Doctor of osteopathy

Definition

A doctor of osteopathy , called a doctor of osteopathic medicine (D.O.) in the United States, is a physician trained in a form of manual treatment called osteopathic manipulative medicine (OMM) as well as mainstream (allopathic) medical and surgical techniques and practices. The term osteopathy was coined by Andrew Taylor Still (1828–1917), the founder of osteopathy in the United States. Osteopathy is a combination of two Greek words meaning “bone” and “suffering,” reflecting Dr. Still's belief that human diseases are ultimately caused by disorders of the musculoskeletal system.

There is some distinction between doctors of osteopathic medicine trained in the United States and those trained elsewhere. In the United States, D.O.s have moved closer to their M.D. counterparts in education and postgraduate training; the chief difference between the two groups of physicians as of 2008 is that doctors of osteopathy place additional emphasis on a holistic approach to patients and on maintaining the body's normal musculoskeletal alignment as central to good health. In addition, it is possible for American M.D.'s to take training courses in OMM at schools of osteopathic medicine. Outside the United States, practitioners of osteopathy do not usually combine OMM with allopathic medical or surgical treatments but focus their practice on OMM and other modalities of alternative medicine.

Description

Osteopathic medicine as a health care profession began with the work of Dr. Still in the period following the Civil War. Dr. Still had been trained in conventional medicine at the College of Physicians and Surgeons in Kansas City, Missouri. He served as a surgeon in the Union Army during the Civil War but began to reexamine the medical practices of his day after three of his children died of meningitis in 1864. After ten years of studying the body, Still came to the conclusion that the musculoskeletal system is the key to the health of the whole body, and that the body can maintain its health when its muscles and bones are properly aligned and stimulated. In addition to developing the techniques of OMM, Still emphasized preventive health care and the importance of treating the whole patient rather than just the disease. His motto was, “To find health should be the object of the doctor. Anyone can find disease.” In 1892 Dr. Still founded the first American school of osteopathic medicine, the Kirksville College of Osteopathic Medicine, in Kirksville, Missouri.

Osteopathic medicine was for many years labeled a “cult” by mainstream physicians, and osteopathic and mainstream medical schools and hospitals developed along separate paths. This separatism began to change in the 1960s, when the U.S. military began to accept D.O.s in its medical services on an equal basis with M.D.s. In 1969 the American Medical Association (AMA) approved the admission of D.O.s to full AMA membership and AMA-approved internship and residency programs. As of 2008, the majority of osteopathic physicians in the United States receive their postgraduate training in residency programs governed by the AMA. D.O.s are licensed to practice medicine in all 50 states, Nebraska being the last state to grant this legal privilege in 1989. Osteopathic medicine in the United States is no longer considered a form of alternative medicine.

As of 2008 there are 25 colleges of osteopathic medicine in the United States, graduating about 2,800 students each year. Twenty percent of all medical students in the United States are enrolled in osteopathic medical schools. In 2006, an osteopathic medical student was elected president of the American Medical Student Association (AMSA).

Osteopathic physicians are more likely to administer OMM to seniors than to younger patients in the primary care setting. Recent surveys indicate that more patients and more mainstream physicians have a positive attitude toward manual therapy, with 76% of patients considering it a safe modality of treatment, and 59% favoring more widespread use of it in primary care settings. OMM can improve range of motion in the elderly and assist with postural problems, thus reducing the risk of falls and other injuries.

Pain management is another area in which the holistic approach of osteopathic physicians is often helpful to seniors, particularly those who prefer exercise and other forms of treatment (including spiritual care) to narcotic medications. In addition, the focus on preventive medicine in osteopathic medicine is geared toward helping seniors maintain their independence as long as possible.

Work settings

A doctor of osteopathic medicine in the United States can practice in any health care setting where an M.D. would be licensed to practice, including hospitals, emergency departments, freestanding clinics, ambulatory surgery centers, nursing homes , hospices , and other specialized health care facilities.

Care team role

A doctor of osteopathic medicine can care for a senior's overall health (including emergency treatment) as well as give specialized care for the patient's posture, bones, joints, and muscles. Schools of osteopathic medicine in the United States have traditionally emphasized primary care and patient-centered medicine rather than specialization, and a larger percentage of D.O.s become primary care physicians than M.D.s. In addition, many older patients state that they prefer D.O.s because they find them more empathetic and patient-focused than mainstream M.D.s. Since 2002, several osteopathic hospitals in the United States have introduced a geriatric care and assessment curriculum as part of their residency programs in family medicine.

Some of the specific techniques included in OMM, such as soft tissue stretching; joint mobilization (increasing a joint's range of motion); myofascial release (stretching of the connective tissue overlying the muscles in order to improve posture and increase range of motion); and trigger point therapy (treatment of hypersensitive sore spots in muscle or soft tissue to relieve chronic pain ) are particularly beneficial to seniors with posture problems, arthritis and other joint disorders, or chronic pain related to the muscles and connective tissue.

Education/Training

Osteopathic physicians in the United States receive the same basic training in medicine and surgery as their counterparts in allopathic medical schools. A candidate for admission to a college of osteopathic medicine must complete at least 30 hours (or three-quarters of the number of credits required for graduation) from an accredited four-year college or university, with a full bachelor's degree preferred. The 25 colleges of osteopathic medicine in the United States have curricula that are virtually identical to those of mainstream medical schools, with the first two years being devoted to classroom and laboratory work and the third and fourth years consisting of clinical rotations in the major branches of medicine and surgery. After graduation, the D.O. can apply for an internship or residency program approved by either the American Osteopathic Association (AOA) or the AMA; he or she can also prepare for board certification in geriatric medicine.

KEY TERMS

Allopathy —The treatment of disease using conventional evidence-based medical or surgical therapies. In recent years allopathy has become a synonym for mainstream Western medicine. Physicians who are doctors of medicine (M.D.s) are sometimes called allopaths.

Fascia —A sheet of connective tissue that covers and interpenetrates the muscles or other body structures. It provides support and protection for the body and acts as a shock absorber.

Gerontology —The medical specialty that studies and treats diseases and disorders related to the aging process as well as diseases and disorders of the elderly population.

Holistic medicine —Any approach to health care that emphasizes treatment of the whole person, mind and spirit as well as body. Osteopathic medicine has traditionally been holistic.

Modality —A method of treatment or approach to therapy.

Osteopathic manipulative medicine (OMM) —A type of manual therapy used to improve the patient's postural balance and the functioning of his or her bones, joints, surrounding soft tissues, and muscles.

Family teaching

A doctor of osteopathic medicine licensed in the United States can give a senior or family member the same level and quality of health care advice as an M.

D., with additional information about specific OMM treatments that may be helpful to the senior. Moreover, several surveys have found that osteopathic physicians generally spend more time discussing care with the patient and family members than their allopathic counterparts. A D.O. who is board-certified in gerontology can give the same specialized advice and information about illnesses in the elderly and their treatment as an M.D. with certification in that specialty.

Resources

BOOKS

DiGiovanna, Eileen, Stanley Schiowitz, and Dennis J. Dowling, eds. An Osteopathic Approach to Diagnosis and Treatment, 3rd ed. Philadelphia: Lippincott Williams and Wilkins, 2005.

Gevitz, Norman. The Dos: Osteopathic Medicine in America, 2nd ed. Baltimore, MD: Johns Hopkins University Press, 2004.

PERIODICALS

Cavalieri, T. A. “Management of Pain in Older Adults.”Journal of the American Osteopathic Association 105 (March 2005): S12–S17.

Robbins, M. R. “Training Family Medicine Residents for Assessment and Advocacy of Older Adults.” Journal of the American Osteopathic Association 102 (November 2002): 632–636.

Stoll, S. T., D. P. Russo, and J. W. Atchison. “Physicians' and Patients' Attitudes toward Manual Medicine: Implications for Continuing Medical Education.”Journal of Continuing Education in the Health Professions 23 (Winter 2003): 13–20.

Sun, C., G. J. Desai, D. S. Pucci, and S. Jew. “Musculoskeletal Disorders: Does the Osteopathic Medical Profession Demonstrate Its Unique and Distinctive Characteristics?” Journal of the American Osteopathic Association 104 (April 2004): 149–155.

Vieder, J. N. “Dos Should Embrace Increased Emphasis on Care for Older Adults.” Journal of the American Osteopathic Association 103 (January 2003): 7–8.

Westmoreland, J. L., N. H. Williams, C. Wilkinson, et al. “Should Your GP Be an Osteopath? Patients' Views of an Osteopathy Clinic Based in Primary Care.” Complementary Therapies in Medicine 15 (June 2007): 121–127.

ORGANIZATIONS

American Association of Colleges of Osteopathic Medicine (AACOM), 5550 Friendship Blvd., Suite 310, Chevy Chase, MD, 20815, (301) 968-4100, (301) 968-4101, http://www.aacom.org/Pages/default.aspx.

American Osteopathic Association (AOA), 142 East Ontario Street, Chicago, IL, 60611, (312) 202-8000, (800) 621-1773, (312) 202-8000, http://www.osteopathic.org/index.cfm.

Rebecca J. Frey Ph.D.