MD using holistic approach

[hmania]

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Out of curiosity, are there any MD's adopting the holistic approach when treating a patient?

 

[sylvanthus]

Nope totally impossible, only DOs do it.

 

[MedPR]

Out of curiosity, are there any MD's adopting the holistic approach when treating a patient?

No, MD schools actually teach you to ignore everything about the patient except what is pertinent to their disease, illness, or injury. By having tunnel-vision, you optimize your focus.

Nope totally impossible, only DOs do it.

+1.

 

[Drrrrrr. Celty]

MD's seek primarily to use medications to realign the bodies lympatic fluids which are a sacramental force to the Amina Mundi.
You see only DO's use the scientifically backed up holistic methods. MD's simply use meds to plump patients up for their satanic sacrificial pyres once they can no longer persist in the realm.

 

[WorldChanger36]

Out of curiosity, are there any MD's adopting the holistic approach when treating a patient?

Although rare yes many MDs do. You'll see it more in IM fields and family med

 

[hmania]

Although rare yes many MDs do. You'll see it more in IM fields and family med

really? are you sure?

 

[FrkyBgStok]

today, the only difference in care is based on personalities. If an MD and DO are compared, and the DO is more holistic, it is because the MD is a dbag. A good MD uses a holistic approach.

 

[Iliketoytles]

today, the only difference in care is based on personalities. If an MD and DO are compared, and the DO is more holistic, it is because the MD is a dbag. A good MD uses a holistic approach.

Truth.

 

[WorldChanger36]

really? are you sure?

Yeah I am sure.

 

[munchymanRX]

I invite those involved in this thread to examine how medicine is taught at Osteopathic and Allopathic schools, and then determine what 'holistic method' means and whether it is different between the two curricula.




SPOILER ALERT: It isn't. 🙂

 

[WorldChanger36]

I invite those involved in this thread to examine how medicine is taught at Osteopathic and Allopathic schools, and then determine what 'holistic method' means and whether it is different between the two curricula.




SPOILER ALERT: It isn't. 🙂

I agree

 

[SpecterGT260]

Nope totally impossible, only DOs do it.

No, MD schools actually teach you to ignore everything about the patient except what is pertinent to their disease, illness, or injury. By having tunnel-vision, you optimize your focus.




+1.

MD's seek primarily to use medications to realign the bodies lympatic fluids which are a sacramental force to the Amina Mundi.
You see only DO's use the scientifically backed up holistic methods. MD's simply use meds to plump patients up for their satanic sacrificial pyres once they can no longer persist in the realm.

all of this is 100% correct 👍

 

[TriagePreMed]

Out of curiosity, are there any MD's adopting the holistic approach when treating a patient?

And be like a dirty Osteopath? Pfft, please.

 

[rzoo14]

today, the only difference in care is based on personalities. If an MD and DO are compared, and the DO is more holistic, it is because the MD is a dbag. A good MD uses a holistic approach.

+1.

I invite those involved in this thread to examine how medicine is taught at Osteopathic and Allopathic schools, and then determine what 'holistic method' means and whether it is different between the two curricula.




SPOILER ALERT: It isn't. 🙂

I have to agree with this. I've talked to a few students from TCOM and UTMB/UT Houston. They share a lot of similarities in their curriculum.

 

[HalfListic]

Just to throw this out, there is a difference in 'a holistic approach' and OMM. OMM includes holistic care and thinking, which is common among all good doctors. But, OMM also contains Osteopathic principals and practices unique to DO's, including but not limited to OMT.

Also, there is a spectrum how holistic one's approach can be. You could call getting a patient history a 'holistic approach'...That being said, there are MDs and DOs who practice all kinds of philosophies of medicine. But, if you look at the masses, the average, the majority, I would say that DOs are at least slightly more holistic in care and philosophy.

 

[QualityProcess]

MD's simply use meds to plump patients up for their satanic sacrificial pyres once they can no longer persist in the realm.

serenade is my current #1 ranked counter-troll.

I really don't understand the rhetoric. I'm trying. I read Gevitz's The DOs, and know the history, and I've read a lot on the subject because I'm limited to applying to DO schools.

So I asked several MDs and DOs. What's the tangible, clinical, pragmatic difference between a DO and an MD?

I get the the same basic answer from both MDs and DOs, and rarely more than five words. "Clinically irrelevant." "No difference." "I can't do manipulation."

And the "clinically irrelevant" came from a DO I've watched perform OMT in the ED, so he still relates to his academic training and hasn't lost touch (pun intended).

 

[HalfListic]

I really don't understand the rhetoric. I'm trying. I read Gevitz's The DOs, and know the history, and I've read a lot on the subject because I'm limited to applying to DO schools.

So I asked several MDs and DOs. What's the tangible, clinical, pragmatic difference between a DO and an MD?

I get the the same basic answer from both MDs and DOs, and rarely more than five words. "Clinically irrelevant." "No difference." "I can't do manipulation."

And the "clinically irrelevant" came from a DO I've watched perform OMT in the ED, so he still relates to his academic training and hasn't lost touch (pun intended).

Try reading a brief guide to osteopathic medicine...

I think the point is, even subtle differences can be significant. It took a while for me to realize that I really hadn't done my research on Osteopathic Medicine. I read The DOs like you and tons of others, but thats just historical context...which wouldn't help in this case.

There are many more sources, but Ive found that not many people are really that motivated to put in too much time to research OME, so that brief guide might be the best thing for most people.

Edit: Its a difficult question to answer too...from either perspective. Are MDs and DOs different? Thats what this discussion always leads to. Its not something that many current physicians MD or DO really have a great grasp on either, from my experience.

The answer is always both. Theres no difference to what either of them can do...but if you don't know the differences that do exist, I would suggest *you* (anyone) needs to research further...

 

[TriagePreMed]

Try reading a brief guide to osteopathic medicine...

I think the point is, even subtle differences can be significant. It took a while for me to realize that I really hadn't done my research on Osteopathic Medicine. I read The DOs like you and tons of others, but thats just historical context...which wouldn't help in this case.

There are many more sources, but Ive found that not many people are really that motivated to put in too much time to research OME, so that brief guide might be the best thing for most people.

Edit: Its a difficult question to answer too...from either perspective. Are MDs and DOs different? Thats what this discussion always leads to. Its not something that many current physicians MD or DO really have a great grasp on either, from my experience.

The answer is always both. Theres no difference to what either of them can do...but if you don't know the differences that do exist, I would suggest *you* (anyone) needs to research further...

I don't know, man. I kinda trust physicians more when they say there is no difference than your interpretation of the facts.

 

[HalfListic]

I don't know, man. I kinda trust physicians more when they say there is no difference than your interpretation of the facts.

So, what are my interpretations of the facts that you don't agree with?

I think you were around for my arguments for combining the degree's right? I also just said that in practice, MDs and DOs are the same in potential. So, elaborate...maybe you misread my comment?

But, having said that...if one cant state some simple differences between DO and MD philosophy, education and practice potentials...they are either uniformed for some reason unwilling to state the obvious...

 

[SpecterGT260]

Try reading a brief guide to osteopathic medicine...

I think the point is, even subtle differences can be significant. It took a while for me to realize that I really hadn't done my research on Osteopathic Medicine. I read The DOs like you and tons of others, but thats just historical context...which wouldn't help in this case.

There are many more sources, but Ive found that not many people are really that motivated to put in too much time to research OME, so that brief guide might be the best thing for most people.

Edit: Its a difficult question to answer too...from either perspective. Are MDs and DOs different? Thats what this discussion always leads to. Its not something that many current physicians MD or DO really have a great grasp on either, from my experience.

The answer is always both. Theres no difference to what either of them can do...but if you don't know the differences that do exist, I would suggest *you* (anyone) needs to research further...

keep in mind that very few people start off specifically in a DO pool. Of those that are, the vast majority choose it because of outside circumstances. It isnt really rational to assume that the two groups of people who were at 1 point only 1 group will have a substantial difference in philosophy. You are making the argument that either extenuating circumstances (which are inherently random) are positively correlated with DO mindset - this is absurd, or that the training itself is enough to rewrite who the person is in terms of "bedside manner" and "draw to primary care" (2 regularly cited differences). I don't buy it.

As far as the other thing goes, MDs are not walking textbooks, and I am not even sure how such a notion could have been started. The MD education revolves around understanding the concepts and the ability to apply - which is inherently outside the box thinking. "outside the box" should not be confused with "accepting without evidence" or anything like that.... not that this is exactly what you mean.
Sure there are "memorizers" in MD schools. But there are plenty of them in DO schools as well.

I just have too many friends in DO schools to believe for a minute that anything about their experience is going to make them more or less anything than who they would have been if they had gone to an MD school


EDIT: try to think of it in terms of a clinical trial. They always provide demographic stats on the sample population. Inevitably you often find 1 factor that is statistically different between the test groups, but it isnt necessarily enough to call it causative. if MD or DO are the two treatments, and if at the end of "treatment" we really see more caring, holisticity (probably not a word...), better bedside, or a higher real drive to primary care, we have to look at all differences between sample groups and make a judgement on validity. Does the training itself make you "nicer"? What about grades/scores? This is a statistical difference between groups I dunno, I just tend to think that nearly everyone in medicine is the same person they were when they started (for the most part) but now with oodles of more knowledge. I dont see how a twice weekly OMM lab will make you more likely to listen to a patient

 

[HalfListic]

keep in mind that very few people start off specifically in a DO pool. Of those that are, the vast majority choose it because of outside circumstances. It isnt really rational to assume that the two groups of people who were at 1 point only 1 group will have a substantial difference in philosophy. You are making the argument that either extenuating circumstances (which are inherently random) are positively correlated with DO mindset - this is absurd, or that the training itself is enough to rewrite who the person is in terms of "bedside manner" and "draw to primary care" (2 regularly cited differences). I don't buy it.

As far as the other thing goes, MDs are not walking textbooks, and I am not even sure how such a notion could have been started. The MD education revolves around understanding the concepts and the ability to apply - which is inherently outside the box thinking. "outside the box" should not be confused with "accepting without evidence" or anything like that.... not that this is exactly what you mean.
Sure there are "memorizers" in MD schools. But there are plenty of them in DO schools as well.

I just have too many friends in DO schools to believe for a minute that anything about their experience is going to make them more or less anything than who they would have been if they had gone to an MD school


EDIT: try to think of it in terms of a clinical trial. They always provide demographic stats on the sample population. Inevitably you often find 1 factor that is statistically different between the test groups, but it isnt necessarily enough to call it causative. if MD or DO are the two treatments, and if at the end of "treatment" we really see more caring, holisticity (probably not a word...), better bedside, or a higher real drive to primary care, we have to look at all differences between sample groups and make a judgement on validity. Does the training itself make you "nicer"? What about grades/scores? This is a statistical difference between groups I dunno, I just tend to think that nearly everyone in medicine is the same person they were when they started (for the most part) but now with oodles of more knowledge. I dont see how a twice weekly OMM lab will make you more likely to listen to a patient

I appreciate this obviously well thought out and stated assessment you just gave. I both agree and disagree with you on many points.

I agree:

- there are still many, maybe most, pre-DOs who are here by default. This will continue to be the case for years (but not always).
-I also agree with your assessment of MDs...Im not sure what you were responding to that I said, but I agree nonetheless.
-I agree with your statement about current students, its been my experience with my friends in DO schools as well...a lot are just there to get licensed and move on. Nothing too wrong with that

(But, this will change with time...many people are beginning to choose DO from the start. And entrance is becoming very similar to MD...its only a matter of time)

I disagree:

-I like your clinical trial comparison. I disagree with your conclusions. You ask if training makes you nicer or more likely to do something (in this case listen to a patient) While this is somewhat of an oversimplification of what DO training is, I can see what you are saying. You concluded that training doesn't change action. This simply isn't so. Training, both in theory and in practice, does change you...unless you don't want it to. Think of it as a business, the companies who have daily meetings to greet each customer as they walk in the door have a lot of success with that.

**I almost forgot to put this one in...maybe my strongest objection here. you say "I just tend to think that nearly everyone in medicine is the same person they were when they started (for the most part) but now with oodles of more knowledge." I strongly disagree. If you don't believe that you can change as a person, or that something as significant as medical school can change you (and not just in knowledge and skills) then I feel that you are missing out on a major opportunity. This sounds melodramatic, but we are all works in progress til we die. The worst thing you could do would be to stay the same...***

-you state in your opening paragraph that two groups that came from a single group cannot be expected to have "a substantial difference in philosophy". Think about that statement...how many examples could I give of groups branching off and forming completely different philosophies; religions, cultures, language, species, clubs...you get my point.

**And just to reiterate, Ive said nothing about MDs here, or before. My statement before still stands for you and for triagePremed and anyone else to consider: If someone doesn't know the simple differences between DO and MD philosophy, education and practice potentials...they are either uniformed or for some reason unwilling to state the obvious...

edit: this isn't an insult to anyone either. I just think that one should really know what Osteopathic Medicine is if they are going into it, want to dispute it, or want to further it.

 

[SpecterGT260]

Ok I see what you are saying.....

The thing about MDs was to someone else up there. I saw it in skimming, cant remember who.

But as far as the rest of the comparison - the point isnt whether or not you can or will change. The point is whehter or not the training itself is driving that change and is doing so in a way that different from another.

maybe a different analogy? You shine a light (pre-med students) through two different prisms. Their trajectories all change. So the question is: is the DO prism different enough from the MD prism to cause that same beam of light to land in a significantly different space? I am sure the DO students in here have classmates that are very "bookie" or even downright d-bags 😛, 2 things that are not exemplified in the classic DO stereotype. Personally, I catch crap from friends in my class for being over-the-top analytical (yes, I am aware of this personal quality, and no it should not be used to characterize MD students in general). We've got people in our class that really seem to have more heart than brains (but still enough of both to pass 😉 ).

Can any DO students point to anything in their curriculum that is unique that will tailor your outlook in these ways? This is what we need - a coherent mechanism by which such conclusions are valid. Otherwise we are finding an arbitrary significance in a population that is not at all causative. Anything short of shock therapy for leaving a patients room before asking them how their children's children's day was, I cant come up with anything 👍

 

[HalfListic]

Ok I see what you are saying.....

The thing about MDs was to someone else up there. I saw it in skimming, cant remember who.

But as far as the rest of the comparison - the point isnt whether or not you can or will change. The point is whehter or not the training itself is driving that change and is doing so in a way that different from another.

maybe a different analogy? You shine a light (pre-med students) through two different prisms. Their trajectories all change. So the question is: is the DO prism different enough from the MD prism to cause that same beam of light to land in a significantly different space? I am sure the DO students in here have classmates that are very "bookie" or even downright d-bags 😛, 2 things that are not exemplified in the classic DO stereotype. Personally, I catch crap from friends in my class for being over-the-top analytical (yes, I am aware of this personal quality, and no it should not be used to characterize MD students in general). We've got people in our class that really seem to have more heart than brains (but still enough of both to pass 😉 ).

Can any DO students point to anything in their curriculum that is unique that will tailor your outlook in these ways? This is what we need - a coherent mechanism by which such conclusions are valid. Otherwise we are finding an arbitrary significance in a population that is not at all causative. Anything short of shock therapy for leaving a patients room before asking them how their children's children's day was, I cant come up with anything 👍

"The thing about MDs was to someone else up there. I saw it in skimming, cant remember who." -OK, got ya!

"The point is whehter or not the training itself is driving that change and is doing so in a way that different from another"
-OK, I thought that was the issue, and Id love to discuss it.


Can training change someone, thats the question. So, to be picky, the prism analogy would only show if one prism (the MD or DO) is different, and not why they are. We can discuss whether they are different if you want, but Ill stick to the question of, does training cause a change.

Ill give an example. Of course we all see the difference in skill before and after training (easy examples: military, law enforcement...physicians) but the question is not about skill, its if the training shapes belief, which then would shape action (method of medical treatment)

An example: "the law of the instrument" or "maslow's hammer". We have all heard it, if you have a hammer, you see everything as a nail. This is also true of medical training. Any specialty we are given, we have a new context from which we perceive our patients problems...surgeons cut, internist prescribe, etc. So, are ideas different than skills? If you were trained in OMT, and believed its efficacy, you would have one more tool to consider in your decision. that is one concrete difference.

Another, you could look at the four tenants of Osteopathic medicine as tools as well. They give you a context in which to see your patients disease. So, if we can agree that DO students are educate and trained slightly different, using the 4 tenants as the example, then I think we would have to conclude that this training makes their diagnostic context as physicians slightly different.

This context translates into several small differences, that in my mind, add up to significant differences in how an MD and DO treat a patient. This observation of mine is supported by several studies (I think we have discussed them before) that show that when a DO treats a patient using the 4 tenants as a guide and OMT as an option, there are certain benefits with a significant *difference from medical only (MD) including:

-decreased hospital stay
-decrease in the amount, or even use, of pharmaceuticals (esp NSAIDs)
-lower perceived pain
- as well as use of patient's first name, discussing preventive measures, and discussing the patient's emotional state, family life, and social activities

For this, and other reasons, I've argued to open the DO training to any physician. We are all medical doctors, some just have the DO training as well, and if its beneficial it should not be exclusive. AT Still was an MD, DO. ...But this is another topic...I just wanted to clarify the context

*(there are problems with the lack of trials in the area of OMT and OME in general...I hope to change it. But, all the results came from blinded trials, randomized and with sham (LT) treatment. So, for the sake of discussion, they are significant trials.)

 

[SpecterGT260]

Those studies have often had some pretty big flaws in them in terms of unaddressed confounders (saw a big one that didnt account for the fact that the DO patient group were double treated..... but there are other study design issues as well).


The whole prism thing was just a though exercise. There honestly isnt a good real world measure unless we have people that have done both training sets. The question really just boils down to "what aspect of the training causes these findings" if we even accept the findings to be real or not simply artifacts of other goings-on

we can agree that OMM constitutes a different tool, but are you suggesting that the training in, and the having of, OMT is a mechanistically sound explanation for a doctor being more personable?

Personally, I have read studies which try to prove the "osteopathic-ness" of medicine post graduation. They were done in major osteopathic institutions (read: old) and asked via survey for things specific to osteopathic tenets rather than focusing on patient interpretation. Things like "did the physician explain to you the osteopathic philosophy" is not a proper metric for this study. Of course that is skewed one way. I have also not seen proper blinding. But I would love to see a retrospective analysis done on through a major hospital via satisfaction surveys (not osteopathic specific) which includes comments about bedside, explanation of treatments and whatever, and subjective reporting on "did you feel listened to/caredabout?" To my knowledge this has not been done (or has been, but since only the AOA is interested in such studies it is possible that they scrubbed the publication in favor of the ones with specific osteo identifiers )

 

[HalfListic]

Those studies have often had some pretty big flaws in them in terms of unaddressed confounders (saw a big one that didnt account for the fact that the DO patient group were double treated..... but there are other study design issues as well).


The whole prism thing was just a though exercise. There honestly isnt a good real world measure unless we have people that have done both training sets. The question really just boils down to "what aspect of the training causes these findings" if we even accept the findings to be real or not simply artifacts of other goings-on

we can agree that OMM constitutes a different tool, but are you suggesting that the training in, and the having of, OMT is a mechanistically sound explanation for a doctor being more personable?

Personally, I have read studies which try to prove the "osteopathic-ness" of medicine post graduation. They were done in major osteopathic institutions (read: old) and asked via survey for things specific to osteopathic tenets rather than focusing on patient interpretation. Things like "did the physician explain to you the osteopathic philosophy" is not a proper metric for this study. Of course that is skewed one way. I have also not seen proper blinding. But I would love to see a retrospective analysis done on through a major hospital via satisfaction surveys (not osteopathic specific) which includes comments about bedside, explanation of treatments and whatever, and subjective reporting on "did you feel listened to/caredabout?" To my knowledge this has not been done (or has been, but since only the AOA is interested in such studies it is possible that they scrubbed the publication in favor of the ones with specific osteo identifiers )

Yeah, there are some trials with problems. But there are also plenty good trials...many people have thrown the baby out with the bathwater on this issue. Here a good example of a good trial:

http://www.om-pc.com/content/4/1/2

I also agree about the kind of studies that should be done, and the questions that should be asked. The one I can think of was the 2003 Maine Osteopathic Outcomes Study. Its outcomes were pretty significant as far as perceived quality of care. The flaw was n-number, but it was blinded and this could easily be repeated on a larger scale. so I hope thats done soon.

But one thing we can also agree...we need more. DO schools need to have teaching hospitals so that they can conduct these studies. But, this is happening at places like TCOM and UMDNJ who have the money and hospital affiliations...so, again, I think its just a matter of time.

So, I guess we now agree that training can change people in general..but now are asking

1-what is different about DO training
2-are the differences a result of that training, or is something else causing the difference

My quick answers:

1-the four tenants of OME, and OMT
2-I'd like to hear what else you think could be the cause of any difference. To be honest, Ive seen it in business...if you train someone to be some way, it works. And it carries into personal life. This is really a universal truth, so I guess Ill defend it, but only if I have to.

(Last of all, just to answer your question...no, I don't think that OMT makes someone nicer. The different quality that OMT would help develop in a DO would be open-mindedness and anti tradition, i.e., not accepting that the status quo is the only or the best way to do something. These are two qualities that I also see more pervasively in DOs)

 

[SpecterGT260]

(Last of all, just to answer your question...no, I don't think that OMT makes someone nicer. The different quality that OMT would help develop in a DO would be open-mindedness and anti tradition, i.e., not accepting that the status quo is the only or the best way to do something. These are two qualities that I also see more pervasively in DOs)

I was with you up until here. As an MD student at a public university, we have a massive hospital with oodles of doctors involved in active clinical and bench research looking for ways to improve the way we do things and constantly looking back to make sure the outcomes are what we would expect. Publication is a requirement for nearly all allopathic residents (at least here.... but I suspect everywhere). IMO the only MDs who are complacent with the status quo are private PCPs. Ive come across quite a few who think "well this is the way weve always done it and it works good enough". I chalk this up to being removed from an academic setting more than being MD as I am sure a good many private DOs would fit the same bill. To be honest, I see many aspects of OMM and the strict adherence to the tenets as a sort of "status quo complacency". There is mounting evidence that some techniques are simply wrong and ineffective yet they are held on to.

 

[SpecterGT260]

This thought hadnt occurred to me previously, but in LOS studies (which are very common by the AOA) I would really like to see discharge for patients being determined by a blinded third party. I am currently doing research where I have to count cells of specific morphology and it is incredibly difficult to blind myself and stay unbiased. There is no way to blind the docs doing OMM, and if they are also calling the shots for discharge we have incorporated a huge bias. I couldnt find it explicitly stated in there, but it does look like they brought in off-site OMT practitioners. They call the design double blinded but in this case it means the patients and the people analyzing the data do not know. It isnt as if the DO performing OMT didnt know if he was there or not (maybe they got him really drunk )

I'll keep looking it over, but just wanted to make the point in how powerful bias and placebo are and why it is always important to go back and form a coherent mechanism and not just " well if it works it works" - such a mindset is why things like Adrenal Success is an actual product....


EDIT:
ok, its in there

Subjects, personnel responsible for collecting data, attending physicians, nurses, and house staff caring for subjects were blinded to group assignment. Only the physicians giving the study treatments were unblinded to group assignment.

although I am not sure how I feel about the ITT numbers being so grossly different from the PP... I guess technically it makes sense because the bump was due to inconsistency with OMT administration. hmmmmm.
Interestingly, in the ITT anaylys, the OMT group was the only group to have a statistically significant finding with serious adverse event. I am not sure how they are defining this but it is interesting how the outcomes differ based on population selection.

 

[HalfListic]

I was with you up until here. As an MD student at a public university, we have a massive hospital with oodles of doctors involved in active clinical and bench research looking for ways to improve the way we do things and constantly looking back to make sure the outcomes are what we would expect. Publication is a requirement for nearly all allopathic residents (at least here.... but I suspect everywhere). IMO the only MDs who are complacent with the status quo are private PCPs. Ive come across quite a few who think "well this is the way weve always done it and it works good enough". I chalk this up to being removed from an academic setting more than being MD as I am sure a good many private DOs would fit the same bill. To be honest, I see many aspects of OMM and the strict adherence to the tenets as a sort of "status quo complacency". There is mounting evidence that some techniques are simply wrong and ineffective yet they are held on to.

I mean this on a larger scale than your response here. I don't mean that MDs are ok without advancing medicine...MDs create far more advances by sheer number of research projects publications they participate in.

What I mean is where they look to for advancing medicine. Most MDs have a hard time looking at physical medicine for things like treating pneumonia or Alzheimer's...focusing their efforts mainly on pharmaceuticals, or even newer, genetically engineered viruses! This is awesome, and wonderful! I want to, and will be, a part of this. But, I think they have a narrow focus of the future.

DOs, again, in general, have no problem with new medicament and treatment/modalities, but they are also open to look at the positive effect of OMT.

Its like MDs are making better and better cars all the time. But, they all still run on gasoline. DOs are just saying look into electric, or at least a hybrid.

Last of all, I agree with this statement whole heartedly, "To be honest, I see many aspects of OMM and the strict adherence to the tenets as a sort of "status quo complacency" There is no excuse to why DOs haven't turned on their research motors and churned out vast quantities of data to support things. There simply isn't enough and that is complacent! There are many aspects of current and old school DOs of which I am critical...But I hope to help change it.

 

[SpecterGT260]

I mean this on a larger scale than your response here. I don't mean that MDs are ok without advancing medicine...MDs create far more advances by sheer number of research projects publications they participate in.

What I mean is where they look to for advancing medicine. Most MDs have a hard time looking at physical medicine for things like treating pneumonia or Alzheimer's...focusing their efforts mainly on pharmaceuticals, or even newer, genetically engineered viruses! This is awesome, and wonderful! I want to, and will be, a part of this. But, I think they have a narrow focus of the future.

DOs, again, in general, have no problem with new medicament and treatment/modalities, but they are also open to look at the positive effect of OMT.

Its like MDs are making better and better cars all the time. But, they all still run on gasoline. DOs are just saying look into electric, or at least a hybrid.

Last of all, I agree with this statement whole heartedly, "To be honest, I see many aspects of OMM and the strict adherence to the tenets as a sort of "status quo complacency" There is no excuse to why DOs haven't turned on their research motors and churned out vast quantities of data to support things. There simply isn't enough and that is complacent! There are many aspects of current and old school DOs of which I am critical...But I hope to help change it.

I think we are overlapping quite a bit, but when we look at publications like this I think many many more studies HAVE been done that are being published by the AOA. The AOA is only publishing stories that have the right answer. The problem i have with most of these papers is that they do not read with the underlying assumption of "what happens when"... They instead start with the premise "we know this to be true, so lets demonstrate it" (or at least that is the feeling I get).

There is also work being done by MDs on old or alternative therapies. The intent is to extract usefulness and "trim the fat" so to speak. And yes, I have a very difficult time swallowing the use of OMM for pnemonia. I suspect you will too after you take med anatomy and phys and OMM in conjunction 😉

on a semi-unrelated note, are you aware of any studies that have looked at OMT vs LT in terms of effect on patient psyche? We know that mood and comfort can play a role in outcomes. Perhaps OMT just feels better than someone faking it Its complicated, but without any coherent mechanism these things need to be ruled out.

 

[SpecterGT260]

http://www.om-pc.com/content/4/1/2/figure/F5

OMT = osteopathic manipulative treatment, LT = light-touch treatment, CCO = conventional care only. Subjects may be included in more than one category. For example, three subjects had respiratory failure as their treatment endpoint and subsequently died while still in the hospital. * Serious adverse event category excludes respiratory failure and death. A, Intention-to-treat analysis. &#8224; OMT significantly greater than LT and CCO, P < 0.05. B, Per-protocol analysis. &#8225; OMT significantly less than CCO, P < 0.05.

For those who believed they knew their group assignment, there was a significant relationship between their actual and perceived group assignment (P < 0.0001), with subjects more likely to identify their group assignment correctly than to guess they were in either of the other two groups. Of those who believed they knew their group assignment, more CCO subjects (40/49 [82%]) correctly identified their group assignment than OMT (47/69 [68%]) or LT (38/62 [61%]) subjects. PP analysis results were similar.

so basically the majority of all patients knew what group they were in 😱

 

[HalfListic]

I think we are overlapping quite a bit, but when we look at publications like this I think many many more studies HAVE been done that are being published by the AOA. The AOA is only publishing stories that have the right answer. The problem i have with most of these papers is that they do not read with the underlying assumption of "what happens when"... They instead start with the premise "we know this to be true, so lets demonstrate it" (or at least that is the feeling I get).

Ok, I disagree here. These trials, the good ones, have a sham treatment for control and are put against medication only. This gives both sides equal change to prove better...so it is significant that the OMT group outperformed medication only on several key items.
(just because its difficult to maintain double blinding doesn't throw out the conclusions entirely...it just means, its difficult to maintain the blinding.)

With your line of thinking, you would have to think that walking into the room with a white coat, shaking someones hand, telling them its OMT and it will help heal them, would have the same effects as OMT. This is unfounded and is a bit lazy to throw out the entire trial based on it.

There is also work being done by MDs on old or alternative therapies. The intent is to extract usefulness and "trim the fat" so to speak. And yes, I have a very difficult time swallowing the use of OMM for pnemonia. I suspect you will too after you take med anatomy and phys and OMM in conjunction 😉

Im glad of this fact, and am aware of it. But to respond to your stomaching OMT for pneumonia: this shows a common misunderstanding of what OMT should be used as. The question is NOT, pills or OMT. The question is pills only, or OMT with less need for pills. See, DOs can still use them...its a Complementary medical procedure and it has been shown to reduce the need for pills, pain, and hospital stay. Whats hard to stomach about that?

on a semi-unrelated note, are you aware of any studies that have looked at OMT vs LT in terms of effect on patient psyche? We know that mood and comfort can play a role in outcomes. Perhaps OMT just feels better than someone faking it Its complicated, but without any coherent mechanism these things need to be ruled out.

now, lastly, here is a good question...I have posed this question too with limited response. I dont think there is a good answer for OMT vs LT yet, hence my argument that there is NOT enough data out there to make a sound conclusion.

Something to think about though...if OMT and/or LT has these great results (assuming they do) why are you so against them. This one of those differences of open-mindedness that I have been referring to.

Im also not OK with blind acceptance of any treatment. But, I have found that I am more open to the possibility that it does work. To me, its the difference between being skeptical (I am) and Anti (many MDs are)

The fact we keep coming back to: theres not enough data...yet 😉

 

[MedPR]

Did this thread really become serious discussion?

 

[rzoo14]

Did this thread really become serious discussion?

I know man. HalfListic and SpecterGT260 are going full on debate mode. I do like it though, a lot of different perspectives to look at and a lot of valid points from both sides.

 

[HalfListic]

Yeah, it's nice to discuss these things. Id love to hear others opinions as well! Anyone can jump in...

It's nice to have all kinds of threads here.

And people like specter give me a chance to stay sharp on my own opinions, and make sure I get rid of any bias I may have.

Plus, it's fun

 

[SpecterGT260]

👍

 

[SpecterGT260]

http://pediatrics.aappublications.org/content/119/3/608.full a friend of mine posted this on FB. thought it applied here.

 

[qwerty2012]

so Md treat their patients partially? 😳

 

[SpecterGT260]

the part that needs to be treated, yes 😉

 

[HalfListic]

http://pediatrics.aappublications.org/content/119/3/608.full a friend of mine posted this on FB. thought it applied here.

I liked it...

a great quote:

The interpretation of any research findings should occur in the context of the magnitude of change that occurred and the clinical significance of the findings.

I think statistics are lost on quite a few pre-meds, med students and even physicians. Ive been glad to see stats become a pre req for many schools (TCOM, for one, just added it)

Its all about interpretation...correct interpretation, with peer agreement and factual/clinical support

 

[SpecterGT260]

I liked it...

a great quote:

The interpretation of any research findings should occur in the context of the magnitude of change that occurred and the clinical significance of the findings.

I think statistics are lost on quite a few pre-meds, med students and even physicians. Ive been glad to see stats become a pre req for many schools (TCOM, for one, just added it)

Its all about interpretation...correct interpretation, with peer agreement and factual/clinical support

we had an EBM lecture that focused on statistical significance and the meaning of relative and absolute changes. He brought up a pain drug that was marketed as "More powerful than xxx", and had statistical significance to back it. However it was 1 positive findings on a questionable with about 60 questions, and in absolute terms increased the "comfort" according to the scale by about 3%. This was touted as double the effect, but that is because their comparison was crappy at abut 2-4%in absolute terms and the market control (tylenol) blew both of them out of the water

It is just important to remember what the numbers really mean, and something can be significant statistically and still have literally zero clinical impact. Also, significance doesnt imply a mechanism - which is my major issue with the OMT papers. Aside from the issue of the majority of patients correctly identifying their treatment group after the fact, there is no mechanism proposed. It is simply "we found a benefit"but without a mechanism there could very well be something coincidental that is the real culprit.

 

[deleted103644]

Out of curiosity, are there any MD's adopting the holistic approach when treating a patient?

Please keep these practices segregated to DO practitioners. It will make it easier to destroy them.

EDIT: The practices, not DOs per se.

 

[SpecterGT260]

Please keep these practices segregated to DO practitioners. It will make it easier to destroy them.

holistic as a word has been adopted by the alternativists and gets flavored poorly... There is nothing wrong with being holistic and your own training is very holistic. The standard pt. exam and interview covers head to toe everything and includes a psych issues such as mood and demeanor.

as a physician (MD or DO, regardless....) you try to either hope the referring practitioner did an appropriate screen in which case you can focus, or as a PCP you need to follow patient statements down the rabbit hole just far enough until you are certain that the information is no longer pertinent to treatment or your patient's outcome.

Both MDs and DOs do this and there is NOT a different way to do it 😉 So one could make the argument that DOs go further down the rabbit hole, but in this context it becomes a cost/benefit argument and I am of the opinion that we, as physicians, shouldnt be responsible for making our patients feel concerned for or cared about - that is the job of the friends/family. Unfortunately we are forced to play ball with patients with hair-trigger emotional snares and it inevitably interferes with proper treatment.

but at my current level of training, when we do patient interviews we get docked mad points if we do not pursue even the little things that the patient says. In one of my last standardized patients, she mentioned stress at work, which led us to insurance issues, which led to an otherwise benign diagnosis, but hey I can give you some information on support for healthcare 👍 Honestly when we talk about how "holistic" one is vs another the first objection that I have is "how in the hell could you be MORE "whole patient" oriented than our training is?"

 

[deleted103644]

I have nothing against holistic medicine if you're going by the literal definition, I'm opposed to "holistic" medicine.

 

[HalfListic]

we had an EBM lecture that focused on statistical significance and the meaning of relative and absolute changes. He brought up a pain drug that was marketed as "More powerful than xxx", and had statistical significance to back it. However it was 1 positive findings on a questionable with about 60 questions, and in absolute terms increased the "comfort" according to the scale by about 3%. This was touted as double the effect, but that is because their comparison was crappy at abut 2-4%in absolute terms and the market control (tylenol) blew both of them out of the water

It is just important to remember what the numbers really mean, and something can be significant statistically and still have literally zero clinical impact. Also, significance doesnt imply a mechanism - which is my major issue with the OMT papers. Aside from the issue of the majority of patients correctly identifying their treatment group after the fact, there is no mechanism proposed. It is simply "we found a benefit"but without a mechanism there could very well be something coincidental that is the real culprit.

a great class to have...thats cool.

"and something can be significant statistically and still have literally zero clinical impact"
-in the same vein, something could have much larger impact than its significance shows in a certain, given, context. This is my major problem with OMT papers...we don't know how to give it proper context yet. So, some blindly accept it, some blindly dismiss it (hey JohnnyD!) ..both are wrong.

 

[HalfListic]

I have nothing against holistic medicine if you're going by the literal definition, I'm opposed to "holistic" medicine.

...sadly, the word holistic has been whored out beyond practical use with out qualification anymore.

It would be nice to have a refreshed vocabulary

 

[deleted103644]

a great class to have...thats cool.

"and something can be significant statistically and still have literally zero clinical impact"
-in the same vein, something could have much larger impact than its significance shows in a certain, given, context. This is my major problem with OMT papers...we don't know how to give it proper context yet. So, some blindly accept it, some blindly dismiss it (hey JohnnyD!) ..both are wrong.

Do you blindly dismiss the History Channel episodes that claim aliens are responsible for pretty much any historic event? Can you disprove any of their claims?

I think we should fully investigate that before we start taking OMM seriously. 😛

 

[HalfListic]

holistic as a word has been adopted by the alternativists and gets flavored poorly... There is nothing wrong with being holistic and your own training is very holistic. The standard pt. exam and interview covers head to toe everything and includes a psych issues such as mood and demeanor.

as a physician (MD or DO, regardless....) you try to either hope the referring practitioner did an appropriate screen in which case you can focus, or as a PCP you need to follow patient statements down the rabbit hole just far enough until you are certain that the information is no longer pertinent to treatment or your patient's outcome.

Both MDs and DOs do this and there is NOT a different way to do it 😉 So one could make the argument that DOs go further down the rabbit hole, but in this context it becomes a cost/benefit argument and I am of the opinion that we, as physicians, shouldnt be responsible for making our patients feel concerned for or cared about - that is the job of the friends/family. Unfortunately we are forced to play ball with patients with hair-trigger emotional snares and it inevitably interferes with proper treatment.

but at my current level of training, when we do patient interviews we get docked mad points if we do not pursue even the little things that the patient says. In one of my last standardized patients, she mentioned stress at work, which led us to insurance issues, which led to an otherwise benign diagnosis, but hey I can give you some information on support for healthcare 👍 Honestly when we talk about how "holistic" one is vs another the first objection that I have is "how in the hell could you be MORE "whole patient" oriented than our training is?"

I think this is an interesting look into what might be another MD, DO difference. You ask how you could be more "whole patient", I think I DO would answer you by pointing out the first statement I bolded.

When DOs say they treat 'holistically" they aren't talking about herbal remedies and rain dances...they are talking about caring for a patient in mind, body and spirit. Its their opinion that health is connect to all three and that it is our responsibility as a physician to make the patient feel cared for, comfortable, etc...this is in addition to the primary duty of correct, competent medical care.

 

[HalfListic]

Do you blindly dismiss the History Channel episodes that claim aliens are responsible for pretty much any historic event? Can you disprove any of their claims?

I think we should fully investigate that before we start taking OMM seriously. 😛

Theres a big difference between OMT and Alien Invasions.

"I think we should fully investigate that before we start taking OMM seriously"

-Obviously we should. We should also not dismiss it until that time. It obviously has benefits...we just need to quantify them, maybe clean it up and peer review it, etc.

Your arguments could have been used to downplay any number of medical advancement, like penicillin.

 

[deleted103644]

Theres a big difference between OMT and Alien Invasions.

"I think we should fully investigate that before we start taking OMM seriously"

-Obviously we should. We should also not dismiss it until that time. It obviously has benefits...we just need to quantify them, maybe clean it up and peer review it, etc.

Your arguments could have been used to downplay any number of medical advancement, like penicillin.

Come on Half - you really need to learn about the scientific method.

There's a huge difference between the evidence for penicillin and any alternative therapies.

 

[SpecterGT260]

I think this is an interesting look into what might be another MD, DO difference. You ask how you could be more "whole patient", I think I DO would answer you by pointing out the first statement I bolded.

When DOs say they treat 'holistically" they aren't talking about herbal remedies and rain dances...they are talking about caring for a patient in mind, body and spirit. Its their opinion that health is connect to all three and that it is our responsibility as a physician to make the patient feel cared for, comfortable, etc...this is in addition to the primary duty of correct, competent medical care.

Being of that opinion is not a result of my training but a part of who I am. It also doesn't mean that I won't do it. I just consider it a bandaid