What does a DO do?
The value of placing hands on a patient is universally acknowledged by health professionals. ...(It) has a great deal to do with the patient's well-being, whether he or she suffers from a common cold or a terminal disease. When the DO examines a patient (in this way)...the treatment has already begun. --American Osteopathic Association
From MRIs to new prescription medicines, osteopathic physicians -- DOs -- use all of the available high-tech technologies in diagnosis, treatment, and prevention of disease. But the real key to what DOs do is truly "at hand" with manual medicine, also known as OMT (osteopathic manipulative treatment or therapy).
In conjunction with or in place of medication or surgery, a DO uses a hands-on, non-invasive technique -- manual medicine -- that brings an added dimension to patient care. Not every case calls for OMT, and although skilled in its application, DOs may or may not use it. Once a DO has ruled out non-mechanical (organic) causes for an illness through tests and X-rays, manual medicine may be used in conjunction with or in place of other forms of treatment (medicine or surgery). And because musculoskeletal dysfunction may mimic other disease symptoms, manual medicine often is an important diagnostic and treatment tool.
While most often associated with physical ailments such as lower back pain, manual medicine is successful in treating other chronic disorders such as asthma, menstrual pain, carpal tunnel syndrome, sinus problems, and migraines.
There are a variety of manipulation techniques a DO can use in the form of palpation (touch) as a diagnostic procedure to detect soft tissue changes or structural abnormalities or corrective thrust forces to relieve dysfunction or restriction of motion in joints. Following is what you can expect a DO to do:
A structural exam begins with an evaluation of posture, spine, and balance. A DO uses his or her fingers to palpate the back and extremities, and checks joints, muscles, ligaments, and tendons, for restricted motion or pain. This helps a DO detect even minute changes that signal injury or impairment. A DO integrates this information with the individual's medical history, a physical examination, and a discussion of the patient's emotional factors (stresses from job change or death of a spouse, for instance), diet and exercise habits, to establish a treatment plan.
When indicated, manual medicine techniques are used to treat structural problems and relieve joint restrictions and abnormalities. One or more treatments may be needed, depending on the particular disorder.
Cases in Point
1. A patient complains of a pain on her side. The DO asks questions about the pain, its onset, duration, and intensity, and reviews her medical history. The physician orders a series of tests to determine whether the pain is caused by disease (a gallbladder or appendix problem, for example). The tests are negative. The physician reviews information about her workplace environment, and learns that she has a "surround-style" desk. The DO considers that she might be suffering from postural-mechanical strain. Based upon a physical examination, the negative test results, and conversations with this patient, the physician uses manual medicine to relieve motion restriction and muscle strain caused by improper posture and movement. The physician also recommends changes in the office environment to prevent further problems.
2. A patient complains of cough, congestion, fever, and headache. The DO suspects he is suffering from chronic sinusitis, and conducts an exam and orders the appropriate tests. The diagnosis is confirmed. The physician prescribes an antibiotic to treat the infection and uses a variety of OMT techniques to promote sinus drainage and relieve pain. The patient's congestion decreases dramatically after only one OMT session. When the antibiotic treatment ends, the infection is gone.
What about osteopathic training & education?
To become an osteopathic physician, an individual must be a graduate of one of this country's 30 osteopathic medical schools. Each is accredited by the Bureau of Professional Education of the American Osteopathic Association (AOA). The accreditation is recognized by the U.S. Department of Education and the Council on Postsecondary Education.
Typically, osteopathic medical college applicants have a four-year undergraduate degree, and have completed at least one year of English, biological sciences, physics, general chemistry, and organic chemistry. Osteopathic colleges require a personal interview to assess the applicant's communication skills and learn more about that person's interest in osteopathic medicine.
Much like the basic medical education for an MD, the osteopathic medical college curriculum requires four years of academic study, with a unique emphasis on preventive care and a whole-person approach. The first two years focus on basic sciences such as anatomy and physiology. The third and fourth years are devoted to clinical work with teaching in community hospitals, major medical centers, and doctors' offices.
After graduation, DOs must complete an approved 12-month rotating internship, which takes them through a variety of hospital departments, such as internal medicine and surgery. Many DOs opt to take a residency in a specialty or sub-specialty area, such as radiology or pathology. This involves an additional two to six years of training.
All physicians, MD and DO alike, must pass a state medical board examination in order to obtain a license and practice in that state. DOs also must take continuing medical education (CME) studies. The AOA requires its members to complete at least 120 CME hours every three years in order to retain membership status.
What are some facts about osteopathic medicine & osteopathic physicians?
The term osteopathy is derived from the Greek words osteo meaning structure, because of the emphasis on the musculoskeletal structure -- the bones, muscles, tissues and nerves which comprise 2/3 of the body -- as a single, organic source of wellness, and pathos, meaning empathy or feeling for.
Osteopathic medicine focuses on the total person, with an appreciation for the interrelationship of the various systems of the body working harmoniously together to maintain health and prevent illness and disease.
Osteopathic medicine was first introduced in America in the late 19th Century by Missouri physician Andrew Taylor Still, MD, who advocated a whole-person approach to diagnosis, treatment, and disease prevention.
DOs are "complete" physicians; they can prescribe medication, perform surgery, and are found in all branches of medicine. DOs have similar academic training, internship, residency, and licensing requirements as MDs. Thus, a DO designation simply means that a physician has additional education in osteopathic medicine, and is not practicing a "different" kind of medicine.
There are 82,500 DOs currently in the U.S. There are DOs on staff at about half of the nation's hospitals.
About 33.8 percent of DOs are women.
DOs log 100 million patient visits each year.
Osteopathic medicine is the fastest growing medical field in the U.S., according to the U.S. Bureau of Health Professions. The DO population is growing at a rate of about 1,300, or five percent, per year.
Most (60 percent ) DOs are in primary care, which includes general family practice, pediatrics, and obstetrics and gynecology. DOs also are found in all branches of medicine, including specialties such as geriatrics, cardiology, psychiatry, ophthalmology, and emergency medicine.
Some 15 percent of DOs practice in remote or rural areas with populations of 10,000 or less. They are the front-line health care providers for people who might otherwise lack access to care.
From 1971-1990, there was a 103 percent increase in the number of DOs serving areas with populations of 10,000-25,000 people.
There are 30 colleges of osteopathic medicine in the U.S., with some 20,000 students enrolled.
Minorities (African-Americans, Hispanics, Native Americans, Asian Pacific Islanders) constitute about 20 percent of osteopathic medical college graduates.
DOs comprise about 10 percent of all physicians in the U.S. military and serve in the Public Health Service and the Veteran's Administration. Currently the Surgeon General of the Army is a DO.
DOs are the team doctors for a number of professional sports squads in hockey (Detroit Red Wings), football (San Diego Chargers), basketball (Phoenix Suns and Detroit Pistons), and baseball (Seattle Mariners).
Former President George Bush's personal physician was a DO.
What are the origins of osteopathic medicine?
Since osteopathic medicine in the U.S. began more than a century ago, its principles and practitioners have become part of the medical mainstream.
Yet despite its grounding in traditional medical education and practice, it is only within the last two decades that osteopathic physicians have achieved wider acceptance in the medical community and among the public.
The origins of osteopathic medicine can be traced to one man, Andrew Taylor Still. In 1874, Still first articulated his ideas on improving the medical practice of the times.AT Still
A.T. Still started his practice to care for settlers and Native Americans on the Missouri frontier. In this era, he saw the harsh effects of some of the diseases of that time, such as malaria, cholera, tuberculosis, and smallpox. But it wasn't until illness and death touched his own family that he began to develop a philosophy that resulted in a fundamental shift in the accepted thinking about health and disease prevention.
In the spring of 1864, three of Still's children died from spinal meningitis and later, one from pneumonia. That personal loss provided the impetus for developing an alternative to the accepted medical practices of the day. Thus, a new discipline was born out of a spirit of reform and a rethinking of the focus on disease to a more patient-focused philosophy based on disease prevention and wellness.
Still dedicated himself to an exhaustive study of the body's structure and function to see why it was capable, or incapable, of combating disease.
He observed that abnormal blood and nerve supplies to the body (caused by some dysfunction or change in the musculoskeletal system) often were found in diseased or abnormal tissues or organs. He postulated that a physician could promote health and wellness by removing or changing whatever might be blocking the circulatory and nervous systems.
Thus, the idea of manipulating the body to cure and prevent disease and chronic pain was introduced to America. Although this idea was just spreading in America, it was not a wholly new idea to the rest of the world. Hippocrates wrote about this in the 4th Century BC and it had also been utilized in ancient Asian and European societies. To describe this new science of healing, Still employed the terms osteopathy and osteopathic medicine. It is not clearly known when Still first originated these terms, but Still's philosophy of drugless, manipulative medicine was officially labeled "osteopathy" in 1885.
In 1874, Still first presented his ideas to the medical community. The philosophy was not well received. He traveled from town to town practicing and perfecting osteopathic manipulation techniques. As word spread of the discipline's efficacy, Still's philosophy gained greater acceptance.
In 1892, the first osteopathic medical school opened its doors in Kirksville, MO. Now known as the Kirksville College of Osteopathic Medicine, its original class had only 17 students, five of which were women. By 1897, the class grew to 500.
Also in 1897, the American Association for the Advancement of Osteopathy was organized, later renamed the American Osteopathic Association (AOA).
Shortly thereafter, new colleges of osteopathic medicine were founded in Boston, Philadelphia, Los Angeles, Kansas City, Chicago, and Denver. The first DO practitioner in Southern Arizona was Dr. George W. Martin, who opened his office in Tucson in 1900.
By the time Still died in 1917, there were 5,000 DOs in practice in America.
By 1935, the number of DOs in practice grew to 8,000; by 1955, there were 12,000 practicing DOs. By 1970, the DO numbers had grown to 15,000.
Perceived and braresidentsnded as a something "other" than medical doctors, DOs had to wait until 1973 to gain full practice rights in all 50 states.
With today's interest in wellness, preventive care, and more cost-effective means of health care delivery, osteopathic medicine has become mainstream-- and more -- with its "whole person" approach to health.
What are the philosophies & principles of osteopathic medicine?
With realities such as longevity, chronic diseases, and high costs of care driving the dynamics of today's health care delivery system, there is increasing interest in osteopathic medicine and its complete approach to maintaining health and preventing disease.
Osteopathic physicians provide the most comprehensive and complete medical care available today, because osteopathic medicine uses all of the high-tech aspects of modern medicine -- x-rays, surgery, medication, and diagnostic testing -- and more in its distinctive focus on the whole person.
Some Fundamental Principles of Osteopathic Medicine
Osteopathic medicine sees the human body as a unified organism and uses a whole- person approach to wellness and disease prevention.
The fundamental philosophy of osteopathic medicine is that all the systems of the body are interrelated and are interdependent, and that disturbances in one system can -- and do -- affect the others.
Although a specific organ or area of the body may manifest disorder or disease, the effects resonate throughout the body. Stated simply, if the body is sick, it is sick all over. Similarly, when responding to a disorder or disease, one organ or system does not respond alone; the entire body is mobilized and is involved in the return to health and balance.
The body's musculoskeletal system -- the bones, muscles, tissues, and nerves -- is the key to a person's well-being.
The musculoskeletal system, one of the most easily accessible systems of the body, comprises about 2/3 of the body mass. But its importance goes well beyond providing structural support.
Osteopathic medicine maintains that the musculoskeletal system reflects many internal illnesses and may aggravate or accelerate disease in the circulatory, lymphatic, nervous, and other systems of the body. The musculoskeletal system, therefore, plays a key role in the body's effort to regulate itself and resist illness or disease.
The body has a natural tendency toward health and has the capacity to resist disease and to heal itself.
This principle -- first promulgated many centuries ago by the father of modern medicine, Hippocrates, and now gaining new attention -- is at the core of the osteopathic medicine philosophy and is central to its diagnostic and treatment approach.
Osteopathic medicine considers the person as a whole, including external factors such as environment, stress, exercise, and diet in an overall approach to achieving and maintaining good health.
While applying the appropriate medical diagnosis and treatment for a particular illness or disease, the osteopathic physician does more -- acting as a guide and teacher to help the person take responsibility for his or her well-being.
This proactive, preventive, and personalized approach clearly differentiates osteopathic medicine from all other forms of medicine.
What is osteopathic manipulation?
Osteopathic manipulation is a whole system of evaluation and treatment designed to achieve and maintain health by restoring normal function to the body. In this context, manipulation means the therapeutic application of manual pressure or force. Following are descriptions of some of the osteopathic manipulation techniques commonly used by osteopathic physicians to diagnose and treat patients.
Commonly applied to the muscle area around the spine, this procedure consists of a rhythmic stretching, deep pressure, and traction while monitoring response and motion changes by palpation (touching or feeling). It also is called myofascial treatment.
This technique promotes circulation of the lymphatic fluids and is used to relieve upper and lower respiratory infections. The physician applies pressure to a prone patient's upper anterior chest wall. When the applied force reaches a peak as the patient exhales, the physician quickly removes his/her hands. This helps the body's respiratory system move the lymphatic fluids.
This procedure uses high velocity/low amplitude force to restore motion to a joint and reduces or eliminates the signs of tissue changes, asymmetry, restricted movement, and tenderness.
Muscle Energy Technique
The patient is directed to use his or her muscles from a precise position and in a specific direction against a counterforce applied by the physician.
The patient is moved away from a position where motion is restricted to one of greater comfort. This technique is used in cases that are too acute or too delicate to be treated in other ways.
1) Scott Johnson's book "Something More...Osteopathic Medicine in Southern Arizona"
2) Tucson Osteopathic Medical Foundation.
3) Dr. Norman Gevitz, PhD in The Journal of the American Osteopathic Association, Volume 114, Number 1-2.
4) The Museum of Osteopathic Medicine Website.
5) The American Osteopathic Association.