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Learning the science. Developing the art. At LMU-DCOM

Osteopathic Medicine

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I want to start by saying that I am thrilled to be training for a career as an osteopathic physician. I think there are characteristics of a DO’s training that are so valuable that I wouldn’t trade this experience for another. I think those characteristics are primarily due to the inherent humility, selflessness, passion for the art of medicine, and care for the community that has been a part of osteopathic medicine since its inception, likely as a result of it being viewed as an alternative or non-mainstream field of medicine. Essentially, no one did it for the prestige and that attitude is still alive and well in osteopathic education. But these characteristics are a part of the intangible aspects of osteopathic medical education, the feel of the school and the people in the profession. This is not due to the curriculum, the training hospitals, or even necessarily the professors; it’s the culture that grew from the principles of osteopathic medicine. Essentially, osteopathic medicine is typical medicine. Simply calling the medicine DO’s learn in medical school “osteopathic medicine” suggests that it is more different from “mainstream” medicine than it truly is.  However, I appreciate the subtle differences and the humble culture that resulted.

These are both ‘osteopathic’ medicine:

John-Leuenberger-web      emergency-room

Aside from the intangibles, osteopathic and allopathic training are essentially the same, save for some additional course work in osteopathic manipulative medicine that is completed by osteopathic medical students. The job one gets after training as a physician (allopathic or osteopathic) are precisely the same, typically at the same hospitals and clinics. So, the two degrees granted to physicians lead to the same work in the same profession. This could be imagined as two roads leading to the same place, even merging somewhere in the middle, becoming the same road toward the same end. It is this idea that leads me to be hesitant in differentiating ‘osteopathic medicine’ from ‘allopathic medicine’. However, considering it is important to understand as healthcare in the US continues to evolve, and considering I am a medical student at an osteopathic medical school, I will do the name justice and explain the distinction of ‘osteopathic’ medicine.

Consider the “Tenets of Osteopathic Medicine”:

  1. The body is a unit; the person is a unit of body, mind, and spirit.
  2. The body is capable of self-regulation, self-healing, and health maintenance.
  3. Structure and function are reciprocally interrelated.
  4. Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.

Are these not admirable tenets for a medical profession? I find these to be the most encompassing of the idea of healing. Healing is more than treating. Healing is taking care of someone who is ill – and this necessitates caring for the humanity that is contained within the layers of fascia, tissue, and skin. If you extract yourself from the medical mindset for a moment it seems like a ridiculous idea to treat people more like a tissue culture or system of physiologic errors than like people. But we do it – medicine does it.

If I extract one thing from these tenets of osteopathic medicine it’s “the person is a unit of body, mind, and spirit”. The wording is suggestive of the profession’s value of humanity – “The body is a unit – “ ok, sounds medical so far, but then it clarifies: “The PERSON is a unit of body, mind, and spirit”. We aren’t stuck in a lab adding drugs to test tubes or tissue cultures; we are treating PEOPLE who are deeper than the flesh. The value of the person adds to osteopathic medicine, it doesn’t detract, and this emphasis is carried throughout our education.

The most prominent difference between MD training and DO training is the manipulative medicine aspect. This is something that frustrates many first year DO students, as it is an additional course on top of the standard first year of medical school, but I have yet to meet a second year student who isn’t appreciative – to some degree – knowing these tools. What I find most valuable about learning osteopathic manipulation – besides the valuable anatomy review – is becoming comfortable and proficient in touch.

Learning to treat human beings requires some degree of touch, whether that is merely touching their head while looking in a patient’s ear, or placing your stethoscope on a patient’s chest. Touch is necessary. What might amaze some people is that us first year medical students are really bad/awkward at touching other people. It is an art to be able to palpate ribs, a liver margin, lymph nodes, the thyroid, etc. It takes practice learning to feel things through skin, fat and connective tissues. As DO students we practice palpatory diagnostics a lot and I can foresee this skill being extremely valuable in the future.

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The more I learn about these techniques the more I am realizing that they are not odd or “alternative” medical techniques, rather mostly borrowed techniques from other professions with a few unique to osteopathic medicine. So far in our first year we have learned muscle energy, myofacial release, counterstrain, and functional. Any one of these you can look up in Physical Therapy textbooks, and some are found in massage therapy. We just incorporate them in a medical framework that allows them to be applied to treat a broad array of ailments. All of them focus on the musculoskeletal system.

I think that learning manipulative techniques and understanding their uses and efficacy (as well as limitations) provides great value to physicians who put effort into understanding the techniques. Not only does it allow for an additional tool in the doctor’s bag, but it helps us as students to become better diagnostitians, anatomists, and future healers. As I mentioned in a previous post (PM&R) I want to become a physiatrist – a physician who helps people recover from injury (trauma, stroke, etc.) or improve a patient’s quality of life in spite of physical/developmental limitations (Muscular dystrophy, ALS, MS, etc.). Physiatrists are, historically, physicians who were trained as medical doctors as well as physical therapists. Today, this essentially translates perfectly to osteopathic medicine. As I say, osteopathic medicine and physiatry was love at first sight. I am excited to put my osteopathic skills to good use and help people recover from injury or live with debilitating disease and I know some manipulative medicine will come in handy in my future.

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As far as informing you of what osteopathic medicine is – well, it’s your classic doctoring, everything you imagine when you hear ‘physician’. Everything doctors do, osteopathic doctors do. Osteopathic physicians perform surgery, treat depression, fix fractured bones, and are sports medicine physicians, cardiologists, radiologists, urologists, neurosurgeons, family doctors, hospitalists, and everything between. Osteopathic medicine is medicine. Osteopathic physicians are physicians.

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