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Hello,

I have a quick question about the uses of OMM.
Is it legal for a DO to teach a patent's family member the correct way to perform OMM?
I'm asking this because in the future, I want to go volunteer to an underserved area, and the patients there may not have access to certain medication that can be treated with OMM.
I'm thinking that if I were to teach the patient's relative the correct way to perform OMM, they can continuously do the manipulation at home so that they do not have to rely on the accessibility of certain drugs.

thanks!
 

ChiTownBHawks

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Hello,

I have a quick question about the uses of OMM.
Is it legal for a DO to teach a patent's family member the correct way to perform OMM?
I'm asking this because in the future, I want to go volunteer to an underserved area, and the patients there may not have access to certain medication that can be treated with OMM.
I'm thinking that if I were to teach the patient's relative the correct way to perform OMM, they can continuously do the manipulation at home so that they do not have to rely on the accessibility of certain drugs.

thanks!
huh?
 
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Captain DO

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I'm not sure of the legal aspects, but I believe only the DO community has the training and ability to effectively zap somatic dysfunction.

You can teach them how to place their hands, what they should do...but they're not trained on how it feels throughout the motion. How to hold. The little details that might make the diffference.

Personally, I'll only ever let a fellow DO touch and feel me.
 

Crayola227

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I will say as an MD I was very lucky to have some DO colleagues teach me some stuff to do to myself at home, but I think it was like a professional courtesy type thing.

There are things as MDs we can teach patients to do or have a partner help with, like home stretches or PT manuevers, that's not really OMM but I mean there's some common sense musculoskeletal medicine stuff you can send them home with. Anything that's a "pop" is probably bad news. Stretches and exercises and pressure points could be OK with your typical "if it hurts lay off" disclaimer.

My advice, is don't go beyond standard of care, whatever that is for DOs or MDs respectively.

If the info is available online I know docs will tell patients to look something up online.

But as common sense as some adjustments seem to you or I, anything more advanced than what a yoga intructor could teach someone sounds like bad news.
 
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Siggy

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It depends on the technique. I wouldn't necessarily have a problem teaching a family member how to do counterstrain. HVLA, on the other hand, would be a hard "no."
 
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Crayola227

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It depends on the technique. I wouldn't necessarily have a problem teaching a family member how to do counterstrain. HVLA, on the other hand, would be a hard "no."
Ah God thank you! That was the term for quite a bit of the voodoo magic my beloved DOs sent me home with.

I have to say a few times I offered to let the DO rotating students and fresh interns "play" with my spine high velocity (that was the term thank you Siggy) I got a bit maladjusted, hurt like a bitch a few days, but we all knew what we were doing was strictly off the books and I was a guinea pig. Nothing that could have busted anything, but being on the receiving end I can tell you as someone said above you probably shouldn't give patients any bright ideas.

Don't underestimate how much benefit patients can get with less sexy stuff. At the end of the day some of that counterstrain stuff really changed my freaking life.
 
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Teach a pregnant woman's partner to do simple soft tissue tx or pubic shotgun ME. No problem with that. Heck, we teach high school and middle school students to do it.

Teach a family member to treat the psoas syndrome with ME or MFR. That's all quality medicine.
 
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ortnakas

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It depends on the technique. I wouldn't necessarily have a problem teaching a family member how to do counterstrain. HVLA, on the other hand, would be a hard "no."
100% agree. Psoas stretch or Marian Clark drainage? Sure, why not. Cervical HVLA? He11 no.
 

AMEHigh

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Sounds like a great way to get sued.
Huh? That is false.

I know some DOs advocate teaching parents OMM techniques for things like ear infections to help with drainage. Now whether or not you think that it works is another question, but to spout off that someone would get sued for that is incorrect.
 

samac

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Huh? That is false.

I know some DOs advocate teaching parents OMM techniques for things like ear infections to help with drainage. Now whether or not you think that it works is another question, but to spout off that someone would get sued for that is incorrect.
I really feel like someone could sue here if something went wrong. "But the doctor told me to!"
 
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ChiTownBHawks

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I really feel like someone could sue here if something went wrong. "But the doctor told me to!"
Or if the infection got worse and spread: "But, the doctor told me to do that to make the gooey smelly stuff go away."
 

AMEHigh

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I really feel like someone could sue here if something went wrong. "But the doctor told me to!"
That's not exactly how medical malpractice work.

Ok maybe someone might think they want to sue a DO for teaching them the Galbreath technique and it not working, but I'm 99.9% sure that no lawyer would take on their case and it would get nowhere.

Doctors advise on all sorts of "non medical" techniques such as exercising, massaging, warm compresses, etc all the time. Malpractice isn't going up because of those or advising on a simple OMM technique.
 

Crayola227

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I think the point is that if you try to teach them something like cervical HVLA in one office visit and they home and someone breaks something, you will be seen as going outside the standard of care, and if they are damages you can be sued for those damages.

If I send a patient home with a scalpel and tell them to lance their own boil, and anything bad happens, similar scenario. There is no reason to think the patient is qualified to do that themselves and manage any complications of that, despite any caveat messages about it I send them home with.
 

MetalloBetalactamase

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Treated? Yes. Treated efficaciously or even perhaps ethically, no.

There are serious ethical questions that arise from giving a patient any treatment that is essentially a placebo and not advising them that it is: that there is no substantiative empirical evidence that the treatment works i.e. OMM/OMT. You should not offer a placebo without educating your patient that it is a placebo. There is no excuse for withholding essential information from patients.

Many common complaints are symptoms of more serious health complaints.
 

Oo Cipher oO

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Treated? Yes. Treated efficaciously or even perhaps ethically, no.

There are serious ethical questions that arise from giving a patient any treatment that is essentially a placebo and not advising them that it is: that there is no substantiative empirical evidence that the treatment works i.e. OMM/OMT. You should not offer a placebo without educating your patient that it is a placebo. There is no excuse for withholding essential information from patients.

Many common complaints are symptoms of more serious health complaints.
Sigh...back to this topic again? Ok folks this thread is done. The rest of this discussion will be people arguing the merits of OMM as a whole. OP I hope you got your answer.
 

hallowmann

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Treated? Yes. Treated efficaciously or even perhaps ethically, no.

There are serious ethical questions that arise from giving a patient any treatment that is essentially a placebo and not advising them that it is: that there is no substantiative empirical evidence that the treatment works i.e. OMM/OMT. You should not offer a placebo without educating your patient that it is a placebo. There is no excuse for withholding essential information from patients.

Many common complaints are symptoms of more serious health complaints.
There have been studies demonstrating that certain OMT is effective at treating low-back pain. Is it going to cure your asthma? No, but if it prevents a patient with chronic LBP, PUD and CAD from using NSAIDs or COX-2 inhibitors that have plenty of other unfavorable side effects, its probably worth it. In any case, I'm not here to defend OMT or whatever, but I couldn't just leave your comment out there like that.

On a separate note, there are plenty of "treatments" in medicine that are most likely the result of placebo. To give an example, arthroscopy for osteoarthritis of the knee (http://www.nejm.org/doi/full/10.1056/NEJMoa013259). We certainly try to make sure there is evidence for everything we do, but there still are plenty of things that we do that we either know has no effect or we don't know whether it really has an effect, and yet we still use it. Another example would be iodoform packing vs. non-iodoform packing, no extra benefit found with iodoform, but we still use it because it makes us feel better.
 

ortnakas

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I agree with @hallowmann . I don't think it's the magic cure-all some of our OPP professors would have us believe. But could splenic pump help an infection go away a bit faster? Sure, maybe. Do some OMT techniques help with back pain? Absolutely, even if some are glorified stretching. I don't know if sacral rocking actually does anything to your parasympathetics, but it's great for menstrual cramps. And the singultus technique for hiccups is possibly the most useful thing I've learned in medical school.
 
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there is no serious medical condition that can be treated with omm...
This is true, there is no serious condition that can be treated with OMM. I even discussed this one of my basic science professors who strongly believes that OMM has no real therapeutic value. If it does its merely placebo.
 

Mad Jack

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Ah God thank you! That was the term for quite a bit of the voodoo magic my beloved DOs sent me home with.

I have to say a few times I offered to let the DO rotating students and fresh interns "play" with my spine high velocity (that was the term thank you Siggy) I got a bit maladjusted, hurt like a bitch a few days, but we all knew what we were doing was strictly off the books and I was a guinea pig. Nothing that could have busted anything, but being on the receiving end I can tell you as someone said above you probably shouldn't give patients any bright ideas.

Don't underestimate how much benefit patients can get with less sexy stuff. At the end of the day some of that counterstrain stuff really changed my freaking life.
Lots of the younger kids in my class knock CS, but it's pretty much the best thing ever for my muscles when they get tight.
 
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Chronic pain is very serious but can it really be treated with OMM or was that just something you've been told over and over?
Most likely told that, the body of evidence for efficacy is limited at best, only about 5 percent of practicing DOs actually use OMM in their daily medical practice.
 

Crayola227

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It's too bad, as an MD who's been in a couple car accidents, when I used my medical insurance, I went to the MD, got a handful of pills like vicodin and cyclobenzapine, a page of stretches, and a pat on the head. RICE. Insurance wouldn't cover PT, chiropractic, and for young working people (cohort of the most economically productive and otherwise healthy and cheap), musculoskeletal problems are the number one health care and missed work money drain. I was in undergrad full time and had to cut 20 hour a week jobs x 2 years. When the car insurance was paying, cue the PT and chiropractic and me doing effective self-care without pills, and I'm back in the ****ing game after a few months.

Of all the combos of skills and degrees, the special character of the DO, that's the one I value most. All the punch of an MD, none of the homeopathy hooey of some chiropractors. Just this year, after years of back problems and internet research and PT and chiropractic and yoga and home stretches, and the DO resident sitting next to me showed me one little counterstrain move and in 10 seconds rocks my ****ing world.

One of my best friends in med school just did one rotation with a DO, and learned enough to spend 15 min here and there fixing me for a few weeks at a time when the books were hitting me hard.

Of all things, I sure as hell would rather all the MDs get some OMM added to the curriculum rather than see DO training lose it. I don't know what all you guys do and if there's room to cut some, but some of that **** is pure gold. Whatever small percent of DOs make up the medical licenses x 5%, hell, if we lose even that, I think we've lost a helluva lot more than that. Who will have all the necessary skills to ****ing deal with back pain of all "easily treated" conditions? Better to leave it to the MDs and the chiropractors? No son, that ain't gonna do it.
 
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Crayola227

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Cue "EBM" "EBM" "EBM" chant in the face of my anecdote, but whatever. You'll never do a randomized control trial about the outcome of jumping from a plane with and without a parachute. Doesn't mean you shouldn't use one.

Some **** that works will never have any EBM to back it for a number of reasons. You have to think beyond even what studies do exist or do demonstrate and why.
 

Mad Jack

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I would argue the number is less than 5%. I've personally never met a DO attending at a hospital or office that used OMM. I can only think of 1 or 2 total in my class who would seriously consider using OMM on a regular basis in their career. Anyways, no one shows up in the ER with a condition that could remotely be treated with OMM. even if they did CMS/insurance is not going to pay for it.

Ring ring. "hospital this is ambulance 51 we have a patient with a tender left paraspinal, asymmetry, decreased range of motion, and tissue texture changes. OMG HIS T7 IS SIDEBENT LEFT ROTATED RIGHT."
What saves lives and what improves quality of life are entirely different things. While I won't do OMM professionally, I have friends and family with pain issues that I use it all the time that find it incredibly effective.
 
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CrocodilePancake

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Hello,

I have a quick question about the uses of OMM.
Is it legal for a DO to teach a patent's family member the correct way to perform OMM?
I'm asking this because in the future, I want to go volunteer to an underserved area, and the patients there may not have access to certain medication that can be treated with OMM.
I'm thinking that if I were to teach the patient's relative the correct way to perform OMM, they can continuously do the manipulation at home so that they do not have to rely on the accessibility of certain drugs.

thanks!
make sure to describe to the patient how to sprinkle on the osteopathic fairy dust required for improved patient comfort and effectiveness
 

JustPlainBill

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Hello,

I have a quick question about the uses of OMM.
Is it legal for a DO to teach a patent's family member the correct way to perform OMM?
I'm asking this because in the future, I want to go volunteer to an underserved area, and the patients there may not have access to certain medication that can be treated with OMM.
I'm thinking that if I were to teach the patient's relative the correct way to perform OMM, they can continuously do the manipulation at home so that they do not have to rely on the accessibility of certain drugs.

thanks!
So, a few things ---

1) Not meaning to be rude but from your sig, you're still a pre-med -- let's wait until you've been through the first 2 years of OMM training before you make a judgment call on "certain medication that can be treated with OMM" -- I think you meant to say that a patient cannot afford medications for a condition that can be treated with OMM -- at this level, it sounds as if you've got stars in your eyes about what OMM can/can't do --

2) As a pre-med, you may not have had the experience of listening to a patient tell you that they ran out of "their insulin" (70/30) and "borrowed" insulin from their father in law (Lantus) and gave themselves the same dosage (30U BID) -- or the mom who decided that eczema on her 13 year old's forearms was best treated with some Augmentin she had lying around -- or the --- you get the idea -- apply this to OMM and now you may have opened a door to liability -- "well the doc treated my back pain with this and showed me how" and the patient winds up having nephrolithiasis, delays seeking treatment and bingo, you now have hydronephrosis and possible sepsis depending on how it goes -- bad juju

3) Not trying to discourage you but recognize it's your license on the line (and your malpractice rates) and every time you want to go for credentialing, the forms WILL ask if you've ever had a malpractice incident or been reported to the national database or had any issues with the state medical board or been involved with a case involving harm to a patient --- Now, do you want to be $150k+ in debt, with a family and house to support without the ability to practice medicine because you taught someone OMM who just "promised" that they'd only use it for this one situation?

Again, no warranties expressed or implied, your mileage may vary ----

As an aside, I think I'd be more concerned about getting into medical school and doing well, rather than what my future as an indigent care volunteer would look like -- I went in with this sort of attitude also and I learned at the county hospital that most people don't want your help, they just want you to fix them enough so they can continue their chosen lifestyle -- hence the repeat pancreatitis from the 1 case every 2 days and 3-4 on the weekend patient who was told in bold, italicized, large font letters in discharge instructions that they would die if they kept up this lifestyle merely to show up again 3 weeks later with the same complaint --- and that was not an isolated case.
 
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JustPlainBill

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I would argue the number is less than 5%. I've personally never met a DO attending at a hospital or office that used OMM. I can only think of 1 or 2 total in my class who would seriously consider using OMM on a regular basis in their career. Anyways, no one shows up in the ER with a condition that could remotely be treated with OMM. even if they did CMS/insurance is not going to pay for it.

Ring ring. "hospital this is ambulance 51 we have a patient with a tender left paraspinal, asymmetry, decreased range of motion, and tissue texture changes. OMG HIS T7 IS SIDEBENT LEFT ROTATED RIGHT."
Reminds me of the time when I wanted to be a chiropractor (many moons ago, long story) and had a family member tell me that chiros were now accepted into the military the same as MD/DOs -- as I was considering it, my spouse raised a concern about being deployed -- I had to really work to let her know that IF I went in as a chiro, I would not likely be moving low and fast from shell crater to building to crew served weapons emplacement to offer an emergency adjustment on a downed troop with low back pain --- I had to restrain outright laughter but the image of someone in full battle-rattle doing an adjustment under fire was just too much ---
 
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Cue "EBM" "EBM" "EBM" chant in the face of my anecdote, but whatever. You'll never do a randomized control trial about the outcome of jumping from a plane with and without a parachute. Doesn't mean you shouldn't use one.

Some **** that works will never have any EBM to back it for a number of reasons. You have to think beyond even what studies do exist or do demonstrate and why.
Sporadically there have been studies, e.g.
http://www.biomedcentral.com/1471-2474/6/43
http://www.manualtherapyjournal.com/article/S1356-689X(13)00084-2/pdf
http://www.manualtherapyjournal.com/article/S1356-689X(14)00114-3/pdf

The most recent one had 455 patients.
 
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Reminds me of the time when I wanted to be a chiropractor (many moons ago, long story) and had a family member tell me that chiros were now accepted into the military the same as MD/DOs -- as I was considering it, my spouse raised a concern about being deployed -- I had to really work to let her know that IF I went in as a chiro, I would not likely be moving low and fast from shell crater to building to crew served weapons emplacement to offer an emergency adjustment on a downed troop with low back pain --- I had to restrain outright laughter but the image of someone in full battle-rattle doing an adjustment under fire was just too much ---
As you know, sepsis is caused by subluxation. Subluxation also causes syphilis.
 

JustPlainBill

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As you know, sepsis is caused by subluxation. Subluxation also causes syphilis.
Yes, subluxation without a raincoat can cause syphilis --- depending on your choices of who you sublux with -- but that's more sacral rocking than anything else ;->
 

Crayola227

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I'm not sure if MD students do surface anatomy lab, but because of OMM class, it makes finding stuff super easy. My palpating skills are off the chiz-ain and touching people isn't really awkward anymore. Also I love diagnosing innominates, something about seeing that physical side of medicine with bones and muscles is awesome. I don't really like OMM, but I definitely see it's purposes and the good things that come out of it. Also, not sure about people who complain about having to take an extra class, but it's pretty simple stuff if you practice and learn trigger words.
No, we don't really do surface anatomy lab. Surgeons and anesthesiolgists and the ED seem to know their surfaces OK for sticking needles in people without hitting a major nerve. Some rheums who do joint injections. In primary care they teach you landmarks for deltoid and glute IM injections. IM in hospital landmrks for IJ and paracentesis.

There were like 2 pages in Netter's on surface anatomy and probably 2 questions on the anatomy written exam, and we did like *1* one hour surface anatomy/palpation lab, and everyone left early.

I've never met a DO attending who uses OMM other than to threaten students with it - "if you order propanolol instead of propofol I'll deliver a high velocity low amplitude thrust to your face."

I'll stick to learning the physician's approach to diagnosis/treatment rather than osteopathic or allopathic approach - for patients' sake there should not be a difference.
Hilarious anecdote.

Right, there shouldn't be a difference, MDs should learn more OMM, like surface anatomy, and more about musculoskeletal medicine. I was lucky my school offerred an optional didactic lecture class so I got 12 extra hours of training from a PM&R doc, and my colleagues seem so impressed I can dx de Quervain's tenosynovitis and a really good ddx for LBP and know good manuevers to determine if a complaint is bony vs tendon vs ligamentous vs neurological in nature, the quality of my neuro exam, shoulder, hip, knee, ankle exam and indication for imaging. Some MDs seem to know all this, others seem scarily impressed by these skills I have, and my DO colleagues still seem to know more than the average bear on this stuff from my obseravtions by comparison. I wish I could add better palpatory skills, strain/counterstrain, and some other magic voo doo you guys know that I see really help in a pinch (no pun intended on the pinch thing), and some other skills. I've looked it up and I know about some of this craniosacral stuff and it sounds bogus but that's not the whole story.

As far as making it optional/available to allopaths, most of the course I looked into were like 1-2 year courses, or one that was like 12 weeks, and expensive. It's a bit of a shame not to just add it to the captive audience that are med students still in school. Obviously there are specialists that wouldn't gain much by these skills (endocrinologist, opthalmologists) but the ED, PCPs, other general fields, IM, surgeons, could all gain I think. (Surgeons don't just cut, the osteos and gen surg and neurosurg all Rx PT (most medicaid and medicare and cheap Obamacare DOES not cover) and home exercises pre and post surg.

MDs I think pick up on the difference in DO training better than the other way round, don't knock the extra skills you're gaining from OMM so easily.

So, a few things ---

1) Not meaning to be rude but from your sig, you're still a pre-med -- let's wait until you've been through the first 2 years of OMM training before you make a judgment call on "certain medication that can be treated with OMM" -- I think you meant to say that a patient cannot afford medications for a condition that can be treated with OMM -- at this level, it sounds as if you've got stars in your eyes about what OMM can/can't do --

2) As a pre-med, you may not have had the experience of listening to a patient tell you that they ran out of "their insulin" (70/30) and "borrowed" insulin from their father in law (Lantus) and gave themselves the same dosage (30U BID) -- or the mom who decided that eczema on her 13 year old's forearms was best treated with some Augmentin she had lying around -- or the --- you get the idea -- apply this to OMM and now you may have opened a door to liability -- "well the doc treated my back pain with this and showed me how" and the patient winds up having nephrolithiasis, delays seeking treatment and bingo, you now have hydronephrosis and possible sepsis depending on how it goes -- bad juju

3) Not trying to discourage you but recognize it's your license on the line (and your malpractice rates) and every time you want to go for credentialing, the forms WILL ask if you've ever had a malpractice incident or been reported to the national database or had any issues with the state medical board or been involved with a case involving harm to a patient --- Now, do you want to be $150k+ in debt, with a family and house to support without the ability to practice medicine because you taught someone OMM who just "promised" that they'd only use it for this one situation?

Again, no warranties expressed or implied, your mileage may vary ----

As an aside, I think I'd be more concerned about getting into medical school and doing well, rather than what my future as an indigent care volunteer would look like -- I went in with this sort of attitude also and I learned at the county hospital that most people don't want your help, they just want you to fix them enough so they can continue their chosen lifestyle -- hence the repeat pancreatitis from the 1 case every 2 days and 3-4 on the weekend patient who was told in bold, italicized, large font letters in discharge instructions that they would die if they kept up this lifestyle merely to show up again 3 weeks later with the same complaint --- and that was not an isolated case.
I don't see addiction as a "chosen" lifestyle, in fact, the very definition of it "increased use, lack of control of use, in the face of adverse consequences" and other evidence, pretty clearly classifies it as a brain disease. Not one that is untreatable, but as far as how much people can "choose" treatment, that's controlled by a lot of factors. Mental health and addiction services are severely lacking. Inpatient treatment for rehab is often not covered and/or prohibitively expensive. In my state, no coverage for medicaid recipients, the cheapest program $10,000 just for alcoholic detox, $20,000 for longer program that is 4 weeks. These programs want a bunch of it up front too.

I don't know how well these patients get set up for outpatient follow up, and certainly I'm sure there's quite a few that just head home straight for the case of booze and never bother to try to get help quitting. Da Nile ain't just a river in Egypt.

As far as other lifestyles like eating junk, there's plenty of studies linking obesity to factors including nutritional status of the mother affecting epigenetics of offspring, and most eating habits are formed in childhood, and difficult to break. For a lot of people all the soda and cheesburgers are almost an addiction, and definitely forms of self-soothing coping mechanisms later in life, even taking poverty out of the equation of why a lot of people eat like ****.

Congress ruled that tomato sauce counts as veggie for pizza for cafeteria school lunch for children.

I just react strongly when we start looking at people with addiction as something other than disease, especially when it's killing them. But then, most physicians don't have much personal or up-close family experience or solid scientific training on addiction. And understanding only helps so much when we don't have tools to effectively treat these issues, and a society that is a set-up for these problems. Easier to save our compassion for the ones who "deserve" it and can be helped more easily I guess.
 
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JustPlainBill

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I just react strongly when we start looking at people with addiction as something other than disease, especially when it's killing them. But then, most physicians don't have much personal or up-close family experience or solid scientific training on addiction. And understanding only helps so much when we don't have tools to effectively treat these issues, and a society that is a set-up for these problems. Easier to save our compassion for the ones who "deserve" it and can be helped more easily I guess.
Understand your point --- and addiction is a truly horrendous thing whether it occurs in church (Think pastor who brags he can 4 whole fried chickens so bring plenty for the church picnic), in a socialite setting (Think upper class suburban housewife who has her morning bloody mary, wine with lunch and afternoon cocktail during her "downtime") to the homeless person with a bottle of MD 20/20 --- but I've also seen those who have had thousands of dollars worth of addiction treatment done at taxpayer expense who maintain a victim mentality and make the willful decision to continue in the lifestyle that so much public funding was spent on to help them combat ----

And as far as "deserving" it -- this is an argument that has been going on since Christ walked the earth and he even commented that the poor will always be with us and we are to remember them in our giving and outreach --- but also counsels that the real help starts in the family first and then the burden on society should be for those with no family to help them --- and so it goes ----

Appreciate your point of view -- well spoken and thoughtfully considered ---
 
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ortnakas

DO PGY-2
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Chronic pain is very serious but can it really be treated with OMM or was that just something you've been told over and over?
Depends on you define "can it really be treated." I don't think anyone (on this thread, anyway) is recommending it as a replacement for traditional therapy. It can definitely make a difference as a supplement though. That's my perspective on the vast majority of OMT.
 
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wjs010

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I would argue the number is less than 5%. I've personally never met a DO attending at a hospital or office that used OMM. I can only think of 1 or 2 total in my class who would seriously consider using OMM on a regular basis in their career. Anyways, no one shows up in the ER with a condition that could remotely be treated with OMM. even if they did CMS/insurance is not going to pay for it.

Ring ring. "hospital this is ambulance 51 we have a patient with a tender left paraspinal, asymmetry, decreased range of motion, and tissue texture changes. OMG HIS T7 IS SIDEBENT LEFT ROTATED RIGHT."
Hvla stat!
 

sonofva

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Aug 31, 2009
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Dude I've taught people oa decompression one for headaches and ****. And sacral rocking if granny can't poo regular... That's about it