Medecine forum
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
jedi
08-08-2007 07:56
|
Unless you go to KCOM or CCOM or one of the other first schools, you are a DO student because of the very "proliferation" you want to stop. It's kind of strange to want to save a profession and yet limit the number of people joining it. It's like trying to form an army, but being upset about the large number of recruiting offices.
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
gilman
08-08-2007 08:10
|
Hey Guys and Gals,
Let me just say how happy/proud I am to see so many fellow DO students who actuaklly give a damn about our future as osteopaths! I know that the vast majority of us are pursuing an osteopathic medical education because we all really want to. I am really happy to see so many steadfast people who care about their fellow D.O.s. Let's keep up our morale!
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
mike
08-08-2007 08:28
|
As osteopathic physicians we need to decide where we want to go. I get the feeling that most DO's want to be seen as physicians first and foremost. Unfortunately, the AOA has it's own agenda which has nothing to do with it's members wishes. The AOA is composed of people intent on maintaining a system where they can be big fishes in a small pond while at the same time ensuring the continuation of a system to validate their own professional existance which is based on bitterness against mainsteam medicine that rejected them. I don't believe that the younger generation of DO's carry such a grudge, due in large part to the older generation of DO's fighting for, and gaining, recognition.
We have several choices. We can totally ignore the AOA and all things DO, including AOA residencies and internships. The problem is that there will always be enough people who want to be surgeons, ER docs, etc, who can't get into ACGME programs and will fall back to less competitive AOA programs. Another option is to stay within the system, run for office, get involved, and change the system from within.
Personally, I think we should quit all things AOA and start a new organization. A good starting point would be an AMA Member Group. There are already member groups for IMG's, women, and minorities, so why not for osteopathic physicians?
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
danica
08-08-2007 08:36
|
I think that the majority of young DO's embrace the philosophy and identity of being a DO so scarpping the whole thing and starting over is not practical. Nor is it practical to turn to the AMA and MD's for help. This is fundamentally not their problem. It is ours. And, the problem is all in the execution of what the profession is attempting to do. It is not so much a problem with osteopathic GME--there are some very good DO residency programs out there as well as some real stinkers--the problem is a matter of priorities.
The profession does not support nor hold accountable COM's and OPTI's for quality the way the allopathic world does. Things are simply "looser." Too many people tacitly accept a lower bar for accountability, quality and rigor. This in turn breeds apathy. There also needs to be a fundamental change in the academic culture at COM's. COM's need to continue to evolve from trade schools to full fledged academic health science centers.
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
joyride
09-08-2007 00:55
|
Lao Tzu, in "The Art of War" tells us to: know your enemy more than you know yourself.
Honestly, the only way to know the enemy is to engage the enemy in his/her duties, study his/her ways, actions and belief/thought systems, even to go as far as knowing their physical-chemical makeup.
You're asking: "Uhh.. Drfting, you got a point here?"
Yes, I have many points. Some of these, people aren't going to like.
1) If we future osteopaths *truly* want something done, we have 2 options, and both will get us there:
a) organize in a collected, focused, structured, determined, group-wise kind of mission
OR
b) we all come up with vague "standards" we want to reach, and we brainstorm as many actions we can take. we list those so people can, at least, find one thing that inspires them, and a few people begin pioneering, making paths for others to follow.
The concepts conveyed above can be intertwined in a nice mesh that would make us a pretty wacked-out "enemy" to behold.
2) I'm a firm believer that a few people agreeing something needs to be done is *NOT* enough. The few agreeing need to *DO* something.
You probably ask: "What the heck are you talking about? *ME*? What can *I* do? How can little 'ol *me* make a difference?"
The age-old situation: Someone not yet sucked into the system looks at it and says, "I need to fix something here. But what first?" only to get lost in the bowels of inaction so long as to become as potent as a frozen rose.
Going forward, I think we need to brainstorm about how to TAKE ACTION and WHERE WE WANT TO GO.
---TAKING ACTION:
1) Write letters to the AOA.
*We need stats not only on PLANNED residencies, but on FUNDED and ACCREDITED residencies. If they will not give us these stats, then at least one of us at each COM will need to do the research. I know my school, NYCOM, has the NYCOMEC book, listing all PLANNED, FUNDED and AOA-ACCREDITED residency spots at each of the networked hospitals.
Why are these stats important? To factually decide whether, truly, the AOA has/hasn't begun growing, expanding, and funding residency spots in proportion to the number of D.O.s graduating each year. We probably need historical data, if the AOA will give it to us. How far back? Maybe someone can help with this?
*Based on the stats, we need to ask questions...thought-provoking, guided, to-the-point questions in a setting that can be "refereed" so that no one can hide behind stoic or vague answers. Who'd be our "referee"? We need to brainstorm.
- Do we want closed-doored discussion? open to the public? open only to DOs and student DOs and the AOA?
- IF this is some "objective" of ours, we need to ask: What is being done/can be done by the AOA to insure that *all who want to* will be able to get AOA-accredited and FUNDED residency spots out of their COM?
- I think we definitely need to ask, "Does the AOA ideologically preceive itself superior, inferior or equal to the AMA?" Given the concept of "psychological complexes," if the leadership is going one way, and the students another, then something urgently needs to be done.
- Another nexus of questions to ask are: What does it mean for a residency to be FUNDED? Where do the FUNDS come from? How long before a PLANNED residency becomes FUNDED? How can we get more FUNDS to PLANNED residencies? What is the extent the AOA is involved in the FUNDING of a residency?
- On a scale of 1 to 10, How important is it to the AOA that future DOs have:
1) research experience? What is being done to increase the opportunities?
2) a desire to go to an AOA residency over an AMA residency? What is being done to further scrutinize and qualify a hospital as "worthy" of having an AOA-accredited residency?
3) a desire to go through the traditional 1-year rotating internship?
2) Talk with your classmates. Get them fired up. Get them to this page. Get them to talk with others. Get them to brainstorm with you. Get a general assessment of the overall class attitude, and report back with your school as the heading, and some categories you make up on your own. We know high-ranking people of COM's lurk here and read more than we know.
3) Run for SGA offices...high-ranking positions. Become a member of SOMA and/or other Osteopathic-related associations to begin understanding what their aims, goals and motives are. Report back here and let us all know what your assessment is. Eventually, enough people will bring a good "synthesis" of what these organizations are all about.
4) Each person should at least go to AOA's website and look up the position papers and see whether you agree. Do you want to be part of a group that feels X, Y, Z, A, D, and G, but you simply don't "jive" with their positions? It'd be sort of like joining the NRA when you support Kerry and his wishing to enact laws enforcing liability onto gun manufacturers, meaning: the gun company could be held liable for killing, injuring, maiming, hurting, grazing, dismembering, etc someone. Ask yourself, would gun companies want policemen packing their brand of weapons to shoot criminals, whose surviving family members could sue and win because of the liability laws?
Yes, this is extreme. No, the position papers from the AOA are, truly, not insane, too liberal, freakish, or haughty..in my honest opinion. To be fair, I suggest everyone go to this link and download the .pdf: AOA Position Papers
reasons for doing this: a) you're gonna be a DO, b) it's good to know the belief systems present in the system that will garner, groom, mold and shape you, c) if you happen to NOT be a pre-DO, student DO, or even a DO who hasn't read this, the educational value is outstanding, rewarding, and beneficial.
5) Make signs, placards, printouts, etc and post them in public places around school, saying things like, "What has your AOA done for you lately?" or "Truly, how many AOA residencies are there?" or " What's the AOA's stand on sodas in schools?" or "How often do you dream about your 1-year, rotating AOA internship?" Don't give people answers on the media. Let these questions fester in their minds. Report back with some assessment of the effects of this type of signage.
---WHERE WE WANT TO GO (with this)
1) What do we want to see happen? What demands are we gonna throw on the table? What requests do we want to make? Name a position... where do we all stand/ what's the general consensus?
2) As a group, who are WE? Are we limiting ourselves to people in DO school? residents also? board-certified DOs also? even AOA members? faculty at our schools?
3) We need to answer one question, and then, depending on the answer, we can either move forward or cause a ruckus discussing things: Do we feel we are inferior to, equal to, or superior to the AMA and MDs? [do realize here that I am asking for ideology, and the intent is to stir, churn and watch what settles. I'm not asking for chaos or bashing or condemning, etc. I am intending straightforward discussion.] With a final resolution / consensus from this "input session" we will find the clear-cut direction of our next steps. Think of this as a guage of how far the students/grads, etc feel Osteopaths have come since the older generations were given equal practice rights.
Once we decide what we're trying to accomplish, and where we feel we stand in relation to our counterparts / co-workers in the allopathic field, then we know where we're coming from and where we're trying to go...we get past those hurdles and the rest is just tweaking and number influence (see TAKING ACTION, above).
Thanks, ahead of time, for the input, if any. Let's use this as a "starting point" and let our input drive the directions from here.
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
lanod
09-08-2007 00:58
|
I'm uncertain what these stats actually mean: do the total number of AOA-approved residency training positions open up every year? that is, do they "refresh"? or, do only a certain percentage of those positions open every year (ie.. only a few people exit residency and become board certified)? I would think the latter is true, leaving these stats to be deceptive to the casual observer.
Before I list the stats, I am using acronyms to condense things: A-ARTPr and A-RTPos stand for AOA-approved residency training programs, and positions, respectively. A-AITP and A-AIP stand for AOA-approved internship training programs and AOA-approved internship positions, respectively. I understand "programs" to be different hospitals, and the "positions" mean warm bodies can fill them and get paid. I apologize for the inconvenience of having NO tables, but, I'm trying my best here!
(I apologize here for the formatting. I have put it in a .txt file and attached it to this post. I hope that helps.)
We know the stats in the right column refresh each year because the 1-year rotating internships are just that... 1 year. Still, the number of A-AIP does not equal the # Entering. In fact, historically, we don't know if it ever HAS. We don't even know how many students graduate each year, therefore we don't know if the # graduating = the number of A-AIP. I'm beginning to see why only 5 states require the rotating year.
Then, there's a huge discrepency between the # of A-ARTPos and the # Entering each year. What is that discrepency? I cannot tell because I have yet to understand the number of graduating residents/year, ie. the # of spots opening up each year for the people coming out of the rotating year.
If you look at this as a progression over time, you only see from 2000 to 2004, a net addition of 311 A-ARTPos. Shouldn't the number of A-RTPos opening each year/becoming available at least equal the number of students that graduated two years prior?
We need more stats on the # A-RTPos opening up each year.
Anyone else have more "analysis" coming from these stats?
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
danica
09-08-2007 01:18
|
it's so funny to read all this revolution business... i'm a DO, i like the profession and to echo some of what's been said here and in other threads (ad nauseum), i can't see that great of a distinction between MDs and DOs at this point. at least not in terms of clinical practice. DOs long, long ago RIGHTLY incorporated the fruits of scientific labor into their treatment practices. Still argued against many of the medical practices of his time expressly because they weren't based on any sort of science but rather on tradition. patients weren't helped and were often hurt because of this. his system was based on long, hard study of anatomy followed by long, hard years of clinical practice. were his studies rigorous by today's standards? probably not. but then, neither were anyone elses. and as western life sciences progressed, DOs accepted the medical treatments that came out of this progress.
but guess what, as osteopathic theories and techniques have progressed, MDs, PTs, chiros, PMR docs, and a whole host of others have incorporated them too. they've incorporated the "holistic" thing as well. i would bet (and i would win) that the number of people in "MD world" who apply osteopathic principles in their day to day practices exceeds the number of DOs that do - even if they don't call them osteopathic principles. and as someone else mentioned on another thread, being a DO doesn't necessarily mean you're an osteopath.
if you accept all of the above, then it won't be so hard for you to accept this: the revolution is over and we won. or at least we kinda won...DO schools are still behind when it comes to teaching or even introducing OTHER systems of medicine. this was substantiated in a published report a while back which examined med school curricula for teaching alternative and complementary systems. (not that i personally agree with all of those practices...i do think we as physicians should at least be aware of the major ones.)
so then this leaves the question, what's the real difference between "DO world" and "MD world"? i can think of two:
1. In a hundred years of existence, DOs have contributed next to nothing to the scientific basis of medicine. Today all of the DO schools together rank...what was it...200th or so in terms of NIH funding. THAT'S ALL 20 SCHOOLS TOGETHER! how many of our schools have PhD programs? That's really sad when you consider the origin of our field.
2. The DOs are continually fretting about being accepted by MDs. That's also sad.
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
emerson
09-08-2007 01:22
|
It is true that many M.D.s are practicing medicine in a more holistic manner than has been seen in the past. I think most health practitioners see the benefits of prevention and the value of whole-mind, body, spirit care, whether they have the time to address these things is another issue. BUT, if you put aside all philosophical differences between MDs and DOs, there is still manipulative therapy. M.D.s, with very few exceptions, cannot or will not do manual medicine. Allopathic physicians seldom touch their patients, except with some sort of instrument, and they can do relatively zilch to alleviate some of the most common and essential aches and pains experienced by humans. OMT sets us apart, in my opinion; it puts us ahead of our allopathic counterparts.
OMT has virtually disappeared where it was once quite common in the last several years, as DOs have fought to attain status equal to MDs. Many DOs in primary care do very little to no OMT. I don't see how it would necessarily follow that if we start re-emphasizing OMT, there would be wide-spread objections. I think there is a pro-active alternative/complementary healthcare climate in this country now that would possibly embrace OMT like never before. I think that NOW, this is what clearly sets us apart, and there should be a rebirth of OMT, with an emphasis on those techniques best supported by good science.
Also, full-fledged health science centers at COMs are not the only answer to curing the academic plight--although I do think that is important. The emphasis in most DO programs is on patient care, and rightly so. But, if we want to have an ever-evolving, ever-growing profession, it must be scientifically founded and empirically based. DOs in practice, DO students and M.S. and Ph.D. students alike should be empowered to do research in areas specific to osteopathy. When I read issues of the JAOA that have several molecular studies, but not one study on efficacy/safety of an OMT technique...we have a problem. Funding is a serious problem, and it needs to be addressed and dealt with meaningfully and completely. It seems that for years COMs concentrated their efforts on teaching students medicine. Well, unfortunately that's not good enough. To assemble the best faculty for students and to secure the future of the profession, there must be an incredible increase in the amount of research at osteopathic institutions, particularly areas related to manipulation.
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
ava
09-08-2007 01:28
|
I think that the majority of young DO's embrace the philosophy and identity of being a DO so scarpping the whole thing and starting over is not practical. Nor is it practical to turn to the AMA and MD's for help. This is fundamentally not their problem. It is ours. And, the problem is all in the execution of what the profession is attempting to do. It is not so much a problem with osteopathic GME--there are some very good DO residency programs out there as well as some real stinkers--the problem is a matter of priorities.
The profession does not support nor hold accountable COM's and OPTI's for quality the way the allopathic world does. Things are simply "looser." Too many people tacitly accept a lower bar for accountability, quality and rigor. This in turn breeds apathy. There also needs to be a fundamental change in the academic culture at COM's. COM's need to continue to evolve from trade schools to full fledged academic health science centers.
thanks russo for this great thread. very interesting. it still astonishes me how many DO's don't know the first thing about osteopathy, nor do they care. Sadly, most new DO's are not osteopaths at all... just MD's wearing the wrong initials (+ a little chiropractor training). Sick.
Its even more amazing how much of a difference you can make if you help first and second years see the clinical relevance of what they learn. Give them some functional anatomy and they run with it and become fantastic. Don't and they slack off in OMM class, become competent in their chosen specialties while blowing off OMM and osteopathic thought in rotations... and after not using it for those 2 years, they are allopaths forever. Our education system needs total overhaul if we are to save the profession.
Long live the revolution!
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
ivan
09-08-2007 01:40
|
I will take that as a compliment! Save the profession? You truly believe that "functional anatomy" -bones, tendons, and 'rhythmic impulses' will save medicine? I encourage you and anyone else to study and love anything you want, but if I told you anesthesiology was the cornerstone of medicine (because it treats pain, the number one chief complaint) you might laugh.
Most OMM guru's turn me off not because they love OMM, but because so many of them act like it is the center of the medical universe.
I am happy that you have found something you love!
Good luck!
THE REVOLUTION has the opportunity to save the profession- of osteopathic medicine ... ya goof
I dont think anywhere in that post did I say that some "rhythmic impulse" was to save medicine... and my goal was certainly NOT to turn you on
OMM is a specialty- as is neurology or anesthesiology. Osteopathy is a system of medicine... more than a specialty (i.e. the entire reason we have our own schools and degree). capiche?
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
ciara
09-08-2007 01:53
|
Quote from "Sun Tzu: Know thy enemy as you know thyself." That is the correct way to quote the author of the Art of War. And it bothers me tremendously that you view the AMA as an enemy I am considering becoming a DO because I agree with their approach to medicine. But as I observe and read in here I am noticing that the field is fraught with a lot of diverging views that are leading me to question my decision and perhaps I would be more inclined to pursue the MD where at least I know the AMA has their act together.
It is my firm belief to treat the patients with the utmost respect care and quality you expect to receive yourself. And if the AOA and the AMA are fighting or you DO's and DO's in school can not present yourselves as unified force then the AMA will always win. At this point I will be reconsidering my options for MD school and DO school as I am getting a very sour taste in my mouth about the profession of DO.
Regards,
Honestly, the only way to know the enemy is to engage the enemy in his/her duties, study his/her ways, actions and belief/thought systems, even to go as far as knowing their physical-chemical makeup.
You're asking: "Uhh.. Drfting, you got a point here?"
Yes, I have many points. Some of these, people aren't going to like.
1) If we future osteopaths *truly* want something done, we have 2 options, and both will get us there:
a) organize in a collected, focused, structured, determined, group-wise kind of mission
OR
b) we all come up with vague "standards" we want to reach, and we brainstorm as many actions we can take. we list those so people can, at least, find one thing that inspires them, and a few people begin pioneering, making paths for others to follow.
The concepts conveyed above can be intertwined in a nice mesh that would make us a pretty wacked-out "enemy" to behold.
2) I'm a firm believer that a few people agreeing something needs to be done is *NOT* enough. The few agreeing need to *DO* something.
You probably ask: "What the heck are you talking about? *ME*? What can *I* do? How can little 'ol *me* make a difference?"
The age-old situation: Someone not yet sucked into the system looks at it and says, "I need to fix something here. But what first?" only to get lost in the bowels of inaction so long as to become as potent as a frozen rose.
Going forward, I think we need to brainstorm about how to TAKE ACTION and WHERE WE WANT TO GO.
---TAKING ACTION:
1) Write letters to the AOA.
*We need stats not only on PLANNED residencies, but on FUNDED and ACCREDITED residencies. If they will not give us these stats, then at least one of us at each COM will need to do the research. I know my school, NYCOM, has the NYCOMEC book, listing all PLANNED, FUNDED and AOA-ACCREDITED residency spots at each of the networked hospitals.
Why are these stats important? To factually decide whether, truly, the AOA has/hasn't begun growing, expanding, and funding residency spots in proportion to the number of D.O.s graduating each year. We probably need historical data, if the AOA will give it to us. How far back? Maybe someone can help with this?
*Based on the stats, we need to ask questions...thought-provoking, guided, to-the-point questions in a setting that can be "refereed" so that no one can hide behind stoic or vague answers. Who'd be our "referee"? We need to brainstorm.
- Do we want closed-doored discussion? open to the public? open only to DOs and student DOs and the AOA?
- IF this is some "objective" of ours, we need to ask: What is being done/can be done by the AOA to insure that *all who want to* will be able to get AOA-accredited and FUNDED residency spots out of their COM?
- I think we definitely need to ask, "Does the AOA ideologically preceive itself superior, inferior or equal to the AMA?" Given the concept of "psychological complexes," if the leadership is going one way, and the students another, then something urgently needs to be done.
- Another nexus of questions to ask are: What does it mean for a residency to be FUNDED? Where do the FUNDS come from? How long before a PLANNED residency becomes FUNDED? How can we get more FUNDS to PLANNED residencies? What is the extent the AOA is involved in the FUNDING of a residency?
- On a scale of 1 to 10, How important is it to the AOA that future DOs have:
1) research experience? What is being done to increase the opportunities?
2) a desire to go to an AOA residency over an AMA residency? What is being done to further scrutinize and qualify a hospital as "worthy" of having an AOA-accredited residency?
3) a desire to go through the traditional 1-year rotating internship?
2) Talk with your classmates. Get them fired up. Get them to this page. Get them to talk with others. Get them to brainstorm with you. Get a general assessment of the overall class attitude, and report back with your school as the heading, and some categories you make up on your own. We know high-ranking people of COM's lurk here and read more than we know.
3) Run for SGA offices...high-ranking positions. Become a member of SOMA and/or other Osteopathic-related associations to begin understanding what their aims, goals and motives are. Report back here and let us all know what your assessment is. Eventually, enough people will bring a good "synthesis" of what these organizations are all about.
4) Each person should at least go to AOA's website and look up the position papers and see whether you agree. Do you want to be part of a group that feels X, Y, Z, A, D, and G, but you simply don't "jive" with their positions? It'd be sort of like joining the NRA when you support Kerry and his wishing to enact laws enforcing liability onto gun manufacturers, meaning: the gun company could be held liable for killing, injuring, maiming, hurting, grazing, dismembering, etc someone. Ask yourself, would gun companies want policemen packing their brand of weapons to shoot criminals, whose surviving family members could sue and win because of the liability laws?
Yes, this is extreme. No, the position papers from the AOA are, truly, not insane, too liberal, freakish, or haughty..in my honest opinion. To be fair, I suggest everyone go to this link and download the .pdf: AOA Position Papers
reasons for doing this: a) you're gonna be a DO, b) it's good to know the belief systems present in the system that will garner, groom, mold and shape you, c) if you happen to NOT be a pre-DO, student DO, or even a DO who hasn't read this, the educational value is outstanding, rewarding, and beneficial.
5) Make signs, placards, printouts, etc and post them in public places around school, saying things like, "What has your AOA done for you lately?" or "Truly, how many AOA residencies are there?" or " What's the AOA's stand on sodas in schools?" or "How often do you dream about your 1-year, rotating AOA internship?" Don't give people answers on the media. Let these questions fester in their minds. Report back with some assessment of the effects of this type of signage.
---WHERE WE WANT TO GO (with this)
1) What do we want to see happen? What demands are we gonna throw on the table? What requests do we want to make? Name a position... where do we all stand/ what's the general consensus?
2) As a group, who are WE? Are we limiting ourselves to people in DO school? residents also? board-certified DOs also? even AOA members? faculty at our schools?
3) We need to answer one question, and then, depending on the answer, we can either move forward or cause a ruckus discussing things: Do we feel we are inferior to, equal to, or superior to the AMA and MDs? [do realize here that I am asking for ideology, and the intent is to stir, churn and watch what settles. I'm not asking for chaos or bashing or condemning, etc. I am intending straightforward discussion.] With a final resolution / consensus from this "input session" we will find the clear-cut direction of our next steps. Think of this as a guage of how far the students/grads, etc feel Osteopaths have come since the older generations were given equal practice rights.
Once we decide what we're trying to accomplish, and where we feel we stand in relation to our counterparts / co-workers in the allopathic field, then we know where we're coming from and where we're trying to go...we get past those hurdles and the rest is just tweaking and number influence (see TAKING ACTION, above).
Thanks, ahead of time, for the input, if any. Let's use this as a "starting point" and let our input drive the directions from here.
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
emerson
09-08-2007 02:20
|
I posted two very long posts, months ago, before entering Osteopathic medical school. Time has changed me, and I want to detail a few points I have observed.
1) I misquoted and incorrectly referenced the "know thy enemy" quote, and for that, I should be flogged with a wet noodle.
2) Enemy was the term I used to help us (whoever we are) discover, truly, what /who that entity is.
It seems that not many of the people reading have responded; I truly expected about 5 or 6 pages to read through with good discussion, and that has not happened.
There are a few main points brought up in reference to the "enemy" that I feel need to be addressed:
a) THE AMA: This group is not against "us," and, from what I can read, are truly about their *own* agendas. They have even adopted DO as a reference to "physician" instead of it solely being MD. (There was a thread on this topic months ago, and I could not find it today.)
b) WITHIN: Groups have their own "psyche" due to the values, beliefs and systems the members of that group establish and uphold. Therefore, I referenced the AOA's stance paper for insight.
Therefore, I also contend that, unless we get some sort of "measure" of the psyche of the AOA, the current COMs, residents and certified DOs, "we" students are going to sit by and watch the potential for "accentuating that DOs, *because* they practice OMM, are unique"-- a reference to a general point made in Gevitz's speech to us 1st years at NYCOM, during Orientation Week, as being the next step in our evolving as a profession.
Dr. Gevitz set it in stone for me about my "position" as a future practicing DO:
I am not different than an MD student; that has already been legally established. I am unique because I am learning to approach a patient with a set of mental/philosophical "tools" as well as the "tool" of being able to treat somatic dysfunctions with my hands.
Here is what my position is, formally voiced:
Instead of DOs incorporating with MDs and losing our uniqueness, at every point of junction where it's medically judged proper to treat using OMT, we need to.
I finally found, what I think to be, the "voice" that "we" need to develop, erasing the question of an "enemy within," unless you choose not to develop that voice.
3) No one has clearly defined the "we" I proposed that should be found.
Ideally, it'd be every future and present DO; experience tells me that's not going to happen. Modulating down to the clearest view of what "really" is possible, I'd say that "we" should be defined as:
"Those who are studying DO philosophy and treatment modalities, who support that uniqueness, and who, at any possible juncture within proper medical judgement, consistently choose to implement OMT."
This takes care of students, residents and certified DOs, as well as patients who ask for OMT, and and and those inquisitive-minded MDs who are under way at Harvard, learning OMT techniques. I'm learning that it's not enough for the DO to know his/her stuff, it's also a patient education issue, and as more patients learn about efficacy, the more they should ask for it.
4) As far as education issues go, money is the short answer, and imposing stricter standards is the most-influential suggestion made. It's pretty clear to me that the positions at hospitals this year for 3rd and 4th year rotations will be different for me in my 3rd year because of money exchanges and connections.
Residencies, I know jack diddly squat about, and can only read from different sites about the integration of OMT into that residency. Hopefully, the more OMT is stressed, the more that DO is likely to practice OMM when s/he is out practicing. I honestly think OMT should be stressed wherever it can be medically and feasibly integrated. This comes down to the AOA enforcing guidelines on AOA-approved residencies, and those residency directors employing DOs who integrate OMM into their practices.
Does anyone know of a study saying whether DOs who are residency-trained with integrated OMT actually use OMT in practice? Maybe such a study would be able to give direction to policy change, or give insight into what could be done better.
5) In reading another thread, I found this quote by healthydawg:
"before i fall off my soapbox, let me offer at least one possible cure for this malaise. that is to get the AOA, ACOFP, ABCDE, XYZPDEQ and whoever else is running this show to STOP FRETTING ABOUT WHERE WE ARE IN RELATION TO THE MDs. WE WON THAT BATTLE...ENOUGH ALREADY! WE'RE DOCTORS! rather, we should be working day and night to develop REAL research programs in our schools, hospitals (all 6 of 'em), non-profits, etc. REAL PROGRAMS that do BASIC SCIENCE research AS WELL AS clinical (OMT) research. real programs as in the kind that produce scientists (PhDs) who can seriously study OMT and every thing else. give me some real reasons to have as much faith in OMT as i do in abx."
I think healthydawg has very correctly given definition to the direction we need to go in: validate OMT by studies.
My questions at this juncture are:
Does anyone know how to get funding for research?
Does anyone know someone who knows how to get funding?
Does anyone have any experience with research design?
Is researching these techniques as easy as saying, "Ahh.. headache without aura. We will suppose no difference in pain reduction (over time?) between treating with aspirin, treating with aspirin and cervical HVLA to the OA joint with myofascial release to the OA joint, and only cervical HVLA and myofascial release"?
Does anyone know what the standards are that need to be met in an OMT study to be determined "reliable" and to be "accepted" by the scientific community?
I will leave off with this post for now, and I hope, when you incorporate it with the first two posts I wrote, you get some more direction.
I encourage more people to place themselves at the edge of the envelope and keep going. Stop the cycle of complex inner turmoil of being someone in relation to someone else; develop your unique "tools" and try showing others around you that it's cool if they develop and use theirs.
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
lanod
09-08-2007 02:29
|
We are a unique group of individuals who thoroughly look at the true causes of a disease, and not merely its symptoms. I know of more DO's saving lives, than their MD counterparts.
I have worked on a post-surgical floor, where both MDs, and DOs practice, and most of the patients, I have taken care of, have told me that it was a DO, not an MD, that relieved their pain; finding the true anatomical anomaly that was causing such anguish. Most MD's don't have the concept to tell their patients to change their behavior or enviroment, as well as looking at socioeconomic/psychosocial patterns.
Most DOs provide thorough tests and evaluations to find the truth, instead of trying to treat the symptoms. DOs treat the very cause of illness.
One patient of mine told me that he had seen three MDs before he saw a DO, where he had symptoms of Shortness of breath, malaise, and back pain. It was the DO that found a 4 cm AAA in the patient's abdomen.
I am very proud to be going to Osteopathic Medical School because I full heartily believe in the philiosophy and logic behind Osteopathy. A physician who disagrees with the benefits of touch;massage; the removal of blockage and strain on the nerves, blood vessels, joints, bones and muscles; proper exercise; proper sleep; eating in moderation; proper hygiene; and having an healthy attitude, is not a physician at all.
We still see the Mega Drug Corporations making millions, while flying doctors to Hawaii, or taking them out for Brunch, trying to persuade doctors to sell these toxins. Some drugs are okay, and have a high efficacy and low toxicity, but many patients I see take drugs to counteract the symptoms of other drugs. I honestly hate medicine doctors because they only focus on the symptoms, and don't look deep into a patients history, nor do they question the way the patient is living. Some drug breakthroughs are a miracle (antibiotics, aneasthetics, etc.), but most drugs perhaps do more harm than good. As physicians we should be skeptical of these drugs, and demand proper research, and thorough investigation from independent laboratorys that have nothing to gain financially.
DOs learn from nature, observation, and touch. We look beyond the symptoms, and look at the true cause. We believe the body has a natural tendency to want to be healthy, and when disease prevails, there are anatomical and physiology abnomalities that exacerbate and retard that tendency.
I disagree with Dr. Joseph Mercola's biased article, "The Paradox of Osteopathy," where he states, "A decreasing interest in osteopathic manipulation may also indicate that more physicians enter osteopathic medical school not as a result of a deeply held belief in the osteopathic philosophy but after failing to be admitted to allopathic medical schools. The osteopathic physicians who are more committed to osteopathic manipulation tend to be more likely than their colleagues to have a fundamentalist religious orientation. "
I am not a fundamentalist religious person, and I know many students who have only applied to DO schools. I was in an allopathic medical school, but I changed my mind after interviewing many of my patients, and talking with many DOs. I realized that at allopathic schools, you focus not on the person, and try to prevent certain behaviors, but to simply treat the symptoms, and partly the disease. Half assed medicine in my opinion.
Dr. Joseph Mercola even questions why we even have DO's in America today, or even the benefit of OMT. There have been many articles written, including The New England Journal of Medicine that show overall health benefits, and reduction in pain from the use of OMT. The efficacy of OMT has been shown, and also published in many articles. I have seen the efficacy with my own eyes, and you can ask any number of patients who have seen a DO that they not only were relieved of their pain, but the overall costs, and time in the hospital were decreased.
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
hooligan
09-08-2007 02:39
|
I am a PM&R resident at the University of Michigan, one of the largest and most "respected" allopathic hospitals in the country (not boasting, I'm saying this to make a point).
I use OMM every week on my patients. MD and DO Attendings in my program regularly refer patients to me for OMM.
We have an MD attending on faculty who does OMM full time, and has excellent skills.
If OMM does not work, we have PT/OT, medications, orthotics, or spinal injections such as epidurals and facet blocks to use.
My point is, if Dr. Still's vision was to improve medicine, he has helped to do so here, at least. Goal accomplished in my book. Vice Versa, the allopathic world has improved the care I can give to my patients.
Most of the PM&R docs I have worked with are very osteopathic in approach.
Best, Ligament
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
emerson
09-08-2007 02:45
|
Firstly, let me just say that I am humbled to observe the type of enthusiasm exhibited by all the people who invest in this forum. One of our degree's major challenges has always been to become like our counterparts even subsequent to the legalization of the D.O degree as an equal to the MD. A challenge, that has been overcome with great velocity over the past few decades. However, as we all now, there is much more work to be done.
From reading the numerous threads posted, I am ambivalent about the notion adopted by nearly everyone here. As I do understand that there is a need for change in medical education among osteopathic med schools, I also think more diplomatic attempts are indicated first. We constantly complain of the lackadaisical attitudes of the AOA in regards to augmenting the quality of medical education, medical professional representation, and OMM research. We talk about the dearth in clinical research at D.O schools, namely in regards to OMM and we even talk about ranking low in terms of NIH funding for basic science and clinical research. These are all valid and crucial points and require attention to sustain the merit of our medical education; however, I feel that more diplomatic approaches are indicated first.
Research
We discussed the need for an increase in NIH funding among DO medical school. However, the fact is that most DO schools don't have the experience or resources in order to compete with high quality grant proposals compiled by competing schools. As a result, NIH funding to most DO schools is low.
Secondly, most DO schools don't provide enough of an incentive to their faculty to apply for these research grants (most likely due to the fact that these schools don't put enough of a significance on research); thereby, decreasing the necessary publication output.
In terms of OMM, we talk about design flaws. A common problem in performing OMM research is the high level of subjectivity of physician perception. As a result, the study loses its objectivity and impedes the significance. Therefore, an institution needs to create a quantitative method for ascertaining the significance of change before and after OMM treatment.
We also need to team up with major institutions to aid us in OMM research. I believe it was mentioned in this forum that Harvard is teaching its trainees OMT. Also mentioned in some literature I was reading some time back, Harvard researchers found basic science findings that imply a valid efficacy of OMT. This is the precise collaboration that is necessary in order to validate OMT. Of course, the question remains - if the treatment helps a patient; what's the purpose of the study? Well I think most of us know the consequences of our medical system shifting towards the Evidence Based approach. Ergo, no evidence = no compensation (figured that would be important to most of you)
In conclusion to the research aspect, it's essential that institutions motivate their faculty to perform research and provide incentives to do so. It would also be beneficial if our esteemed AOA could provide grant writing courses as CME for physicians and scientists who are interested in augmenting research at their institutions. Research is definitely a wave of the future and if our schools don't keep up, the consequences are obvious.
Proliferation of Schools
The major fear that I have of an increased number of schools is a direct decrease in the quality of the applicant pool. Although the AOA and AMA are working together to eradicate the physician shortage that faces our nation today; an increase in the number of medical school is only going to drive down the quality of the applicant pool. Secondly, as others mentioned, is the AOA willing to increase the quality and quantity of post-graduate programs? If the answer is no, then why open up new medical schools when you can't sustain the needs of the ones that already exist? One of AOA's major problems is that it acts most prematurely during times that warrant rationalistic thinking. Not to get me wrong, I don't think that we should do away with AOA as after all, it does play a large role in political inner workings of our system and fights for students; but I do feel that more attention should be tendered to the medical education and less towards making OMT brochures.
In conclusion, I feel that we need to come up with a plan on how our medical schools can retain the quality of education without becoming obsolete. One of the ways we can do this is might be by creating medical schools at prominent universities that don't yet have them. This affiliation creates greater resources for our medical schools and adds distinction to our degree. This is the exact thing that our "profession" needs if it wants to succeed socially, academically, and politically.
Publications
This is something that hasn't been discussed a whole lot. Although we speak of Norm Gevitz's book and various articles that have been published about osteopathic medicine; my take on achieving a positive image in the media is BECOME PROMINANT IN MEDICINE. That doesn't mean that all our students and faculty need to win Nobel Prizes (although it sure does help!); but it doesn't hurt students and attending to publish a few case reports here and there. The initials D.O after a paper further propagates our recognition and visibility in the academic world. I often peruse MDConsult and JAMA among the other medical journals I subscribe and it's alarming to see how little our attendings and students contribute to medical literature. I understand that medical school and practice life are busy but if you're not going to contribute to Medicine while you are in your academic stage, then when?
My Final Conclusions
Becoming an osteopathic physician is no different than becoming an allopathic physician. Both are highly qualified professionals that serve humanity in their quest to combat suffering. Just as there are good osteopathic physicians, there are good allopathic physicians; and there are numerous allopathic physicians that are more "osteopathic-minded" than some of us will ever be. Everyone has their own reasons for becoming a D.O but in the end, it's up to us to gain the recognition we strive for.
As a result, it's healthy and essential to talk about all the things that are wrong with the system so we can fix them later. As a younger generation of D.Os, it is up to us to change how our organization represents us by taking action and offering solutions to the problems. I, for one, would be thrilled to collaborate with others to enhance the quality of medical education for us and the next generation.
|
|
|
Re: Reinventing Osteopathic Medicine: Or, so you say want a Revolution? |
|
|
| |
