OMM private practice as a psychiatrist?

[amberrambler]

I'm a PGY4 DO and am seriously thinking about refreshing my OMM skill set and practice OMM in some sort of independent contracting/private practice modality NOT affiliated with psychiatry. During medical school, I didn't appreciate the usefulness of it but am interested in diversifying my career (I don't think I want to practice psychiatry 5 days/week). I know this has been touched upon in past threads but wanted to see if there were new thoughts/perspectives about the practicalities/logistics/liability/ethical issues with this? I am not interested in debating the evidence behind OMM 🙂

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[WisNeuro]

I am not interested in debating the evidence behind OMM 🙂

I mean, snakeoil is a booming industry. Look at the Amen clinics. I'm interested in someone who is interested in the ethics of a treatment, yet is unwilling to discuss the evidence, or lack thereof, of said treatment.

 

[Sushirolls]

The more degrees of separation you have from the psychiatry side of things the better.

 

[MrChance2]

I don’t see why not. There’s plenty of wholistic wellness clinics. Most patients with anxiety would benefit from having less muscle tension and depressed patients with chronic pain would benefit from having less pain etc... I don’t see why Psychiatry and OMM couldn’t be tied together as long as care is taken to give proper standard of care on the psychiatric side regardless of OMM treatment.

I personally wouldn’t feel comfortable doing OMM on patients I treat psychiatrically though I don’t think it would be unethical, I just see uncomfortable situations occurring, but I have done OMM on inpatient psychiatric patients As a medical student as an OMM consult that I am not seeing psychiatrically with good results.

also Just because someone doesn’t want to debate a treatment with strangers on the internet doesn’t mean the treatment is BS.

anything can happen in court with malpractice I suppose but keep in mind the osteopathic boards which give the medical license generally seem to have the idealogy” of “the more omm the better” and unless you are doing something really really bad would likely be on your side.

 

[WisNeuro]

also Just because someone doesn’t want to debate a treatment with strangers on the internet doesn’t mean the treatment is BS.

Of course not, it's the fact that it doesn't perform any better than sham touch that makes the treatment BS.

 

[MrChance2]

Of course not, it's the fact that it doesn't perform any better than sham touch that makes the treatment BS.

I just want to clarify what your definition of OMM is?

Quite a lot of OMM has overlap with physical therapy treatments or chiropractic maneuvers. I’ll agree there are some BS treatments out there but there are large parts of OMM with good evidence. I’m generally a skeptic and don’t use OMM currently but It is possible to practice OMM without the “snake oil” part and have results far exceeding placebo. To say that all OMM is “snake oil” is to say any sort of physical medicine is a sham which pretty much anyone who has rehabbed an injury would say is not true. That doesn’t mean there’s not some individual BS treatments.

 

[WisNeuro]

I just want to clarify what your definition of OMM is?

Quite a lot of OMM has overlap with physical therapy treatments or chiropractic maneuvers. I’ll agree there are some BS treatments out there but there are large parts of OMM with good evidence. I’m generally a skeptic and don’t use OMM currently but It is possible to practice OMM without the “snake oil” part and have results far exceeding placebo.

There is a reason that almost all positive studies of OMM are exclusively printed in journals of osteopathic medicine. They tend to either not have control groups at all, or the control groups are...less than robust. I'm willing to reconsider if there is a meta-analysis of well-designed RCTs here, but I haven't seen them. Last I saw was some Cochrane reviews years ago that showed no difference between OMM and sham touch in studies that met criteria for quality.

 

[Mass Effect]

Of course not, it's the fact that it doesn't perform any better than sham touch that makes the treatment BS.

https://www.nejm.org/doi/full/10.1056/NEJM199911043411903

 

[futuredo32]

I'm a DO who happens to not like psychiatry. Would you not need a fellowship in OMM to do this?

 

[Sushirolls]

Any DO or MD can do OMM...
Fellowship not needed.

 

[Animal Mother]

https://www.nejm.org/doi/full/10.1056/NEJM199911043411903

Placebo effect is strong. Just about anything helps LBP. What this really says is that an OMM practitioner can be replaced by a bottle of ibuprofen.

 

[amberrambler]

Lol...oh sigh. Okay, thanks everyone! I would look at having the practice be entirely separated from my psychiatry practice and in a different town/city. @futuredo...don’t think you need any additional required training from what I’ve read....

 

[Mass Effect]

Placebo effect is strong. Just about anything helps LBP. What this really says is that an OMM practitioner can be replaced by a bottle of ibuprofen.

Or that OMM can replace a bottle of ibuprofen and cyclobenzaprine. You can disagree if you like (and God knows I don't use OMM), but it's simply not true that there is no evidence behind any of it. I have personally seen patients get benefit from tension headaches, back pain, chronic neck tension, menstrual cramps, and sports injuries. In fact, OMM is used even by MDs in family medicine and sports clinics (as I found out in my ACGME residency).

 

[WisNeuro]

https://www.nejm.org/doi/full/10.1056/NEJM199911043411903

I mean, we can show treatment effects from placebo and sham touch as well. This is why robust control groups are necessary.

 

[Mad Jack]

I mean, we can show treatment effects from placebo and sham touch as well. This is why robust control groups are necessary.

I mean, I've seen patients come off opioids entirely on a voluntary basis with OMM treatment for their chronic pain. So placebo or not, if it can reduce polypharmacy, improve patient QoL, and serve as harm reduction, is it a problem?

Many argue that the response to therapy is a placebo effect, as untrained therapists generally fare as well as professionals in outcome. Yet it is considered a core component of mental health treatment because even if it is a placebo, those that receive it fare better than those who do not.

https://www.researchgate.net/profile/Jeffrey_Berman2/publication/19261008_Does_Professional_Training_Make_a_Therapist_More_Effective/links/00463529dc24d7caf3000000/Does-Professional-Training-Make-a-Therapist-More-Effective.pdf

 

[WisNeuro]

I mean, I've seen patients come off opioids entirely on a voluntary basis with OMM treatment for their chronic pain. So placebo or not, if it can reduce polypharmacy, improve patient QoL, and serve as harm reduction, is it a problem?

Many argue that the response to therapy is a placebo effect, as untrained therapists generally fare as well as professionals in outcome. Yet it is considered a core component of mental health treatment because even if it is a placebo, those that receive it fare better than those who do not.

https://www.researchgate.net/profile/Jeffrey_Berman2/publication/19261008_Does_Professional_Training_Make_a_Therapist_More_Effective/links/00463529dc24d7caf3000000/Does-Professional-Training-Make-a-Therapist-More-Effective.pdf

To the first point, true, but should we really be upcharging what we know is placebo in the healthcare community.

As for the second, the research is dicey, another area that really needs some more stringent studies. Everyone trots out the common factors work of Wampold and colleagues, but neglects to talk about the glaring methodological issues that arise when you collapse a ton of heterogeneous treatments and conditions into broad overarching groups. Therapy very well could be the same for most people, no matter the provider, but the data suggesting such is pretty flawed and misleading. Just further highlights the need for public research funding into healthcare. Let's find out what works, what doesn't, what's good enough, and what isn't.

 

[Dharma]

Of course not, it's the fact that it doesn't perform any better than sham touch that makes the treatment BS.

Depends on the modality. I would hesitate making a blanket statement especially given the breadth of techniques that vary quite significantly in proposed mechanism of action and subsequent delivery. Many of the techniques are commonly utilized w effect in physical therapy. Isometric techniques to elicit reciprocal inhibition of antagonist muscle groups come to mind amongst others.

 

[WisNeuro]

Depends on the modality. I would hesitate making a blanket statement especially given the breadth of techniques that vary quite significantly in proposed mechanism of action and subsequent delivery. Many of the techniques are commonly utilized w effect in physical therapy. Isometric techniques to elicit reciprocal inhibition of antagonist muscle groups come to mind amongst others.

That brings to mind a paper I just saw about the need for robust controls. It was an attempt at meta-analysis in this area, but they had difficulty actually conducting the analyses because all of the sham treatments differed so greatly.

 

[Stagg737]

That brings to mind a paper I just saw about the need for robust controls. It was an attempt at meta-analysis in this area, but they had difficulty actually conducting the analyses because all of the sham treatments differed so greatly.

Given the numerous different modalities and physical locations of performing OMM, it is pretty difficult to come up with a consistent and reliable form of sham treatment for many modalities. I agree with the lack of large-scale trials and consistency being an issue, but the common theme of "there's no good research so we shouldn't be doing it" is one which becomes tiresome and is potentially withholding significant treatment from patients who would significantly benefit. By that logic we shouldn't even bother treating most idiopathic LBP at all since almost every modality has similar effects to placebo or sham treatments, but we'd be failing to meet our duty as physicians on the principle of beneficence.

 

[WisNeuro]

Given the numerous different modalities and physical locations of performing OMM, it is pretty difficult to come up with a consistent and reliable form of sham treatment for many modalities. I agree with the lack of large-scale trials and consistency being an issue, but the common theme of "there's no good research so we shouldn't be doing it" is one which becomes tiresome and is potentially withholding significant treatment from patients who would significantly benefit. By that logic we shouldn't even bother treating most idiopathic LBP at all since almost every modality has similar effects to placebo or sham treatments, but we'd be failing to meet our duty as physicians on the principle of beneficence.

How long has OMM/OMT been around though, more than 100 years? I don't think the claim that "research is hard" is any reason not to have quality outcome studies when we've had a loooonnnng time to consider the issue. I can see the point when we're dealing with newer treatments and procedures, but not something like that.

 

[Mad Jack]

How long has OMM/OMT been around though, more than 100 years? I don't think the claim that "research is hard" is any reason not to have quality outcome studies when we've had a loooonnnng time to consider the issue. I can see the point when we're dealing with newer treatments and procedures, but not something like that.

Same arguments could be made for most forms of talk therapy and the manner in which they have been studied. The problem with OMM, as with talk therapy, is that pain, like mental illness, is multifactorial in nature and two practitioners are going to do things a bit differently than one another. Back pain, like depression, is a symptom of any number of etiologies and how they manifest in an individual. Couple this with the fact that doing it properly is an art and everyone has their own take that might vary with regard to pressure, positioning, etc, and the fact that believable controls that patients and providers are willing to buy into are difficult to create, and it's easy to say why it's hard to study.

It's the same reason a lot of studies in critical care are so difficult and even the "best" research in the field is often trashed due to questions about methodology- each patient, even with the same diagnosis, has any number of etiologies of said diagnosis, comorbidities, variable responses to both their disease process and the treatment provided, etc. Couple that with the difficulty of finding adequate controls and comparative treatments and you've got a real mess on your hands.

 

[WisNeuro]

Same arguments could be made for most forms of talk therapy and the manner in which they have been studied. The problem with OMM, as with talk therapy, is that pain, like mental illness, is multifactorial in nature and two practitioners are going to do things a bit differently than one another. Back pain, like depression, is a symptom of any number of etiologies and how they manifest in an individual. Couple this with the fact that doing it properly is an art and everyone has their own take that might vary with regard to pressure, positioning, etc, and the fact that believable controls that patients and providers are willing to buy into are difficult to create, and it's easy to say why it's hard to study.

I wouldn't necessarily agree with all of this. At least with psych therapies, the control conditions are generally standardized, so it's much easier to actually do meta-analyses. There are other methodological issues, such as in the common factors work, where many things that are pretty different are rolled into artificial categories. That stuff is definitely a problem. Real clinical research will always be hard, and never be perfect, but we should at least strive for research that is adequate.

 

[michaelrack]

If the OMM practice is going to be separate from your psychiatry practice in a separate location, I don't see why you're seeking advice on this forum

 

[KeikoTanaka]

The problem with OMM research is it is impossible to do a double blind study for it. The physician must know the diagnosis before even being allowed to touch the patient... otherwise you make the patient feel way worse. Also it's super hard to do a "sham treatment" because most of the time the therapies are sooo directed, the patient knows if you're doing something or not right then and there.

Patients who participate and want OMM are generally already more proactive, healthier, and wealthier people who are knowledgeable enough to know about it/pay for it. So looking at retrospective data is difficult as well. Two patients come in: One got Abx for Pneumonia, the other got Abx and Lymphatic techniques 3x a week. The second patient heals faster. Was this because of the OMM? Or is it because the person who wanted OMM also runs 4 miles a week, takes multivitamins, eats all organic, and does yoga every weekend?

But, at the end of the day, the human body is just one big architectural phenomenon, and, to be honest, it really does make a lot of sense that if you change the tone of muscles and therefore alter the kinematic of joints, the patient will feel better, and patient's who feel better, perform better. We don't have the technology to measure the minutiae of OMM yet, but I don't think it's impossible in the future to monitor these types of things.

Chiropractors work for the NFL and make millions. I don't think they'd pay them if the players thought it was all bull**** and didn't get some type of relief. NFL is also #1 purchaser of pain medications, so who knows lol.

 

[WisNeuro]

I have to return to the idea that just because research is hard, is no reason not to try and do it well to support proof of concept. Otherwise you're essentially supporting the idea that naturopaths and Goop are on to something and that insurance should be reimbursing for them.

 

[KeikoTanaka]

I have to return to the idea that just because research is hard, is no reason not to try and do it well to support proof of concept. Otherwise you're essentially supporting the idea that naturopaths and Goop are on to something and that insurance should be reimbursing for them.

As others have pointed out, they do try to do it. But its always going to seem biased because it is only posted in Osteopathic journals. I get email updates every week about various manipulations and the results in certain pathologies.

I would share said research with you, but unfortunately you have to be a member to view the Publications. You're more than welcome to sign up, but as someone who is not a manipulative practitioner, the language used may sound completely foreign anyways.

All OMM publications can be seen at Research on Osteopathic Manipulative Medicine (OMM) | American Academy of Osteopathy (AAO) (Not sure if this link is working, but you can google American Association of Osteopathy -- "Osteoblast" is the online journal that publicizes all the research

 

[WisNeuro]

That doesn't answer the several large meta analyses that found no benefit. From what I have seen, there are far more meta analyses that show no benefit, than those that show something, and even those are questionable due to the aforementioned issues with control. Heck, there are even many well written criticisms of it from DOs themselves.

 

[KeikoTanaka]

That doesn't answer the several large meta analyses that found no benefit. From what I have seen, there are far more meta analyses that show no benefit, than those that show something, and even those are questionable due to the aforementioned issues with control. Heck, there are even many well written criticisms of it from DOs themselves.

Like many things, it's a very personalized experience. Many DOs criticize it because it's just "one class that takes away from their studies" because they couldn't get into an MD school so end up in DO schools, and they make sure to never let us forget (It's quite annoying - I'd rather they have not gotten accepted and given to a person who can suck it up or at least try to appreciate it).

So yes, there's already going to be a negative taste of OMM in some DOs mouths because it "reminds them they didn't get into an MD school" - I would take that criticism with a grain of salt.

It's very practitioner and very patient dependent. You have to know the problem before you can treat it, and then there's 100s of treatment options for one problem, and you could do everything right and all the patient has to do is go back to work and forget to sit with good posture, stand up too quickly, and the whole treatment goes to waste as the patient's muscle goes back into spasm which was causing them pain the whole time.

Don't get me wrong - as a DO who learns the ins and outs of this, much of it isn't really applicable to every day life anymore. If you look into the history of DOs, OMM used to be only given to individuals at DO-only hospitals. And to gain entrance to such hospital, you had to sign your life away, abstain from alcohol, and commit to living there for over a week receiving treatment 3x a day. This is in stark contrast to modern day life where you might only see your Dr once a month or less, so unless you were SUPER conscious about your own body and going super often, some things won't have a really great affect.

Other parts of it however, especially for young people, athletes, people with ACUTE pain, I do believe it can help, just like physical therapy modalities.

 

[WisNeuro]

Like many things, it's a very personalized experience.

I agree that some people find benefit from it, but that the benefit is most likely the placebo effect. From what I have seen, there is no high, or even mediocre, quality evidence that shows a clinical effect that can be attributable to anything above and beyond placebo. Utilizing the placebo effect is not in and of itself a problem, we do it in other areas. But let's not pretend it's anything other than that unless we can support that notion empirically.

 

[KeikoTanaka]

I agree that some people find benefit from it, but that the benefit is most likely the placebo effect. From what I have seen, there is no high, or even mediocre, quality evidence that shows a clinical effect that can be attributable to anything above and beyond placebo. Utilizing the placebo effect is not in and of itself a problem, we do it in other areas. But let's not pretend it's anything other than that unless we can support that notion empirically.

I think that with a proper relationship, OMM utilization within the overall healthcare scheme has the potential to heal, and this is not just placebo. If you manipulate someone and it relieves pain just long enough for a patient to go home and do some home-exercises, just like a Cortisone injection/NSAID would have done, it allows them to strengthen weak muscles/stretch hypertonic muscles, which can be a measurable thing, even though the direct OMM therapy itself wasn't the thing that fixed their actual problem, it was just a facilitating factor.

NSAIDs wont change the muscle tone either - but if it reduces the pain to allow the patient to undergo an hour long PT session, the PT session is what will ultimately fix them, not the NSAID, even though the scientific community agrees NSAID use is beneficial in pain/injury.

Going to a Chiro/DO and getting adjusted in a very passive way will not fix you. The whole process has to be active on the part of both the practitioner and patient for it to work.

Getting 1000 patients and doing some technique and "measuring" pain, is so subjective, and, to be honest, everyone is missing the point. It's like when people who don't understand evolution try to argue there's no "missing link" therefore evolution does not exist. They fail to realize it's a slow and gradual transition which requires many factors to play in to work. OMM is just an igniter for the patient to help themselves - So it's very hard to measure the effects of OMM alone when it then is up to 1000x factors afterwards to see if the patient will actually get better.

Just like how NSAIDs can be given to 1000 patients with osteoarthritis, but if they never lose weight, strengthen their hamstrings, begin to run with better posture, the NSAIDs will burn a hole in their stomach before they get rid of their arthritic pain.

 

[WisNeuro]

I think that with a proper relationship, OMM utilization within the overall healthcare scheme has the potential to heal, and this is not just placebo.

You can't really say this without the data. The placebo effect is quite strong. For example, pain relief from sham surgery can be just as effective as real surgery. As I said, there is nothing wrong with utilizing the placebo effect, but we don't have to cover it up in magic and fairy dust and teach it as doctrine.

 

[KeikoTanaka]

You can't really say this without the data. The placebo effect is quite strong. For example, pain relief from sham surgery can be just as effective as real surgery. As I said, there is nothing wrong with utilizing the placebo effect, but we don't have to cover it up in magic and fairy dust and teach it as doctrine.

It's only one more class as a part of a whole doctorate degree (Can't say the same for chiropractors), that, unless was taught in the way that we learn it, cannot really be applied/learned in any other capacity.

Learning OMM is not just about the manipulations, even though that's the "big thing" that people know. But, in actuality, teaches osteopathic physicians a whole approach to a patient. Even if you don't utilize the manipulations after school, it still teaches you to look for certain stigmata which could be indicative of underlying visceral organ pathology. 90% of OMM is just palpation skills to narrow down a long list of differential diagnoses. And yes, of course, you do need to go ahead and order Imaging and bloodwork, but imagine if you can shave off one 80$ test just because you "felt" something that pointed your differentials in another way.

At the end of the day, the placebo is nice, and perhaps you're right and all we are doing is making them feel good with placebo, but unless you actually learned OMM/Anatomy/Body Kinematics you wouldn't be able to do the proper thing to even incite such a placebo effect. Or worse, you could actually hurt the patient.

A lot of OMM is good even just for diagnostic reasons. Imagine if a patient has a certain pain and you're 90% sure it's just musculoskeletal, and you do something and the pain goes away. That's good, you just at least helped point your further treatment in the right direction and now you don't need to order an MRI/EMG thinking there was nerve damage.

So, I agree, OMM could all be just placebo, but, I don't see the harm in learning it, even if it didn't help the patient at all and it was all fake, it is just another tool in the huge tool box the Physician has to narrow down pathology.

And in some patients with horrific end stage liver disease, sometimes the "all natural" approach is all they can tolerate, and I'd rather be able to provide them with that then nothing at all, even if its just all placebo.

 

[WisNeuro]

So, I agree, OMM could all be just placebo, but, I don't see the harm in learning it, even if it didn't help the patient at all and it was all fake, it is just another tool in the huge tool box the Physician has to narrow down pathology.

And in some patients with horrific end stage liver disease, sometimes the "all natural" approach is all they can tolerate, and I'd rather be able to provide them with that then nothing at all, even if its just all placebo.

This is all fine and good, but by extension, you would also have to be ok with naturopathy, homeopathy, and vaginal eggs simply on the basis that some people report that it helps them in some way.

 

[KeikoTanaka]

This is all fine and good, but by extension, you would also have to be ok with naturopathy, homeopathy, and vaginal eggs simply on the basis that some people report that it helps them in some way.

Theoretically, I am okay with all these modalities, so long as the patient is understanding of the potential side effects and still relays everything back to their primary care physician to make the final decision as to whether or not they should actually take said therapy/herbal supplement/whatever as everything can have cross reactions or negative side effects.

If a patient decides a turmeric honey tea is better for them than any pain medication I can give them, that is their prerogative, they just have to relay this to me so I can make adjustments as necessary in my own treatment plans.

If something is outright dangerous, or could have negative impacts on my therapy, I would obviously need to know to halt this therapy.

 

[WisNeuro]

Theoretically, I am okay with all these modalities, so long as the patient is understanding of the potential side effects and still relays everything back to their primary care physician to make the final decision as to whether or not they should actually take said therapy/herbal supplement/whatever as everything can have cross reactions or negative side effects.

If a patient decides a turmeric honey tea is better for them than any pain medication I can give them, that is their prerogative, they just have to relay this to me so I can make adjustments as necessary in my own treatment plans.

If something is outright dangerous, or could have negative impacts on my therapy, I would obviously need to know to halt this therapy.

This is also fine, but it sidesteps the other issue I've raised before. Should insurance, including Medicare/aid, pay for things with no or inadequate empirical support? Because this argument would say that OMM/OMT as well as expensive homeopathic elixirs should all be covered.

 

[amberrambler]

The question was about doing private practice - which I would anticipate being cash only. It’s a bummer this forum can’t be kinder and more understanding towards each other and to me, a symptom of what’s missing in the physician community at large.

 

[KeikoTanaka]

This is also fine, but it sidesteps the other issue I've raised before. Should insurance, including Medicare/aid, pay for things with no or inadequate empirical support? Because this argument would say that OMM/OMT as well as expensive homeopathic elixirs should all be covered.

I didn't know this was part of the argument. I am definitely not the expert on this as I have no idea what insurance will / will not pay for right now, nor do I understand the process by how they decide to initially begin paying for certain services.

As it stands right now, I don't think Homeopathy/Naturopathy should be receiving insurance monies, and should solely be for those that can pay out of pocket because they want some augmentation to their life / wellness. I don't think Chiros necessarily should be able to bill insurance either, but, that's a ****-storm of an argument likely to make one the subject of public annihilation because of how many people love their chiros lol

 

[KeikoTanaka]

The question was about doing private practice - which I would anticipate being cash only. It’s a bummer this forum can’t be kinder and more understanding towards each other and to me, a symptom of what’s missing in the physician community at large.

I thought we were having a very civil debate. I didn't detect any malice in any of these posts. I thought this was an adult intellectual conversation about the scientific process and efficacious modalities in medicine. Sorry if you got negative vibes.

 

[WisNeuro]

As it stands right now, I don't think Homeopathy/Naturopathy should be receiving insurance monies, and should solely be for those that can pay out of pocket because they want some augmentation to their life / wellness. I don't think Chiros necessarily should be able to bill insurance either, but, that's a ****-storm of an argument likely to make one the subject of public annihilation because of how many people love their chiros lol

By this same argument, you should also not think insurance should pay for OMM/OMT as the evidence base is similar. I am personally fine with the public at large paying for whatever they want in terms of treatment. Caveat Emptor to the extent that frankly dangerous things should be disallowed (e.g., supplements which send thousands to the ED every year). But, I am not a fan of my tax dollars going to fund unproven treatments, with the exception of some newer treatments that are clearly experimental.

 

[WisNeuro]

The question was about doing private practice - which I would anticipate being cash only. It’s a bummer this forum can’t be kinder and more understanding towards each other and to me, a symptom of what’s missing in the physician community at large.

If anything, the opposite happens on this forum. The fact that we can discuss two sides of an issue passionately, and remain civil and friendly with each other is great. There are multiple people on here who I have argued with and against on many issues. It's great. Healthcare innovation thrives on healthy debate. As providers we should all be well grounded in our practices and be able to outline the evidence base behind them, as well as be able to integrate new information that comes in. Otherwise, we are useless to our patients as time goes on.

 

[KeikoTanaka]

By this same argument, you should also not think insurance should pay for OMM/OMT as the evidence base is similar. I am personally fine with the public at large paying for whatever they want in terms of treatment. Caveat Emptor to the extent that frankly dangerous things should be disallowed (e.g., supplements which send thousands to the ED every year). But, I am not a fan of my tax dollars going to fund unproven treatments, with the exception of some newer treatments that are clearly experimental.

And I am okay with that mindset. Like I said, osteopathic medicine is more than just a manipulation to bill insurance with, it's a whole approach to a patient. And it's not any better or worse than an MDs approach (assuming theyre both astute and good physicians in their own right) - and the palpatory skills that give you insight to a patient's pathology via osteopathic medicine is not a billable factor - it's merely an intrinsic part of the whole osteopathic experience. I'm okay with then saying "okay I'll bill insurance for our meeting today, but if you'd like to pay cash for additional manipulations, we can do that today as well"

Edit: But I do have to wonder how not being able to bill insurance for certain techniques would ultimately affect other professions such as Physical Therapy. Or if we just do the same thing and one is provable, then they can bill for that, and therefore we could also bill for that? I'm not sure how to go about even ascertaining what is and is not efficacious

 

[WisNeuro]

And I am okay with that mindset. Like I said, osteopathic medicine is more than just a manipulation to bill insurance with, it's a whole approach to a patient. And it's not any better or worse than an MDs approach (assuming theyre both astute and good physicians in their own right) - and the palpatory skills that give you insight to a patient's pathology via osteopathic medicine is not a billable factor - it's merely an intrinsic part of the whole osteopathic experience. I'm okay with then saying "okay I'll bill insurance for our meeting today, but if you'd like to pay cash for additional manipulations, we can do that today as well"

Edit: But I do have to wonder how not being able to bill insurance for certain techniques would ultimately affect other professions such as Physical Therapy. Or if we just do the same thing and one is provable, then they can bill for that, and therefore we could also bill for that? I'm not sure how to go about even ascertaining what is and is not efficacious

Just what we've been talking about, high quality research.

 

[whopper]

I'm not very familiar with OMM but from my limited understanding there is touching of the body. The boundary violations between physically touching a patient while treating them are a touchy-feely issue in psychiatry.

 

[hamstergang]

I'm not very familiar with OMM but from my limited understanding there is touching of the body. The boundary violations between physically touching a patient while treating them are a touchy-feely issue in psychiatry.

But we're doctors, so we must touch patients for some aspects of the physical exam. Do you get vitals? Do you check the AIMS?

 

[nexus73]

I'm not very familiar with OMM but from my limited understanding there is touching of the body. The boundary violations between physically touching a patient while treating them are a touchy-feely issue in psychiatry.

I think this is probably the main question. How would you set up an OMM only clinic as a psychiatrist and make it clear you are not providing mental health care? Is this possible? Are you still expected to be aware of mental health issues the patient is having even if you're only seeing them in the capacity of doing OMM, essentially what a physical therapist or chiropractor would be doing? If you can set these limits, is touching patients going to lead to increased liability simply because you are a psychiatrist at your other job, even without providing psychiatric care at your OMM clinic?

 

[whopper]

Doesn't sound appropriate to me in the least at all.

Are we supposed to touch patients for the physical exam? Yes but psychiatrists are usually not in a situation where they are supposed to do the PE. In inpatient I would occasionally do it, but outpatient is different.

 

[KeikoTanaka]

Doesn't sound appropriate to me in the least at all.

Are we supposed to touch patients for the physical exam? Yes but psychiatrists are usually not in a situation where they are supposed to do the PE. In inpatient I would occasionally do it, but outpatient is different.

Everything is all about communication. If you feel like the patient's chronic anxiety is giving them more neck tension than normal, and that you could do a structural exam/myofascial to the neck/cranial OMM to fix that, I don't see why a consenting adult cannot talk out such an agreement with a physician, regardless of the specialty.

 

[Smists]

I don’t see why not. There’s plenty of wholistic wellness clinics. Most patients with anxiety would benefit from having less muscle tension and depressed patients with chronic pain would benefit from having less pain etc... I don’t see why Psychiatry and OMM couldn’t be tied together as long as care is taken to give proper standard of care on the psychiatric side regardless of OMM treatment.

I personally wouldn’t feel comfortable doing OMM on patients I treat psychiatrically though I don’t think it would be unethical, I just see uncomfortable situations occurring, but I have done OMM on inpatient psychiatric patients As a medical student as an OMM consult that I am not seeing psychiatrically with good results.

also Just because someone doesn’t want to debate a treatment with strangers on the internet doesn’t mean the treatment is BS.

anything can happen in court with malpractice I suppose but keep in mind the osteopathic boards which give the medical license generally seem to have the idealogy” of “the more omm the better” and unless you are doing something really really bad would likely be on your side.

The question of wearing two hats parallels what you are asking. I think a separation between prescriber vs psychotherapist or even fact witness vs expert witness or what you propose psychiatrist vs omm physician works!

 

[Smists]

I just want to put it out there I'm digging the synthesis, I'm a DO and in psychiatry. I've gone so far as working cranial and assert the utility of stimulating glymphatics and lymphatic system for effective drug delivery and stimulating immune system.

Naysayors can google research coming out of texas looking at use of omt for cancer and gi diseases. They have studies on omt adjunct to abx to treat pneumonia and shorten course of symptoms and shorter length of stay.

All of this to say is the mash up is out there. I'll PM you a name of someone I reached out to when I was wrapping med school who is triple boarded and private practice.

 

[amberrambler]

Great, thank you! I’ve been learning about somatic experiencing therapy (some therapists are actually trained in a physical touch modality) and see a lot of parallels with cranial osteopathy...which is what got me reflecting on it. It’s like OMM has stayed focused on the medicalized physical realm but it seems like it could complement psychiatry but agree, it gets ethically murky. Not sure if I would ever pursue OMM professionally, even with trying to keep them “separate” (bc how do you really do that) but it’s interesting to ponder.