Thanks for your thoughtful and thorough reply AQB24712
Regarding the possibility of merging MD and DO:
Because MDs would not have it. They would not recognize DOs as physicians. They would not admit them to the AMA (hence the formation of the AOA). They would not give them hospital privileges. The two schools work together much more collegially now, but I don't know what the prevailing wisdom is about possibly merging the two associations.
I understand that this was not possible in the past because of contention but is it possible now and should we do it? I think answering these questions in this discussion would be spectacular.
I don't think "we" can accomplish this merger.
Mom's take on this idea is that it won't happen because the AOA sees no benefit in merging with the AMA. A notable attempt at such a merger took place in California
in the middle of the last century, and was a spectacular failure that left much distrust on both sides in its wake. Reminds me of Christianity's many campaigns of forced conversion.
I'm not especially sure that a merger is needed, although I understand the arguments that've been made in this thread. It's interesting to me to see how MDs and DOs work together more than they used to. In the early days of WVSOM, the faculty had some trouble finding locations for their students to do clinical rotations. I think I might have mentioned that my current primary care doctor is an MD in a mixed practice of primary care MDs, DOs, and PAs. Mom noted that Michigan State has three schools of medicine: osteopathic, veterinary, and "human" (MSU's term).
Osteopathic manipulative treatment is the difference, along with the emphasis on primary care, the holistic approach, and the focus on community service.
I am going to be a little intellectually lazy and ask you to provide some evidence. From a cursory examination of the research I think that there are some positive effects (size? application?) of OMT and there are definitely some dis-proven uses of OMT. Regardless of the proven and dis-proven uses of OMT, it is important to determine if these methods (along with others) are being taught from a scientific background. Are they teaching their students OMT broadly or are they clearly outlining what does and does not work?
Another point on OMT:
How difficult is OMT to learn? If it is really efficacious it should should be integrated into allopathic medicine. If it is difficult it can be a specialty. If it is easy then it should be standard medical school curriculum.
Well, I'm going to be a little intellectually lazy in return and not provide any evidence!
I'll just tell you some more about my conversation with my mother, a.k.a. EKB24741, a.k.a. Dr. Betty. I told her that it seemed to me that OMT was not so much emphasized anymore; it doesn't have a big presence on the Web sites of the AOA, AACOM, or WVSOM.
She said that OMT (also sometimes called OMM, osteopathic manipulative medicine) does work quite well in somewhat limited applications, specifically musculoskeletal issues, and most especially back pain. (When I've had OMT, it was for treatment of the chronic muscle spasms in my back that've plagued me my entire adult life.) That some treatments work without knowledge of the specific mechanisms involved. (I noticed a near-complete cessation of chronic muscle tensions headaches when I started taking a low dose of paroxetine, a selective serotonin reuptake inhibitor. Not what it was prescribed for. I read some time later, perhaps in Harvard Women's Health Watch,
that this was a noted result with no explanation to date.)
All DOs are taught OMT in medical school, but not all of them integrate it into their practice to any significant degree, and some don't use it at all. Dr. Betty says this is for many reasons: Sometimes they're not very good at it. Sometimes it's not terribly useful in the specialty they've chosen (She had an awful car crash last summer, and when she went to see her alumnus orthopedic surgeon, Dr. Morgan, to see how her bionic knees had done in the accident, she said she'd really gotten beaten up and could maybe use some OMT. He told her that he didn't practice it anymore, really.
I didn't realize that OMT is a board-certifiable specialty, which EKB says it is. She says there's a married pair of DOs on the WVSOM faculty whose practice consists pretty much solely of OMT. It's a time-intensive treatment, that is, typically a series of manipulations is prescribed, but because "reimbursement schemes" (insurances, etc.) aren't favorable toward that sort of plan (as anyone who's tried to get coverage for continuing mental health counseling might know), it's not so economically feasible for DOs to give it much emphasis in their practices. Thinking back on my own medical history, I had OMT only for acute spasms, and was given programs of physical therapy and exercises to continue on my own.
I understand why people give OMT the side-eye, and I can see clear differences between it and chiropractic. It's not the only tool in the physician's arsenal, and the physician doesn't claim it'll cure everything.
Dr. Betty and I also had a nice talk about the history of osteopathic medicine. As I said before, Dr. Still's philosophy and methods might not pass a 21st century sniff test. Mom noted that he had his training during the Civil War, when all kinds of wacky shit abounded in the name of medicine, and when one could proclaim oneself a doctor after serving an apprenticeship of indeterminate length with another doctor whose training might have been...anything. Pharmacology was a hairy buffalo mess of unstandardized formulations and dosages.
Okay, now, my mom is so cool. She told me about the Flexner Report
of 1910, a study of medical education commissioned by the Carnegie Foundation (Andrew Carnegie was a fascinating guy [/tangent]) that led to the closure of many schools of quackery and the standardization of admissions and curricula. (The report had the unfortunate effect of keeping women and minorities largely out of medical school, due to the resultant increased cost.) It's an interesting article; it's so much fun to learn about these bits of history that I knew nothing about.
When Flexner researched his report, "modern" medicine faced vigorous competition from several quarters, including osteopathic medicine, chiropractic medicine, eclectic medicine, naturopathy and homeopathy. Flexner clearly doubted the scientific validity of all forms of medicine other than that based on scientific research, deeming any approach to medicine that did not advocate the use of treatments such as vaccines to prevent and cure illness as tantamount to quackery and charlatanism. Medical schools that offered training in various disciplines including eclectic medicine, physiomedicalism, naturopathy, and homeopathy, were told either to drop these courses from their curriculum or lose their accreditation and underwriting support. A few schools resisted for a time, but eventually all complied with the Report or shut their doors.
By holistic do you mean (stolen from Wikipedia) "a concept in medical practice upholding that all aspects of people's needs, psychological, physical and social should be taken into account and seen as a whole?" I feel like we should all be careful using words like holistic that have many varied definitions. It is known that psychological and social (a part of psychological?) factors effect well-being but this is something that should definitely be integrated into allopathic medicine.
Yeah, that's a fuzzy word, all right. This is what the AOA's Web site says:
You are more than just the sum of your body parts. That’s why doctors of osteopathic medicine (DOs) practice a “whole person” approach to health care. Instead of just treating specific symptoms, osteopathic physicians concentrate on treating you as a whole.
Osteopathic physicians understand how all the body’s systems are interconnected and how each one affects the others. They focus special attention on the musculoskeletal system, which reflects and influences the condition of all other body systems.
This system of bones and muscles makes up about two-thirds of the body’s mass, and a routine part of the examination DOs give patients is a careful evaluation of these important structures. DOs know that the body’s structure plays a critical role in its ability to function. They can use their eyes and hands to identify structural problems and to support the body’s natural tendency toward health and self-healing.
Osteopathic physicians also use their ears to listen to you and your health concerns. DOs help patients develop attitudes and lifestyles that don’t just fight illness but also help prevent disease. Millions of Americans prefer this concerned and compassionate care and have made DOs their physicians for life.
Heh, I can see some forum members' eyes rolling.
My personal experience is that both DO and MD programs have a heavy emphasis on community service. All of the medical students I know (DO or MD) are and have been involved in community service. Dartmouth did a survey that shows 81% of their students are doing community service. This isn't proof but I definitely don't think you can make an argument that allopathic medical schools don't place a heavy emphasis on community service.
Hmm, I suspect I might've been mostly thinking about WVSOM:
The mission of the West Virginia School of Osteopathic Medicine (WVSOM) is to educate students from diverse backgrounds as lifelong learners in osteopathic medicine and complementary health related programs; to advance scientific knowledge through academic, clinical and basic science research; and to promote patient-centered, evidence based medicine.
WVSOM is dedicated to serve, first and foremost, the state of West Virginia and the special health care needs of its residents, emphasizing primary care in rural areas.
Now, this is a big fat hairy dope deal, as physicians and proper health care have historically been in short supply throughout Appalachia. All WVSOM students' first clinical rotation "is an eight week preceptorship with a rural, family medicine osteopathic physician." (West Virginia has allopathic schools at WVU and Marshall; I don't know offhand anything about their missions. ETA: WVU's dental school has a mobile clinic that tours the rural areas providing free or low-cost dental care, which is awesome. I've seen that giant bus out on the road; I don't know how they drive that sucker on some of those roads.))
(If by chance anyone's interest in rural medicine and the history of WVSOM has inexplicably been piqued, I recommend Roland Sharp, Country Doctor: Memories of a Life Well Lived
, a memoir by the 103-year-old DO who led the team that founded WVSOM, after many years as a coal company doctor and rural physician.)
On a more mundane note:
I know Wikipedia isn't proof but their article on osteopathy suggests that it is a completely interchangeable term for osteopathic medicine. And your own usage of the terms within the profession agree:
Also please note that osteopathic physicians practice osteopathic medicine, not osteopathy.
West Virginia Board of Osteopathy
I know!! Screwy, huh? Coincidentally enough, the West Virginia state association has recently changed the name of the board to the West Virginia Board of Osteopathic Medicine. The AOA and AACOM Web sites confirm that the full title of the degree (DO) is Doctor of Osteopathic Medicine, which I didn't know. I'm sure this is to continue to strengthen the differentiation between licensed physicians in the United States and the dubious practitioners elsewhere who call themselves osteopaths.
Sorry that was so long...
Hur hur hur. I mean, no problem! I really enjoyed revisiting all this stuff with my mother.
As qualified as they may be, I would never go to a DO because I disagree with their worldview. This is the same reason I choose not to see MD's who integrate complementary and alternative medicine into their practices, regardless of how qualified they are.
I understand that. And I have sought out DOs as primary care physicians because I agree with their philosophy/worldview. I don't think any of us would argue with Dr. Betty's contention that there are more and less capable physicians of all sorts. I ditched my previous primary care physician, a DO, because the quality of care I was getting from him had markedly declined to the point at which he dismissed symptoms of gallbladder disease (unrelievable, recurrent bouts of intense nausea) as a sign of perimenopause without further exploration. I had an emergency cholecystectomy and never looked back. And of course, Andrew Weil is an MD.