Doctor Fishypants

When I first applied to medical school, I had never heard of osteopathic medicine. To me, a physician was someone who went to medical school and got an M.D. degree. During my year as an EMT, I even called on a hospital that employs one osteopathic physician (D.O.) for every allopathic physician (M.D.), and I never knew that there was a difference. When I shadowed a few doctors at my local hospitals, even those who knew an osteopathic physician couldn’t tell me what that difference was. Both D.O.s and M.D.s are fully qualified physicians licensed to prescribe medication and perform surgery in the United States. In fact, there are quite a few ways in which osteopaths and allopaths are alike. Here’s a short list, courtesy of the American Osteopathic Association:

• Applicants to both D.O. and M.D. medical colleges typically have 4-year undergraduate degrees with an emphasis on scientific courses.
• Both D.O.s and M.D.s complete 4 years of basic medical education.
• After medical school, both D.O.s and M.D.s obtain graduate medical education through programs like internships and residencies that last 3-6 years.
• D.O.s and M.D.s must pass comparable examinations to obtain state licenses.

So, what’s the difference? To answer that question, let’s take a quick look at the history of osteopathic medicine and how it came to be.

History

Osteopathic medicine was founded in 1874 by Andrew Taylor Still, M.D. Still’s medical training, like most physicians of his time, came through apprenticeship. He was fascinated by human anatomy and believed that most of our diseases had some kind of somatic component. He was dissatsifed with the health care of his day and believed that a system based on medicines and drugs was potentially more harmful than helpful. In 1892, Still opened the American School of Osteopathy in Kirksville, MO, and began training students with an emphasis on the musculoskeletal system. In the century since osteopathic medicine began, the scope of practice has grown to include traditional allopathic medicine while still retaining its emphasis on the musculoskeletal system and the body’s innate ability to heal itself.

Principles

There are a few basic principles of osteopathic medicine that form the basis for every patient encounter, physical exam, diagnosis, and treatment regimen. They are:

1. The body is a unit.
2. Structure and function are reciprocally related.
3. The body possesses self-regulatory mechanisms.
4. The body has the inherent capacity to defend itself and to repair itself.
5. When normal adaptability is disrupted, or when environmental changes overcome the body’s capacity for self-maintenance, disease may ensue.
6. Rational treatment is based on the previous principles.
7. Movement of body fluids is essential to the maintenance of health.
8. The nerves play a crucial part of controlling fluids in the body.
9. There are somatic components to disease that are not only manifestations of disease but also are factors that contribute to maintenance of the diseased state.

The D.O. Difference

As previously mentioned, both D.O.s and M.D.s are fully licensed to practice medicine in the United States. Approximately 65% of practicing osteopathic physicians, however, specialize in primary care areas like pediatrics, family practice, obstetrics and gynecology, and internal medicine. D.O.s also bring something extra to medicine:

• Osteopathic medical schools emphasize training students to be primary care physicians.
• D.O.s practice a “whole person” approach to medicine. Instead of just treating specific symptoms or illnesses, they regard your body as an integrated whole.
• Osteopathic physicians focus on preventive health care.
• D.O.s receive extra training in the musculoskeletal system-your body’s interconnected system of nerves, muscles and bones that make up two-thirds of your body mass. This training provides osteopathic physicians with a better understanding of the ways that an illness or injury in one part of your body can affect another.
• Osteopathic manipulative treatment (OMT) is incorporated into the training and practice of osteopathic physicians. With OMT, osteopathic physicians use their hands to diagnose illness and injury and to encourage your body’s natural tendency toward good health. By combining all other available medical options with OMT, D.O.s offer their patients the most comprehensive care available in medicine today.

The above passage is available on the AOA’s website. I’d like to draw special attention to the bolded item, because it is the single most important factor in my decision to pursue a D.O. degree. In a medical system where patients are more often referred to by their disease instead of their names and emotional attachment to patients is so heavily frowned upon, a school of thought that places the patient on a higher pedestal than their disease is refreshing. It’s what every physician, osteopathic or allopathic, should strive for.