Andrew Taylor Still MD, DO, the founder of osteopathic medicine, started a new model for treating patients after years as a practicing MD physician. He was driven to start a new model for medicine in the United States due to the rampant over-use of drugs like heroin and cocaine for the treatment of so many common ailments in the 1800’s. He was seeing so many people harmed (often permanently) by these chemical interventions that he strived to develop a more conservative model of healthcare delivery based on promoting homeostasis, supporting the body’s natural disease fighting abilities (immune system), and optimizing the structure-function relationship (anatomy) that underlies all of life. He had such positive results that he continued to develop his methods and started his own medical school where he taught these principles as an effective way to approach the treatment of disease. This conservative medical treatment method caught on and quickly grew into the second largest form of medicine in the US. However, it wasn’t until the US military started accepting DOs as military physicians did osteopathy become so integrated into US healthcare that MDs and DOs are nearly indistinguishable today.
The differentiating philosophy is simple: Osteopathic medicine approaches disease as a disruption of the body’s homeostasis; the whole body is affected, including the mind. Treatment aims to restore balance via structural/mechanical, emotional/spiritual, and chemical optimization (in that order). This unfortunately sounds different, odd, or interesting to those who are accustomed to the ‘mainstream’ model for medical treatment in the United States – that being allopathic medicine. Allopathy literally means to treat by opposites. If you are cold then I should warm you. If your blood pressure is high then I should lower it. If you have back pain then I should give you a pain killer. All of these treatments are opposite of the symptoms that are being treated. This often makes quite a lot of sense, but sometimes it avoids the main problem of why your body temperature is lower, why your blood pressure is high, and why your back is causing you pain. Osteopathic medicine, in its philosophy, approaches disease differently.
Differences that exist between MDs and DOs are few and far between, but some of the practical differences are:
1.) Philosophy: Osteopathic medicine attempts to achieve homeostasis by restoring and optimizing structure/function, treating pathology and physical disruptions in homeostasis, and by treating the whole person including the mind, body, and spirit.
2.) Manipulative Treatments – osteopathic physicians are trained in many different treatment modalities involving manipulating the musculoskeletal system. These include muscle energy, cranio-sacral, myofacial-release, counterstrain, and high-velocity low-amplitude (HVLA). Many of these techniques have well known and documented clinical benefits and are used by other practitioners (physical therapists and/or chiropractors). Many other treatment modalities are anecdotally beneficial at best. However, spending hundreds of hours manipulating the musculoskeletal system, touching patients, and mastering the art of palpation has undeniable benefits for the osteopathic medical student and therefore their future patients.
3.) Musculoskeletal system specialization – related to the manipulative treatments listed above, osteopathic physicians have additional coursework in manipulations involving the musculoskeletal system and spend hundreds of hours working on palpating, and manipulating the musculoskeletal system, learning to understand its motion, limitations, barriers, and functions. That being said, osteopathic physicians tend to be exceedingly knowledgeable about the musculoskeletal system and its role in health and disease processes.
4.) Research – unfortunately, until recently, osteopathic physicians were little involved in research. In the modern age of evidence-based medicine, this has resulted in a great disadvantage to what is referred to as ‘osteopathic medicine’ due to the lack of high-quality research studies on the efficacy of osteopathic medicine. However, this is beginning to change as many research studies are being conducted into osteopathic approaches to medical care. Additionally, research into all areas of medicine and science is being conducted at every osteopathic medical school in the country helping to support the evidence based practice of medicine. Osteopathic medicine still remains a very practice-focused, primary care, and front lines type of medicine. Research definitely comes after treating people whereas many allopathic medical schools focus much time and energy on research and grant funding.
We are all studying medicine. Our curricula are the same, our professors are often the same, our training hospitals are the same, and now – at risk of being labeled a heretic among osteopaths – I suggest we are the same. While those aging osteopaths currently in power want to preserve the unique identity of osteopathic medicine as a distinct profession separate from allopathic medicine, I wonder why? Why fight to remain separate but equal when fighting for the same cause? We all want to learn, discover, apply our skills to better the lives of those who are ill. Why do we make something out of nothing and compare, argue, and over-analyze? Why not focus our energies toward bettering patient care? I think our two professions (or is it one profession?) have something to learn from one another. Our world would benefit greatly from the two modes of medical education coming together and becoming some sort of united front. Fortuntately, this is already beginning to happen as the DO and MD graduate medical education bodies have merged and become a single graduate medical education accrediting body, all under the ACGME. I think this is the beginning of a bright future of an advantageous partnership between the two routes of medical education in the US.
In honor of National Osteopathic Medicine week (although it has now passed) I wanted to share my understanding of osteopathic medicine and its unique attributes. I hope everyone has a great week! Educate someone on osteopathic medicine this week!
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