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Interesting article: Please comment

Discussion in 'Medical Students - DO' started by drusso, Aug 15, 2001.

  1. drusso

    drusso Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Nov 21, 1998
    Over the rainbow
    Acad Med 2001 Aug;76(8):821-8

    Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession.

    Johnson SM, Kurtz ME.

    Dr. Johnson is professor and Dr. Kurtz is professor, Department of Family and Community Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing.

    PURPOSE: To determine whether osteopathic manipulative treatment (OMT), a key identifiable feature of osteopathic medicine, is becoming a "lost art" in the profession, and whether the long-term evolution of osteopathic medicine into mainstream medicine and particularly specialization has had a similar impact on the use of OMT by family practitioners and specialists. METHOD: In April 1998, a two-page questionnaire was mailed to 3,000 randomly selected osteopathic physicians in the United States to assess factors affecting their use of OMT. Descriptive statistics, linear regression analyses, and analysis of variance techniques were used to test for differences. RESULTS: The response rate was 33.2%. Over 50% of the responding osteopathic physicians used OMT on less than 5% of their patients, and analysis of variance revealed OMT use was significantly affected by practice type, graduation date, and family physicians versus specialists. For specialists, 58% of the variance regression was attributed to barriers to use, practice protocol, attitudes, and training, whereas for family physicians, 43% of the variance regression was attributed to barriers to use, practice protocol, and attitudes. More important, the eventual level of OMT use was related to whether postgraduate training had been undertaken in osteopathic, allopathic, or mixed staff facilities, particularly for osteopathic specialists. CONCLUSIONS: The evidence supports the assertion that OMT is becoming a lost art among osteopathic practitioners. Osteopathic as well as allopathic medical educators and policymakers should address the impact of the diminished use of OMT on both U.S. health care and the unique identifying practices associated with the osteopathic profession.

    PMID: 11500286 [PubMed - in process]
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  3. doughboy

    doughboy Senior Member 7+ Year Member

    Jul 16, 2001
    Hence my disappointment and therefore my sour attitude toward "osteopathic" medicine. If we have something so precious, why doesn't it make more of an impact?
  4. turtleboard

    turtleboard SDN Advisor 10+ Year Member

    Jun 3, 1999
    New York, New York
    Osteopathic physicians make OMT out to be more than it really is. For quite some time I've been arguing that there's got to be more to DO medicine than simply OMT, and every academician in every osteopathic college I've visited agrees. THe article assumes that OMT is the one thing that makes osteopathic medicine unique, but most of you osteopathic med students and physicians will agree with me when I say that it is merely one of many things.
  5. Amra

    Amra A Quiet Voice of Reason 10+ Year Member

    Jun 20, 2001
    South Beach, Florida

    I am curious... what other differences do you see between allopathic and osteopathic? I am presuming your are "in the system" therefore would have a different view than myself... my perspective is limited to conversations with osteopaths and osteopathic philosophy (books/articles/etc)...

    My perspective on it from conversations simply boil down to a reality v. ideaology perspective.

    Reality: What techniques can I work into my practice? Most DOs I've spoke with do not use it extensively (and that is probally an overstatement). The reasons they cite is time v. billing -- it is just not financially feasble to perform. They could get more billing seeing patients every 15 minutes as opposed to the every 20-30 mins needed for OMT work. Please don't think "cold hearted bastard doctor is more interested in $$ than helping patients." Doctors have to feed their families too (and their assistants/nurses/receptionists/etc). Unfortunately, being a doctor is also a business.

    Ideaology: OMT is a therapeutic modality that is proven to work. Keeping in mind the osteopathic credo (surgeons too) "proper structure begets proper function." I've seen pics of DO's manipulating newborns (circa 1940-50's).. The ideological application of OMT is (almost) limitless. Personally, I have been manipulated (osteopathic and chiropractic) for 10+ years and I swear by that more so than other methodologies... That is MY attraction to osteopathic medicine.. :)

    Just a voice in the crowd shouting "Remember your roots!"

  6. RockyMan

    RockyMan Member 10+ Year Member

    Apr 10, 2000
    Thanks for posting the abstract drusso, I?ll have to take a look at the full article when I?ve a bit more time tomorrow AM. From the abstract I can?t tell much about response bias control, definition of terms like ?practice protocol? or ?barriers to use.? Was there no interaction between reported attitudes and claims for barriers to use? I would suspect that there was-- if you are critical of OMT, you may be more likely to see more barriers to use.

    I wonder what techniques or wording they used to define OMT in their survey? Conceivably some doctors (physiatrists, orthopods, sports med docs) might do things that might be difficult to define as OMT or not-OMT, which could complicate the survey for a fraction of the respondents.

    The authors seem to feel ?...that OMT is becoming a lost art...?, but I don?t really see how that can actually occur as long as the DO schools are all putting us through hundreds of hours of training during the first two med school years. Also, even though they may be relatively few, there ARE a number of OMM specialist doctors, and for all I know, their numbers may actually be increasing over time. Maybe as OMT is lost from general practice and many specialties, it is being absorbed into its own core group of specialties?

    The implication from the abstract seems to be that DO graduates who train for specialties, especially in ?non-osteopathic institutions,? use OMT less often. No surprise there, fits in w/ everything I?ve seen as a med student.

    Generally I?d say that the OMM training I got at my school (KCOM) has nearly zero functional connection to the medicine I?ve been doing in my clinical years. That is, in only a couple of situations, both with family medicine primary care doctors working in small-town clinics, have I ever diagnosed pts who came in w/ joint pain as their chief complaint-- i.e., cases where we were looking for ?somatic dysfunction? and treated them w/ any OMT techniques. Granted, I haven?t done orthopedics rotations yet....still, all my pts this year really haven?t presented w/ strictly somatic dysfunction complaints, they?ve been hospital admits and clinic visits for other reasons. So I try to treat the main problem and go on to the next patient. I?m sure that I?ve had plenty of pts w/ spinal kyphosis, musculoskeletal asymmetries, reduced range of motion in various joints, etc.-- those just weren?t the things they wanted help with when I saw them.

    Excellent point, doughboy-- perhaps medical procedures are all in a kind of Darwinian struggle for survival, and the most powerful techniques, often applicable to the most serious problems, tend to survive the longest over time... lots of DO?s find they have other techniques that are more useful then OMT for their patients, ergo that?s what they do. Ipso facto OMT is less and less relevant to more and more DO?s, as we all go into our various practices, and medical practice itself becomes more and more complex. At my school it seemed to me that the OMM Dept. was (pretty much exclusively) training us to be general practice doctors in small towns and giving us all this OTM work so we could compete w/ the chiropracter down the street for pts who had back aches, headaches, etc. I think that some of my friends in class may do something like that... but a relatively small percentage, I suspect.

    I agree turtleboard, maybe we DO?s could come up w/ something other than practicing OMT as a commonality for DO?s. What should it be? I guess the AOA could try to force all the DO?s to use OMT, but how would that work? Not an advisable course, I would think.

    Amra-- I?m glad you get relief from OMT/chiropractic, but if you show up w/ an acute MI on my CCU rotation, there?s a lot of other stuff I?m going to do for you before I get around to tender points, etc. Also, as much as you like being treated, testimonials are not sufficient proof of efficacy (e.g., check out today?s NYTimes front page article on pulmonary surgery for emphysema), which I imagine you already know. It seems to me that, like other things we do, OMT techniques really must be PROVEN to work. Unfortunately, if you look at the literature in osteopathic journals, for many techniques (e.g., crainial OMT) there is little or no substantial objective evidence for success, or even a credible diagnotic/therapeutic mechanism. As far as roots are concerned, I often wonder how things would be now if, forty or fifty years ago, DO schools and physicians had mounted a collaborative, SERIOUS scientific program to rigorously investigate the various techniques that are currently taught as OMT?

    Clearly the million-dollar question is ?Why do so many DO?s choose against using OMT in their medical practices?? It?s nice to see somebody doing research on the topic, I hope the article itself is very good.
  7. osteodoc13

    osteodoc13 Member 7+ Year Member

    Jul 26, 2001
    Chino, CA
    I have to take exception with one (at least) thing RockyMan said in his post:

    >Unfortunately, if you look at the >literature in osteopathic journals, for >many techniques (e.g., crainial OMT) there >is little or no substantial objective >evidence for success, or even a credible >diagnotic/therapeutic mechanism.

    I hate to be getting a reputation as one who pushes cranial as a panacea, because I don't believe that any one modality is better than another but they have different indications and applications. However, I must state that there are plenty of therapeutic modalities and medications that have no known therapeutic mechanism. I would refer people to my earlier posts, but there are plenty of unproven theories that are used in medicine today which continue to be used because they are effective.

    As I read through threads like this, I see so many students who are against the use of OMT, and I wonder why they are attracted to osteopathic medicine? I agree that OMT does not equal osteopathy, but I would love to hear from those out there as to why they choose to be a DO if they are so against OMT.
  8. together

    together Senior Member 10+ Year Member

    Oct 27, 2000
    Boston, MA
    "All disease is 100% mental."

    -- Candance Pert
  9. kidterrific

    kidterrific Senior Member 10+ Year Member

    Oct 12, 2000
    Detroit, MI
    Just because it physicians choose not to use it, doesn't mean it's not:
    A) Effective
    B) Used
    C) Requested

    Bad analogy, but Cocaine use has decreased significantly since the 80's, but I can guarantee you that there are still people buying it up. Acupuncture isn't mainstream, but people will fly to corners of the earth to have needles stuck in them. Don't jump on a bandwagon - use what you know, use what you like, and, most importantly, use what you believe in. If you treat them, they will come.
  10. mmcnemar2004

    mmcnemar2004 Member 7+ Year Member

    May 20, 2001
    That's right, OMT is an extra treatment option, some will use it some will not. They need to repeat the study since over 30% were excluded. This will make it more scientifically valid, even though I believe we have a better chance at getting pigs to fly than 70% of physicians to answer their questionaire.
  11. R. Dale Jackson

    R. Dale Jackson Senior Member 10+ Year Member

    Mar 2, 2000
    East Lansing, Michigan
    One thing I have noticed is that the face of osteopathic medicine is changing rapidly. This is attributable to the ongoing changing of the guard...out with the old and in with the new. As younger medical students/D.O.'s, we are not having to face the professional prejudices that our brothers and sisters who came before us did. The osteopathic profession is exploding with the opening of new schools and the advent of the OPTI's (which is still a new, work-in-progress). From my experiences, the younger generation is more passionate about advancing OP&P. I have seen many examples of this take the form of both word and deed.
    As far as OMT goes, it is both an extra tool and a "skill". Not everyone is "good" at OMM and therefore some choose not to incorporate it as much...yes there are other reasons for choosing not to as well, but many of these barriers are coming down (e.g. billing). With that said, OMT is only one of many things that make D.O.'s different from M.D.'s. The science is the same, but the philosophy and the practice are different in a number of ways.
    The problem we have is the dilution that many D.O.'s suffer from when they are immersed in ACGME training. For many it is not practical--because of distance, time, etc--to maintain a strong osteopathic influence. Their OP&P therefore is diluted by allopathic principles and practices. This is most evident if you have the opportunity to observe two osteopathic physicians--one who was trained in an AOA program and one who was trained in an ACGME program with no D.O. staff/mentors. This is why we must continue to work to expand our OPTI's, open new residency programs and obtain parallel accreditation status for existing programs...what I mean here is that there are a number of MD residencies that have ACGME trained D.O.'s as residency directors/staff. Many of these doctors have an interest in incorporating more OP&P into their ACGME residencies and then applying for AOA accreditation. In the past, the "old guard" prevented them from do so. Well, that is changing.
    It is a brave new world ladies and gentlemen. Those of us on this board are the physicians of tomorrow. My only advice is stay informed, speak up and work hard to advance our profession. I personally think that there is no better doctor to be, than an well-trained osteopathic one.
    Dale :)

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