The D.O.'s: Osteopathic Medicine in America, by Norman Gevitz

[calcarine]

I highly recommend that anyone applying to osteopathic schools read this book. It is a facinating, wonderfully written and researched history of osteopathic medicine that is entertaining to read (given you want to know the history and philosophy of the profession you are entering). I have a new respect for osteopathy but see the dynamic web we all will be a part of one day....that is if we are lucky.

I would like to start a discussion of this book if anyone is interested.

Primarily, I am interested in how others feel about the future of OMM and the benefit of osteopathy keeping its identity seperate from M.D's.

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[DiverDoc]

I highly recommend that anyone applying to osteopathic schools read this book. It is a facinating, wonderfully written and researched history of osteopathic medicine that is entertaining to read (given you want to know the history and philosophy of the profession you are entering). I have a new respect for osteopathy but see the dynamic web we all will be a part of one day....that is if we are lucky.

I would like to start a discussion of this book if anyone is interested.

Primarily, I am interested in how others feel about the future of OMM and the benefit of osteopathy keeping its identity seperate from M.D's.

Gevitz def. did his homework, but schiza its a headache to read. The most I could do was 25 pages at a shot before I had to do something else. 😱

 

[Omashu]

Still reading it.....I enjoyed it so far. I absolutely agree that it is a "must" for any DO applicant. I found the history behind the profession very interesting.

"Primarily, I am interested in how others feel about the future of OMM and the benefit of osteopathy keeping its identity separate from MD's"

I haven't even applied yet - but if I am accepted, I plan on using OMM. From reading threads on this in the past, I get the impression that OMM is dying out. I plan on using it because it is part of the foundation that distinguishes us from Allopathic medicine. Many say that there's no difference between MD & DO - well there is - OMM, and I would be proud to practice this.

That leads me to a question....Why isn't the % of DO's practicing OMM as high as it should be?

 

[Porco Rosso]

i read it last year. great book and gives fairly good history of osteopathic roots. It answered many of my questions and realizing that osteopathic medicine was the right choice for me.

 

[Concubine]

Still reading it.....I enjoyed it so far. I absolutely agree that it is a "must" for any DO applicant. I found the history behind the profession very interesting.

"Primarily, I am interested in how others feel about the future of OMM and the benefit of osteopathy keeping its identity separate from MD's"

I haven't even applied yet - but if I am accepted, I plan on using OMM. From reading threads on this in the past, I get the impression that OMM is dying out. I plan on using it because it is part of the foundation that distinguishes us from Allopathic medicine. Many say that there's no difference between MD & DO - well there is - OMM, and I would be proud to practice this.

That leads me to a question....Why isn't the % of DO's practicing OMM as high as it should be?

Perhaps the primary reason that the % of DO's practicining OMM because the evidence that it provides significant benefits is somewhat ambiguous? I'm not sure. I think the the two degrees (MD and DO) coming together is much more productive than seperation.

 

[RySerr21]

Perhaps the primary reason that the % of DO's practicining OMM because the evidence that it provides significant benefits is somewhat ambiguous? I'm not sure. I think the the two degrees (MD and DO) coming together is much more productive than seperation.

i believe there is substantial evidence that it works, in different types of situations. i just got back from shadowing a sports medicine doc who practices OMM (i went specifically to see him do it) and he said he admits that not all of the OMM you will learn is useful and he doesnt believe in all of it (specifically the cranial stuff, not sure why...maybe its because there is a lack of evidence supporting its benefits??) but that 80% of the stuff you will learn is backed by evidence and is useful in practice. so, who knows. he said that each DO will pick and choose which techniques he/she thinks will be most useful so i guess time will tell.

at the same time, how many applicants are applying DO because they want to learn OMM? i'm sure there are some (like mysef). But i also believe quite a few go DO because they have no other choice (low gpa or whatever) so they might have little to no interest in actually using OMM in practice, they just want to get a medical degree, which is perfectly understandable. but i think that may play a big part as to why there is such a low % of DOs practicing OMM. just my opinion though.

how would joining the two degrees together increase "productivity?"

 

[DocRawk]

I'm a firm believer in OMM. The doc I'm shadowing has used it several times while I was there. I've seen patients come in with an injury and walk out feeling 100% better. On the other hand, I don't know how valuable keeping the degrees separate is...the "philosophy" is pretty much a sales technique since a doctor is either gonna be holistic and have good bedside manner, or he's not. It's more dependent upon who the doc is than where they went to school. Maybe OMM could be a certification available to those that choose to take the extra hours in med school or through continuing education once they are practicing? Wouldn't John Doe, MD, OMM pretty much be the same thing as John Doe, DO? I honestly don't care either way. I chose DO for OMM and because TCOM has a bada$$ rural med program I wanted to get into.

 

[Omashu]

Perhaps the primary reason that the % of DO's practicining OMM because the evidence that it provides significant benefits is somewhat ambiguous? I'm not sure. I think the the two degrees (MD and DO) coming together is much more productive than seperation.

How come osteopathic schools still incorporate it in their curriculum? Why would they waste all that money, instructing students....?
I watched the DO I shadowed do this and his patient was so supportive of OMM, happy that she had a physician that could help her.

What I mean by separation is that it would be more beneficial for patients to have an option on the type of physician. I'm not saying that MD's and DO's shouldn't work together, they should. But I fear that if DO's stop practicing OMM/Treat the problem rather than just the symptom, then yes the two would blend together and there would be no difference, and I personally would think that it would be a shame.

Yes, it all depends on the individual doctor - whenever I go to the doctor with a problem and they automatically hand me an RX - I don't agree with that. I'm not saying that holistic medicine is the way to go either. You know what - I don't have an answer.

 

[MJB]

Extremely, extremely good read for anyone with even a little bit of interest in the subject, or even anyone that's ever asked the question "What's a D.O.?". I'm getting ready to ship it to my Father In Law as he just asked me this question last week...actually it was "What's the difference?".

I read it around Thanksgiving of 2006...and will likely read it again sooner than later.

 

[Concubine]

how would joining the two degrees together increase "productivity?"

I think that the DO degree has come a long way from its roots. Ultimately, the important thing is that both MDs and DOs are practicing evidence based medicine. When I refer to increasing productivity, I'm talking about cooperation and collaboration between the two types of physicians.

 

[Omashu]

I think that the DO degree has come a long way from its roots. Ultimately, the important thing is that both MDs and DOs are practicing evidence based medicine. When I refer to increasing productivity, I'm talking about cooperation and collaboration between the two types of physicians.

👍

 

[Concubine]

I'm definitely not saying it doesn't work, or that it does not provide significant benefits to patients. I don't know that much about it and I'll wait to pass any judgement on OMM until I'm learning it.

However, it does pose an interesting question: If OMM does provide significant benefits, why hasn't the allopathic community incorporated it into their education and practice?

 

[Omashu]

hmmmm......

 

[JaggerPlate]

I'm definitely not saying it doesn't work, or that it does not provide significant benefits to patients. I don't know that much about it and I'll wait to pass any judgement on OMM until I'm learning it.

However, it does pose an interesting question: If OMM does provide significant benefits, why hasn't the allopathic community incorporated it into their education and practice?

I thought I read somewhere that certain MD schools are starting to offer it as an elective and had great interest.

 

[calcarine]

I'm definitely not saying it doesn't work, or that it does not provide significant benefits to patients. I don't know that much about it and I'll wait to pass any judgement on OMM until I'm learning it.

However, it does pose an interesting question: If OMM does provide significant benefits, why hasn't the allopathic community incorporated it into their education and practice?

I have heard of some MD's taking courses on OMM after obtaining their degrees.

The book addresses this issue well. It claims that there has not been enough research to show any substantial clinical evidence of its clinical benefit. Because most osteopathic schools are not affiliated with large research institutions there are minimal resources for OMM research. However, I agree with Gevitz that inorder for OMM to survive there must be more scientific evidence of its effectiveness.

As for the division of DO and MD I am not sure what I think. Osteopathy was originally developed as a drug-free treatment for disorders that were otherwise "untreatable." Osteopathy no longer has this identity. It is basically a primary care MD + OMM. So should they join forces? I have not made a decision yet.

 

[RySerr21]

I think that the DO degree has come a long way from its roots. Ultimately, the important thing is that both MDs and DOs are practicing evidence based medicine. When I refer to increasing productivity, I'm talking about cooperation and collaboration between the two types of physicians.

gotcha. thanks for the clarification, i totally agree 👍 there is quite a bit of cooperation/collaboration now a days wouldn't you say? or do you feel there should be more?

 

[RySerr21]

\

However, it does pose an interesting question: If OMM does provide significant benefits, why hasn't the allopathic community incorporated it into their education and practice?

they have began incorporating it into the education and practice. i talked with a faculty member at Western who says they have stuff set up with schools in the LA area where the MD applicants can learn OMM. not to the full extent of course. and a lot of MD programs are incorporating the OMM philosophy into the curriculum, as others have said

 

[Concubine]

gotcha. thanks for the clarification, i totally agree 👍 there is quite a bit of cooperation/collaboration now a days wouldn't you say? or do you feel there should be more?

I think we are almost there. Until the stigma goes away that at least some MD's think that MD > DO, then we haven't completely removed the barriers for complete and unhindered collaboration. However, we are almost there.

 

[prefontaine]

The DOs: Osteopathic Medicine in America

http://owl.english.purdue.edu/handouts/grammar/g_apost.html

 

[notarealname]

the problem is that a few allopathic students I met a few years ago told me DO doctors are incompetent (I didn't know I was going for DO at that time)... I am sure it would turn a nervous patient away from DOs.

 

[theserbatron]

someone mentioned the DO degree coming a long way from its roots, but I also believe allopathic practice has come a long way from its roots as well. DOs aren't just "bonesetters" anymore, and no physician these days is letting blood or dosing out mercury to patients. Medical practice has evolved, and as such, it's only natural that the scope of education for MDs and DOs would do the same. as far as OMM goes... i think any particular coursework or program that helps a physician embrace a philosophy that is patient-centered is good. whether its MD or DO, it should be rooted in evidence-based and patient-centered practice. period.

DOs established a market for themselves in this country by offering something different, like OMM, and fought the hard fight to gain good standing in the eyes of the scientific community. I hope in the future the best of both MD and DO skills will continue to be shared amongst the schools and professionals in the field.

 

[RySerr21]

the problem is that a few allopathic students I met a few years ago told me DO doctors are incompetent (I didn't know I was going for DO at that time)... I am sure it would turn a nervous patient away from DOs.

the students are both arrogant and ignorant. luckily most students/current doctors aren't that stupid

 

[Thewrongstuff]

Thanks I was looking for something to deeper explain the whole mind, body, spirit thing.

 

[Jack Daniel]

Thanks I was looking for something to deeper explain the whole mind, body, spirit thing.

Here's a recommendation for you:
Healing Body and Mind: A Critical Issue for Health Care Reform by Roger Kathol, M.D., 2007

See if you can locate a copy. I've found it to be very interesting and insightful.
It has nothing to do, ostensibly, with osteopathic medicine, but actually it has everything to do with osteopathic philosophy (as I currently understand it).

The book argues that our medical system must do a better job treating both the body AND mind--not just giving people access to psychiatric care, but by seamlessly incorporating mental health care with each and every medical visit. The author lays out in 9 chapters various lines of supporting evidence from anecdotal to formal studies why physical health needs to address social, psychological and behavior factors.

You would think this would be common sense: mind, body, spirit. However, this author is presenting this as if its a revelation.

And here's the kicker:
There's another book in this Praeger Series. The title is Between Stress and Hope: From a Disease-Centered to a Health-Centered Perspective." That sure sounds a lot like "treating the body, not the symptoms."

 

[Thewrongstuff]

Here's a recommendation for you:
Healing Body and Mind: A Critical Issue for Health Care Reform by Roger Kathol, M.D., 2007

See if you can locate a copy. I've found it to be very interesting and insightful.
It has nothing to do, ostensibly, with osteopathic medicine, but actually it has everything to do with osteopathic philosophy (as I currently understand it).

The book argues that our medical system must do a better job treating both the body AND mind--not just giving people access to psychiatric care, but by seamlessly incorporating mental health care with each and every medical visit. The author lays out in 9 chapters various lines of supporting evidence from anecdotal to formal studies why physical health needs to address social, psychological and behavior factors.

You would think this would be common sense: mind, body, spirit. However, this author is presenting this as if its a revelation.

And here's the kicker:
There's another book in this Praeger Series. The title is Between Stress and Hope: From a Disease-Centered to a Health-Centered Perspective." That sure sounds a lot like "treating the body, not the symptoms."

Thanks, I'll look into those and probably bring them along my overseas trip during the summer. I've always pondered, if placebo in patients causes "physical changes" in the brain then applying that sort of concept wide range might do wonders.

 

[Shinken]

I thought I read somewhere that certain MD schools are starting to offer it as an elective and had great interest.

I've interviewed at several dual-accredited Family Medicine programs (ACGME/AOA) and *all* of them require the allopathic interns & residents to learn and participate in the OMM instruction and even the OMM clinic. There was no separation between the DO and MD residents with respect to OMM.

Not only that, but in my out rotations, I met several MD residents that were more excited to learn and apply OMM than some of the DO residents! That was both surprising and sad at the same time.

 

[sexyman]

Shinken- That is really interesting. I am currently reading "The DOs" and it seems for as long as the DO profession has been around there have been MD physicians intrigued with OMM and willing to learn. Many of them earning both degrees.

Great rec btw: love the book so far.

 

[StringerBell]

The DOs: Osteopathic Medicine in America

http://owl.english.purdue.edu/handouts/grammar/g_apost.html

In addition, upon matriculation to Western, they send you a copy of it. And much of your early education emphasizes the history of osteopathic medicine, as well as its future.

We are definitely proud of our Osteopathic tradition.

 

[McDoctor]

Primarily, I am interested in how others feel about the future of OMM and the benefit of osteopathy keeping its identity seperate from M.D's.

Keeping a unique identity to the DO degree does not have to be tied to preserving OMM. The osteopathic profession could distinguish itself by emphasizing primary care, public health, education, and more judicious utilization of invasive medical procedures and pharmaceuticals.

Mainstream medicine in the U.S. has become a glut of excessive procedures, specialty care for common conditions, and costly laboratory and radiologic testing which minimally influences care or outcomes. The DO profession should seek to become the antithesis to the excessive medical care that has become the standard for the insured population (at the expense of small business owners and the uninsured).

Tying ones identity to OMM is not a good idea in my opinion. Much of OMM as it was taught to me more closely resembled religion than science, with unwavering core principles (beliefs) that are unchanged in over 100 years, based on some now archaic beliefs on how the body works. There are merits to OMM as a medical procedure for certain conditions, but it should not be a sole method of diagnosis and treatment for all ailments. That would more closely resemble chiropractic care.

I am 8-9 years out from structured OMM lectures in 1st and 2nd year medical school 🙂eek:...I just did the math), so perhaps take my assumptions about how OMT is currently taught with a grain of salt. But it would be shortsighted, and a huge mistake, to think of OMM as the sole identity of osteopathy.

 

[ThePiratesse]

Keeping a unique identity to the DO degree does not have to be tied to preserving OMM. The osteopathic profession could distinguish itself by emphasizing primary care, public health, education, and more judicious utilization of invasive medical procedures and pharmaceuticals.

Mainstream medicine in the U.S. has become a glut of excessive procedures, specialty care for common conditions, and costly laboratory and radiologic testing which minimally influences care or outcomes. The DO profession should seek to become the antithesis to the excessive medical care that has become the standard for the insured population (at the expense of small business owners and the uninsured).

Tying ones identity to OMM is not a good idea in my opinion. Much of OMM as it was taught to me more closely resembled religion than science, with unwavering core principles (beliefs) that are unchanged in over 100 years, based on some now archaic beliefs on how the body works. There are merits to OMM as a medical procedure for certain conditions, but it should not be a sole method of diagnosis and treatment for all ailments. That would more closely resemble chiropractic care.

I am 8-9 years out from structured OMM lectures in 1st and 2nd year medical school 🙂eek:...I just did the math), so perhaps take my assumptions about how OMT is currently taught with a grain of salt. But it would be shortsighted, and a huge mistake, to think of OMM as the sole identity of osteopathy.

I think you make a great point about distinguishing DO from MD. In fact, I agree with almost everything you said, even not tying our identity just to OMM. However, I also believe OMM adds to distinguishing ourselves because its use can help limit "excessive procedures, specialty care for common conditions, and costly laboratory and radiologic testing " and surgery. OMM is another tool to try before taking the next step. It would be a shame to discredit it completely. As for religion over science, maybe that's because as students, we have to learn to have a little faith in ourselves to be able learn and apply these techniques. A type of learning most of us have never had experience in since its more than just books and power point lectures. Its funny because we joke about that aspect of it at my school, thus the "OPP padawan" next to my name. As for the "archaic beliefs on how the body works", Still was very much ahead of his time. He may not have known the absolute science behind it, but today we do and many new techniques have been added since his time.

 

[McDoctor]

I think you make a great point about distinguishing DO from MD. In fact, I agree with almost everything you said, even not tying our identity just to OMM. However, I also believe OMM adds to distinguishing ourselves because its use can help limit "excessive procedures, specialty care for common conditions, and costly laboratory and radiologic testing " and surgery. OMM is another tool to try before taking the next step. It would be a shame to discredit it completely. As for religion over science, maybe that's because as students, we have to learn to have a little faith in ourselves to be able learn and apply these techniques. A type of learning most of us have never had experience in since its more than just books and power point lectures. Its funny because we joke about that aspect of it at my school, thus the "OPP padawan" next to my name. As for the "archaic beliefs on how the body works", Still was very much ahead of his time. He may not have known the absolute science behind it, but today we do and many new techniques have been added since his time.

I actually agree with you. But it just needs to be better researched and held to the same standard as any other medical procedure. The problem I have with OMM is when it is broadly applied to every patient just for the sake of doing a procedure (and billing for it). This is fundamentally not much different from doing any procedure excessively or unnecessarily, whether it be heart caths, endoscopies, or joint injections. OMM faculty that I am familar with tend to advocate performing OMT on everyone for everything.

I think we're on the same page. I probably came off as more anti-OMM than I intended. I use OMM, only just with a fairly narrow focus. I try to pester the residents and interns to carry out some pilot studies at our hospital, but I lack the time to get as involved as I'd like.

 

[ThePiratesse]

I actually agree with you. But it just needs to be better researched and held to the same standard as any other medical procedure. The problem I have with OMM is when it is broadly applied to every patient just for the sake of doing a procedure (and billing for it). This is fundamentally not much different from doing any procedure excessively or unnecessarily, whether it be heart caths, endoscopies, or joint injections. OMM faculty that I am familar with tend to advocate performing OMT on everyone for everything.

I think we're on the same page. I probably came off as more anti-OMM than I intended. I use OMM, only just with a fairly narrow focus. I try to pester the residents and interns to carry out some pilot studies at our hospital, but I lack the time to get as involved as I'd like.

Very true. I've seen both sides. The DO's that use it just to bill an extra procedure and the ones who use it legitimately. The good thing is that there is a lot of good research going on out there... I think we will continue to see a positive trend in evidence-based medicine for OMM. 👍

 

[Ki45toryu]

There is ongoing research dedicated to OMM as we speak. My OMM director speaks about his experiences directing some of the research himself at medical conventions.

A lot of it is probably very difficult to prove with standardized research methodology right now though.

Most of OMM's results can be seen right in front of your eye though.....a patient goes from a doubled over heap because of piriformis syndrom or a flairing psoas to upright and walking fine 5 minutes later.

 

[slim78]

It is supposed to come tomorrow. I really look forward to reading it.

Google had some of it scanned online and the little bit I was able to read intrigued me.

 

[sexyman]

I really enjoyed it (read it in 5 sittings).

 

[bth7]

A lot of it is probably very difficult to prove with standardized research methodology right now though.

Here's some info with links to some of the studies / publications that have been done:

Osteopathic medicine
Osteopathic and allopathic medicine (lots of statistical studies quoted)

Here's a link to numerous studies on the topic: references.


bth

 

[MaximusD]

Perhaps the primary reason that the % of DO's practicining OMM because the evidence that it provides significant benefits is somewhat ambiguous? I'm not sure. I think the the two degrees (MD and DO) coming together is much more productive than seperation.

Imagine what schools like PCOM would become. Instead of an interesting niche and a unique history, PCOM would be relegated to some sort of "lower-tier MD school" and would get a ****-ton of applications from students that really dont know anything about its history or its goals.

The more I think about it, the more I like the DO aspect of things. Gives my career some sense of uniqueness.

 

[MaximusD]

There is ongoing research dedicated to OMM as we speak. My OMM director speaks about his experiences directing some of the research himself at medical conventions.

A lot of it is probably very difficult to prove with standardized research methodology right now though.

Most of OMM's results can be seen right in front of your eye though.....a patient goes from a doubled over heap because of piriformis syndrom or a flairing psoas to upright and walking fine 5 minutes later.

I like OMM, but lets face it unless you use adjunct medicinal therapy with NSAIDS, the results are unlikely to be this drastic. OMM would probably be more likely to increase the pt's mobility moreso than decrease his relative pain from 10 to 0.

 

[MaximusD]

I actually agree with you. But it just needs to be better researched and held to the same standard as any other medical procedure. The problem I have with OMM is when it is broadly applied to every patient just for the sake of doing a procedure (and billing for it). This is fundamentally not much different from doing any procedure excessively or unnecessarily, whether it be heart caths, endoscopies, or joint injections. OMM faculty that I am familar with tend to advocate performing OMT on everyone for everything.

I think we're on the same page. I probably came off as more anti-OMM than I intended. I use OMM, only just with a fairly narrow focus. I try to pester the residents and interns to carry out some pilot studies at our hospital, but I lack the time to get as involved as I'd like.

Not so in my experience at PCOM. Every procedure we do comes with a list of contraindications in addition to clinical situations in which it would be useful. Our OMM profs are openly critical of reasoning out WHY we do each procedure and openly call some aspects "dogma" that is in need of investigation. This is a far cry, however, from saying that OMM as a whole is not adequately researched. Any physician who cannot see usefulness in soft tissue, myofascial release, or some HVLA hasn't done their homework, period.

I like your posts, but be careful with the negativity on here especially if you DO use OMM. It can be contagious to those who don't understand. In what scope do you currently employ OMM? I am really interested, actually as I am unsure to what extent I will use it in the future...

I am not pro-OMM necessarily, I am just trying to get the most out of my education for which I am overpaying.

 

[sexyman]

OMM would probably be more likely to increase the pt's mobility moreso than decrease his relative pain from 10 to 0.

You seem a bit overly ambitious...

Doctors aren't miracle workers, most of your patients aren't going to make a 100% recovery or make a 180 turn around going from extreme pain and discomfort to perfectly healthy whether you use OMM or drugs/surgery.

 

[MaximusD]

You seem a bit overly ambitious...

Doctors aren't miracle workers, most of your patients aren't going to make a 100% recovery or make a 180 turn around going from extreme pain and discomfort to perfectly healthy whether you use OMM or drugs/surgery.

what? you didn't read my post carefully.

I was skeptical.... i'm a little mad at your haste. I clearly said that he wouldn't improve vastly but may see gains in mobility. How is that claiming a 180 turnaround...

 

[MaximusD]

You seem a bit overly ambitious...

Doctors aren't miracle workers, most of your patients aren't going to make a 100% recovery or make a 180 turn around going from extreme pain and discomfort to perfectly healthy whether you use OMM or drugs/surgery.

or did you mean to quote someone else?

 

[sexyman]

I know that you said he wouldn't improve vastly...

I like OMM, but lets face it unless you use adjunct medicinal therapy with NSAIDS, the results are unlikely to be this drastic. OMM would probably be more likely to increase the pt's mobility moreso than decrease his relative pain from 10 to 0.

My point is that a lot of patients will not go from 10-0, whether you are using OMM, surgery, or drugs. So this is no reason to consider OMM ineffective or useless.

Maybe I read into your post too much, who knows. No need to be mad though.

 

[MaximusD]

here let me rephrase to exactly what I meant.

It would be more likely that the patient would achieve a noticeable increase in mobility and a slight lessening of his pain with the use of OMM. As an addition, NSAIDs such as celebrex (Rx), ibuprofen, or other COX inhibitors would be more likely to decrease the pain as an adjunct. OMM alone is UNLIKELY to decrease the pt's pain from 10-0.

This is exactly what the first post said, but in more clearly laid out language.