OMM question

[jamcat]

---

Members don't see this ad.

I've asked this in the Osteopathic forum but haven't been able to get a clear response, so I thought I'd ask it here in the hopes that some of the helpful DO students could share their insight. As a potential future DO student, I've thought a lot about OMM, and I'm having trouble figuring it out.

Essentially:
If it's been shown to work, why aren't MDs using it?
If it has not been shown to work, why are DOs using it?

I'm all about the "treat the whole patient" philosophy (and I think a lot of MD schools are too), but I'm truly baffled by OMM.

Thanks!

 

[Goro]

Shhh, I'll let you in on a secret: Only ~5% of DOs actually use OMT.

MD wouldn't use it because they haven't heard of it, or been trained in it.

I've asked this in the Osteopathic forum but haven't been able to get a clear response, so I thought I'd ask it here in the hopes that some of the helpful DO students could share their insight. As a potential future DO student, I've thought a lot about OMM, and I'm having trouble figuring it out.

Essentially:
If it's been shown to work, why aren't MDs using it?
If it has not been shown to work, why are DOs using it?

I'm all about the "treat the whole patient" philosophy (and I think a lot of MD schools are too), but I'm truly baffled by OMM.

Thanks!

 

[AlteredScale]

I've asked this in the Osteopathic forum but haven't been able to get a clear response, so I thought I'd ask it here in the hopes that some of the helpful DO students could share their insight. As a potential future DO student, I've thought a lot about OMM, and I'm having trouble figuring it out.

Essentially:
If it's been shown to work, why aren't MDs using it?
If it has not been shown to work, why are DOs using it?

I'm all about the "treat the whole patient" philosophy (and I think a lot of MD schools are too), but I'm truly baffled by OMM.

Thanks!

The efficacy of OMT across the board has still not been proven in its entirety via randomized, controlled trials - http://www.ncbi.nlm.nih.gov/pubmed/23776117 http://www.ncbi.nlm.nih.gov/pubmed/23570655 http://www.ncbi.nlm.nih.gov/pubmed/21053038

OMT does however complement treatment in terms of increasing the comfort of patients and in majority, seen as an alternative therapy for patients (http://www.ncbi.nlm.nih.gov/pubmed/20544039)

MD's don't use it because they do not have training in it.
MOST DO's do not use it in their everyday practice, but have it as a tool to their practice.

The upcoming residency merger which will potentially allow MD grads to become certified in OMT should they desire to.

This is a good review to read up on: http://www.ncbi.nlm.nih.gov/pubmed/20188997

 

[jamcat]

Thanks once again, Goro and AlteredScale! So if only ~5% of DOs use OMT, is it because the others...don't believe it works? Or it just doesn't come up in their practice? And as far as the MDs go, I would assume if research has been published in a peer-reviewed journal that shows OMT works, any MD worth their salt who would have have the occasion to use it would clamor for training. I mean new treatments come out all the time that current doctors must receive training for. I can't believe that an MD would say "Yup, it works and could help my patients but I'm just not going to bother." And I can't imagine DO schools saying to these MDs "Sorry, we're not going to teach you OMM even though it's a valuable treatment because you're a MD." Or maybe this does actually happen; I'm a naive pre-med about these matters, which is why I'm asking you guys! I mean, if it's an effective treatment, it's an effective treatment and should be learned by all doctors, right?

And AlteredScale, thanks very much for the links. You would think that there would be more rigorous testing of something that is a hallmark of osteopathic medicine!

I'll be applying both MD and DO this year and am committed to actually learning about this stuff pre-interview so I don't just have to BS my way through "Why DO?" To be honest, I'm not fully sold on OMT, which I know is what sets DO/MD apart, but I'm researching with an open mind.

 

[AlteredScale]

Thanks once again, Goro and AlteredScale! So if only ~5% of DOs use OMT, is it because the others...don't believe it works? Or it just doesn't come up in their practice? And as far as the MDs go, I would assume if research has been published in a peer-reviewed journal that shows OMT works, any MD worth their salt who would have have the occasion to use it would clamor for training. I mean new treatments come out all the time that current doctors must receive training for. I can't believe that an MD would say "Yup, it works and could help my patients but I'm just not going to bother." And I can't imagine DO schools saying to these MDs "Sorry, we're not going to teach you OMM even though it's a valuable treatment because you're a MD." Or maybe this does actually happen; I'm a naive pre-med about these matters, which is why I'm asking you guys! I mean, if it's an effective treatment, it's an effective treatment and should be learned by all doctors, right?

And AlteredScale, thanks very much for the links. You would think that there would be more rigorous testing of something that is a hallmark of osteopathic medicine!

I'll be applying both MD and DO this year and am committed to actually learning about this stuff pre-interview so I don't just have to BS my way through "Why DO?" To be honest, I'm not fully sold on OMT, which I know is what sets DO/MD apart, but I'm researching with an open mind.

Well if you look at the current studies that are being conducted in OMT (https://clinicaltrials.gov/ct2/results?term=OMT&Search=Search) there seems to a be a huge push to really try and fortify the efficacy of OMT.

It's just so difficult to truly test it. OMT can't really be tested in vitro or in vivo since it's dealing with an entire system. Moreover, do measures such as "patient comfort in walking" really mean much? IMO not so because comfort is extremely subjective.

At this point it's just some alternative tool that DO's have the choice the use in their practice but are not required to. They are required to learn it however.

 

[jamcat]

I asked this over in the Osteopathic forum but I think people may have thought that I was attacking DOs (which I'm not, as I may become one!) and suggested that if you're not a huge fan of OMM, you shouldn't apply to DO schools. I'll be applying both MD and DO this cycle, and I'm really doing some soul searching. I'd really appreciate any words of wisdom from anyone who has any! Thanks--I appreciate it very much.

This is what I wrote:

I'm in a unique situation of having a lowish undergrad GPA (but stellar post-bacc) and a fine MCAT (37), so I'm likely to get more love from DO schools. Over on the pre-osteopathic boards, they recommend DO schools for somebody like me and suggest that if I don't wish to go DO, I care more about the initials after my name than I do about being a doctor. I don't. But it does leave me stuck in the middle here, and I hope you can appreciate my position. On the one hand we're told the only reason I wouldn't apply DO is because I care about initials; on the other we're told that you should only apply DO if you have a genuine draw to osteopathic medicine. What about those of us who don't care about initials but don't have a particular draw to osteopathic medicine? My undergrad GPA likely puts me out of the running for MD schools. Do I not become a doctor because I'm not sold on OMM? Any words of wisdom for somebody like me?

 

[AlteredScale]

I asked this over in the Osteopathic forum but I think people may have thought that I was attacking DOs (which I'm not, as I may become one!) and suggested that if you're not a huge fan of OMM, you shouldn't apply to DO schools. I'll be applying both MD and DO this cycle, and I'm really doing some soul searching. I'd really appreciate any words of wisdom from anyone who has any! Thanks--I appreciate it very much.

This is what I wrote:

I'm in a unique situation of having a lowish undergrad GPA (but stellar post-bacc) and a fine MCAT (37), so I'm likely to get more love from DO schools. Over on the pre-osteopathic boards, they recommend DO schools for somebody like me and suggest that if I don't wish to go DO, I care more about the initials after my name than I do about being a doctor. I don't. But it does leave me stuck in the middle here, and I hope you can appreciate my position. On the one hand we're told the only reason I wouldn't apply DO is because I care about initials; on the other we're told that you should only apply DO if you have a genuine draw to osteopathic medicine. What about those of us who don't care about initials but don't have a particular draw to osteopathic medicine? My undergrad GPA likely puts me out of the running for MD schools. Do I not become a doctor because I'm not sold on OMM? Any words of wisdom for somebody like me?

What is your GPA? with the post bad averaged in?

 

[jamcat]

PMing you the deets, AlteredScale, as I'm worried that I'm going to become recognizable on SDN (although that's likely paranoid, I know). Thanks!

 

[DoctorKrieger]

Thanks once again, Goro and AlteredScale! So if only ~5% of DOs use OMT, is it because the others...don't believe it works? Or it just doesn't come up in their practice? And as far as the MDs go, I would assume if research has been published in a peer-reviewed journal that shows OMT works, any MD worth their salt who would have have the occasion to use it would clamor for training. I mean new treatments come out all the time that current doctors must receive training for. I can't believe that an MD would say "Yup, it works and could help my patients but I'm just not going to bother." And I can't imagine DO schools saying to these MDs "Sorry, we're not going to teach you OMM even though it's a valuable treatment because you're a MD." Or maybe this does actually happen; I'm a naive pre-med about these matters, which is why I'm asking you guys! I mean, if it's an effective treatment, it's an effective treatment and should be learned by all doctors, right?

And AlteredScale, thanks very much for the links. You would think that there would be more rigorous testing of something that is a hallmark of osteopathic medicine!

I'll be applying both MD and DO this year and am committed to actually learning about this stuff pre-interview so I don't just have to BS my way through "Why DO?" To be honest, I'm not fully sold on OMT, which I know is what sets DO/MD apart, but I'm researching with an open mind.

There are several reasons most DOs don't do OMM after graduation. Many specialties aren't conducive to it, such as surgery, gas, EM, etc. It also takes time to perform correctly, and many family practice DOs just don't have time to mess with it. Also, it is largely one of those 'use it or lose it' skills and many DOs forget half the techniques they learned by the time they graduate (if they were even proficient at it to begin with). Then, there are plenty of those who just do not buy into the whole OMM thing (and for a lot of the stuff we're taught, I can't blame them). Some techniques have merit, others leave me wondering how this could possibly be taught in an institution of higher learning.

Grand scheme of things, it's a very small portion of your med school career. For even the most anti-OMM DO student, it's not much more than a minor annoyance the day or two before an exam (but an annoyance, it most certainly is). Even if you're not sold on it, don't let it be the deciding factor for which school you go to. Just think of it as a weekly trip down the rabbit hole to Wonderland where logic need not apply and the Kool-Aid is the only drink on tap.

 

[DocWinter]

Like Krieger said.

FM, IM, sports medicine are the main specialties where you would use OMT.
Anesthesia, Surgery, derm, etc. just don't have a place to use it.

OMT is (or should be) focused on biomechanics. It is (or should be) about getting muscles, bones, nerves etc in the right place. Some or most schools might teach it a little heavy on the "magic" and less on the biomechanics, which is where most students just push through and jump the hoops. I would drop half my techniques to learn soft tissue massage instead if I could, because I feel that has more practical use than some of the stuff we learn.
Yes, it's not a huge part of practice for the majority of practicing physicians.

 

[s5260205]

Does any DO physiatrist use OMM in their practise? How valid is OMM for PM&R?

 

[Stlblues17]

I would surmise that another factor in why a majority of DOs do not use OMM in practice is it's time consuming nature, for some that have time constraints may feel it easier to write for a muscle relaxer than manually apply an OMM technique.

Probably not a huge factor, but it seems reasonable to me

 

[medickdb]

Like Krieger said.

FM, IM, sports medicine are the main specialties where you would use OMT.
Anesthesia, Surgery, derm, etc. just don't have a place to use it.

OMT is (or should be) focused on biomechanics. It is (or should be) about getting muscles, bones, nerves etc in the right place. Some or most schools might teach it a little heavy on the "magic" and less on the biomechanics, which is where most students just push through and jump the hoops. I would drop half my techniques to learn soft tissue massage instead if I could, because I feel that has more practical use than some of the stuff we learn.
Yes, it's not a huge part of practice for the majority of practicing physicians.

I agree. It's not that I don't find some of OMM useful. It's the unscientific language used and lack of good evidence.

I wish the top minds would just come together and decide what's worth keeping and what just needs to go. It's perfectly fine to take pride in your past, but when it comes to the ever changing world of medicine, sometimes it's best to get with the times.

At the end of the day, I really don't think OMM should completely be taken away. Hold on to the concepts that can still be made relevant.

AT Still was simply a man who cared to challenge the treatments of his time. Treatments that provided no benefit or even harm. That principle still applies today, and it applies to osteopathic medicine just as much as it applies to medicine at large. We need to hold ourselves to the same standard.

 

[j4pac]

OMT, like every other treatment modality, has its appropriate indications and contraindications. I believe that it can be very effective in the proper context. Not much in regards to pain has good randomized trials and that is because it is very operator dependent and patient dependent. But there is no question in my mind that I have helped specific patients with OMT. Not all of them...but many. I see OMT as a tool in my tool bag and nothing more.

 

[keevwu]

Does any DO physiatrist use OMM in their practise? How valid is OMM for PM&R?

I remember reading a paper where DOs used OMM to complement the treatment of depression (along with meds), and it worked well. But the major flaw in the paper was it's small sample size.

 

[s5260205]

I remember reading a paper where DOs used OMM to complement the treatment of depression (along with meds), and it worked well. But the major flaw in the paper was it's small sample size.

Sorry I was referring to physiatrist, not psychiatrist, but it's still interesting to know.

 

[keevwu]

Sorry I was referring to physiatrist, not psychiatrist, but it's still interesting to know.

oh my bad hahah

 

[ortnakas]

Sorry I was referring to physiatrist, not psychiatrist, but it's still interesting to know.

n = 1, but we have a PM&R faculty member who says he uses OMM all the time. It's one of the fields where OMM makes sense.

 

[RunninGirl3]

I've asked this in the Osteopathic forum but haven't been able to get a clear response, so I thought I'd ask it here in the hopes that some of the helpful DO students could share their insight. As a potential future DO student, I've thought a lot about OMM, and I'm having trouble figuring it out.

Essentially:
If it's been shown to work, why aren't MDs using it?
If it has not been shown to work, why are DOs using it?

I'm all about the "treat the whole patient" philosophy (and I think a lot of MD schools are too), but I'm truly baffled by OMM.

Thanks!

I believe another factor to consider is billing and reimbursement. For the amount of time a provider puts into performing OMM, assessing, re-assessing, etc...the costs may outweigh the outcome and reimbursement benefits.

I'm practicing as a physical therapist currently, and definitely rely on some OMT techniques in my treatment plans, but as PTs, we generally have a little more time to spend with patients and are expected to be performing hands-on treatments.

Finally, from what I've seen, successful OMT can create dependent patients (i.e. "Doc, I need to see you every week for the rest of my life for my back to feel good"). Personally, I want to give patients the tools to be INDEPENDENT. If it takes 3-5 OMT sessions to get there, that's fine. But I don't have any desire to continue the same treatments for years with no overall gains.

 

[mommy2three]

I believe another factor to consider is billing and reimbursement. For the amount of time a provider puts into performing OMM, assessing, re-assessing, etc...the costs may outweigh the outcome and reimbursement benefits.

I'm practicing as a physical therapist currently, and definitely rely on some OMT techniques in my treatment plans, but as PTs, we generally have a little more time to spend with patients and are expected to be performing hands-on treatments.

Finally, from what I've seen, successful OMT can create dependent patients (i.e. "Doc, I need to see you every week for the rest of my life for my back to feel good"). Personally, I want to give patients the tools to be INDEPENDENT. If it takes 3-5 OMT sessions to get there, that's fine. But I don't have any desire to continue the same treatments for years with no overall gains.

It is actually not that hard to bill for it and you can incorporate it into many regular visits
I can and have taught my patients how to do a galbreath technique on their children who have an ear infection. Not only can I bill for the procedure (1 area of OMT with a 25 modifier on the sick visit code of the day), if I spend more than 5 minutes teaching the parent how to do a technique or a stretch to do at home it can be billed under osteopathic education.
There is a great book out there call The 5 minute OMM consult and it contains a bunch of common conditions along with techniques you can do if you have 1 vs 3 vs more time. Also has a picture atlas with description of techniques at the back, counterstrain map, special tests etc. Great reference if you need quick access on how to integrate techniques into practice

 

[RunninGirl3]

It is actually not that hard to bill for it and you can incorporate it into many regular visits
I can and have taught my patients how to do a galbreath technique on their children who have an ear infection. Not only can I bill for the procedure (1 area of OMT with a 25 modifier on the sick visit code of the day), if I spend more than 5 minutes teaching the parent how to do a technique or a stretch to do at home it can be billed under osteopathic education.
There is a great book out there call The 5 minute OMM consult and it contains a bunch of common conditions along with techniques you can do if you have 1 vs 3 vs more time. Also has a picture atlas with description of techniques at the back, counterstrain map, special tests etc. Great reference if you need quick access on how to integrate techniques into practice

Great advice - thanks!