What is Osteopathic Medicine? The field I study, and how it is different from the "traditional" MD by tfeldman

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· @tfeldman · (edited)
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What is Osteopathic Medicine? The field I study, and how it is different from the "traditional" MD
<html>
<h1><strong>Introduction:</strong></h1>
<p><img src="https://www.steemimg.com/images/2016/09/28/osteopathy-212590_640c686f.jpg" width="640" height="480"/></p>
<h2><strong>I have seen the "health frustration" throughout Steem. Many people have mistrust for the “typical physician" and feeling like there isn’t anyone they can trust with their health. I get it. You experience your body and what works for you. But, do you really understand your body? Do you really know the mechanisms that are occurring in your body to improve your health? People will find any source on the internet to validate their “gut feeling” beliefs.&nbsp;&nbsp;</strong></h2>
<p><br>
Is this bad? Not exactly, but it can be frustrating to the doctor. <strong>Let me make a comparison; if you clog up your toilet and need a plumber, do you question the plumbers knowledge because you use the toilet everyday?…I doubt it. I bet you just want the toilet to be unclogged.&nbsp;&nbsp;</strong></p>
<p><br></p>
<p><br>
Individual people experience their health, whether good or bad, everyday; however, that does not mean they have the educated knowledge to understand it, or more importantly, to fully manage it. Let’s face it—people (and even myself—about to be a doctor in May, need doctors). From my experience in medical school and in the hospital system, there are good medical doctors and bad ones; but overall, I think doctors really want to help. It is an amazing feeling to save someones life, and it is also meaningful when one dies and you have the role to comfort the loved ones who will bare that suffering.&nbsp;</p>
<p><br></p>
<p><br>
My into is long…but an important one. Before I go into the differences between the training of an MD (Medical Doctor—AKA allopath) versus DO (Doctor of Osteopathy—AKA Osteopath) I wanted to set things straight about how doctors care about their patients. Whether individuals here have problems with vaccines, pharmaceutical companies, or just any physician giving them tips about their health, <strong>I want the readers here to take a leap of faith. Or, rather, like many on Steem, take a leap into science. </strong>Most trained physicians were biology majors (like myself) or chemistry majors before going into the 4-year journey of becoming a physician. Science is the basis we have to give the best management and quality of life to our patients…well that and a big heart. <strong>There are good and evil people in every profession. The majority of physicians I have had contact with are not only smart, but they also came into medicine to help others. Most would not endure these long hours that only a medical student can understand, or get into an average of 200,000 dollars of government debt if they did not want to help/make a difference in some way.&nbsp;&nbsp;</strong></p>
<p><br></p>
<p><br>
<strong>Before speaking about why I love osteopathic medicine, I want to give credit to the “MD"</strong>. The majority of people I work with at the hospital are MDs. Many are brilliant people, with a heart to help others. They are great at the differential diagnosis, and finding ways to manage patients through consultation or medical management. <strong>The one thing that separates us (osteopaths) from any variation you can see physician-to-physician is the study of osteopathic manipulative medicine, which is only taught in osteopathic schools.</strong> <strong>The philosophy is also slightly different, but again, that philosophy could be shared whether DO or MD. However, osteopathic schools engrain a special philosophy, which will be discussed later. &nbsp;The philosophy is a personal quality, not one that can be taught by reading a book. I hope to keep the osteopathic philosophy as I start my career as a medical doctor.</strong></p>
<p><br></p>
<h1>Difference in Training: MD VS DO<br>
</h1>
<h2>Undergraduate:&nbsp;</h2>
<p><img src="https://www.steemimg.com/images/2016/09/28/audience-1677028_6407f5bb.jpg" width="640" height="480"/></p>
<p><br></p>
<p><strong>Almost all MD and DO schools require a 4-year undergraduate degree at some college, with no requirements in a specific major. </strong>There are rare exceptions to this rule, in both fields, but to my knowledge, all require <strong>many courses in biology, chemistry, psychology, and physics.</strong> To express the amount of courses required... after fulfilling all my chemistry requirements, I was one course away from having a minor in chemistry! It is easy to see why most medical professionals major in science before medical school because one gets most of the major requirements just by doing what is required to apply to medical school.&nbsp;<br>
</p>
<p><strong>I really loved history and philosophy too so I decided to major in world religion as well.</strong> It didn’t leave me time to study abroad…DANG! but I have no regrets for choosing my two majors.…Basically, you could be a music major and take over 15 science courses and still get into medical school.&nbsp; <strong>&nbsp;</strong></p>
<p><br></p>
<h2><strong>Entrance Exam for Medical School:&nbsp;</strong></h2>
<p><img src="https://www.steemimg.com/images/2016/09/28/test-986769_640d8a43.jpg" width="640" height="480"/></p>
<p><br></p>
<p><strong>For both MD and DO medical schools, you must take the MCAT, which is a national entrance exam in the US. </strong>The test, at least when I took it, consisted of all the science courses you took in college. So sections were broken into physical science (physics), chemistry, and biology. Basically, you had to remember everything you learned in college… I know…<strong>WHAT A BLAST (excuse the sarcasm)!&nbsp;<br>
</strong><br>
<strong>…So the knowledge going into medical school for DO and MD is the same.&nbsp;</strong></p>
<p><br>
<strong>What is harder to get into:</strong> Over the years, they are equalizing more and more. In the continental US, MD schools, are more strict on MCAT scores and typically slightly harder to get into. However, Caribbean medical schools are the easiest to get into and are only MD. So I guess in a way, MD schools are by far the easiest schools to get into (however, I have met very bright physicians from Caribbean based schools, so I would never judge a doctor just because he went somewhere that was easier to get into. It's a simple fact: once a student is into medical school, it's a hard road where the strong survive!) . Osteopathic schools, which are fewer in number and all private, take more consideration on the interview process and grades during college versus MCAT scores.<strong> </strong>It is not at all easy to get into…competitive scores in DO schools are probably averaging a 3.7- 3.8 GPA in college and an MCAT score of 28-30. Every year, it gets harder and harder to get into medical school. I find this a problem. If you are smart and want to study your butt off, then you deserve to get into medical school, especially since there is much need for more medical professionals.&nbsp;&nbsp;</p>
<p><br></p>
<h2><strong>Differences in Medical School: MD VS DO&nbsp;</strong></h2>
<p><img src="https://www.steemimg.com/images/2016/09/28/paramedics-doll-1142284_640be002.jpg" width="640" height="426"/></p>
<p><br>
<strong>The medical knowledge training for MD and DO is equivalent.</strong> Both fields spend two years studying for ridiculous amounts of time (I would say average over 80-90 hours a week including school) on human anatomy, microbiology, biochemistry, physiology of every organ system, pathology/histology, pharmacology, psychiatry, and much more. At one point, it was like having final college exams every week.&nbsp;<br>
</p>
<p><strong>DOs (osteopathic doctors) also have 200-500 hours of additional training in osteopathic manipulation </strong>(I will cover this topic in this post). <strong>MDs do not receive training in this form of medicine.&nbsp;</strong></p>
<p><br></p>
<p><strong>DOs also are taught a philosophy of “holistic” medicine. In summary, the philosophy is that the body is connected in three ways: mind, body, and spirit. If one in altered in any way, the body is not balanced and can cause medical issues, such as physical manifestations. For instance, if someone has neck pain, you may give ibuprofen to decrease that inflammation. However, if their neck pain is being exacerbated by stress, then it may cause hormones to be released, to again, cause muscle tightness in the neck.</strong> <strong>So, it is not that ibuprofen is bad or should not be used, but a physician should also consult the patient’s stress before just prescribing medication.&nbsp;&nbsp;</strong></p>
<p><br></p>
<p><br>
<strong>Bottom Line:&nbsp;</strong></p>
<p><strong>Doctors of Osteopathy (DO) and Medical Doctors (MD) physicians are equivalent in medical knowledge taught and prerequisites required to attend the school. Osteopathic schools are distinct in that while learning medicine, they teach the philosophy of holistic medicine; it still includes prescribing the correct medication when necessary/appropriate but also treating beyond the body and into the mind and spirit as well. Osteopathic physicians are also trained in "Osteopathic Manipulative Medicine,” which is an additional 200-500 hours of training. &nbsp;&nbsp;</strong></p>
<h2><br>
<strong>United States residencies and future medical professions after medical school:</strong></h2>
<p><br></p>
<p><img src="https://www.steemimg.com/images/2016/09/28/isolated-1188036_640ce8de.png" width="640" height="426"/></p>
<p><br></p>
<p><br>
Next year, I will hopefully get my first job as a medical resident. There are DO only residencies or MD residencies (which can be comprised of MDs and DOs). <strong>You are officially a doctor after medical school, but typically train in a specific field of medicine.</strong> <strong>I, like 2-generations before me, will likely be in a family medicine residency, which is a three-year program. You are paid to see your own patients but are still learning from experienced physicians during those three years.</strong> <strong>DOs and MDs have equivalent rights as physicians. There are no separate restrictions between DOs and MDs.</strong> <strong>A DO and MD both can prescribe what is legal to prescribe and can become any type of physician</strong> (whether family medicine, or a heart surgeon).&nbsp;&nbsp;</p>
<p><br></p>
<h1>&nbsp;<strong>A Glimpse Into Osteopathic Medicine&nbsp;&nbsp;</strong></h1>
<p><br></p>
<p><img src="https://www.steemimg.com/images/2016/09/28/osteopathy-212590_640c686f.jpg" width="640" height="480"/></p>
<p><br>
To start off, I would like to first note that I will dedicate an entire post to Osteopathic Manipulative Medicine (OMM) and Osteopathic Manipulative Treatment (OMT) in the future. I want to end this post by discussing the historical foundation of osteopathy, and a brief description of Osteopathic Manipulation.&nbsp;<br>
</p>
<h2><strong>The Foundation and Philosophy:&nbsp;</strong></h2>
<p><img src="https://www.steemimg.com/images/2016/09/28/civil-war-74010_6400b956.jpg" width="640" height="457"/></p>
<p>Dr. Taylor Still is the founder of osteopathic medicine. <strong>In 1892 he opened the first school, the American School of Osteopathy in Kirksville, MO.</strong> He received the traditional MD degree in the mid-1800s, and was a surgeon during the Civil War. <strong>After the war, three of his children died of meningitis, despite medical efforts that the world knew. He became fed up with the lack of healing during the 19th century.</strong> At this time “bloodletting and purging” and medicines such as morphine and mercury (for syphilis) were being used often (Ref 1 and 2).&nbsp;</p>
<p><br>
In the 19th century medicine was not pretty! There were no antibiotics available, and there was not much science backing any of the techniques. <strong>Dr. Still was fed up with it, and that is why he made his own field of medicine. He taught people and discovered that the body had the amazing ability to heal itself through homeostasis (Ref 2).&nbsp;</strong></p>
<p><br>
<strong>He taught osteopathic manipulation, in which the physician would move the patients body in ways that could restore function to that area that was dysfunctional. Osteopathic studies, while fewer than many pharmacologic studies, have given signifiant validation to the claims that were discovered during Still’s time. From my own personal experience using these techniques on patients in hospitals, they are very effective. In just 5 minutes, I often can make a very tight muscle in someones back or neck become very relaxed. Dr.</strong>&nbsp;<strong>Still studied anatomy intensely! He realized that fascia (webbing of tissue) around bone, vascular/neural/lymphatic tissue, and muscle were all connected. By manipulating the patient's body with the physicians hands (moving the structures mentioned through various methods), the fascia can be freed, which speeds up the healing process. The body wants to be in homeostasis, and if a physician can guide that musculoskeletal component to a “normal state,” homeostasis will hopefully be reinstated or, at least, improved.</strong></p>
<p><br>
There have been many amazing accomplishments in osteopathic medicine in the early days, and I would like to highlight one of these....</p>
<p><br></p>
<p><img src="https://www.steemimg.com/images/2016/09/28/fever-310721_640909b4.png" width="640" height="369"/></p>
<p><strong>In 1918, the Great Flu Pandemic wiped out 40 million people world-wide. 650,000 people died in America. If someone just got the viral “flu” there was a 5% chance of death and if someone got bacterial pneumonia (again, before antibiotics were used) there was a 60% chance of dying (Ref 3).</strong>&nbsp;</p>
<p><br></p>
<p>The flu would often lead to a secondary pneumonia. <strong>Under MD care at the time, there was not good medicine, and they would often use pain relief as the main treatment. Under MD care, 5-15 % died from the flu &nbsp;and 25-60 % died from flu + pneumonia.</strong> <strong>Osteopathic care at the time, which used more supportive care measures such as hydration and osteopathic manipulative medicine, only had 0.2 % of patients die who had the flu, and only 10 % die who had the flu and pneumonia (Ref 3).&nbsp;</strong></p>
<p><br></p>
<p><strong>One thing is for sure--there was a signifiant decrease in mortality when osteopathic physicians treated patients during the Great Flu Pandemic of 1918.&nbsp;</strong></p>
<p><br></p>
<p><br>
<strong>I hope this brings insight for Steemers to appreciate the osteopathic medical approach. I am proud to be graduating in May, but I also hope to keep this philosophy alive within. I plan to continue using osteopathic manipulation as one tool I have to help patients.&nbsp;</strong></p>
<p><br></p>
<p><br>
In the near future, I will discuss in more detail osteopathic manipulation, and maybe perhaps make videos of how the techniques are performed. There is much scientific theory behind these techniques, which I will also be able to provide you. I will also try to validate these techniques with current medical research.</p>
<p><br></p>
<p><br>
My diabetes posts have met great reception on here. Informing people about health is an important passion of mine, and I will continue blogging about other health topics such as diabetes as well.<br>
</p>
<p>Stay tuned, and I appreciate the followers.</p>
<p><br></p>
<p>Thanks!</p>
<p>and...the classy photo of myself!</p>
<p><img src="https://www.steemimg.com/images/2016/09/14/medsmalllllllllla844b.jpg" width="159" height="240"/></p>
<p><br></p>
<p>*Sources<br>
</p>
<p>Ref 1) &nbsp;American Association of Colleges of Osteopathic Medicine: &nbsp;&nbsp;http://www.aacom.org/become-a-doctor/about-om/history&nbsp;</p>
<p>Ref 2) &nbsp;&nbsp;Foundations of Osteopathic Medicine – 3rd Edition, Chila-Editor, (Lippincott, Williams &amp; &nbsp;Wilkins), 2010 (VitalSource) &nbsp;</p>
<p>Ref 3) Historical Foundations of Med Thought, a powerpoint produced by Dr. Kuchera at our Medical University</p>
<p>*All images from Pixabay.com are no source is needed. Photo of myself as a senior in medical school (last photo).</p>
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vote details (61)
@lemouth ·
I agree with the fact that that both are complementary (which you have not exactly written in your post but I guess my conclusion is not wrong, isn't it?). One problem may be related to people that want to totally get rid of MD and focus only on alternatives. In some cases, it will simply not work.
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@tfeldman ·
You make a good point. I think MD and DO have blended philosophies. DOs and MDs both believe that many medications are beneficial for helping the patient who is burdened by a disease. DO really emphasized preventative medicine, which is now a cornerstone in both professions. The idea of treating the "whole" person is becoming more widespread in the MD field. I think that what is special about the mind, body, and spirit model is that it is incorporated in every aspect of medicine during the DO curriculum. 

Osteopathic manipulation to me is like another "tool" in my pocket to help a patient. If a patient had diabetes, I would obviously prescribe prescription medications (insulin if needed, ACE inhibitors, statins, ....). Osteopathic manipulation  would not "cure" diabetes. It is not possible. However, if someone had back pain and wanted surgery, I think a DO would try more manipulation, and hopefully could prevent that patient from getting an unnecessary surgery.

DO is not alternate medicine by any means. It is, however, attractive to people who appreciate alternate medicine because it gives the body a chance to heal with using two hands.
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@lemouth ·
Thanks for the clarifications! :)
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@justtryme90 ·
Welcome to the site, I look forward to your future postings. Educating on issues which influence all of our health is important, thanks for taking the time to teach us.
👍  
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@tfeldman ·
No problem! It is exciting to provide this information. Thanks for reading!
👍  
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@kenny-crane · (edited)
Hello and welcome to steemit!

This article is interesting and informative.  I had some knowledge of the differences between an MD and a DO but this article expanded on the basics and put it in historical context.  I look forward to reading more from you!

EDIT: I thought this was your first post but I checked your blog and saw many other articles!  I followed you so I can get the new ones in my feed.
👍  
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@tfeldman ·
Thanks for following. I look forward to sharing more information. This was just a "snap-shot" of Osteopatic medicine. I'm glad it brought good insight into the field!
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@dgiors · (edited)
@tfeldman I'm sure you have good intentions and have studied your practice intensely. Last thing I wish to do is attack you personally so please don't take this as such. Through your post here you haven't mentioned any of the risks or potential side effects of your practice.

I do not question your training at all. In my estimation DOs go through a rigorous schooling just like MDs. That said I hope people do some research into science based medicine before seeking osteopathic treatment. There are considerable risks associated with the practice worth considering.

http://whatstheharm.net/osteopathy.html
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@elena000 ·
Try to add to your research experience of Thai massage. unique ancient technique.
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@tfeldman · (edited)
I would be happy to point you to some other sources when I finish my ER shift in about 15 hours. Osteopathic manipulation causes some of the least amount of harm actually! I will be making a complete post on Osteopathic manipulation in a future post. Side effects will be included ;). This post was a very brief overview.  Aspirin or ibuprofin, for instance, have a much worse potential for harm than many osteopathic techniques
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@tfeldman · (edited)
Firstly, thank you for bringing your thoughts to the table. I have looked at the website above "what's the harm" and actually found no scientific basis in any of the part on osteopathy (if you do find a link for this please send it to me). I would like to point out a few problems I have with what I saw on this site....

 One, is that the creator of this site is not a medical professional and is using "stories" from patients who believed they were wronged by osteopaths. This is not science based medicine. 

Secondly, I am also not sure if these case reports were from DOs in America. Osteoapath is different in Europe (however, they did adapt many techniques from osteopathic traditions in America, which could still bring validity to your point). From the case reports, these were spanned over several years. In other words, it does not appear that it was happening at high frequency, relatively.  For instance if a DO or MDs conduct surgery on someone, will there be complications?....absolutely and at a higher rate (but maybe not a high relative rate). The question at hand is does that procedure/technique pros outweigh the cons? As far as the case reports are concerned, I have trouble finding any proof that osteopathic techniques were the **cause** of these complications provided on this website. 

I also think he makes a completely false statement when he relates chiropractic ( I have no problems with chiropractors by the way either) medicine to osteopathy (unless he did not mean osteopathic physicians in America). We are medical doctors, who in fact, use traditional medical techniques as well as osteopathic manipulative treatment. 

*I use the terms osteopath, osteopathic, osteopathic medicine very "loosely" in my article...yet I am only referring to US osteopathic medicine (the place it was founded)...in today's language osteopath and osteopathy is used more around the world where the training is different. In Dr. Still's time, osteopathy was the American term. 

I would also like to take a brief moment to discuss my point of view on the overwhelming safety of Osteopathic Medicine (at least in America). Firstly, there are **many** techniques used, some of which are much more gentle on the body than others. For instance, one technique when someone has a very sore muscle from a new injury, and the doctor actually puts a patient in a position where they feel less pain. This is because you shorten that muscle. The muscle becomes relaxed and the patient has less pain in that area. This is actually **objective** in itself because if there is less tension in a muscle, that is a physical exam finding. I have never heard of any adverse effects to this technique, one that I use often.

There are techniques that have the potential to causes problems. One is HVLA (high velocity, low amplitude) to the neck. This is essentially "popping the neck." It is a very beneficial technique but has absolute contraindications. For instance, if someone has vertebral artery disease, Down Syndrome, and many others, this technique should NOT be used. As medical doctors, it is our responsibility to ask patients about their medical history. If a physician used this technique in the wrong patient, that is the doctors fault, not the fault of the profession (just like if a DO or MD prescribes a wrong medication). I have practiced this technique but have never actually used it in the hospital setting. Different settings call for less or more aggressive techniques. When someone is hurting in an acute situation, indirect (the direction away from the restriction) should be used more often. 

There are many techniques that are supported by medical research, and some that lack enough support. Cranial OMT has less objective research...however there are some studies suggesting its validity. I don't use cranial OMT often, but I do believe in it. However, due to less evidence, I can see how this would lack support for the community at large. 

There are so many techniques that I could make 100s of posts on different techniques. I **will** be providing more data and research in my future OMM (osteopathic manipulative medicine) posts and I invite you to read those in the future.

Because so many techniques we use really have no bad effects (besides maybe temporary muscle pain, dizziness, nausea, and so on), I will give you a source with multiple scientific studies on cervical HVLA, the most dangerous technique of them all (although as the data shows is still relatively very rare...one estimate was 1/5,000,000 suffer a bad consequence. Again, osteopathic physicians don't need to use a technique they or the patient are not comfortable with (patient not feeling comfortable is a contraindication in itself):  http://files.academyofosteopathy.org/CME/2012OMEDconvention/King_Presentation.pdf

Thank you for your time. I hope to keep engaging in conversation..and maybe can even turn you into an osteopathic fan!
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@dgiors ·
Thank you for the thorough response. It's true that the link I provided wasn't on the level of a scientific journal. There is a divide between the practice of osteopathy in the United States and elsewhere. You've made a strong case that U.S. osteopathy practices are evidence based.

There are a couple places I get the pseudo-science vibe from you though. One is in your defense of Chiropractic. There is a divide among practitioners. Some offer forms of physical therapy. I have no problem with that. Others are  more traditional basing their practice on the findings of D.D. Palmer in the late 1800s. His reasoning was that a subluxated vertebra is the cause of 95 percent of diseases by inhibing the flow if innate. A "life force" traveling the nerves. I'm pretty sure that stands out as an unscientific and quite unreasonable supposition. Again only a subset of Chiropractic practitioners adhere to the origins of the practice. Many have chosen to move forward with science and have thrown out much of  Palmer's assertions.

So at the end of the day I wonder why those who have left the origins of Chiropractic behind keep the name. Shouldn't they advertise themselves as P.T. and not feel sullied by the subset dealing with a form of pseudo-science arcana?

If I were to venture a guess you probably find fault with D. D. Palmer's methods and you too would discount traditionalist chiropractors.

Another area I think you stray beyond science is in alluding to the spirit. Spirit as a personal belief is great. No problem. But what does science have to say about the existence of a spirit? If it exists what is it? How do you perform falsifiable tests against the spirit?

There's a reason I'm nitpicking on that word. Because when it's used as a focus of your practice you've stepped into pseudo-science. So many of the pseudo-sciences lean upon words like spirit, power, energy, life-force, chakra that it's a wide open door to introduce feel-good metaphors for spectacularly unfounded claims.

That's not to say you practice in unfounded claims. The mind, body, spirit trifecta of holistic healing approach has the ring of being possibly pseudo-scientific.

As per your response I'm willing to believe that you operate in a professional, scientific and safe manner. I'm wondering why you chose to use unscientific banter when describing major tenets of your practice.

Thanks again. You obviously put great care and time into your well reasoned response. You ooze of passion for your practice. I look forward to hearing from you again.
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@plotbot2015 ·
I have one nephew who just started an MD and one niece who just started her DO.  It will be interesting to compare notes with them over Christmas break.
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@tfeldman ·
Sounds great. They are equal fields in quality. "Parallel but distinct." Once they join with MDs in the 3rd and 4th year hospital rotations, they will learn from each other!
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@dylann56 ·
Hey there guys, can someone here please tell me more on how to choose the best medical residency? I will appreciate any replies right here.
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@michaelwade ·
First off, think about your personal interests and career goals. What specialty resonates with you? Consider the location – are you drawn to a specific city or region? Next, delve into program specifics. Look for accredited programs with a solid reputation, experienced faculty, and a supportive learning environment. Gathering insights from current residents can provide invaluable firsthand perspectives. You can also explore online platforms like <a href="https://medresidency.com/">MedResidency</a> – it's a treasure trove of information. There, you'll find details on various programs, application timelines, and even some insider tips. Best of luck, and I hope you find the perfect match!
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