When OMM becomes dangerous

[FutureNavyDOc]

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Since I'm not the biggest supporter/ believer in OMM, I might be a bit biased, but here's what happened yesterday that truly made me understand the DANGER of over-emphasizing OMM:


A 47-year old male smoker presents to his PCP the day following having such severe pain in his Left arm and shoulder that it woke him from deep sleep at 4am. His family history is remarkable for his dad dying of an MI at 47. The pt has never had his cholesterol checked and is running a blood pressure of 180/80.

The PCP thinks it is a musculoskeletal problem (rotator cuff injury), gives the pt some extra strength Tylenol, opens his inlet and tells him to rest his arm, and gives him Verapamil for his BP.

The pt returns 2 days later after having the same experience as before again waking him up in the middle of the night. The PCP did some more OMM, and thinking there might be something more made a referral appointment to the cardiologist that I am rotating with, but again did NOT even order an EKG.

Two weeks to the day after the first event, the patient presents for his cardiology appointment. The CMA takes the pt in to a room, performs an EKG and takes the history. I was standing by the printer when the EKG came off, grabbed it and saw obvious T-wave inversion in leads II, III and aVF. I asked the CMA when the pt had his MI.

"He never had one" she replied.

"Bull poop (or something of that nature I replied) look at this EKG!"

I then reviewed the history and got the info from the first 3 paragraphs. The FP hadn't even asked about any family history of MI!

About this time, my attending came in to the Doctor's area. I told him that I thought we had an inferior MI on our hands. Since he knows the doc who does our cardiology unit at school, he was very skeptical of my EKG knowledge even to the point that when I told him who taught our Cardio unit, he groaned and said to read Dubin's "Rapid Interpretation of EKG's" before he would even attempt to teach me about EKG's. Having finished the Dubin book a week before, I finally knew how to read EKG's. He looked at the EKG and said, "Yep, this guy definitely had an MI."

So then we go into the room and have to tell this guy that he had a heart attack and his PCP completely missed it. The poor guy's BP is now 220/120. He is on no meds, so we gave him doses of Sular (CCB), Toprol (B-blocker), Lisinopril (ACE-inhibitor), and Micardis (ARB) to try to get his BP under control. He is shaking so bad from the news that he can't even hold a half full cup of water without spilling it. We sent him upstairs to get an Echocardiogram.

Later that day, we reviewed the Echo; luckily the guy only has minor wall infarction with very little decrease in his Ejection Fraction. If he quits the smoking and makes some other life changes, he can still live a long and healthy life, no thanks to his PCP who sat on an MI for 2 weeks. I know it is easy to sit where I am at and think very little of that PCP because his actions could have killed his pt especially when I haven't done an FP rotation yet, however when someone does OMM on a patient with MI-type symptoms and doesn't even think about cardiac issues until the pt returns 2 weeks later, it makes me question how much our OMM classes are cutting into our ability to learn real applicable medicine, and if DO schools are emphasizing OMM way too much especially considering the often harped upon complete lack of evidence to support it.

A musculoskeletal problem may bother a patient and make them miserable for a while, but a missed MI can kill them.

 

[(nicedream)]

That's just a bad physician. If he wasn't a bonecracker, he probably would have sent him for PT and/or given him painkillers. Bad docs who practice OMM miss things and use OMM instead, while others miss things and use other wrong treatments. Bad medicine is bad medicine.

 

[DragonWell]

Thanks for sharing that story. It really makes me reflect on the importance of catching those "red flag" symptoms when they appear in a patient. It seems like the doc in this case was negligent and the patient was extremely lucky that the consequences of this missed diagnosis were not more serious. I'd guess the patient would have a pretty cut and dry malpractice suit if he chose to pursue it.

I disagree with your argument that this case reveals some danger inherent in OMM; OMM is just a tool, and like any tool can be used appropriately or inappropriately. Let's say your patient had gone to an MD that had never even heard of OMM, but had instead prescribed a pain killer for a percieved muscle strain. The outcome of the case could be exactly the same, but would that lead you to arugue that pain killers are inherently dangerous and that med schools are overemphasizing pharmacology?

As you mention earlier, OMM isn't your cup of tea, and I get that, but one incompetent doc practicing OMM irresponsibly doesn't mean OMM doesn't have a useful place next to EKG, pharmacueticals, and all the other tools of medicine.

 

[FutureNavyDOc]

I never said that OMM as a tool was dangerous.

What I feel is dangerous is the over-emphasis of OMM at many DO schools to the point that students are lead to think that OMM can be the treatment and cure of all medical problems.

So many times in OMM lectures we were told to try OMM as a first resort and to look for musculoskeletal "osteopathic lesions" that we could treat. Where this becomes a problem in my eyes is when a DO looks only for somatic dysfunctions to treat and forgets that the organs beneath the muscles and the skeleton are more important for survival than the muscles and bones themselves.

The same danger can present when too much of any one modality is taught and emphasized such as holistic cures. Can Saw Palmetto help shrink a prostate? Maybe. But is there a holistic cure that can treat a heart attack? Not unless tPA has gone organic!

If this doc didn't do OMM, and had referred the pt on to a PT, I would hope the PT would know enough to suspect something more than just muscle pain. I talked to a 2nd year PT last night who picked up that it was likely an MI 10 seconds into the story.

I totally agree that this was an exercise in bad medicine and have no doubt that a substantial mal-practice settlement could and very likely should result.

 

[strongyloides]

What I feel is dangerous is the over-emphasis of OMM at many DO schools to the point that students are lead to think that OMM can be the treatment and cure of all medical problems.

Please. What are you talking about, "many schools." You only know what goes on at 1 school, your own. And even then, I'm sure I can find colleages at your own school who would disagree with you all day long. At my school red flags are overemphasized, and OMM is repeatly described as an adjunct to comprehensive medical treatment.

Your post is completely biased. You can still correct it by re-labeling it "bad medicine" instead of "dangers of OMM."

 

[DD214_DOC]

I don't agree that this has anything to do with OMM. OMM is just a treatment modality. The PCP had the wrong dx and prescribed an appropriate treatment for what he felt was the real problem. He's just not a very good doc.

Now, if there was a large number of bad docs coming from a particular school, then there would be reason to question that particular school's curriculum and focus on OMM. Since that isn't the case, the PCP just missed something, was not thinking, or made an assumption way too early.

 

[FutureNavyDOc]

Please. What are you talking about, "many schools." You only know what goes on at 1 school, your own. And even then, I'm sure I can find colleages at your own school who would disagree with you all day long. At my school red flags are overemphasized, and OMM is repeatly described as an adjunct to comprehensive medical treatment.

Your post is completely biased. You can still correct it by re-labeling it "bad medicine" instead of "dangers of OMM."

I have talked with many other DO students both at my school and others who agree with me. I don't doubt there are those who would disagree with me, however if you took a survey, I am confident there would be more in my corner.

Also, having taken Step I boards, I see the un-sunstantiated claims that OMM departments are forced to teach whether they believe in them or not that become board questions.

Yes my post is biased. I apologize for being biased against techniques and tenants that OMM cures all that could have resulted in the death of a patient.

Call me biased all day long if you wish, but I would rather save a patient's life and be biased than not be biased and attend the funeral of a 47 year old man who died because I missed a clear cut diagnosis.

Red flags are overemphasized? How can you overemphasize the signs that should clue you in to a serious problem with your patient? I don't think that it is possible to over-emphasize red flags. If this school would have overemphasized red flags, the patient I talked about would have been in a cath lab that day and would have had a much better chance of survival. I would rather have no OMM training at all and pick-up on the red flags than to treat every Rotated vertebrae to ever walk into my office and miss the occassional MI.


Hooah,
The PCP thought the guy had injured his rotator cuff. The proper treatment for this is opening the inlet?
Please tell me how opening the inlet is a more appropriate option for a pt with a rotator cuff injury than PT, MRI, and an ortho consult? If you open the inlet, does that magically re-heal torn ligaments? Even our OMM department wouldn't make those claims.

 

[Old_Mil]

So many times in OMM lectures we were told to try OMM as a first resort and to look for musculoskeletal "osteopathic lesions" that we could treat.

This is actually a real problem.

For people who have been around medicine and know what it is really practiced like "out there", it's pretty easy to ignore the OMM cheerleading and study what is important to being a good clinician.

Unfortunately, there is a % of students who buy into the rhetoric and try and make OMM the foundational treatment modality around which everything else is built. Sounds like the patient in question ran into one of these - for lack of a better term - quacks.

 

[strongyloides]

Red flags are overemphasized? How can you overemphasize the signs that should clue you in to a serious problem with your patient?

By constantly including mention of it. Sure, we are taught that OMM plays a role in managing certain cardiac patients. But its always surrounded by context and caveats. "You've diagnosed a cardiac condition, your patient is given drugs X, Y, and Z, you've sent for labs A, B, and C -- what OMM technique could you try while waiting for the labs?" Our professors mentioned metastatic disease to bone almost every day when we were doing low back / musculoskeletal stuff.

I have personal experience with an MD missing a serious heart condition, and if it wasn't for layman's suspicion to bring him to the ER, my close relative would be dead. Quackery / bad medicine transcends suggestive philosophy provided to med students. It's unfair to say that OMM is the reason he didn't have a better DDx or clinical suspicion. Sounds more like a really, really bad doc. They exist in large number, make no mistake.

 

[scpod]

What I feel is dangerous is the over-emphasis of OMM at many DO schools...So many times in OMM lectures we were told to try OMM as a first resort and to look for musculoskeletal "osteopathic lesions" that we could treat...

I've never been told this. Which schools in particular are saying this? I've just never heard anyone else mention it.

 

[FutureNavyDOc]

I've never been told this. Which schools in particular are saying this? I've just never heard anyone else mention it.

DMU, Kirksville, and PCOM that I know of for sure.

 

[the1doc]

all i can say is, "thank goodness for my 300+ hours spent learning OMM!!!"

now, when i have a pt. with an MI, i can thoughtfully include elevated 1st rib and T2 extended rotated sidebent right in my differential diagnosis!!!

kidney/prostate problems? type II lumbar segmental disorder OR sacral torsion!

headaches? vertical strain, horizontal strain, or SBS compression!!!

praises to a.t. still, our osteopathic god!

 

[DropkickMurphy]

How dare ye speak against the Missouri Messiah! BlasssssphEEEEEmer!

 

[It'sElectric]

DMU, Kirksville, and PCOM that I know of for sure.

I've just begun at DMU, NavyDoc, but I have never really experienced the OMM faculty trying to push OMM first, everything else second. At the very least, I'm not interpreting what they say in lecture as anything along those lines. The OMM faculty is definitely gung ho OMM, but I'm pretty sure that's how all OMM people are (kind of like foreign language teachers in high school being a little nutty). Even still, I would hope that any student being given such ridiculous advice would be able to reflect on every single other class that's NOT OMM and realize that OMM is not the end all be all that OMM people might think it is.

 

[ShyRem]

That's a bad doc. I've seen just as many MDs miss a clear-cut MI (on my mother-in-law - similar story, took them FOUR times of her going to the ER with debilitating arm pain before she finally had a significant 'classic' MI the ***** caught).

As for OMM being "first line treatment", depends on the problem. Ligament laxity? OMM is awesome for treating secondary muscle issues. Muscle spasm? Again, OMM is great. Tension headaches? OMM. Back pain due to misalignment because of muscle tension/torsion/just basically FUBAR'd? OMM. Ankle sprains can have significant reduction in pain by OMM (I know first-hand as the patient on this one). Gait problems? OMM can help, but after thorough exam to rule-out any other significant issues that are out of OMM scope. This should have been drilled into this doc while in school, on rotations, in residency, and in his/her own common sense.

Your problem, OP, isn't the OMM. It's the doc who was incompetent to begin with in this particular case. He/she might be a great doc in other ways, just not for this one. I've seen plenty of OB/GYNs who couldn't make their way around a code to save their lives - but they're awesome in OB. Don't blame the treatment - blame the doc who prescribed it. Just like you wouldn't blame the drug if the wrong drug was prescribed - you'd blame the doc who prescribed it.

 

[JonnyG]

At PCOM, they never say push OMM first. The first thing you are suppose to do is conduct a physical exam. This is also not a case of OMM being dangerous (cervical HVLA on an elderly patient is dangerous) its stupidity on the PCP for not listening to your patient.

PCOM isn't big on the OMM as a sole mode of treatment. They do try to show you how to incorporate it later. Also xray it first is commonly mentioned before doing OMM

 

[Dave C]

That has nothing to do with OMM.
With that history and chief complaint you'd have to be an idiot not to see the underlining cause. Bad physician period.

A 47-year old male smoker presents to his PCP the day following having such severe pain in his Left arm and shoulder that it woke him from deep sleep at 4am. His family history is remarkable for his dad dying of an MI at 47. The pt has never had his cholesterol checked and is running a blood pressure of 180/80.

 

[hyperbaric]

Since I'm not the biggest supporter/ believer in OMM, I might be a bit biased, but here's what happened yesterday that truly made me understand the DANGER of over-emphasizing OMM:


A 47-year old male smoker presents to his PCP the day following having such severe pain in his Left arm and shoulder that it woke him from deep sleep at 4am. His family history is remarkable for his dad dying of an MI at 47. The pt has never had his cholesterol checked and is running a blood pressure of 180/80.

The PCP thinks it is a musculoskeletal problem (rotator cuff injury), gives the pt some extra strength Tylenol, opens his inlet and tells him to rest his arm, and gives him Verapamil for his BP.

The pt returns 2 days later after having the same experience as before again waking him up in the middle of the night. The PCP did some more OMM, and thinking there might be something more made a referral appointment to the cardiologist that I am rotating with, but again did NOT even order an EKG.

Two weeks to the day after the first event, the patient presents for his cardiology appointment. The CMA takes the pt in to a room, performs an EKG and takes the history. I was standing by the printer when the EKG came off, grabbed it and saw obvious T-wave inversion in leads II, III and aVF. I asked the CMA when the pt had his MI.

“He never had one” she replied.

“Bull poop (or something of that nature I replied) look at this EKG!”

I then reviewed the history and got the info from the first 3 paragraphs. The FP hadn’t even asked about any family history of MI!

About this time, my attending came in to the Doctor’s area. I told him that I thought we had an inferior MI on our hands. Since he knows the doc who does our cardiology unit at school, he was very skeptical of my EKG knowledge even to the point that when I told him who taught our Cardio unit, he groaned and said to read Dubin’s “Rapid Interpretation of EKG’s” before he would even attempt to teach me about EKG’s. Having finished the Dubin book a week before, I finally knew how to read EKG’s. He looked at the EKG and said, “Yep, this guy definitely had an MI.”

So then we go into the room and have to tell this guy that he had a heart attack and his PCP completely missed it. The poor guy’s BP is now 220/120. He is on no meds, so we gave him doses of Sular (CCB), Toprol (B-blocker), Lisinopril (ACE-inhibitor), and Micardis (ARB) to try to get his BP under control. He is shaking so bad from the news that he can’t even hold a half full cup of water without spilling it. We sent him upstairs to get an Echocardiogram.

Later that day, we reviewed the Echo; luckily the guy only has minor wall infarction with very little decrease in his Ejection Fraction. If he quits the smoking and makes some other life changes, he can still live a long and healthy life, no thanks to his PCP who sat on an MI for 2 weeks. I know it is easy to sit where I am at and think very little of that PCP because his actions could have killed his pt especially when I haven’t done an FP rotation yet, however when someone does OMM on a patient with MI-type symptoms and doesn’t even think about cardiac issues until the pt returns 2 weeks later, it makes me question how much our OMM classes are cutting into our ability to learn real applicable medicine, and if DO schools are emphasizing OMM way too much especially considering the often harped upon complete lack of evidence to support it.

A musculoskeletal problem may bother a patient and make them miserable for a while, but a missed MI can kill them.

Others have said it and I agree - this was a bad doc, not bad OMM. While I am guilty of whining about OMM being wasted study time, I do NOT feel as though it interferes with my ability to learn "real applicable medicine." Even with OMM, I still find time for the real time burners - SDN and EtOH.

 

[dcratamt]

That's just a bad physician. If he wasn't a bonecracker, he probably would have sent him for PT and/or given him painkillers. Bad docs who practice OMM miss things and use OMM instead, while others miss things and use other wrong treatments. Bad medicine is bad medicine.

Exactly!

 

[FutureNavyDOc]

I've just begun at DMU, NavyDoc, but I have never really experienced the OMM faculty trying to push OMM first, everything else second. At the very least, I'm not interpreting what they say in lecture as anything along those lines. The OMM faculty is definitely gung ho OMM, but I'm pretty sure that's how all OMM people are (kind of like foreign language teachers in high school being a little nutty). Even still, I would hope that any student being given such ridiculous advice would be able to reflect on every single other class that's NOT OMM and realize that OMM is not the end all be all that OMM people might think it is.

With the change in faculty, you may not see it as much, although it didn't really kick up for our classes until 2nd semester and into 2nd year.

Wait for all of Woolley's claims about Cranial's powers 2nd semester 2nd year.
Did you know you can stick pencils in the heads of dead babies after cutting their skull caps off and take pictures of it and compare it to other dead babies and show the pics in class and disturb 200 students? Woolley proved it.




I totally realize that it is bad doctoring. No one is arguing that. I also don't doubt the ability of an MD to miss an MI either.

What I have a problem with is the emphasis on OMM and musculoskeletal medicine to the point that some people (not all or even a majority) seem to think OMM and Musculoskeletal problems first in any and all areas.

If you like OMM and are good at it, I have no problem if you want to use it for your patients as long as you make sure there are no red flags or obvious more important problems than the T4 RlSl.

What I am getting at in the danger part of this thread is the danger of emphasizing OMM to the point that we create some docs who think OMM first and totally miss out on an MI or acute Appy. I would hope that any intelligent doc DO, MD, or chirporactor, even one who only does OMM, would recognize such a clear cut MI and know what to do.

 

[beastmaster]

Wait for all of Woolley's claims about Cranial's powers 2nd semester 2nd year.
Did you know you can stick pencils in the heads of dead babies after cutting their skull caps off and take pictures of it and compare it to other dead babies and show the pics in class and disturb 200 students? Woolley proved it.

Sounds like every school has a certian OMM professor who has mystical powers. He's usually the bald guy with a beard, teaches cranial, and can palpate the 4th dimension.

 

[It'sElectric]

With the change in faculty, you may not see it as much, although it didn't really kick up for our classes until 2nd semester and into 2nd year.

Wait for all of Woolley's claims about Cranial's powers 2nd semester 2nd year.
Did you know you can stick pencils in the heads of dead babies after cutting their skull caps off and take pictures of it and compare it to other dead babies and show the pics in class and disturb 200 students? Woolley proved it.




I totally realize that it is bad doctoring. No one is arguing that. I also don't doubt the ability of an MD to miss an MI either.

What I have a problem with is the emphasis on OMM and musculoskeletal medicine to the point that some people (not all or even a majority) seem to think OMM and Musculoskeletal problems first in any and all areas.

If you like OMM and are good at it, I have no problem if you want to use it for your patients as long as you make sure there are no red flags or obvious more important problems than the T4 RlSl.

What I am getting at in the danger part of this thread is the danger of emphasizing OMM to the point that we create some docs who think OMM first and totally miss out on an MI or acute Appy. I would hope that any intelligent doc DO, MD, or chirporactor, even one who only does OMM, would recognize such a clear cut MI and know what to do.

She's already mentioned her excitement to teach about Cranial coming up, so it's quite clear that it's "her thing", but I truly don't think they're trying to say that OMM first and foremost. If they or if they ever do, I know that I for one will never buy into that sort of BS. I hope and can almost count on the fact that the rest of my classmates won't either.

 

[FutureNavyDOc]

She's already mentioned her excitement to teach about Cranial coming up, so it's quite clear that it's "her thing", but I truly don't think they're trying to say that OMM first and foremost. If they or if they ever do, I know that I for one will never buy into that sort of BS. I hope and can almost count on the fact that the rest of my classmates won't either.

Good to hear it.

Cranial is definitely her thing. She is all over it like fat kids on box of Twinkies.

I too would like to think that I can count on the rest of my class not to buy into it, however I would also like to think no one would ever fall for the e-mail hoax about sending $1,000 to help the exiled King of Nigeria get his fortune back, but it apparently works since they keep trying it!

Bottom line is, we shouldn't have to worry about people believing that BS since no one should be feeding un-proven and un-substantiated BS to us, at least not in Med School!



Beastmaster,
Agreed. DMU's is a middle-aged woman, but I am sure the meat of the situation is the same.



The day she showed those pictures of the skull-capped dead infants with pencils in their ears, I was sitting right next to a buddy of mine whose wife had only 2 weeks before given birth to their first child. He was literally crying by the 2nd set of the disturbing images.🙁

 

[It'sElectric]

Good to hear it.

Cranial is definitely her thing. She is all over it like fat kids on box of Twinkies.

I too would like to think that I can count on the rest of my class not to buy into it, however I would also like to think no one would ever fall for the e-mail hoax about sending $1,000 to help the exiled King of Nigeria get his fortune back, but it apparently works since they keep trying it!

Bottom line is, we shouldn't have to worry about people believing that BS since no one should be feeding un-proven and un-substantiated BS to us, at least not in Med School!



Beastmaster,
Agreed. DMU's is a middle-aged woman, but I am sure the meat of the situation is the same.



The day she showed those pictures of the skull-capped dead infants with pencils in their ears, I was sitting right next to a buddy of mine whose wife had only 2 weeks before given birth to their first child. He was literally crying by the 2nd set of the disturbing images.🙁

It's a goddamn mystery to me that anyone (even a 90 y/o person) has ever fallen into that Nigerian email scam.
Why again was she showing these pictures? Did they in anyway even remotely pertain to the lecture?

 

[jrf331]

It's a goddamn mystery to me that anyone (even a 90 y/o person) has ever fallen into that Nigerian email scam.
Why again was she showing these pictures? Did they in anyway even remotely pertain to the lecture?

Who the hell knows what goes on in her head. I could believe she would do that. I also can't believe that the childs parents agreed to it. Boy, now that i think of it I should have reported her.

 

[DD214_DOC]

At PCOM, they never say push OMM first. The first thing you are suppose to do is conduct a physical exam. This is also not a case of OMM being dangerous (cervical HVLA on an elderly patient is dangerous) its stupidity on the PCP for not listening to your patient.

PCOM isn't big on the OMM as a sole mode of treatment. They do try to show you how to incorporate it later. Also xray it first is commonly mentioned before doing OMM

We're also reminded that we're physicians first and practicioners of OMM second.

 

[DMAKSIMOVIC]

Wait for all of Woolley's claims about Cranial's powers 2nd semester 2nd year.
Did you know you can stick pencils in the heads of dead babies after cutting their skull caps off and take pictures of it and compare it to other dead babies and show the pics in class and disturb 200 students? Woolley proved it.

That was uber brutal.....That was the beginning of the end of OMM for me. I loved our first year but 2nd year blew. I would have rather repeated all of first year again than learn cranial.....it's the reason I don't do any OMM now.

 

[drusso]

That's a great story. However, it could have been an OMM practitioner, an orthopod, or a neurosurgeon. I have seen extremely competent, talented, and well-intentioned surgical sub-specialists miss extremely basic medical diagnoses at very prestigious institutions...."When all you have is a hammer, everything looks like a nail." While caught up in their super-specialized practices, they stopped thinking like doctors.

The fact of the matter is that as physicians we start learning bad habits and taking short-cuts in our thinking beginning the 2nd week of internship. The best advice I ever got was from a D.O. ER physician who would admonish housestaff to, "Stop and think like a fourth year medical student for a minute." By that he meant, go back to the basics. Forget what you "think you know," "what your experience has taught you," "what you saw the last time on call," etc. and just go back to the basics.

I don't think he missed this because of OMM. He missed it because he forgot the basics. I would wager that nearly every 4th year D.O. student would get the right answer if this scenario was presented on the COMLEX-II.

 

[siinew]

Good to hear it.

Cranial is definitely her thing. She is all over it like fat kids on box of Twinkies.

I too would like to think that I can count on the rest of my class not to buy into it, however I would also like to think no one would ever fall for the e-mail hoax about sending $1,000 to help the exiled King of Nigeria get his fortune back, but it apparently works since they keep trying it!

Bottom line is, we shouldn't have to worry about people believing that BS since no one should be feeding un-proven and un-substantiated BS to us, at least not in Med School!



Beastmaster,
Agreed. DMU's is a middle-aged woman, but I am sure the meat of the situation is the same.



The day she showed those pictures of the skull-capped dead infants with pencils in their ears, I was sitting right next to a buddy of mine whose wife had only 2 weeks before given birth to their first child. He was literally crying by the 2nd set of the disturbing images.🙁

Man, WTF are you doing in a DO school, FutureNavyDoc? You sound like a disillusioned wanna-be MD who didn't have the grades/MCAT to make it into an MD school and instead managed to talk your way into a DO schoo. So you spend all your embittered time whining about OMM and its relatives?

Quacks are quacks. There's plenty of MD quacks and plenty of DO quacks, and there are amazing docs with both those sets of letters after their names too. I would have bought your original point in your original posting (which is definitely valid), until you started ranting about cranial. Now I think you're just cynical and pissed off because you don't like your school and want to bitch about OMM.

 

[FutureNavyDOc]

Man, WTF are you doing in a DO school, FutureNavyDoc? You sound like a disillusioned wanna-be MD who didn't have the grades/MCAT to make it into an MD school and instead managed to talk your way into a DO schoo. So you spend all your embittered time whining about OMM and its relatives?

Quacks are quacks. There's plenty of MD quacks and plenty of DO quacks, and there are amazing docs with both those sets of letters after their names too. I would have bought your original point in your original posting (which is definitely valid), until you started ranting about cranial. Now I think you're just cynical and pissed off because you don't like your school and want to bitch about OMM.

I've already explained this several times on other threads, but since there are always new extremely intelligent individuals who like to ASSuME they know everything, here it is again:


I got into 3 different MD schools and 4 DO. The reason I went DO was 100% because of geography. DMU was 6 hours closer to where my wife was finishing up her college work than the MD schools or other DO schools.

I love my school. I love the majority of the profs and feel that I got a great education. I just feel that it could have been an even better education if the time spent learning un proven OMM cranial techniques was spent learning about legitimate aspects of medicine that have proven benefit.



Again, I realize that any doc DO or MD or DPM or whatever could have missed this MI. My concern is that due to the emphasis placed on musculoskeletal medicine and OMM that some (not all or even most) DO's graduate thinking that they can solve every problem with OMM and as such think that the root of every problem is musculoskeletal and they miss the big one such as the PCP doc in the original post.

 

[Hernandez]

We're also reminded that we're physicians first and practicioners of OMM second.

I don't believe the 2 are mutually exclusive. While OMM was obviously not the answer here, at my school at least, they do take a little bit of time to emphasis viseral-somatic/somatic-viseral responses and say you should be cognizant of them when treating a dysfunction, especially if it does not improve.

I myself am dubious about the outlandish claims those in (what I view as) the OMM fringe make. And frankly it irritates the hell out of me the things they'd say with absolutely no backing. But OMM (especially HVLA, muscle energy, soft tissue) is a tool I use when I deem it appropriate and will continue to do so on occasion. It sounds to me like FutureNavyDOc was one of these guys who did choose Osteopathy, but went there as a last choice.

 

[FutureNavyDOc]

It sounds to me like FutureNavyDOc was one of these guys who did choose Osteopathy, but went there as a last choice.

Would you read my last post before you make such an obtuse assumption?


I saw DO school as equivalent to MD school which is why I made my choice based on geography not initials.

The mistake I made was thinking that we would be taught proven methods in Med school and that our profs would be honest with us. I didn't expect to hear unproven outlandish claims about OMM such as Cranial cures ADHD. When claims like that are made, it seems more like a Homeopathic course than an actual Medical course.


I agree that the outlandish claims are made by those in the fringe, but I want to know why does that fringe still dominate the AOA and Osteopathic education? Why is that fringe allowed to make board questions that have no proof behind them? (i.e. Is the Craniosacral impulse increased or decreased in a pt with depression? when there has been multiple studies that showed essentially no inter-examiner reliability, let alone any correlation between rate and happiness in the supposed Craniao-sacral impulse. )
This is similar to if Pat Buchannan and Jerry Falwell made the policy for the entire Republican Party. It would never fly there and I have no idea why it still flies here.

 

[siinew]

This is similar to if Pat Buchannan and Jerry Falwell made the policy for the entire Republican Party. It would never fly there and I have no idea why it still flies here.

They do make the policy for the entire Republican party though, don't they? Sure seems like it to me. 🙂

But seriously, I see your point(s). I don't necessarily agree, but don't know enough to argue about it anyway. However, I would like to point out that "proving" things via reductionism has many fallacies to it as well. Simply showing the mechanism for a strep throat infection, for instance, does not really prove why it occurs in a given patient vs. another one when the bacteria is clearly living in both patients. Neither does reducing, classifying and cataloging the known "mechanisms" for the immune system via the reductionist approach. The "how" gets answered, often, but the "why" is pretty much about as un-understood as it was 2 centuries ago, imo. I'm not knocking where we are at, but just trying to point out that it is far from being the complete picture.

I think that at least the AOA in regards to these more "fringe" aspects of OMM is at least addressing (in its own way) the fact that we DON'T know everything about the human body simply because we have powerful microscopes. Maybe some of these claims haven't been proven. Have they been disproven? Can you think of any such similar jumps in understanding (medical and non-medical) that have been met with skepticism through the years? I sure can. Real "science" starts as philosophy (probably the root of the "PhD" originally(?)), and the "mainstream" science which is largely dictated in this society by money/power is at least 2 - 3 generations behind said science in any given area at any given time. Or do you just implicitly trust phamaceutical company claims and misdirection of medicine over the past several decades?

So my point is, although I don't know anything about OMM, that I can at least respect the fact that the other side of the spectrum doesn't really know anything either, on the same topic. Or are there studies done by hard-core cranial skeptics that have disproven any of those claims? Any studies that are more than opinion-based self-validation on either side (see previous remark about mainstream science being 2-3 generations behind because of ...).

 

[drusso]

but I want to know why does that fringe still dominate the AOA and Osteopathic education? Why is that fringe allowed to make board questions that have no proof behind them? (i.e. Is the Craniosacral impulse increased or decreased in a pt with depression? when there has been multiple studies that showed essentially no inter-examiner reliability, let alone any correlation between rate and happiness in the supposed Craniao-sacral impulse. )

This is similar to if Pat Buchannan and Jerry Falwell made the policy for the entire Republican Party. It would never fly there and I have no idea why it still flies here.

The answer is simple: Few DO's have the knowledge, skills, and resources to develop a scientific evidence base in favor of other views. Still fewer DO's invest the time and energy to be proactively involved in the organizations that can affect change. People have all kinds of excuses, "My practice is too busy." "The AOA self-selects its own ideological adherents," "The hurdles are too big." etc. These are just excuses.

It's no different from any other social movement, professional group, or organization: DO's deserve the leadership that they get. If you want things to be different, then you'll have to take the lumps in order to steer things in a different direction. Nothing happens over night. But, look at the population pyramid of the osteopathic profession: The 25-40 age group is HUGE!

The previous generations of leadership---who indeed achieved some very remarkable things in terms of fighting "the old battles" are about to depart our terrestial dwellings. The next 20 years of the profession are in the hands of current students, residents, and young physicians in practice. It takes about 15-20 years to "turn over" an organization. Will they invest in research? Will they invest in sustained, strategic growth? Will they invest in GME? Will it be more collaborative? Will they choose careers in academic osteopathic medicine??

 

[SOUNDMAN]

This is actually a real problem.

For people who have been around medicine and know what it is really practiced like "out there", it's pretty easy to ignore the OMM cheerleading and study what is important to being a good clinician.

I think this part of the statement is dead on. So many people take OMM as gospel, and aren't looking at the big picture. The PCP missed the primary thing you are taught as a physician: What is the differential diagnosis, and which ones can kill you. Rule those out first! MI is at the top of the list with this presentation.

 

[FutureNavyDOc]

Regarding Fallwell and Buchannan, just because they think they are the voice of the entire republican party (or the world in Limbaugh's case) doesn't make it so, but you get my point.


Drusso,
Good points about the AOA. I sure hope it changes in the coming years. I have a hard time believing a combined match is more than 10 years away, which I believe will be a great advance for the profession especially for the then students.
As my username suggests, I have a commitment to serve out to the US Navy after graduation. Once that is completed and there is no more chance of my being sent to Afghanistan/Iraq/Iran/wherever else we have troops, I plan on becoming active in the AOA and trying to instill change from within.

 

[hyperbaric]

The answer is simple: Few DO's have the knowledge, skills, and resources to develop a scientific evidence base in favor of other views. Still fewer DO's invest the time and energy to be proactively involved in the organizations that can affect change. People have all kinds of excuses, "My practice is too busy." "The AOA self-selects its own ideological adherents," "The hurdles are too big." etc. These are just excuses.

It's no different from any other social movement, professional group, or organization: DO's deserve the leadership that they get. If you want things to be different, then you'll have to take the lumps in order to steer things in a different direction. Nothing happens over night. But, look at the population pyramid of the osteopathic profession: The 25-40 age group is HUGE!

The previous generations of leadership---who indeed achieved some very remarkable things in terms of fighting "the old battles" are about to depart our terrestial dwellings. The next 20 years of the profession are in the hands of current students, residents, and young physicians in practice. It takes about 15-20 years to "turn over" an organization. Will they invest in research? Will they invest in sustained, strategic growth? Will they invest in GME? Will it be more collaborative? Will they choose careers in academic osteopathic medicine??

👍

 

[Xoynx]

First, I haven't even interviewed for DO schools yet, but even I know that pain that comes on suddenly at night is probably not biomechanical.

Second, I'd like to know how many DOs overprescribe meds compared to MDs. Just wondering.

Third, I'm way excited about learning OMM *except* for the CS stuff, which I think is way undersubstantiated.

 

[DropkickMurphy]

Regarding Fallwell and Buchannan, just because they think they are the voice of the entire republican party (or the world in Limbaugh's case) doesn't make it so, but you get my point.


Drusso,
Good points about the AOA. I sure hope it changes in the coming years. I have a hard time believing a combined match is more than 10 years away, which I believe will be a great advance for the profession especially for the then students.
As my username suggests, I have a commitment to serve out to the US Navy after graduation. Once that is completed and there is no more chance of my being sent to Afghanistan/Iraq/Iran/wherever else we have troops, I plan on becoming active in the AOA and trying to instill change from within.

"Trojan horse......"

 

[Brooklyndo2.1]

all I know is I tend to think of anything in medicine in a certain way:::
1. does this look like something that can possible kill a patient?? chest pain= r/o
sob=r/o PE etc etc etc
2. everything else

3. OMM? maybe, maybe pt, ot, etc....
oh yea and im an omm fellow... you know, brainwashed and all.

btw, to a urologist chest pain is obviously related to the cardiac mets from the bladder Ca...duh... (or something equally likely)

as for cranial, i have and will say this :: germ theory was also thought of as nonsense by some very respected physicians...
doesnt mean we can prove if it works, how it works, what it works for, etc... my patients headache went away... and im relatively sure from the lack of early morning headache, progressive vomiting...maybe CT , or MRI... that there isnt a mass or a bleed... hey cranial got rid of the headache...or something...whatever... patient is happy and pain free...im happy.

 

[the1doc]

all I know is I tend to think of anything in medicine in a certain way:::
1. does this look like something that can possible kill a patient?? chest pain= r/o
sob=r/o PE etc etc etc
2. everything else

3. OMM? maybe, maybe pt, ot, etc....
oh yea and im an omm fellow... you know, brainwashed and all.

btw, to a urologist chest pain is obviously related to the cardiac mets from the bladder Ca...duh... (or something equally likely)

as for cranial, i have and will say this :: germ theory was also thought of as nonsense by some very respected physicians...
doesnt mean we can prove if it works, how it works, what it works for, etc... my patients headache went away... and im relatively sure from the lack of early morning headache, progressive vomiting...maybe CT , or MRI... that there isnt a mass or a bleed... hey cranial got rid of the headache...or something...whatever... patient is happy and pain free...im happy.

I'm sorry that you chose to waste your time playing omm fellow.

We could apply your rationale to anything that "might" be true....religion, aliens, ghosts, and cranial. I just finished watching an infomercial for "miracle spring water"....i don't know...it seemed pretty damn convincing....people take one swig of miracle water and voila! they throw down the canes and dance like pros....yet i remain skeptical....just as i remain skeptical of the folks who claim cranial worked for them (or some of their patients).

 

[DOAnestMan]

I do not understand the hostility you feel towards cranial. If you do not like it, don't use it. At OUCOM, OMM is not always taught as the first line of therapy, but as a helpful adjunct for many common conditions. Obviously, OMM would not be the first treatment for an MI, but when you are S/P MI and stable, what would the harm be in trying to restore lymphatic flow and normalizing tension? The best thing about being a DO is that we are trained to have an extra tool in our black bag to help our patients.
If you personally do not like doing OMM, that is certainly your prerogative and guess what: you'll never have to do it after your COMLEX PE! However, I myself have felt the benefits of well done OMM and have had overwhelmingly positive results from patients' responses to OMM (including Cranial at times) for me to discount it.

 

[Al2VCOM]

As my username suggests, I have a commitment to serve out to the US Navy after graduation. Once that is completed and there is no more chance of my being sent to Afghanistan/Iraq/Iran/wherever else we have troops, I plan on becoming active in the AOA and trying to instill change from within.[/QUOTE]

You really think that you will join the AOA?
I dont think they would have you, if they knew how you talked about DO education.
Could you be right about some critical things?
Could nothing, you ARE. But it wont help. I wouldn't want you on any body dealing with policy within the AOA. A shame really, you could have done some good. You are smart enough, proficient at expressing yourself, gaging the opinions of others. You say things that piss other people off, and it is destructive.
If you want to change things by attacking a modality and cornerstone of osteopathic medicine, who is going to listen, even if you are right?
People who care enough about their title and professional appearance to help you make positive change?
No.

 

[It'sElectric]

You really think that you will join the AOA?
I dont think they would have you, if they knew how you talked about DO education.
Could you be right about some critical things?
Could nothing, you ARE. But it wont help. I wouldn't want you on any body dealing with policy within the AOA. A shame really, you could have done some good. You are smart enough, proficient at expressing yourself, gaging the opinions of others. You say things that piss other people off, and it is destructive.
If you want to change things by attacking a modality and cornerstone of osteopathic medicine, who is going to listen, even if you are right?
People who care enough about their title and professional appearance to help you make positive change?
No.

I'm willing to bet that NavyDoc would approach things slightly differently and w/ a little more tact if he were indeed trying to make a run at an AOA position in the future. I would NEVER EVER perfectly equate how someone behaves on an internet message board w/ how they will go about things in real life.

Your post was kind of confusing and rambling by the way.

 

[the1doc]

"I wouldn't want you on any body dealing with policy within the AOA".

Good thing you're not making those decisions.

"You say things that piss other people off, and it is destructive."

So now if anyone says anything contradictory, it is destructive?
What the AOA doesn't need is more lapdogs. They already have plenty of those. The osteopathic profession needs people willing to promote change - and change is rarely easy.

"If you want to change things by attacking a modality and cornerstone of osteopathic medicine, who is going to listen, even if you are right?"

That is a stupid question. This isn't a cult. This is science. If evidence supports a modality, the modality will withstand scrutiny.

 

[Al2VCOM]

Excuse me for sounding critical.
I am glad people are trying to improve osteopathic medicine.
My thinking is just that, mine. I don't make policy, I don't think that contradiction is destructive, but I do think it should be professional.

"What the AOA doesn't need is more lapdogs. They already have plenty of those. The osteopathic profession needs people willing to promote change - and change is rarely easy."

I agree thoroughly, agian I apologize if my post didn't make sense, or implied any cultist ideals... and an attack on the character of NavyDoc was not intended either. I think tact should always be stressed.

No, I dont equate people with what they say here. I don't know them.
I think people should always approach their profession and its image in a respectful manner, even if they dont agree with all that it stands for. That doesn't mean I am a lap dog.

 

[It'sElectric]

Fair enough.

 

[FutureNavyDOc]

I'm willing to bet that NavyDoc would approach things slightly differently and w/ a little more tact if he were indeed trying to make a run at an AOA position in the future. I would NEVER EVER perfectly equate how someone behaves on an internet message board w/ how they will go about things in real life.

Your post was kind of confusing and rambling by the way.

My future plans in the AOA have no bearing on my approach here. My intention here is to stir up conversation from both sides to try to get an idea of the opinions and rationale of those on both sides of the fence, both my own and the other.

Would I make the same/similar remarks in the same tone as I made on here in a speech while running for an office? Absolutely not, however I will not sacrificie my beliefs for votes. If I am elected, I want it to be because more people agreed with me than opposed which I sincerely believe to be accurate of all DO's. It may not represent the majority of AOA members because those who feel as I do tend to be weeded out of the AOA or leave due to their own feelings of being disengaged from the AOA.


There are many aspects of being a DO specifically from the Student end that the AOA must change for the sake of their students.

The main one being the need for a combined match which appears to be obvious to everyone except the Good Old Boys club at the top of the AOA.

What is the point to the AOA holding on to their own separate match that is used by less and less DO students each year? In 2004 53% of DO students used the DO match down from 55% in 2003, 56% in 2002, 57% in 2001 and 59% in 2000. It doesn't take a PhD in statistics to figure out that trend. The main reason cited for not doing the DO match was fear of being forced into a DO residency that was near the bottom of their list when they could have had an Allopathic residency much higher up on their list. Also, why does the AOA insist on holding on to so many FP residency sites when a large number of them are not consistently filled and many have not been filled for years?


Also, unlike this site, I believe that the majority of DO's and DO students are not content with the current OMM curriculum as well as the emphasis placed on it (which obviously varies from school to school).
The main areas that I feel need to be addressed in regards to OMM are Cranial, the lack of EBM, and the un-substantiated claims of the abilities of OMM, particularly cranial, that appear both on course exams and board exams.
No where else on boards can you find questions that have no scientific proof behind them. Evidence Based Medicine is now being taught (at least at DMU) as an important part of every system and it permeates every course with one exception; OMM.

The demi-god status that AT Still and OMM receive are as out-dated as the belief that tabacco has medicinal properties, however the AOA clings to them both as though they were the last hopes for success instead of recognizing the past as the past and moving forward. Was AT Still a great physician? For the tools he had at his time, yes. Would AT Still practice only OMM if he were still around today? Based on the fact that he would be 176, I doubt it😉 But seriously, I believe that AT would be embracing new methods of treating patients especially if they were proven to improve the survival and health of the patients.
Interestingly enough, cranial and the majority of the 2nd year of OMM as the curriculum at DMU goes (2nd year is almost all extremities and Cranial) came about after AT Still, so if the AOA embraces cranial and extremity OMM it is clearly ignorant to chastise those DO's who don't believe in Cranial as not following Still!

 

[SOUNDMAN]

Nice post well said FND.

 

[jrf331]

Navy doc I gotta agree with you on that post.