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And what do you do if the pt has no relief of their symptoms with FPR?
Same thing I would do if the patient got no relief from Pepcid. Try something else. Protonix, Nexium, Axid, etc.
Would you just apologize, circle the billing code, and give them the boot?
The issue I have with OMM as a whole is that some things don't work for some people and I have a problem performing a 10 second technique that might not work and then sending them on their way and billing for it.
One thing you are going to eventually learn is that medicine is not perfect. We try to help our patients in every way possible (hence the reason we use OMT in the first place). We try to do our best but something even our best doesnt work. Would you charge a patient for a cholecystectomy if they had residual symptoms after the surgery? Would you charge a patient for seeing them and telling them their symptoms are from influenza, and thus you are unable to give them a prescription? Would you charge a patient who coems to you with migraines and you have already given them Rxs for every triptan on the market with no relief?
For example, you're placing the pt into completely opposite positions for ME vs. FPR. Theoretically speaking, how can they both have a theraputic effect? I understand the anatomical reasons for both treatments but it seems like almost a crapshoot when trying to choose which treatments to use in 2 minutes.
You have more to learn about OMT. Im not about to conduct an online lecture series.
Just out of curiosity, how many of your patients come to you specifically with musculoskeletal problems?
Top reasons people see their doctor:
Children: 1. Common cold 2. Otitis media 3. Nausea/Vomiting/Diarrhea
Adults: 1. Common cold 2. Undiagnosed pain (MSK or other) 3. Dermatologic complaints 4. Gastrointestinal complaints 5. Low back pain 6. Depression/Anxiety
If a patient comes to you with a sinus infection or pneumonia, would you perform a lymphatic technique and have no problem billing for it? Ethically speaking, would you perform a pedal pump and bill for it? Or would you tell the patient to walk on a treadmill for 10 minutes once a day?
Patient compliance. What is the likelihood that my patient will heed my advice? Recent studies show that patient compliance is as high as 60% and as low as 25%. 2 minutes of treatment in my office is GOING to get done. Relying on them to walk on a treadmill while they are feeling ill is ridiculous.
Again, this is assuming that there is a justification for performing these OMM techniques on the patients.
Why assume? Look at the literature. You can do the online searches for yourself.
History has shown that there is an osteopathic manipulative treatment for just about every type of disease or dysfunction out there. While I don't consider myself to have nearly as much experience as you do, I can tell you right now I don't buy into some of it.
Me neither
It's not due to closed mindedness, but rather a lack of evidence supporting it AND proposed mechanisms that seem unbelieveable to me.
Agree 100%
For example, to bring up the issue most commonly bashed here, I find it hard to believe anyone can feel CSF moving under skull bones.
You are in the overwhelming majority, and I agree with you.
Until there is a way to measure these pulsations from contact outside the skull with a computer and then compare it to the sensitivity of the human finger tip I will refuse to perform this in a practice.
Agreed. But to lump cranial in with the true musculoskeletal treatment techniques is obsurd.