked, but you know. It's kind of funny because if we get a seeker, we are susposed to refer them to Pain Management (which is run by MDs). Then they go there and the MDs refer back to us for OMT. It really makes the druggies mad. lol
In my FP rotation I did quite a bit as well. Since I was with DO, sometimes they wanted to do the OMT, so I didn't get to do it as much as I would have liked, but you know. It's kind of funny because if we get a seeker, we are susposed to refer them to Pain Management (which is run by MDs). Then they go there and the MDs refer back to us for OMT. It really makes the druggies mad. lol
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I think that's awesome that you guys get to show the MDs how usefull OMM can be. I'm a 4th yr MD student and I've been to a chiropractor (a great one!) when I felt like I needed it for the past 10 years. I get Sh** all the time about going to a chiro but avoiding surgery and meds has been worth it. Some times I wonder why I didn't go to DO school. Keep it up and keep teaching the MDs that its a valuable treatment!
