Wednesday, June 30, 2004
Osteopathic medicine
What is a D.O.?
I've seen this all over campus in the past 2 years. What does it mean to become an osteopathic physician? Basically, osteopathic philosophy states a few things:
1) That the osteopathic physician will treat the whole patient, not the disease. In reality, all physicians do this now. Maybe in the 1800s when osteopathy was formed and for a number of years afterwards the difference was more pronounced. However, in today's medical society, I don't think this is much of a point any longer.
2) That the entire body is interconnected, and no one part can be diseased without every part becoming affected. This actually makes sense. There is a lot of evidence that the body is affected by the mind and vice-versa. The osteopathic philosophy takes this one step further and says that one can detect illness in one part of the body by examining another part. This is the part where many people go "whoa, wait a minute. I don't think so..." But if you believe that everything is interconnected, why is it so hard to accept that an abnormality in one region of the body can be caused by disease somewhere else? People are quick to accept that left shoulder and arm pain can be caused by myocardial ischemia, but to think that pain in the back or arm could be caused by visceral injury - no, that's going to far!
3) That these areas of dysfunction can be detected by a physician by palpation of various body parts - the spine, the paraspinal musculature, the joints of the extremities, etc. There is a principle called "facilitation," in which it is postulated that ischemia/damage to a visceral organ sends afferent signals via sensory nerves to the spinal cord. This facilitation results from a reflex of sorts. As the afferent signals are coming into the dorsal cord, they synapse on interneurons in the dorsal horns, which then synapse on several different neurons, including efferent motor and autonomic neurons. These post-synaptic neurons are responsible for the changes seen in facilitation. Acutely, there is muscle tension, edema, warmth from local vasodilation, and pain. Chronically, the musculature becomes ropy and fibrous, there is coolness from vasoconstriction, and a decrease in pain compared with acute injury.
4) That the osteopathic physician will use his/her gifts of manipulation to treat the body. When these areas of dysfunction are detected, there are several methods used to aid in their correction. The reason I say "aid in their correction" is because an osteopath believes that the body's natural tendency is toward health - meaning that we are meant to be healthy, not ill. The osteopath may use soft tissue massage, skeletal manipulation, and/or medications and physical therapy to aid the patient in returning toward a state of health.
Osteopathic physicians are not chiropractors. Osteopaths are fully licensed physicians and can enter any medical specialty. Osteopathy has, however, historically been involved with general practice (family medicine, pediatrics, OB/Gyn), but currently there are D.O.s practicing in every medical specialty alongside M.D.s.
There has been for a long time and in many places a discussion about why the two physician groups don't merge and become one larger group. I don't know why they don't - people say the osteopaths would lose their heritage, but already the vast majority don't use manipulation to any great extent. It's not proven by large scale studies to be effective - although there is a large push to begin these studies. Whether these studies will prove what they hope they will is an altogether different story. I don't care one way or the other. I've seen manipulation work, it's fun to do, but I think there are times to use it - and the emergency department will infrequently give me reason to.
In my opinion, a physician is a physician is a physician. As long as the patient is provided with adequate and competent care, the initials behind the name do not matter. The only thing that matters is that patient and his/her illness. That is the scope of that patient's world at that moment - not where the physician went to school. If I have a good knowledge and grasp of manipulative medicine, that is just one more tool I have to treat my patient - even if I decide never to use it.
more to come...
¶ 11:02 PM
I've seen this all over campus in the past 2 years. What does it mean to become an osteopathic physician? Basically, osteopathic philosophy states a few things:
1) That the osteopathic physician will treat the whole patient, not the disease. In reality, all physicians do this now. Maybe in the 1800s when osteopathy was formed and for a number of years afterwards the difference was more pronounced. However, in today's medical society, I don't think this is much of a point any longer.
2) That the entire body is interconnected, and no one part can be diseased without every part becoming affected. This actually makes sense. There is a lot of evidence that the body is affected by the mind and vice-versa. The osteopathic philosophy takes this one step further and says that one can detect illness in one part of the body by examining another part. This is the part where many people go "whoa, wait a minute. I don't think so..." But if you believe that everything is interconnected, why is it so hard to accept that an abnormality in one region of the body can be caused by disease somewhere else? People are quick to accept that left shoulder and arm pain can be caused by myocardial ischemia, but to think that pain in the back or arm could be caused by visceral injury - no, that's going to far!
3) That these areas of dysfunction can be detected by a physician by palpation of various body parts - the spine, the paraspinal musculature, the joints of the extremities, etc. There is a principle called "facilitation," in which it is postulated that ischemia/damage to a visceral organ sends afferent signals via sensory nerves to the spinal cord. This facilitation results from a reflex of sorts. As the afferent signals are coming into the dorsal cord, they synapse on interneurons in the dorsal horns, which then synapse on several different neurons, including efferent motor and autonomic neurons. These post-synaptic neurons are responsible for the changes seen in facilitation. Acutely, there is muscle tension, edema, warmth from local vasodilation, and pain. Chronically, the musculature becomes ropy and fibrous, there is coolness from vasoconstriction, and a decrease in pain compared with acute injury.
4) That the osteopathic physician will use his/her gifts of manipulation to treat the body. When these areas of dysfunction are detected, there are several methods used to aid in their correction. The reason I say "aid in their correction" is because an osteopath believes that the body's natural tendency is toward health - meaning that we are meant to be healthy, not ill. The osteopath may use soft tissue massage, skeletal manipulation, and/or medications and physical therapy to aid the patient in returning toward a state of health.
Osteopathic physicians are not chiropractors. Osteopaths are fully licensed physicians and can enter any medical specialty. Osteopathy has, however, historically been involved with general practice (family medicine, pediatrics, OB/Gyn), but currently there are D.O.s practicing in every medical specialty alongside M.D.s.
There has been for a long time and in many places a discussion about why the two physician groups don't merge and become one larger group. I don't know why they don't - people say the osteopaths would lose their heritage, but already the vast majority don't use manipulation to any great extent. It's not proven by large scale studies to be effective - although there is a large push to begin these studies. Whether these studies will prove what they hope they will is an altogether different story. I don't care one way or the other. I've seen manipulation work, it's fun to do, but I think there are times to use it - and the emergency department will infrequently give me reason to.
In my opinion, a physician is a physician is a physician. As long as the patient is provided with adequate and competent care, the initials behind the name do not matter. The only thing that matters is that patient and his/her illness. That is the scope of that patient's world at that moment - not where the physician went to school. If I have a good knowledge and grasp of manipulative medicine, that is just one more tool I have to treat my patient - even if I decide never to use it.
more to come...
¶ 11:02 PM
