Poll: Do you believe in OMM?

[FutureCTDoc]

People like to be touched in ways that feel good. I learned a lot about touch and palpation in Massage School. Perhaps just kind warm human touch does a lot for people, and they feel better from the attention.

I know that going in for physical medicine and being touched nicely and with care in a professional environment always makes me feel better.

Maybe that's a huge benefit of OMM?

I think touch makes everyone around us more human. If it's that making people feel better then perhaps the science behind something is human connection. Obviously not having studied the technique, I truly cannot say. I am not sure exactly what OMM entails, though I am sure I will understand later.

Andrea

What does making us more human have to do with healing? There is no "huge benefit of OMM". If you don't know what OMM entails how can you comment on the issue? Massage doesn't equal OMM.The underpinnings of cranial are insane and even if other techniques are less loony it doesn't mean that they are A) Effective B) Scientifically sound.

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[NerdyAndrea]

I know that it involves touch, and I know that many people feel better when they are in the company of someone who appears to be human, and helping them. I am commenting because I hope to learn, and that perhaps someone will see a comment and look at it as an outreach for gaining knowledge.

I believe there's a lot to be gained through touch, and OMM does involve touch I believe.

I am not trying to equate anything to anything else. I am speaking from the perspective of what I have watched over time. That's not science either. However, if I speak on what I've seen, maybe it will help someone, or add a new way of looking at someone or a condition. No need to jump on me. I am here to learn like most others on SDN. I learn something everytime I get on here, same as I do in class each day.

I hope you understand where I am coming from with simply being human, and able to relate to people can be healing for them. I never sad it was the same as anything but that perhaps it offered some benefits from being touched in a way meant to be healing.

A

 

[FutureCTDoc]

I know that it involves touch, and I know that many people feel better when they are in the company of someone who appears to be human, and helping them. I am commenting because I hope to learn, and that perhaps someone will see a comment and look at it as an outreach for gaining knowledge.

I believe there's a lot to be gained through touch, and OMM does involve touch I believe.

I am not trying to equate anything to anything else. I am speaking from the perspective of what I have watched over time. That's not science either. However, if I speak on what I've seen, maybe it will help someone, or add a new way of looking at someone or a condition. No need to jump on me. I am here to learn like most others on SDN. I learn something everytime I get on here, same as I do in class each day.

I hope you understand where I am coming from with simply being human, and able to relate to people can be healing for them. I never sad it was the same as anything but that perhaps it offered some benefits from being touched in a way meant to be healing.

A

OMT is a lot more than "touch". You're right at one point OMM isn't a science and I recognize neither is medicine. However I will always be less than impressed with OMT given the current research on it. "Relating" to people doesn't cure back pain. Right now all the current research is underwhelming.

 

[NerdyAndrea]

No it won't cure back pain, but being able to relate and to give them some show of caring, can often ease some of the psychological symptons of pain.

I can speak on that from personal experience, I just had and L5-SI partial disc excision in September. I still have a partial herniation, and some days are better than others, but the pain is a lot better than when it started!

Just having someone to talk to when it was really bad helped a lot. Chronic pain is depressing.

I tried non-invasive first, just to make sure, and when it didn't work ater a few tries I figured alright, no harm no foul, time for my PCP, who referred me to the neurosurgeon. I commend the neurosurgeon for the wonderful job he did. This was something no amount of massage, accupuncture, OMT, or Physical Medicine was going to treat. Having smeone treat me sympathetically and in a caring manner meant a lot.
Just the kind touch and attention during the worst of the oain gave me a lot of hope and the drive to keep believing the pain would end, as well as that I would heal.

I did not try a chiropractor, because I felt well what if something is really wrong? Jerking motions to my back would be really bad. I also feared OMT for the same reason, wondering if I would suffer jerking motions, so I didn't seek that out either.

Also a question that has to be asked is what's the orgin of the pain?

Okay.... I am glad you got to read my post CTC thanks for responding, and hearing my views out as well.

A

 

[snurpy]

No it won't cure back pain, but being able to relate and to give them some show of caring, can often ease some of the psychological symptons of pain.

I can speak on that from personal experience, I just had and L5-SI partial disc excision in September. I still have a partial herniation, and some days are better than others, but the pain is a lot better than when it started!

Just having someone to talk to when it was really bad helped a lot. Chronic pain is depressing.

I tried non-invasive first, just to make sure, and when it didn't work ater a few tries I figured alright, no harm no foul, time for my PCP, who referred me to the neurosurgeon. I commend the neurosurgeon for the wonderful job he did. This was something no amount of massage, accupuncture, OMT, or Physical Medicine was going to treat. Having smeone treat me sympathetically and in a caring manner meant a lot.
Just the kind touch and attention during the worst of the oain gave me a lot of hope and the drive to keep believing the pain would end, as well as that I would heal.

I did not try a chiropractor, because I felt well what if something is really wrong? Jerking motions to my back would be really bad. I also feared OMT for the same reason, wondering if I would suffer jerking motions, so I didn't seek that out either.

Also a question that has to be asked is what's the orgin of the pain?

Okay.... I am glad you got to read my post CTC thanks for responding, and hearing my views out as well.

A

Speaking as a 1st year DO student nearly finishing up a year of OMM...

I think the problem is that patients have very little to no idea what OMM really is about, and are assuming it's all HVLA, spine cracking, jerky things that seems totally random and can take your head off if done improperly. I'm not sure of what a chiropractor would prescribe, but as a DO, HVLA is usually not recommended at all in the situation of patients who have had car accidents or are susceptible to further vertebral injury. I'm not sure what your diagnosis would be, but the physician would probably utilize muscle energy over something "jerky" as you're describing. Muscle energy is not something I think many chiropractors would use or understand really because it requires a deeper level of understanding of anatomy to know how you can manipulate the body to use its own muscles and the patient's isometric contractions in such a way to relieve restricted areas. That might sound like a lot of voodoo black magic nonsense, but when you practice in the lab, I guarantee you that most if not all of your classmates will have a dysfunctional area where it's restricted. Treatment of the area has always been beneficial to my classmates, and I think it's particularly useful for musculoskeletal pain.

As far as viscerosomatic reflexes, or pelvic diaphragms, I'm not sure yet because we're generally healthy medical students who don't have bowel movement problems, gallbladder inflammation, etc, so it's not really feasible to say that it's true in a classroom setting. However, our professors who are in the field for many years swear by many anecdotes of where they've used OMM to treat other types of dysfunctions that are not just musculoskeletal pain, but include anything from breathing ease to stopping a bedwetting problem in a child who had a cranio-sacral dysfunction.

 

[mechanictodr]

I'm not saying it doesn't work, but the only people I have run into where I work that swear by it are a little kooky to begin with. I guess it may be good for the hot yoga organic food crowd, but ehh... just knowing that much puts me off.

 

[JeetKuneDo]

I say our generation of DO's, some of who will one day be leaders in AOA, should just make omm optional.

 

[Lokhtar]

How exactly do you double-blind an OMM study? Have a robot perform the manipulation? Toddlers? Who?

You don't have to necesarily do a double blind, you can do a relative effectiveness:

1. Placebo
2. Standard Allopathic Treatment
3. OMM
4. A Masseuse or other treatment with musuloskeleton component

 

[J-Rad]

Trendelenburg and prehospital spinal immobilization to name 2.

Propranolol for infantile hemangioma, #3.

 

[Lokhtar]

Yes. I know it works. Ask my back and neck.

Oh, and there are publications out there that agree as well.

Well, anecdotal evidence is not evidence.

The publication thing is obviously where it matters, but for most treatments, it's been iffy. Some have been shown to have an effect, others none at all (cranial).

Am I the only person who thinks this way?? But if your goal as a physician is to relieve a patients pain and suffering...and you perform OMM on them....and to them it is relieving pain.....have you not just done your job as a physician???

The only way I can see this being unethical is if you market OMM to your patients as being able to do things it hasnt been proven to do. But if you offer to try it on patients and state that it *MAY* help them not *WILL* help them...i really see nothing wrong with that.

Who knows if OMM is placebo effect...and lacks studies to back its efficacy. But you know what? Placebo effect or not, the placebo effect IS well documented in studies and it does work!

Physicians are not allowed to prescribe placebos and claim they are medicine. It is unethical. I as a patient would be pretty pissed off if a physician did that to me.

 

[Quantum Mecha]

I'm curious to see how many people entering a DO program (or are interested in one) on this forum actually believe OMM is based on solid science. Or whether they believe science is even necessary.

Does solid science refer to effectiveness (say, they do OMM on a large group of people and it helps most of them), or mechanism of action (what is actually going on and how that relates to the relief)?

 

[faith2]

Please do not get offended by this question DO's but are you really going to be able to use it when you are a practicing physician? My primary care doctor is a DO and he never asked if I wanted it or if I am educated about it. I can not imagine when a dr would use it in certain firleds like EM for example or RAD. I think that OMM set DO's and MD's apart once upon a time but now only the letters set the 2 apart duties specialties etc are the same amongst the two in this country. Alot of DO students that I shadowed told me they learn it because they have to and that's it.


I am not saying that it does or does not work because I do not know, but since DO's are using it less and less how will we find out?

 

[JaggerPlate]

I say our generation of DO's, some of who will one day be leaders in AOA, should just make omm optional.

There will come a point in time where the 'old guard' will retire and 'we' will be in charge, and I definitely thinks things will be different then. However, I don't know if making OMM optional is a great idea. Again though ... not far enough along, so unsure.

 

[Siggy]

There is no "huge benefit of OMM".

I'd argue that there is evidence that shows that OMM is as beneficial as pain killers for lower back pain in a huge benefit. While I'm by no means biased against pharmaceuticals and pharmaceutical pain management, if alternatives to pharmaceuticals exists, then it deserves consideration.

 

[Bacchus]

I don't think so. Those that will be elected to the AOA from our time will carry on the Old Guard's wishes. You'll see it in your class, there are zealots still.

 

[creativename]

I'd say that's dangerous. I also think consistency would be lost. Who knows.

Why even attempt a double blind study of OMM? I assume you can't anesthetize the patient, so outside of what Siggy proposed I don't see how you could achieve your precious double blind. This post needs to be moved to the osteo student board for valuable input to get inserted. It's the blind leading the blind by setting it up in the premed section.

 

[Bacchus]

I never said to conduct a double blind study?

 

[RustedKOD]

I am no a HUGE believer in OMT but in my humble opinion some of the treatments are great. Most notable is the sprained ankle treatment with HVLA because I've seen in work with my own eyes. I am still an OMS-I and so far this is the only treatment I know that works for real.

 

[Bacchus]

Why would you do HVLA on a sprained joint? I don't have my atlas available, but I would garner that's a rather important contraindication.

 

[Warbler]

Have both the treatment and the control technician not be physicians. You train the treatment technician in the appropriate technique and the control technician in a placebo technique. Since both technicians think that their treatment is the correct treatment, you now have a double blind method of treatment.

That seems more than a little ridiculous.

Having people make up and perform "Placebo techniques" meant to mimic the appearance of a therapy that we believe works, but aren't sure why it does? Thats easily as unscientific as not having a double-blind experiment.

Unfortunately, not everything fits neatly into a lab setting.

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On the other hand, to all the people encouraging OMM even if it is a placebo, or just to give human contact: If you have any faith at all in OMM wouldn't you rather it be properly vetted so we could find what works, why, and how to IMPROVE it, instead of just sticking with what we know?

And if we discover it really is a placebo effect, why not just get "OMM Technicians" to roll you around, and give you a hug on the way out, and pay them minimum wage instead of wasting a physicians time learning it, then practicing it on patients?

------------------

And to all the folks who think its total BS- why arent you in an MD program?

 

[Siggy]

Are you seriously arguing that using sham treatments as a control for studies are vastly different from placebo pill controls?

Article discussing sham controls in mainstream medicine. http://pats.atsjournals.org/cgi/content/full/4/7/574

Are you going to suggest that sham controls for OMM are somehow more dangerous than the partial burr hole sham control in the Parkinson's disease patients?

 

[JeetKuneDo]

And to all the folks who think its total BS- why arent you in an MD program?

We want to be physicians...

I don't think there's anything wrong with thinking omm is BS and going to a DO program. I'm sure you don't have to agree with it to pass and do well in the class.

 

[rugger14]

We want to be physicians...

I don't think there's anything wrong with thinking omm is BS and going to a DO program. I'm sure you don't have to agree with it to pass and do well in the class.

don't worry pre-meds, you will learn all about OMM when you get here

 

[JaggerPlate]

We want to be physicians...

I don't think there's anything wrong with thinking omm is BS and going to a DO program. I'm sure you don't have to agree with it to pass and do well in the class.

Eh, maybe after 2 years of OMM it's fine, but talking about how interested you are in OMM in the interview then bashing it as 'bs' before you even walk into a single OMM lab is a bit in my opinion.

 

[nascardoc]

I think its funny that most of the people on here bashing OMM haven't even stepped foot into medical school yet. How can you evaluate it without trying it? Is it perfect, no.....but is it a useful tool to put into your medical toolbox, definitely. After studying it for 2 years and using it in lab and on pts, you will see it actually does work. It is not intended, nor was it presented at my school, as the end all be all treatment that will cure everything. Should it be used as first-line treatment, not in everything. I have seen treatments work magic and I have seen treatments fail, but I am a believer in using OMM in the right situations.

 

[JeetKuneDo]

Ok, calling omm complete bs was pretty ignorant.

 

[JaggerPlate]

Ok, calling omm complete bs was pretty ignorant.

I mean, if you go through 2 years of it, and still feel that way ... by all means, say how you feel. But to call it 'complete BS' before even stepping into a single OMM lab is a bit much IMO. Don't stress though.

 

[TexasTriathlete]

A lot of these techniques are things that athletic trainers and physical therapists have been doing for a long time, or some variant of them. There isn't any chanting or mystical mumbo jumbo going on. It's just f-ing manual therapy. And yes, it works.

 

[Donvb]

I say our generation of DO's, some of who will one day be leaders in AOA, should just make omm optional.

D.O.'s who go on to be "leaders in AOA" all believe fully in OMT and most use it often in their practices... This will never change because these are the physicians that want to show the disparity between what they have, and what MD's have. D.O.'s who do not have that same vigor in "being a D.O." and just enjoy being a "physician," don't run for AOA leadership in general. THAT in my opinion, is why OMM will never become "optional" as long as there is the D.O. degree.

 

[Lokhtar]

Eh, maybe after 2 years of OMM it's fine, but talking about how interested you are in OMM in the interview then bashing it as 'bs' before you even walk into a single OMM lab is a bit in my opinion.

No, that's not how science works.

I think its funny that most of the people on here bashing OMM haven't even stepped foot into medical school yet. How can you evaluate it without trying it? Is it perfect, no.....but is it a useful tool to put into your medical toolbox, definitely. After studying it for 2 years and using it in lab and on pts, you will see it actually does work. It is not intended, nor was it presented at my school, as the end all be all treatment that will cure everything. Should it be used as first-line treatment, not in everything. I have seen treatments work magic and I have seen treatments fail, but I am a believer in using OMM in the right situations.

Anecdotal evidence is not evidence. What you have 'seen' is irrelevant.


OMM may or may not work. I have only looked into cranial - which does not work. But to say you have seen it work so it works, or to say that you cannot analyze it without attending medical school are both big fallacies. Thats how quacks work.

 

[JaggerPlate]

No, that's not how science works.

So, you're saying science works by making second hand claims based on the interweb without doing any first hand research??? Nopeeski.


I'm not saying anything controversial here ...

 

[Lokhtar]

So, you're saying science works by making second hand claims based on the interweb without doing any first hand research??? Nopeeski.


I'm not saying anything controversial here ...

No, saying that you need to go through training to figure out of it works is nonsensical. Science = published data. You don't need to be a PhD in neuroscience to look at the data published by a PhD in neuroscience.

If you want to show if something works (or doesn't), do it through the data. Going to OMM labs is irrelevant for everything except actually performing OMM.

 

[JaggerPlate]

No, saying that you need to go through training to figure out of it works is nonsensical. Science = published data. You don't need to be a PhD in neuroscience to look at the data published by a PhD in neuroscience.

If you want to show if something works (or doesn't), do it through the data. Going to OMM labs is irrelevant for everything except actually performing OMM.

Okay, let me rephrase then ...

people, on SDN, who throw out catch-phrases like 'OMM is BS' have never read an actual study on the efficacy of OMM. They are simply repeating arguments from this site. This is not science/good science (in your own words)

If people are interested, there is a whole section in the Osteo forum dedicated to OMM articles.

 

[Lokhtar]

Okay, let me rephrase then ...

people, on SDN, who throw out catch-phrases like 'OMM is BS' have never read an actual study on the efficacy of OMM. They are simply repeating arguments from this site. This is not science/good science (in your own words)

Yes, of course. I Agree.

If people are interested, there is a whole section in the Osteo forum dedicated to OMM articles.

Pubmed is good too in general .

I did a paper on the efficacy of cranial. In essence: it's quackery and there is no efficacy. There is not even any consistency in detecting and categorizing "rhythms" from practitioner to practitioners. I think the osteopathic body that decides on OMM curriculum is doing themselves, and their students some serious disservice by continuing to teach it. Osteopathic students get a quality medical education, why put cranial in and create a question mark on their own students where none should exist?

Since I haven't done any research on any other aspects of OMM, I won't comment.

 

[thepoopologist]

I'm in the "learning it because I have to" camp. There is no significant research that I am aware of on it, other than the fact that people continue to go to DO's for OMM and DO's continue to make six figures (200k+) from performing OMM treatments. I've asked my profs about it and they say that while they do try to find the underlying cause to the problem and sometimes succeed, sometimes relieving the patients pain is good enough. That's my second hand anecdote. I haven't learned cranial yet and I don't care if everyone tells me its bull****. I'm learning it anyway because COMLEX will probably test me on it.

On a more practical note, it's helped me become more comfortable putting my hands on different body types. I am pretty damn good with the physical exam, or the parts I've been taught so far in my clinical skills course. A lot of it has to do with OMM lab, finding different landmarks on an actual person and then performing the treatments they teach you.

Could I possibly be spending my time learning something else, like all those people who go to DO schools and bitch about what a waste of time OMM is? Yes, but I choose not to be a completely miserable **** about it. Who the **** cares about some stupid ****ing poll. You either learn OMM or you drop out and go to an allopathic school. Just another hoop to jump through.

 

[nascardoc]

No, that's not how science works.



Anecdotal evidence is not evidence. What you have 'seen' is irrelevant.


OMM may or may not work. I have only looked into cranial - which does not work. But to say you have seen it work so it works, or to say that you cannot analyze it without attending medical school are both big fallacies. Thats how quacks work.

How can I not use clinical experience as evidence? I think by seeing patients and using OMM where indicated, serves as evidence. Just because something isn't backed up by X number of studies doesn't mean it isn't useful. You can even take cranial out of the picture. I don't use it. But what about muscle energy, HVLA, strain-counterstrain? Those aren't some random ideas thrown out there, but are based on anatomy and used by other professionals, such as atheletic trainers and physical therapists.

Now before you start calling me a quack (which is hilarious), realize I don't think OMM should be a first-line treatment, but used when appropriate. That is where training for 2 years in the classroom comes in. Of course you don't need training to evaulate numbers, but you do need training to know when its appropriate to use treatments.

 

[Bacchus]

How can I not use clinical experience as evidence? I think by seeing patients and using OMM where indicated, serves as evidence. Just because something isn't backed up by X number of studies doesn't mean it isn't useful. You can even take cranial out of the picture. I don't use it. But what about muscle energy, HVLA, strain-counterstrain? Those aren't some random ideas thrown out there, but are based on anatomy and used by other professionals, such as atheletic trainers and physical therapists.

Now before you start calling me a quack (which is hilarious), realize I don't think OMM should be a first-line treatment, but used when appropriate. That is where training for 2 years in the classroom comes in. Of course you don't need training to evaulate numbers, but you do need training to know when its appropriate to use treatments.

C'mon, you know HVLA isn't effective. The immediate relief is not evidence.

 

[JaggerPlate]

I did a paper on the efficacy of cranial. In essence: it's quackery and there is no efficacy. There is not even any consistency in detecting and categorizing "rhythms" from practitioner to practitioners. I think the osteopathic body that decides on OMM curriculum is doing themselves, and their students some serious disservice by continuing to teach it. Osteopathic students get a quality medical education, why put cranial in and create a question mark on their own students where none should exist?

Since I haven't done any research on any other aspects of OMM, I won't comment.

I've read quite a few on cranial ... and find issues with: 1. reliability between practitioners (it's found to be quite small to nilch) 2. Being able to feel/palpate the rhythmic pulse/CRI. I'm not convinced it doesn't exist, etc, but those are two issues I've always had.

However, I've always thought OMM and the head weren't mutually exclusive concepts. (warning this is a mixture of what I've 'heard' - aka not good to repeat and some studies I've read) From what I understand, it can be effective for otitis media in the chillin, can work well for draining sinuses, and I've also read a few interesting things about headaches and neck muscles, and jaw issues. Again, it's my understanding that this has MUCH more to do with muscles than it does with shifting scull bones or feeling rhythms.

Again though, I'm trying to go into all of it with a pretty open mind and I do have a deep interest in learning it at the moment.

 

[JaggerPlate]

there is no significant research that i am aware of on it, other than the fact that people continue to go to do's for omm and do's continue to make six figures (200k+) from performing omm treatments.

 

[Lokhtar]

How can I not use clinical experience as evidence?

Because it's not evidence. By definition. People who do homeopathy say the same thing as you. "Well, in my experience, it helps patients." That doesn't mean the evidence is valid.

I think by seeing patients and using OMM where indicated, serves as evidence. Just because something isn't backed up by X number of studies doesn't mean it isn't useful.

No, it just means you don't know if its useful.

You can even take cranial out of the picture. I don't use it. But what about muscle energy, HVLA, strain-counterstrain? Those aren't some random ideas thrown out there, but are based on anatomy and used by other professionals, such as atheletic trainers and physical therapists.

I only commented on cranial because I've only done research on it. If you notice, I was speaking specifically about cranial - it's a sham treatment. Other OMM may be effective, I don't say anything negative because I haven't looked at the data.

C'mon, you know HVLA isn't effective. The immediate relief is not evidence.

You should know that it isn't. You are going to be a physician, surely you should know what 'evidence' means?

Now before you start calling me a quack (which is hilarious),

I didn't.

realize I don't think OMM should be a first-line treatment, but used when appropriate. That is where training for 2 years in the classroom comes in. Of course you don't need training to evaulate numbers, but you do need training to know when its appropriate to use treatments.

Again, I am only speaking about cranial, as I've made clear.

From what I understand, it can be effective for otitis media in the chillin, can work well for draining sinuses, and I've also read a few interesting things about headaches and neck muscles, and jaw issues. Again, it's my understanding that this has MUCH more to do with muscles than it does with shifting scull bones or feeling rhythms.

You have any studies on that?

 

[Bacchus]

You don't need a study. These practitioners are strictly OMM that teach us. They have hundreds of cases under them. I trust them when they this will work for X, Y, or Z. There are some things I question or don't believe, but that's my opinion. If you're so hell bent on destroying the efficacy of OMM why do you even read these threads?

 

[nascardoc]

Here is a link that Jagger provided awhile back with an OMM article published in the American Journal of Obstetrics and Gynecology.



Bacchus - I agree 100%.

 

[Lokhtar]

You don't need a study. These practitioners are strictly OMM that teach us. They have hundreds of cases under them. I trust them when they this will work for X, Y, or Z.

That's the same logic used by homeopaths and mystics. Are you sure you want to be grouped in with them?

If a drug company makes the same claim about their drugs being used by someone and people say it works, would you say it doesn't need a study to show it?

 

[Bacchus]

This is manual therapy. As long as one performs an H+P and is competent, they are not going to hurt the patient. Saying OMM is grouped in with mystics and homeopaths is ludicrous. Why do DPTs do many of the same things if they're not effective?

 

[Lokhtar]

This is manual therapy. As long as one performs an H+P and is competent, they are not going to hurt the patient. Saying OMM is grouped in with mystics and homeopaths is ludicrous. Why do DPTs do many of the same things if they're not effective?

Did I say whether it was effective or not? I was responding to the assertion a scientific study isn't needed because people told you it works, or it works in anecdotes.

This is what homeopaths say:

1. It's very hard to design a proper study for homeopathy.
2. I've seen it work!
3. I don't need a study, I've been taught by homeopaths who've been treating and helping patients for years!
4. The proper studies are coming....

Sound familiar?
If you don't want to be lumped in with homeopaths, don't use the same logic and justifications as them. For the record, there have been OMM techniques that have been shown to be effective. Not by hearsay, or anecdotes, but by science. Use those techniques, and say with confidence they work. But only because they've been shown to work. And not because someone somewhere or the other has been using it and says it works.

 

[Bacchus]

This is about confidence. I'm confident enough to know I'll be a physician. I don't need anything else.

 

[Lokhtar]

This is about confidence. I'm confident enough to know I'll be a physician. I don't need anything else.

Huh? I don't get it, of course you'll be a physician - how is this relevant? You don't need anything for what? Confidence in who?

 

[thepoopologist]

Lokhtar, what is the end that you are trying to achieve?

 

[DocHomer]

Lokhtar, what is the end that you are trying to achieve?

I think the dude is just angry.

 

[Lokhtar]

Lokhtar, what is the end that you are trying to achieve?

Ideally, the end of teaching of cranial at American medical schools .