OMM Blues

Discussion in 'Osteopathic' started by Mr Kenobi, 09.23.14.

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  1. Mr Kenobi

    Mr Kenobi Jedi Member 2+ Year Member

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    So, I'm actually a fan of many of the MSK techniques we have learned in OMM during my time in school thus far. Aside from the cult aspect and A.T. Still adoration that takes place by some of the osteopath purists in the OPP department, OMT turned out (at the bare minimum) to be a great weekly anatomy review. I was previously involved in the rehabilitation of injured athletes before deciding to go to med school. I love MSK physical medicine and rehab. It's what originated my drive to continue on in medical academia. OMM techniques are used daily in a sports med rehab facility regardless of whether the therapists know what OMM is. A majority of OMM is MSK medicine..which is great and what I signed up for!

    However, my munificence towards OMM has taken a drastic turn as we have been hurled into studying the disreputable "cranial" the past several weeks. I find myself questioning my fortitude every day. To make matters worse, they are simultaneously integrating it into our EENT systems lectures as well as our clinical medicine OSCEs and I just about can't take it anymore. I do not understand why they waited until we reached the most bogus material possible to start integrating it into EVERYTHING we do! I question how this (cranial) can even exist in modern medical curricula in the US. I've had professors tell me to "just believe" that I am feeling things during the past couple labs--:( Not sure if the professors know (or care), but they are turning people so far off from OMM...even the ones who would like to use the MSK techniques in the future- like me. I am truly starting to feel animosity towards OMM. I legitimately attempted to come in to this year/block with an open mind but the techniques and the theories behind them are so disturbing.

    One of the basic science PhDs (geneticist) gave a lecture on EBM the first semester of our first year and the stuff we are learning in OMM right now is not that. I fear my inability to cease from asking questions or inability to "just believe" that I am feeling things that I don't is going to significantly affect my subjective grade in OMM this semester and the last thing I'd want to have happen is to have a poor performance in OMM hold me back from progressing through my course of study. Seems many of the OMM profs don't take to kindly to students offering up valid questions in regards to some of the more fringy aspects ie. cranial.

    Anyhow, I know I am not alone, even within my own class, but does anybody else in the SDN world have experience with this funk I am in?

    -Kenobi.

    +pity+

    TL;DR--I liked OMM, then cranial happened. Help.
     
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  3. costales

    costales 2+ Year Member

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    Pretend those pages are there for your entertainment. Pass your exam and move on.
     
  4. Mr Kenobi

    Mr Kenobi Jedi Member 2+ Year Member

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    [​IMG]
    Word. Obviously my plan. Just venting frustrations.
     
    Last edited: 09.23.14
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  5. Apoplexy__

    Apoplexy__ Blood-and-thunder appearance Bronze Donor 2+ Year Member

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    I didn't feel any animosity towards OMM until Cranial either, OP. It's an embarrassment.
     
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  6. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    Mr. Kenobi, I feel your pain. We just finished cranial. What's worse is somehow they have gotten of my classmates (a minority, to be sure, but too many) to guzzle the Kool-Aid right out pf the cooler spigot. These are smart kids who had multiple acceptances who were very successful science majors in undergrad. Some people have no BS detector.
     
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  7. CrookedCucumber

    CrookedCucumber 2+ Year Member

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    Look on the bright side. I have many classmates with your same sentiment. The way I see it, our generation gets to decide what DO turns into. I'm glad of the amount of skepticism my future colleagues have in the face of a lack of scientific evidence. I think this bodes well for the profession.
     
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  8. Mr Kenobi

    Mr Kenobi Jedi Member 2+ Year Member

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    Love your optimism about the future. Really, I do. Problem is, there are threads pretty similar to this one in the archives stretching back the better part of a decade.

    I'm sure it's the folks who "drink the cranial kool aid" that end up getting into OPP education at osteopathic medical schools in the first place--which obviously just perpetuates the issue. I think most people adopt the attitude like @costales above. "meh, just get through it and then forget about it"--Not that there is anything wrong it--and it is probably what I'll end up doing...but we all know then that the root of the problem remains. Be nice to see some change for sure.

    Here's to A New Hope for change in the future!:naughty:
    [​IMG]
     
  9. CrookedCucumber

    CrookedCucumber 2+ Year Member

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    It'll take DOs graduating now to take up leadership positions and speak out, but I think it will be done.
     
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  10. NeuroLAX

    NeuroLAX Discere faciendo 2+ Year Member

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    Kenobi, can you recite Chapman's points? Yeah, didn't think so. This too shall pass.

    After boards you'll eventually feel like:

    [​IMG]
     
  11. Shov

    Shov Jokester 5+ Year Member

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    I've been showing up to our cranial labs with a commensurate level of dress:
    upload_2014-9-23_16-44-24.png
     
  12. Petypet

    Petypet 7+ Year Member

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  13. SLC

    SLC Lock, Step, & Gone (Graduated!!!) 5+ Year Member

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    Our school didn't teach us cranial beyond how to do the vault hold, and Venous Sinus Drainage. But believe me, that was enough.

    Anyway, this actually turned out to be a fairly significant problem during COMLEX exams. I passed well, but can't help think I could have done a bit better had I known something about sphenobobular symphysis...or whatever you whackos call it.
     
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  14. Mr Kenobi

    Mr Kenobi Jedi Member 2+ Year Member

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    Smdh. We need to get this out of our curriculum AND off of our licensing exams. It is absolutely absurd.
     
    Last edited: 09.22.15
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  15. SurgeDO

    SurgeDO 2+ Year Member

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  16. DrEnderW

    DrEnderW 2+ Year Member

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    This thread has turned into a reunion for all frequently posting 2nd yr+ DO students.

    I love it.
     
  17. SurgeDO

    SurgeDO 2+ Year Member

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    i've had a couple MD surgeons bring up cranial who were genuinely curious about it. maintaing and voicing a strong stance against cranial manipulation is actually a good way to alienate yourself from the OMM crazies and establish yourself as an independent, evidence based thinker. the (few) MDs who have been skeptical of DOs appreciate it.

    any DO who is offended by voicing your disdain for this nonsense is not worth knowing anyway.
     
  18. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    A couple of things about OMM in general that I've been wondering whether they are unique to my school or are pretty universal:

    1)Do your OMM faculty correct each other publicly? At my school, one faculty member will be teaching lab and the rest will be evenly dispersed in the lab assisting and supervising students. There are a couple faculty members who will invariably shake there heads as the lecturer is explaining a technique, and sometimes even correcting the lecturer verbally but only within earshot of the students nearest to him.

    2)Do the OMM faculty out your school use different terminology than the rest of the medical world? At my school they use rare, (and I assume outdated since we never learned them in anatomy) terms like inion for the external occipital protuberance. They also refer to different DO schools as "The Kansas City School" instead of KCUMB and "The Texas School" instead of TCOM. They refer to "The New York School" and I'm not sure if they're referring to Touro or NYIT-COM.
     
  19. Mr Kenobi

    Mr Kenobi Jedi Member 2+ Year Member

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    1) Yes and 2) Yes. Both occur regularly at my school. This literally made me laugh.
     
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  20. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    This is absolutely correct.

    As to what you said in your original post about how you like the MSK and sports-medicine aspects of OMM- that raises an excellent point of how osteopathic medical education could be modernized. Why can't the osteopathic philosophy be framed as, "we believe physicians should have more training in and exposure to medically accepted musculo-skeletal techniques than what is taught in traditional medical schools"? We could cut out the BS, and rename the stuff that remains to catch up with modern science. We could get rid of the pseudoscience while still maintaining a philosophical distinction. Then haters could disagree with us and say that should be the purview of physical therapy, but they wouldn't be able to accuse us of spewing pseudo-scientific nonsense.

    If I were to paraphrase Han Solo, and say, "I've been through one end of this curriculum to the next and I've never seen anything to make me believe there's one all-powerful Primary Respiratory Mechanism controlling everything," I wouldn't be exaggerating what some people consider cranial to be. And that should tell us something.
     
    Last edited: 09.24.14
  21. hallowmann

    hallowmann 2+ Year Member

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    Hmm, so I just started cranial, and I'm still at keeping an open mind. All we've basically done is palpate landmarks and do a vault hold. We'll see what happens in 1-2wks... this has worried me a bit though...

    1) There is one professor that did this (publicly corrected the course director in front of the whole class) once or twice last year, but they stopped (most likely after being chewed out). Most others make statements to the whole class and the teaching doc, but they are usually things like alternative hand placement, etc. It's pretty messed up that they publicly "correct" the professor under their breath at your (and apparently other) schools. That would definitely turn me off to OMM.

    2) Yeah, there definitely is some use of old terms, like inion, but that's true among all our older faculty, not just in OMM. There are tons of terms like that that change in medicine, like what's happening with the MCL becoming the TCL. It's like when older microbiologists day Pneumocystis carinii instead of Pneumocystis jiroveci.

    No one really calls any school by the city/state they are in at my school, except maybe "Kirksville" - I've heard that a couple times.
     
  22. SurgeDO

    SurgeDO 2+ Year Member

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    oh goodie. i'd pay to see some fresh faces as they are first exposed to the proposed flexion and extension movements of the sphenoid and occiput.

    i remember watching the flexion and extension gif one of our professors brought up on the monitor. over and over again. one of those days you never forget. the 9/11 of DO school.
     
  23. AnonymousD.O.

    AnonymousD.O. 2+ Year Member

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    Do all Osteopathic schools integrate OMM this much? Our OMM course is very segregated from the rest of the curriculum. If it wasn't I would feel very frustrated....and I like OMM for the most part.
     
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  24. Lycian

    Lycian 2+ Year Member

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    In order to be able to do Cranial, you need to have a certain degree of palpatory sensitivity, which is not natural for a lot of people.
    What I have observed and been told my multiple faculty and students is that the students who cannot naturally feel these small movement have a form of Sour Grapes where they actively disparage the practice rather than taking the time to really try to develop the sensitivity to feel anything.
    I think your instructors are doing a bad job if they are just telling you to try to do it until you can feel it, but this situation is on you and your ability, not the practice of cranial itself.
    Despite having minimal training in cranial, I can feel the PRM very easily to the point it's understandable but nonetheless surprising to me others have so much difficulty with it. I also know a LOT of students at my school who have learned cranial and gotten very good results with it in their limited training, and I've worked with numerous physicians who have been able to turn around many many unsolveable cases with it (cranial do's often make 400 an hour with an unlimited patient que).
    I also know there have been studies put together which show cranial has a basis in evidence and efficacy (if anyone wants to pay me a few dollars I will compile and send them to you).
    Ultimately though, whatever I'm saying is my own beliefs and you have different beliefs and it's not my business to change them.
    However, I think as physicians you are obligated to behave in a mature and professional manner and if you disparage a practice just because you can't do it (and rationalize it thus is impossible), that is not the mark of mature adult.
    There is a huge difference between "I don't understand this and I can't do this" verses "I can't do this, therefore it must be demonized"
     
  25. NeuroLAX

    NeuroLAX Discere faciendo 2+ Year Member

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    Not all integrate. There were OMM lectures in the systems blocks, but they were tested on our OPP written exams and not on our systems exams.
     
  26. sylvanthus

    sylvanthus EM/IM/CC PGY-4 7+ Year Member

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    It has nothing to do with people not being able to do it, but more to do with the fact that there is no scientific basis for the very existence of cranial. Crappy studies with low sample sizes published in DO journals does not = legitimate research. Keep in mind this is coming from a DO.

    Keep on believing that you can feel something that doesn't even exist though, someone has to become the next OMM faculty.
     
  27. wjs010

    wjs010 2+ Year Member

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    OP, at least you made it that far. I'm like a month into school and wondering if some of the ROM techniques are legit. Lol
     
  28. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    Haha for me that gif was two weeks ago, we'll see how long and clear it lasts in my head.
     
  29. Lycian

    Lycian 2+ Year Member

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    I disagree with your assertion of it being something that doesn't exist.
    I would assume your basis for that assumption is:
    a) You cannot perceive it.
    b) You have not seen sufficient evidence/research to change your mind on it.
    Neither of those are actually very strong pieces of evidence to disprove it's existence.
    The more accurate and truthful statement would be: based on my present level of understanding, I do not think the PRM exists, rather than stating definitively it is false, does not exist and anyone who thinks otherwise is intellectually compromised.
    I also think there is a lot of evidence to suggest it is very likely to exist, from which many people have been sufficiently convinced to stake a large amount of their life on, but if you are coming from the arbitrary frame "it cannot exist" it makes it impossible to even be able to consider those points. This is a mentality patients hate, I have seen research showing highly correlates to malpractice lawsuits and is just not necessary.

    I think a lot of people don't have the ability to do cranial, but it's good for students to be exposed to it since the ones who can will often go on to incorporate it into their practice and many of the DOs I know who have made the largest positive impression of Osteopathy in the lay public were cranial osteopaths.

    So once again, if cranial doesn't work for you, that's fine, but for the reasons mentioned above, you should not attack the practice or anyone that likes it.

    To make this all go full circle: I knew a woman who suffered from severe crippling migraines and over a 15 year course was hospitalized at least 30 times and pumped full of narcotics to cope with them, and explored every single thing she could think of that might help them. I eventually met her, had her see a cranial osteopath, the D.O. looked at her, said her PRM was messed up in a few places, explained to both of us on a skull what was out of place (and let me palpate it), corrected the bones preventing the PRM from moving properly, and then my friend stopped having migraines. You can sit in an ivory tower and dismiss things like this, but especially given the weight on the side individuals thinking their is something to the phenomena, and with the strength of your evidence I think it is a much better attitude to be open to the possibility it exists, although if you had to guess it did not.

    Anyways there is nothing additional I can say on this subject so I will get back to studying pharmacology and I thank you for taking the time to read and consider what I said even if you don't agree with it! :)
     
  30. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    Not really integrated at my school. Thy pay lip service to OMM in our clinical skills classes and maybe (rarely) mention something during another class about how something ties in to OMM.
     
  31. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    That's also part of my frustration. There are some things where I think 'ok this makes sense, it sounds plausible' but I don't know how scientifically sound it is because the same people are teaching cranial.

    There are definitely aspects of OMM that provide a very useful clinical anatomy review. For example, they have to teach us how to screen for contraindications for the techniques so they have to review basic neurological exam skills on a regular basis. Dermatomes, myotomes, DTR's, signs of stroke and trauma, etc. While hardly unique to osteopathic medicine these regular reviews of those skills are definitely appreciated.
     
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  32. wjs010

    wjs010 2+ Year Member

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    Totally. Agree. The way I see it is, if physical therapists do it, it's legit. That's why I am looking forward to doing some manipulations
     
  33. Petypet

    Petypet 7+ Year Member

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    1. When students are told to blindly accept a treatment that "benefits" patients and "exists," as students, we should be given proof that it does in fact exist. To say something that exists, via subjective data, but not objective data, it is logical to reject said technique.

    2. Your example of the magical DO that "fixed her PRM" is just further proof that the osteopathic profession is based on pure anecdotal evidence and not science. Given that migraines are vasodilatory problem, you have no proof that by manipulating the musculature on top of the skull (b/c lets be honest, you aren't moving the damn skull) you affect the intracranial vasculature. For all we know, said patient has been constipated due to being "pumped full of narcotics" , took a huge dump, and that actually cured the migraine. Its just as logical.
     
  34. Mehd School

    Mehd School 2+ Year Member

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    I'm two months in, and I've already seen enough OMM as far as I'm concerned. I've been asked to "just believe" and "just think its moving" too many times, and we haven't hit cranial yet. I don't buy the bogus separate but equal charade, and I definitely wouldn't put my future patients in the awkward positions my OMM class has done in 8 short weeks. Even if I wanted to I don't see when I'd have the time to do so during an office visit. I'll be a DO, but I won't consider myself an osteopathic physician. What we're being taught from a philosophy standpoint is no different than what our MD friends are learning at schools with an updated curriculum. Being in OMM class is a chore and I wish I didn't have to learn it, but I'm viewing it 100% as a practical anatomy review.

    It's a shame too, because I was genuinely curious about it entering school. Now I never want to see it again.
     
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  35. DrEnderW

    DrEnderW 2+ Year Member

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    As far as I'm aware, there isn't a single study outside of the JAOA that shows efficacy for cranial manipulation. If there does happen to be a rouge study or two, I guarantee its not sufficient evidence to make a scientific claim that would past muster in any other discipline. It surely hasn't been replicated.

    It's not that he hasn't seen the evidence. The evidence does not exist. No one wants to do the studies because it would likely show zero efficacy, especially in a journal outside of the JAOA which has illegitimate publishing criteria an a impact favor of ZERO.

    Someone can like getting their head held, human touch, and respond to relaxation but that is entirely separate from clinical efficacy. If I can publish multiple papers a yr as a med student, why can't the entire field of cranial OMT back up their findings in reputable journals?
     
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  36. Petypet

    Petypet 7+ Year Member

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    There have been a few conventions, I think one was held 2 years ago at ATSU, and according to one of our younger faculty members, people couldn't replicate each other's findings regarding cranial.
     
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  37. Mehd School

    Mehd School 2+ Year Member

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    And, uh, that's not exactly surprising. It's embarrassing the entire profession holding on to this bullcrap. Not all OMM is bullcrap, but most of that isn't "unique" to OMM and can be found in other professions such as PT and OT. Cutting the fat out of our super special tool belt could go a long way for our image.
     
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  38. SurgeDO

    SurgeDO 2+ Year Member

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    the foundation of cranial manipulation, its principles, and its underlying physiology have absolutely no evidence to support it. the whole thought of cranial osteopathy was literally formulated by a medical student during an anatomy class simply by looking at a disassembled cranium. you are looking at this all wrong: deniers of cranial do not need to prove it is non-existent because there is absolutely no reliable source or piece of evidence that suggests it is real. instead, it is the responsibility of cranial supporters to prove that it does in fact exist.

    cranial osteopathy is on the same level of scientology. it is on the same level as chapman's points. if i were to say that aliens that exist in our colons are communicating to the mothership on the moon, my statement would hold the same level of weight as cranial osteopathy currently does. if there are any reliable sources that come out in the future that say otherwise, i will retract my statement.

    if the principles and physiology of cranial were true, several other fields would have noted it already. neurosurgeons are not waiting for a flexion or extension phases before they drill their burr holes. microsurgical removal of spinal cord tumors would be impossible if meninges were continuously oscillating back and fourth through the view of the microscope.
     
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  39. Lycian

    Lycian 2+ Year Member

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    If you sit in on (or look up videos on youtube) of neurosurgeries you can see the pulsation of the CSF exists (ie. some will periodically shoot out of holes in the dura).
    There isn't a good or agreed upon model for why it is, but it nonetheless is there and can be directly viewed in surgery.
     
  40. hallowmann

    hallowmann 2+ Year Member

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    I gotta be honest, you guys seem to have much worse OPP experiences than me. We are rarely if ever told to "just believe" things. Even with our intro to cranial it was presented essentially as "this is what we think is going on, but we don't necessarily know if this is what's happening or why is happening".

    Again, we just started cranial, so maybe things will be different when I learn dysfunction/treatment, but overall I'm a bit surprised at how non-pushy my OPP course is with concepts. It's a bit annoying because of the extra time, but I imagine I'd hate it so much more if I had experiences like the ones mentioned on here.
     
  41. HoboCommander

    HoboCommander 7+ Year Member

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    Cranial is obviously fake, but you still need to know all the techniques for your rotations. I made my preceptors an extra $2000-$5000 per rotation by doing OMM on the patients. When you become an attending, that will be YOUR money, that's extra money every month.
     
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  42. Mr Kenobi

    Mr Kenobi Jedi Member 2+ Year Member

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    Hmmm...naw. I dunno about you, but feels somewhat unethical to perform "procedures" and charge for them that I feel are fake and no benefit to the patient. I'll try to make my money legitimately backed up with some science and a side of morality.
     
  43. HoboCommander

    HoboCommander 7+ Year Member

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    You still need to learn the techniques to perform on rotations where they ask you to perform OMM. This is like asking a religious person to learn evolution in biology class. The teacher doesn't care whether they believe in evolution, they want to know if the student learned the material.

    It's not like real world medicine is all that evidence based. You'll be complaining every single day as a medicine or surgery resident the things you are asked to do if you are looking for evidence backing.
     
  44. Mr Kenobi

    Mr Kenobi Jedi Member 2+ Year Member

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    Catch 22--you have to believe in cranial for it to work...
     
  45. HoboCommander

    HoboCommander 7+ Year Member

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    lol... yep
     
    NurWollen likes this.
  46. NeuroLAX

    NeuroLAX Discere faciendo 2+ Year Member

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    After hearing others' experiences at their respective schools, I can't help but feel like the grass may be a little greener at our schools. I can only speak for myself, but I was never once told to "just believe" and I don't recall our lab going into too much detail with cranial other than the basics, various hand placements and some techniques around the face. The pre-doc OPP fellows get more instruction on it. We also signed up for OPP "selectives" like Advanced HVLA, Cranial, Office-based OMT, where we learned more techniques. You had to do at least one, so for those that chose cranial they got more instruction and the rest of us didn't. No complaints there.
     
  47. GUH

    GUH Underdawg 5+ Year Member

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    I don't know man... are stretches "legit"?
     
  48. Back 5

    Back 5 7+ Year Member

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    01.22.09
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    I like hvla. I don't have time to gently move the torso in and out of flexion 10-50 times to try and correct a segment. If hvla doesn't work, I'll teach them home exercises to loosen up the soft tissue.
     
  49. Jwalker

    Jwalker 5+ Year Member

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    Exactly, people seem to forget this. My rads professor told me that something like 95% of scans he does for PE are negative. With #'s like that - ordering that test is not evidence based medicine. It's I don't want to get sued medicine.
     
    HandsomeRob likes this.
  50. Petypet

    Petypet 7+ Year Member

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    But there is evidence demonstrating that you can catch a PE w/ a CT, and there is further evidence showing significant morbidity and mortality by not diagnosing and treating a PE. That isn't the same as making an argument for cranial.

    A good point though, not all of medicine is level 1A evidence based, but there is at least evidence behind certain practices.
     
  51. sylvanthus

    sylvanthus EM/IM/CC PGY-4 7+ Year Member

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    The burden of proof is on DOs to show that it DOES exist, not for people to prove it doesnt.
     
    emergencycat, Mehd School and user3 like this.

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