Future of Osteopathic Medicine

[TeamZissou]

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http://www.jaoa.org/cgi/content/full/110/6/320?etoc

Here is an article in the most recent issue of JAOA. I found it to be a breath of fresh air and I truly hope our generation of DO's adopt this viewpoint. My opinion is that while OMT has it's place in treating musculoskeletal issues it is NOT going to cure other things. If we cling to the unfounded belief that OMT is useful outside of it's effective area we are only discrediting ourselves and our profession.

 

[Black Adder]

http://www.jaoa.org/cgi/content/full/110/6/320?etoc

Here is an article in the most recent issue of JAOA. I found it to be a breath of fresh are and I truly hope our generation of DO's adopt this viewpoint. My opinion is that while OMT has it's place in treating musculoskeletal issues it is NOT going to cure other things. If we cling to the unfounded belief that OMT is useful outside of it's effective area we are only discrediting ourselves and our profession.

BLASPHEMY!!!!! 🙄


... I think most DOs (students and physicians) share the same view.

 

[kopitar]

While it may not cure all ailments it is incredibly useful in certain facets of medicine. Like the article says, a majority of primary care visits are due to back pain or other musculoskelital problems. Its no secret the effect that obstructed nerves and vessels play in these symptoms. OMT, in my opinion, is an indispensable practice, but should not be made out to be of more use than it actually is.

 

[facetguy]

While it may not cure all ailments it is incredibly useful in certain facets of medicine. Like the article says, a majority of primary care visits are due to back pain or other musculoskelital problems. Its no secret the effect that obstructed nerves and vessels play in these symptoms. OMT, in my opinion, is an indispensable practice, but should not be made out to be of more use than it actually is.

When you say 'obstructed nerves', what do you mean?

 

[peterish]

If OMT does not have significant benefits, then we should stop teaching it, in which case there would be nothing separating MD's and DO's.

If OMT has benefits, then for the good of the public it should be taught to MD's as well.

Either way you look at it, there's no good reason for this country to have 2 separate medical degrees. I think we'll have amalgamation someday, probably in our lifetime.

 

[JaggerPlate]

Wow, pretty well stated - we should understand that the MS system is important and that DOs can offer some relief with OMM, but not act like it cures cancer and recheck some of the more questionable aspects. I don't think this is too unreasonable at all.

 

[JaggerPlate]

I think we'll have amalgamation someday, probably in our lifetime.

I wouldn't count on it tbh.

 

[Manicsleep]

We should but we wont.

OMT is being taught in MD programs and residencies BTW.

 

[JaggerPlate]

We should but we wont.

OMT is being taught in MD programs and residencies BTW.

Maybe in certain PM&R residencies and in CME courses ... but not in large quantities. I don't even think it's covered in most AOA residencies in significant quantities.

 

[Doctor4Life1769]

When you say 'obstructed nerves', what do you mean?

probably means "impinged"

 

[PharmaTope]

actually i believe OMM has a lot of benefits. This is why my primary care physician is a DO vs an MD. I used to see chiro and really believe it is beneficial to people.

 

[facetguy]

probably means "impinged"

So OMM unimpinges impinged nerves? Like a pinched nerve thing? I assume a bone gets out of alignment and OMM puts it back?

 

[FutureCTDoc]

In my opinion OMT has some reasonable uses for treating lower back pain and joint pain. Cranial has no logical basis as the bones of the skull are fused in all but neonates. Cervical can cause strokes and has a high rate of complication. I would prefer more quantitative data from well designed single blinded studies since it seems near impossible to do double blinded.

 

[Spooner13]

In my opinion OMT has some reasonable uses for treating lower back pain and joint pain. Cranial has no logical basis as the bones of the skull are fused in all but neonates. Cervical can cause strokes and has a high rate of complication. I would prefer more quantitative data from well designed single blinded studies since it seems near impossible to do double blinded.

Take a look at this paper about cervical OMT. Towards the bottom of the first page it says: "the risk of a vertebrobasilar accident (VBA) occurring spontaneously, is nearly twice the risk of a VBA resulting from cervical spine manipulation. This includes cases of ischemic stroke and vertebral artery dissection."

https://www.do-online.org/pdf/aoa_position_manipcerspine.pdf

 

[JustPlainBill]

Very interesting---

I thought the whole purpose and origination of the Osteopathic Research Center currently located at UNTHSC/TCOM was to validate some of the claims of osteopathy.

IIRC, the whole thing started when the prez of the AMA visited one of the AOA conferences and basically said,'Ok, if you'll prove OMT using EBM, then we'll be more than happy to use the therapies for our patients since that's what it's all about'. Which caused the AOA to lobby NIH for the ORC and here we go.

Thus far to my knowledge, there's been one study on an animal model where a coronary vessel was occluded and 3 OMM types detected TART changes at the spinal level predicted by osteopathic theory. There's been a few other studies with Parkinson's (decreased restriction in movement) and COPD (musculoskeletal also) but nothing about the visceral claims at this point. They haven't even touched cranial.....the Cranial Institute likes to jump from a pulsating neuron in a petri dish to palpating the mitochondrial respiratory mechanism to cranial bones moving......no comment.....

So, this leads to a great question - what is the 'osteopathic difference' other than OMT that we're all told about in D.O. school?.....The 'we treat the whole patient' doesn't wash as allopaths are doing that also now.....

 

[sylvanthus]

" what is the 'osteopathic difference' other than OMT that we're all told about in D.O. school?....".
There is no difference. The ostopathic philosophy is a draw to get people to apply to the school. When it comes down to it, we are just taking classes like any other medical school.

 

[docdoc121]

" what is the 'osteopathic difference' other than OMT that we're all told about in D.O. school?....".
There is no difference. The ostopathic philosophy is a draw to get people to apply to the school. When it comes down to it, we are just taking classes like any other medical school.

According to a lot of people on sdn, there is no substantial difference in philosophy anymore considering MDs use a similiar, if not the same, exact 'patient-centered, holistically inclined' approach...and OMT is hardly, if ever utilized by the majority of DOs. So where does that leave us? Does that mean that DOs are simply students with lower grades on average than your average US MD student? When everyone just says there is no difference, the uninformed eats it as "oh, so you couldn't get into a regular med school." please try not to make DOs sound like hypocrites. "we're different. no wait, we're the same. actually, we do this other thing. yeah, our own DO residencies..weellll..."

 

[sylvanthus]

In my opinion, there really should not be two seperate pathways to becoming a medical doctor. I think it would be in nearly everyone's best interest to just have MD programs and open up every school to having an optional certificate or master's program in OMT.

This would do several things. It would allow every physician the opportunity to learn OMT, therefore creating more OMT practitioners. It would also free those who have realized they do not like OMT from the requirement. Furthermore, it would also decrease the confusion that patient's experience with regards to what a DO is.

The reason this will never happen is due to power and money. Those in the AOA will never give up that control and money, even if it is in the best interest of the population at large (more OMT practitioners, less confusion, etc etc)

Just my opinion, but I think this would be by far the best solution. Those who like OMT can still have it and lets face it, that is the only difference now.

 

[Daedra22]

I'm not sure I would like to see the DO degree replaced by a unified medical degree. It seems to me that having separate schools and separate associations could be a positive thing. Couldn't DO schools and/or the AOA try to improve medical education in new ways, or advocate for preventative medicine and wellness in the public sphere? Even if we don't like the way the AOA works now, as the next generation of physicians, we could change it. But then, perhaps I'm too optimistic or too inexperienced with medical politics. I would like to think of the separation between DO's and MD's as an opportunity rather than an obstacle.

More on the subject of this thread, I liked the article that was posted, even if it is somewhat obvious. I didn't choose an osteopathic school thinking that I would be able to cure malaria with my bare hands, heh.

 

[Spooner13]

Very interesting---

I thought the whole purpose and origination of the Osteopathic Research Center currently located at UNTHSC/TCOM was to validate some of the claims of osteopathy.

IIRC, the whole thing started when the prez of the AMA visited one of the AOA conferences and basically said,'Ok, if you'll prove OMT using EBM, then we'll be more than happy to use the therapies for our patients since that's what it's all about'. Which caused the AOA to lobby NIH for the ORC and here we go.

Thus far to my knowledge, there's been one study on an animal model where a coronary vessel was occluded and 3 OMM types detected TART changes at the spinal level predicted by osteopathic theory. There's been a few other studies with Parkinson's (decreased restriction in movement) and COPD (musculoskeletal also) but nothing about the visceral claims at this point. They haven't even touched cranial.....the Cranial Institute likes to jump from a pulsating neuron in a petri dish to palpating the mitochondrial respiratory mechanism to cranial bones moving......no comment.....

So, this leads to a great question - what is the 'osteopathic difference' other than OMT that we're all told about in D.O. school?.....The 'we treat the whole patient' doesn't wash as allopaths are doing that also now.....

There definitely needs to be tons more research in OMT. It is very, very frustrating when a professor/physician teaches us something, and then it turns out none of it is based on evidence. This makes me want to scream!

As far as the future of osteopathic medicine...DO students that want to practice OMT in the future need to plan on engaging in research when they begin practicing (especially, those who are instructors at DO schools).

And yeah, other than OMT, there is no difference between what a DO student and an MD student learn during school.

 

[radiodoc99]

OMT needs to be more integrated with anatomy in all classes rather than focusing on OMT techniques. OMT is really anatomy+techniques+pathology. OPP is OMT+Osteopathic philosophy and putting it into practice. Even on 3rd yr rotations OMT or OPP should be integrated as a lecture or class

 

[facetguy]

Does anyone know if the use of OMT in practice has increased, decreased or remained the same over recent years? I'm sure its use is well below what it was a generation ago, but I wonder about today.

 

[sylvanthus]

I'm not sure I would like to see the DO degree replaced by a unified medical degree. It seems to me that having separate schools and separate associations could be a positive thing. Couldn't DO schools and/or the AOA try to improve medical education in new ways, or advocate for preventative medicine and wellness in the public sphere? Even if we don't like the way the AOA works now, as the next generation of physicians, we could change it. But then, perhaps I'm too optimistic or too inexperienced with medical politics. I would like to think of the separation between DO's and MD's as an opportunity rather than an obstacle.

More on the subject of this thread, I liked the article that was posted, even if it is somewhat obvious. I didn't choose an osteopathic school thinking that I would be able to cure malaria with my bare hands, heh.

Everyone is doing this nowadays, it is the popular and "cool" thing to do and it is seen in nursing, medicine, etc etc. So, again DO training has nothing really unique about it save for OMT and if MDs can and are being trained in OMT, than there is no point in keeping the degrees separate.

 

[ILEMres]

Hey guys, new to SDN (posting-wise) here. True true true that OMT isn't magic like Still thought. It's embarassing sometimes... Lol.. Anyway, don't discount what learning OMT gives you. You will have superior palpatory skills when you become a physician AND knowing the spinal nerve distribution & how to palpate TART on a pt's back can & WILL help you differentiate between a heart attack & PUD (and other ailments). It has never failed me. - of course, no matter what for medico-legal reasons you still must r/o the MI w/ labs & EKG...

 

[docdoc121]

So by and large, DO school is essentially students that didn't make a US MD school. Awesome.

 

[Zline]

So by and large, DO school is essentially students that didn't make a US MD school. Awesome.

Not so sure about that. I was accepted to multiple MD and DO programs, and chose a DO program because of location, approach to the teaching of medicine, and philosophy. I have met countless others along the way who have also turned down MD programs in favor of a DO program for similar reasons.

I'm glad I made the decision I did.

 

[ILEMres]

So by and large, DO school is essentially students that didn't make a US MD school. Awesome.

Eh, honestly, yeah. But, not like we didn't make it by a mile, most of the time we didn't make it by the skin of our teeth so we chose the DO route - for good reason. But, you and I both know that there is ZERO difference in the competency of doc's based on their degree. In my residency, 2 different guys are absolutely BRILLIANT & I was thinking, "Man, did they go to school at Harvard?" Nope, they went to DO schools. The program's smartest attending is also a DO.

It really doesn't matter guys. Medical school is medical school. Hey look, those that went to UT Houston couldn't get into Baylor....... SO??

 

[mechanictodr]

There definitely needs to be tons more research in OMT. It is very, very frustrating when a professor/physician teaches us something, and then it turns out none of it is based on evidence. This makes me want to scream!

As far as the future of osteopathic medicine...DO students that want to practice OMT in the future need to plan on engaging in research when they begin practicing (especially, those who are instructors at DO schools).

And yeah, other than OMT, there is no difference between what a DO student and an MD student learn during school.

How many hours of class does an MD student have? Is it less? It would have to be the same minus the time DO students spend in OMT to say that they were equal minus the OMT.

 

[TeamZissou]

How many hours of class does an MD student have? Is it less? It would have to be the same minus the time DO students spend in OMT to say that they were equal minus the OMT.

It's dependent on the school. Overall I would say MD schools generally have less hours though. However it's not simply due to a lack of OMM but rather how they design their curriculum, they actually allow their students hours to study during the day which is MUCH BETTER.

 

[Spooner13]

How many hours of class does an MD student have? Is it less? It would have to be the same minus the time DO students spend in OMT to say that they were equal minus the OMT.

It definitely depends on the individual school and the way they set up their curriculum. I'd say the average hours in class for MD and DO students is very comparable. At my school, we spend 2 hours per week in OMT (1hr in lab and 1hr in lecture). The bottom line is that DO students learn the same material that MD students do, plus OMT.

Learning OMT, like a poster above said, is very useful even if you never practice it after you graduate. You quickly become very comfortable touching patients, and your palpatory skills are very well tuned.

 

[DOtoCanada]

You will have superior palpatory skills when you become a physician AND knowing the spinal nerve distribution & how to palpate TART on a pt's back can & WILL help you differentiate between a heart attack & PUD (and other ailments). It has never failed me. - of course, no matter what for medico-legal reasons you still must r/o the MI w/ labs & EKG...

So no matter what your OMT skills tell you, you will work the patient up in the standard way anyway? Can you explain how OMT has altered your practice of medicine?

 

[radiodoc99]

OMT helps broaden your differential. You think about MSK and anatomical pathology because of your knowledge in OMT. This is huge for primary care.