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Do any allopathic schools offer a course in Osteopathic Manipulative Techniques? Is the course offered during the school year or over the summer?
OMM Course
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Something like 90% of DO graduates never use OMM in their practice, why would the MD schools subject their students to it?
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If it's offered as an elective, I'd hardly call it "subjecting' their students to it.
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This is absolutely true, most DO's do not use their OMM education in practice. However, it has helped me in many ways diagnostically and can be extremely effective for some patients. It will most likely not be a huge part of my practice in the future but having the knowledge set and ability will only allow for more options of care.
No one will ever fault you for having to many options when caring for others.
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They offer it as at least a CME course, it looks like through their PM&R department. Which makes sense, OMM is very relevant to PM&R and Sports Medicine docs.
http://cme.hms.harvard.edu/cmeups/pdf/00271286.pdf
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Thank you. Perhaps others should better educate themselves before they answer incorrectly from now on.
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Those palpation skills, baby. 😛
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Can you describe a situation when OMM helped you diagnostically? If it helps you, then why won't it be a big part of your practice later on?
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Actually a LOT of allo schools give some minor exposure to acupuncture these days, and quite a lot of the pain managment anesthesia types learn it as a nice side business procedure. And yes, Harvard, among other places offers an elective in OMM. The allo schools would never offer chiropractic courses however because the allo world went to legal war against chiropractors a few decades ago (but lost), calling them "quacks" on the public record. It would be hard to now justify teaching quackery in an allo school.
Palpatory skills are very helpful, not necessarily the OMM techniques themselves. In most specialties you will be touching your patients at some point.
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Me personally, I am choosing a specialty where I can use OMT in practice. I think it's an excellent tool, especially diagnostically. I'm not a big fan of HVLA, but there are so many different techniques you can use!
Diagnostically... there are reflexes your autonomical NS uses to signal there is something wrong in your body, and it can show up as chronic back pain, muscle spasms, discrete tender points, etc. We are taught how to find them, how to determine between acute vs chronic conditions, and how to use our findings in conjunction with tests to diagnose patients. We also practice many techniques that MD's don't learn until rotations, such as workups for knee pain (all the tests involved), scoliosis, herniated disks, other MSK complaints and specific tests.
On a personal note... I have had chest pain and left sided back pain for years which was previously worked up for MSK disease, CV disease, stress-related... all negative test results. I become a med student at a DO school, find out I have chronic T4-T6 left sided somatic dysfunction, and a severely painful left 5-6 intercostal space chapman's point (classic signs of GERD). One of my professors sent me to a GI doc, I found out I've had atypical GERD for the last 10 years and now I have Barrett's esophagus. I would have never gotten it checked out otherwise!
So... it works. There are tons of other examples, but it would take too much time to go into!
And yes, there are many allopathic schools embracing OMM because it's a great addition to FM and preventative medicine, as well as orthopedics, sports med, numerous other fields.
Kudos to you for branching out into the other world 🙂
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To be honest, if you are that interested in OMM, you should go to a DO school. It's unlikely that one course in OMM will give you all the tools you need to use it in practice. Also, if you decide you like it, there are residencies & fellowships available in OMM... but you must be a DO to do them.
Just to give you an idea, my school has 3 hours every week for 2 years devoted to OMM. That's not including the time you need to practice (about 2 hours before each practical) so you get the techniques right. It's not something to learn overnight, just like any clinical skill, it takes time to master it. However, by the time you are done with second year, you should be able to diagnose & treat most patients with OMM.
I think the real reason many DO's don't use OMM in practice is that it's difficult to use it when you are the only DO in your practice. Also, some techniques require additional training courses, and some DO's just don't want to put the extra time in. I think once DO's start doing more research on OMM and show the MD's how beneficial it is to patients, more will embrace it in practice.
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I am really in to sports medicie, so i shadowed and did a lot of work in the field during undergrad. Many of the docs were DOs and i looked for ones specifically who used OMM on a daily basis. You just need to be in the write setting. If you are a radiologist, obviously OMM will be useless. But for a sports med physician where most patients will have some sort of musculoskeltal problems, its perfectly applicable. Its also used heavily in PM&R.
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Thank you for the link imurder'!
When I chose an allopathic school over a great DO school, I began to wonder if I had been missing out on something, especially because I am highly intrigued with the field of PM&R. Just happy to see a mergence between the disciplines.
Glad to see that there is interest in manual medicine.
Just for clarifcation, manual medicine is not routinely taught in PM&R residencies. I believe the exception is Michigan State University's PM&R residency program (dually accredited) is unique because specifically OMM is encouraged in their outpatient clinics.
Just for clarifcation, manual medicine is not routinely taught in PM&R residencies. I believe the exception is Michigan State University's PM&R residency program (dually accredited) is unique because specifically OMM is encouraged in their outpatient clinics.
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That doesn't make OMM not useful. I'm an allo student and I've met MDs who use OMM in their primary care practices to diagnose a lot of stuff which might otherwise require much more invasive tests.
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Oh you mean actual evidence based techniques, yeah they are expensive and suck. My school has a well known bias to teach only things that are based on evidence and sound scientific theory. I guess it all started when they removed all of the witch doctors from the faculty in the 1880s. All kidding aside, physical exams and good hx's are the cheapest and best 'tests' you run when formulating a dx (dx after these two have been shown to be correct > 90% of the time). No need to muddy the waters by looking for cranial joint shifts or sublaxations and thats why they are not taught at allo schools. To further Raryn's point, many of our MSK lectures as well as our physical exam class are taught by DO's on faculty and not one has mentioned OMM.
The absence of proof does not necessarily mean that the treatment is ineffective. Like most things, design is key and unfortunately manipulative medicine is hard to study.
A good example is epidural steroid injections and low back pain. Clinically, I have seen many patients benefit from them but the science does not support its efficacy. You will find several studies for and against its use. Does it not work? There are plenty of pain physicians who would beg to defer. Similarly, manipulative medicine has a similar problem. Personally, I don't think that we fully understand the back pain model as well as we think we do and it's reflected in our research.
Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society.
Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, Carragee EJ, Grabois M, Murphy DR, Resnick DK, Stanos SP, Shaffer WO, Wall EM; American Pain Society Low Back Pain Guideline Panel.
Spine (Phila Pa 1976). 2009 May 1;34(10):1066-77.
I doubt the reason why they don't teach OMM at an allopathic institution is because it doesn't work and it's a waste of time. I'm pretty sure that it's because its an allopathic institution and not an osteopathic one☺ There are plenty of things that are not taught in medical school that are clinically relevant and relevant so I wouldn't rest "thats why they are not taught at allo schools" thinking because it simply doesn't hold water in an absolute sense.
OMM is a skill and takes YEARS to develop palpatory skills let alone a treatment plan. There really isn't a need for the DO's that are teaching your MSK classes to mention in because it takes more than a couple of didactic sessions to understand the concepts. I'm pretty sure that they asked your teachers to teach you specifically the MSK exam so I wouldn't expect them to teach you osteopathic principles. That would be a very long didactic session. The MSK examination is enough to digest at a MS1-2 level. The good news is that you are probably getting great MSK training for your physical exam!
A good example is epidural steroid injections and low back pain. Clinically, I have seen many patients benefit from them but the science does not support its efficacy. You will find several studies for and against its use. Does it not work? There are plenty of pain physicians who would beg to defer. Similarly, manipulative medicine has a similar problem. Personally, I don't think that we fully understand the back pain model as well as we think we do and it's reflected in our research.
Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society.
Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, Carragee EJ, Grabois M, Murphy DR, Resnick DK, Stanos SP, Shaffer WO, Wall EM; American Pain Society Low Back Pain Guideline Panel.
Spine (Phila Pa 1976). 2009 May 1;34(10):1066-77.
I doubt the reason why they don't teach OMM at an allopathic institution is because it doesn't work and it's a waste of time. I'm pretty sure that it's because its an allopathic institution and not an osteopathic one☺ There are plenty of things that are not taught in medical school that are clinically relevant and relevant so I wouldn't rest "thats why they are not taught at allo schools" thinking because it simply doesn't hold water in an absolute sense.
OMM is a skill and takes YEARS to develop palpatory skills let alone a treatment plan. There really isn't a need for the DO's that are teaching your MSK classes to mention in because it takes more than a couple of didactic sessions to understand the concepts. I'm pretty sure that they asked your teachers to teach you specifically the MSK exam so I wouldn't expect them to teach you osteopathic principles. That would be a very long didactic session. The MSK examination is enough to digest at a MS1-2 level. The good news is that you are probably getting great MSK training for your physical exam!
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I was just recently accepted to an MD school which I'll be attending, but my family physicians have always been DO's and I have an enormous respect for OMM. I'd love to take OMM as an elective, and I'm glad to hear that some schools offer it.
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Congrats Phange, know you've been waiting to change yoru SDN status for a long time
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My cousin went to UMDNJ RWJ and took manual therapy (OMM) classes at an osteopathic school as an elective. He actually persuaded me to go to an osteopathic school with his integration of manual therapy in internal medicine.
OMM is not going to cure/help every patient, but if it helps one patient a day it's beneficial in my book.
OMM is not going to cure/help every patient, but if it helps one patient a day it's beneficial in my book.
I think the best way is to find a practitioner affiliated with your school and set up a formal rotation or observation. I'm not familiar of any electives that incorporate a formal didactic portion (which is necessary) in addition to clinical exposure. You can also do weekend courses as well. However, they can be pretty expensive especially for a med student.
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Or he could just focus on learning his allopathic coursework, you know, real medicine.
For you know what "real medicine" is, then you most know allopathic and osteopathic medicine very well! Because, this implies that you know the distinct difference. Otherwise, it's just a plain unfounded judgement. However, you are entitled to your opinions...whether or not they are based on fact or not.
I'm not going to debate that manual medicine techniques have not been definitively proven to work in medicine. But I will argue that there is not a perfect model to study these theories either. Absence of proof does not imply that the treatment does not work. There are several examples where clinicians practice contrary to what the literature demonstrates:
-Interventional epidural steroid injections
-laminectomy for sub-acute/chronic radiculopathy
-weaning protocols for cervical orthoses after an anterior cervical disc fusion
-steroid use with acute spinal cord injuries
-platelet rich plasma injections with chronic tendinopathies
These of course are examples in my line of work but I'm sure there are plenty of other similar examples across the specialties.
I applaud the OP for being open-minded and seeking out opportunities like electives or shadowing.
Whether you buy into manual medicine or not, your patients are seeing practitioners. Now should you be at least aware of the literature despite your bias or should you make blanket statements when the truth is you might not really know.
Just something to think about...
I don't really understand Guile's disdain for OMM. OMM is a legitimate, scientifically validated (and if I might add, personally experienced/validated) non-invasive treatment. It seems like a very good ancillary skill to have, especially for a primary care physician.
Interesting...no comments?
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I'm guessing you haven't experienced the ischial spread yet. May not be truly invasive, but it feels wrong on so many levels.
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Every 2-3 years this exact same question is asked. Its alway some allo student who as asking about learning OMM. The threads always progress in the same exact way. I dont get it.
If you dont believe in the philosophy, then dont go to schools that do and dont worry about others who want to explore it.
If you do believe in it, then go to those schools and stop spending your time being overly defensive whenever someone makes a dumb comment about it.
If you dont believe in the philosophy, then dont go to schools that do and dont worry about others who want to explore it.
If you do believe in it, then go to those schools and stop spending your time being overly defensive whenever someone makes a dumb comment about it.
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I don't think there is a lot of evidenced-based medicine behind OMM. The studies that are out there have modest findings about it's usefulness and even those findings have been criticized. The best case I can think of is the Andersson paper where patients had to be first evaluated by a DO to see if they could "benefit from OMM" in the first place. That just screams "biased study" and that was pointed out by many DOs who responded to the NEJM.
In fairness to the whole "evidence based" requirement, pain is very subjective and it is hard to get quantitative results with anything that treats pain.
I am in a very DO heavy part of the world with many DO residents and attendings. With the exception of my FM rotation which had a block on alternative and complementary medicine (and the hospital had an OMM clinic), I've never seen them even mention OMM, let alone use it in an inpatient or outpatient setting. That's anecdotal, but I think it speaks to the fact that 90% of people formally trained in OMM chunk it the second they walk out of their institution. The basic truth is that if OMM were as useful as some people would have others believe; it would be stolen and incorporated into MD programs as a mandatory requirement.
That's not to say that it has no place or isn't useful. I am all for any approach to that bastard of outpatient medicine known as "low back pain" that doesn't involve narcotics. However, I don't think it's efficacy should be overstated.
I also find it absurd when posters elevate OMM to some mystical practice that takes "years to master" as if you have to become some sort of OMM Shaolin Monk for it to really work. It just seems like cover to me for the fact that most people abandon it.
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You don't think that's a non sequitur? Histology is the basis of pathology which is used every day by every physician. You can't quite compare the basic medical sciences with OMM.
Are you really good at manual medicine?
Like every treatment in medicine, there patient selection is important.
To all the people who say it doesn't work, please see the article.
1: Flynn T, Fritz J, Whitman J, Wainner R, Magel J, Rendeiro D, Butler B, Garber
M, Allison S. A clinical prediction rule for classifying patients with low back
pain who demonstrate short-term improvement with spinal manipulation. Spine
(Phila Pa 1976). 2002 Dec 15;27(24):2835-43. PubMed PMID: 12486357.
Read it be for you give the obligatory "nuh-uh, it doesn't work!"
Then we can have a discussion...
To all the people who say it doesn't work, please see the article.
1: Flynn T, Fritz J, Whitman J, Wainner R, Magel J, Rendeiro D, Butler B, Garber
M, Allison S. A clinical prediction rule for classifying patients with low back
pain who demonstrate short-term improvement with spinal manipulation. Spine
(Phila Pa 1976). 2002 Dec 15;27(24):2835-43. PubMed PMID: 12486357.
Read it be for you give the obligatory "nuh-uh, it doesn't work!"
Then we can have a discussion...
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As a Medical Student, I don't consider myself "really good" at anything. I work daily to get better.
Other than that, what is the point of asking? If by manual medicine you mean the physical exam then I think I am a little above par. If you mean OMM, then of course not. I have never studied OMM and wouldn't even know where to begin with it.
Again, I might feel bad about that If I had ever witnessed any of our DO IM residents or attendings utilize it to treat someone.
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I found the article interesting. I think it's logical and rational to come up with criteria for who would benefit from certain treatments and who would not so people can be directed into the appropriate group. The focus of that study (done by physical therapists if I read correctly) was not on OMM, unless I missed the bus completely.
It also is three years after the Andersson study:
http://www.nejm.org/doi/full/10.1056/NEJM199911043411903
Where there was a glaring bias in the methodology:
They selectively charted their outcome from the beginning. Even then, the results were modest:
The article prompted a large number of responses that can be seen here:
http://www.nejm.org/doi/full/10.1056/NEJM200003163421112
The best analysis is probably this one:
At any rate, I key on the Andersson study because it is in the NEJM and not an osteopathic publication, which also presents bias.
FWIW, I never said OMM doesn't work for MS problems. I said it's efficacy shouldn't be overstated. Chiropractic also seems to help some people, but it's efficacy shouldn't be overstated.
Where I really jump off the bus with OMM is when people make claims that the lymph pump shows better outcomes when people have pneumonia. I also find that to be absurd.
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Are you in your clinical years yet? I think you would be surprised. I also wouldn't deem histology as unimportant. Knowing the cellular basis of tissue is terribly important and contributes to pathology, especially when it comes to cancer. I am not trying to sound condescending and you may be ahead of me, but if you aren't, just some advice.
Internists let pathologists do the cells reads, because that is what they are specialized to do. That doesn't mean they lose the knowledge base. I know one of our surgeons makes a habit of stopping by the path office to look at slides from biopsies with the pathologists. It's analogous to doctors reading their own CTs before the official report comes up (though much more common).
Inherent to this is the fact that histology is so important that it has spawned a whole field of medicine.
The same can't really be said of OMM.
Surely a lot of what you learn in your first two years gets dropped when you start doing clinicals. That doesn't mean it's not important.
Perhaps I should have rephrased the question as "are you good at OMM?"
If you have you proclaim to have no experience, then how can you say that it doesn't take "years to master" to be an "OMM Shaolin monk?"
Just curious at how you came to your opinion...
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I have never trained on OMM. So that would be a resounding "no".
Maybe it does take "years to master". My point was; this makes it different from any other aspect of medicine how? It just seems to me that people who make that statement do so to try and explain away why over 90% of DOs don't use OMM (they don't want to take the time and effort to become "masters" of it) as opposed to the other more glaring reason.
If it were such a valuable treatment or diagnostic modality, then they time would be devoted to learn it and it would be incorporated into allopathic programs.
The evidence just doesn't bear that out. I am not saying that OMM has no use, I just can't find any convincing data that it is all that some claim it is cracked up to be. That seems to be supported by the fact that 9/10 of DOs don't use it.
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Okay. I see what you are saying. I just disagree. You'll dump most biochem after Step 1. That doesn't mean it isn't important as it helps you build a fundamental base of knowledge for medicine.
The same can't be said of OMM. You won't get any OMM questions of USMLE exams. It's not deemed as a part of the basic medical science education by the allopathic world.
I'm basically cutting and pasting text from a previous post in quotes below. I'm not sure if you read it or not. But please enlighten me on the "glaring evidence." I've giving you specific studies (with citations) and clinical examples where the literature has not matched clinical practice.
Please give me specific examples
"The absence of proof does not necessarily mean that the treatment is ineffective. Like most things, design is key and unfortunately manipulative medicine is hard to study.
A good example is epidural steroid injections and low back pain. Clinically, I have seen many patients benefit from them but the science does not support its efficacy. You will find several studies for and against its use. Does it not work? There are plenty of pain physicians who would beg to defer. Similarly, manipulative medicine has a similar problem. Personally, I don't think that we fully understand the back pain model as well as we think we do and it's reflected in our research.
Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society.
Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, Carragee EJ, Grabois M, Murphy DR, Resnick DK, Stanos SP, Shaffer WO, Wall EM; American Pain Society Low Back Pain Guideline Panel.
Spine (Phila Pa 1976). 2009 May 1;34(10):1066-77.
I doubt the reason why they don't teach OMM at an allopathic institution is because it doesn't work and it's a waste of time. I'm pretty sure that it's because its an allopathic institution and not an osteopathic one☺ There are plenty of things that are not taught in medical school that are clinically relevant and relevant so I wouldn't rest "thats why they are not taught at allo schools" thinking because it simply doesn't hold water in an absolute sense."
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In my nearly 3 years of residency I have yet to bring my extensive histological knowledge to bear on patient care.
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I assume you have never treated a patient with a kidney problem then, b/c that is a pretty histo heavy field. Like Old grunt said, you may not be reading the actual slide but you need to understand what a pathologist is telling you and how it fits into the clinical situation.
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You've never pondered the MCV in working up anemia?
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Hold on a second. I said "glaring reason". With that I was referring to the fact that over 90% of DOs never use OMM in their practice beyond medical school.
You've also given me one study. That was over the benefits of stratifying back pain patients into what groups could be treated. It was a study done by physical therapists and made no mention of OMM. I read it quickly, so maybe I missed something and please point it out to me if I have.
As for the whole "literature not matching clinical practice", that's all good and find. However, that doesn't provide automatic cover for a practice to be conducted simply because "my intuition/clinical instinct tells me this...." That's the whole point of evidenced based medicine, to try and move medicine towards the objective and away from subjective and anecdote. With something like OMM, it's even trickier. As the practice has been around since AT Still developed it and has been formally studied with less then impressive results.
It also doesn't mean it's is effective, we should take people at their word, and implement it as a standard of care. This is a science based profession.
In my very brief and very undistinguished career to date, I haven't found many things that aren't hard to study and master.
I agree with the back pain model. I disagree that plenty of physicians would beg to differ about OMM. I support that, again, with the notion that most medical students who are trained on OMM abandon it's use after their formal training, despite all attempts by the AOA to entice people to use it.
Thanks. I'll try to read this later.
With all due respect, I think that is somewhat of a bunker mentality. Their might have been a bias 100 years ago, however; as it stands if OMM bore itself out under scientific scrutiny, it would be adapted by allopathic institutions. The skepticism about it as a treatment modality are not un-founded.
Such as?
Again, the problem with OMM is that it is not viewed to be clinically relevant. Once again, that is a problem within the DO community as well.
Just so I don't sound like "that guy"; I view DOs and MDs as equivalent degrees and have been nothing but impressed with the DO's I have encountered as a student (for what that is worth). I even think OMM has limited efficacy in treating low back pain (probably on par with chiropractic). When people start to claim that OMM can cure pneumonia and start throwing out P values of .98 to support their claims, I jump off the crazy train.
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Well, you would be assuming incorrectly. I have treated lots of patients with kidney problems.
Now that we've cleared up the argument-contrary-to-fact, I'm an EM doc... I can count on one finger the number of times I've talked to a pathologist in my day-to-day work.
Pondered the MCV? No, not really. But I don't really work up anemia either. If they're symptomatic I address it, and if they aren't I let someone else do the mental masturbation either as an inpatient or an outpatient.
Sorry for the delayed response. I didn't see that this was responded to.
That is true that a majority of DOs don't use their OMM training. However, I would argue that it might not be in their scope of practice. There are plenty of things that we learn in medical school that we don't do anymore from a practical standpoint. OMM is time consuming and it can be hard to fit into a very hectic day unless you set up your clinic to accordingly.
The study I was referring to is a actually a huge article in the rehabilitation world. It looks at lumbar manipulation (which is a part of OMM) and low back pain. It basically shows that you can stratify who can benefit from lumbar manipulation in the setting of acute low back pain.
I understand the point of evidenced based medicine however it's a best attempt at objectifying the subjective and/or account for diversity of study design. However, there are limitations to EBM one of which is what is "best practice" may not be the best for the patient. Clinicians are going by patient response not just "my intuition/clinical instinct." The fact is that certain patients do feel better.
- Did you or will you learn how to put in a baclofen pump before graduation?
My point is that you don't learn how to do everything in medical school. Just because you don't hear about it doesn't make it irrelevant.
I appreciate your time and a lengthy response. I see that you are very fixed on your current views which I will chalk up to inexperience for the time being. However, once you get into clinical practice I think you'll start to see the subtle differences in didactic learning and clinical practice. For a lot of things in medicine, they are congruent. The reality is there are still a lot of things in medicine that are unexplained. OMM is one of them.
Open your minds people🙂
That is true that a majority of DOs don't use their OMM training. However, I would argue that it might not be in their scope of practice. There are plenty of things that we learn in medical school that we don't do anymore from a practical standpoint. OMM is time consuming and it can be hard to fit into a very hectic day unless you set up your clinic to accordingly.
The study I was referring to is a actually a huge article in the rehabilitation world. It looks at lumbar manipulation (which is a part of OMM) and low back pain. It basically shows that you can stratify who can benefit from lumbar manipulation in the setting of acute low back pain.
I understand the point of evidenced based medicine however it's a best attempt at objectifying the subjective and/or account for diversity of study design. However, there are limitations to EBM one of which is what is "best practice" may not be the best for the patient. Clinicians are going by patient response not just "my intuition/clinical instinct." The fact is that certain patients do feel better.
True. But I'm not the one that's assuming that it's ineffective. I'm arguing that I have personally seen clinical benefit and that the studying these techniques in a scientific way is difficult. Try to find 2 patients with the same back pain. It's impossible.
So you are extremely masterful at everything that you've attempted or you are clinically inexperienced. Seeing as you admit no experience with OMM I will go with the latter. I've done a multitude of procedures in my clinical training and OMM has been one of the hardest things to pick up let alone master.
See above.
You should try to read this if possible.
- Did you or will you learn how to do a cardiac catheterization before graduation?
- Did you or will you learn how to put in a baclofen pump before graduation?
My point is that you don't learn how to do everything in medical school. Just because you don't hear about it doesn't make it irrelevant.
I appreciate your time and a lengthy response. I see that you are very fixed on your current views which I will chalk up to inexperience for the time being. However, once you get into clinical practice I think you'll start to see the subtle differences in didactic learning and clinical practice. For a lot of things in medicine, they are congruent. The reality is there are still a lot of things in medicine that are unexplained. OMM is one of them.
Open your minds people🙂
but do they feel better than they would have if they'd gotten a massage instead? or a half hour counseling session? read your argument again and this time replace OMM with something totally out of left field. see if you end up convinced that "treatment x out of left field" is worthwhile when the most the person arguing for it can say is that in their experience some patients do say they feel better. when is this not true? with anything someone might try? maybe they're just trying to make you feel better since you're so enthusiastic about OMM? or is the entusiasm part of the skill that takes years to master?
