LETTERS
70 • JAOA • Vol 103 • No 2 • February 2003 Letters
Thanks for quality articles
To the Editor:
I want to congratulate the Journal of the Amer-ican
Osteopathic Association for publishing
excellent articles such as the original contri-bution
by Janice A. Knebl, DO, MBA, Jay
H. Shores, PhD, Russell G. Gamber, DO,
William T. Gray, DO, and Kathryn M. Her-ron,
MPH, “Improving functional ability in
the elderly via the Spencer technique, an
osteopathic manipulative treatment: A ran-domized,
controlled trial” (J Am Osteopath
Assoc. 2002;102:387-396) and the article by
Hollis H. King, DO, PhD, “Osteopathy in
the cranial field: Uncovering challenges and
potential applications” (J Am Osteopath Assoc.
2002;102:367-369).
These articles shine a light on our pro-fession,
making us proud to be osteopathic
physicians. These contributions remind us of
how different and even better we can be
than our allopathic counterparts.
Please publish more double-blind trials
that scientifically analyze the results of osteo-pathic
manipulative treatment. I have reread
the articles many times and, with each read-ing,
find something new relative to improve-ment
of patient care.
F. Farid Taie, DO
Garland, Texas
Exploring the benefit
of semantics in the
osteopathic profession
To the Editor:
What does the English language convey
about the osteopathic medical profession?
How accurately does current terminology
describe what we, as osteopathic physicians,
offer with regard to musculoskeletal evalu-ation
and treatment?
In answering these questions, one must
appreciate how language can shape per-ception—
how its use or misuse can influ-ence
the impression the public has about
what we do and what we stand for as osteo-pathic
physicians.
Following are definitions of orthopedic
and osteopathic terminology as they appear
in a current medical text:
Orthopedic—The medical specialty concerned
with the preservation, restoration, and devel-opment
of form and function of the muscu-loskeletal
system, extremities, spine, and
associated structures by medical, surgical,
and physical methods.1(p1277)
Osteopathic—A school of medicine based
upon a concept of the normal body as a vital
machine capable, when in correct adjust-ment,
of making its own remedies against
infection and other toxic conditions; practi-tioners
use the diagnostic and therapeutic
measures of conventional medicine in addi-tion
to manipulative measures. 1(p1284)
By definition, one could argue that the
physical modes of therapy used by osteo-pathic
physicians are akin to orthopedics,
as both address the evaluation and treat-ment
of bones, muscles, joints, and related
vasculature. When the lay person hears the
term orthopedic, there is equity in recogni-tion
as the term relates to the musculoskeletal
system. There is an understanding that
orthopedic medicine is part of the conven-tional
practice of medicine. And although
most of the population equates orthopedic
with surgery, orthopedic terminology could
be applied appropriately to osteopathic
manipulative methods.
Similarly, compare use of the terms man-ual
medicine and manipulation. Both describe
modes of therapy offered by osteopathic
physicians. The difference again is in how
these terms are perceived. The advantage
of using manual medicine instead of manipu-lation
is that it avoids association with less
comprehensive forms of healthcare; the term
manipulation invariably prompts the lay per-son
to link osteopathic medicine and chiro-practic
care when osteopathic medicine is
clearly, or should be clearly, distinct.
Consider the following modification to
current osteopathic medical terminology:
Osteopathic—A school of medicine based on
a concept of the normal body as a vital
machine capable, when in correct adjust-ment,
of making its own remedies against
infection and other toxic conditions; practi-tioners
use the diagnostic and therapeutic
measures of conventional medicine in addi-tion
to orthopedic manual medicine.
Following this logic, the term orthopedic
manual medicine provides the basis for a gen-eral
understanding that the term osteopathic
manipulative medicine does not and lends
credibility and clarity to an often misunder-stood
aspect of our profession.
In addition, this gateway terminology
serves not only to enhance understanding of
a unique feature of osteopathic medicine,
but helps further distinguish the practice of
osteopathic medicine from that of pure
osteopathy. In most countries other than the
United States, osteopaths are not licensed
physicians. In some countries, osteopaths
are not required to be licensed at all. The
medical literature presents osteopathy as a
synonym for osteopathic medicine, which is
inaccurate by virtue of a degree. Osteopath-ic
physicians subsequently suffer from this
misunderstanding. For this reason, it is essen-tial
to emphasize that DOs are not osteopaths
but fully licensed physicians whose con-ventional
training incorporates the osteo-pathic
philosophy—treating the patient in
the context of disease and not merely treat-ing
the disease. Further, DOs, as physicians,
can perform surgery, prescribe medication,
and may apply orthopedic manual modes of
therapy.
A correction in perception, achieved by
an alteration in language, is necessary to
gain the unconditional acceptance of osteo-pathic
physicians as providers of compre-hensive
medical care. Altering the language
we use in no way necessitates a change in
our philosophy or practice of medicine; we
are merely acknowledging that what was
appropriate a century ago may not be appro-priate
today. Introducing new language to
the medical lexicon establishes a means by
which we may build equity, trust in, and
recognition of osteopathic medicine as well
as facilitate a greater understanding of what
we do and the principles on which we stand
as osteopathic physicians.
Adam Smith, MSIII
West Virginia School of Osteopathic Medicine
Lewisburg, West Virginia
References
1. Stedman TL. Stedman’s Medical Dictionary. 27th
ed. Lippincott Williams & Wilkins; 2000:1277,1284.
LETTERS
Failure to convince
osteopathic medical
students of OMT’s worth
increases risk
of subspecialization
To the Editor:
I am 73 years old and have been in family
practice for 30 years. I was 40 years old when
I began osteopathic medical school. As I had
been treated by an osteopathic physician
using osteopathic manipulative treatment
(OMT), I was more aware of its value than
the average medical student.
Most of my classmates trained in physi-cal
manipulation, but as with many college
students, once examinations were complet-ed,
the skill was forgotten. The critical factor
in learning a manual skill (unlike mental
skills) is the longer period of training
required to develop a feel for the skill. At
the end of their first two years of academic
training, my classmates had minimal phys-ical
manipulation skills and a lot of doubts
about OMT because they had abandoned
this training for more pressing courses.
Realizing the importance of OMT, I per-sisted
in hands-on training with experienced
clinicians whenever an opportunity was
available. By my senior year, fellow students
would rush patients with a back injury to
me for treatment because they had forgotten
so much about physical manipulation. I
became the local expert.
Currently, OMT is practiced infrequent-ly,
as was evident in the article by Shirley M.
Johnson, PhD, MPH, and Margot E. Kurtz,
PhD, “Conditions and diagnoses for which
osteopathic primary care physicians and
specialists use osteopathic manipulative
treatment” (J Am Osteopath Assoc. 2002;102:
527-540). I believe this is due to our failure in
convincing students that there are many
conditions that can be improved with OMT
and that prescribed medications are not the
solution to all medical problems.
In my Florida county, there are approx-imately
40 osteopathic physicians, 10 or so of
whom specialize in family practice. Essen-tially
none uses OMT. Further, no one refers
patients with injuries or in need of rehabili-tation
to me. Four local family practice physi-cians
worked for me, at various times. I
made them use OMT, but all four stopped
using OMT after leaving because of their
poor skills in this area.
If there were a specialty designation for
OMT that provided better reimbursement
and teaching recognition, we would have a
bevy of osteopathic medical students who
embrace OMT and who would confidently
incorporate manual medicine into their prac-tices.
In the real world, I am a specialist with
no forum or recognition. The truth is that
osteopathic physicians who use OMT are
the minority, though the delusion that most
osteopathic physicians use OMT exists even
within the profession’s core organization,
the American Osteopathic Association. As
less and less OMT is practiced, our profes-sion
will continue to drift steadily into
increasing subspecialization.
Thank you for providing this forum. I
hope readers will consider how many peo-ple
are in pain, yet who are unaware that
osteopathic physicians who use OMT may
provide better musculoskeletal care than a
pain clinic.
Robert M. Corbett, DO
Crystal River, Florida
In 1998, the National Study of the Impact of Man-aged
Care on Osteopathic Physicians was conducted
on behalf of the Committee on Healthcare Deliv-ery
Systems of the American Osteopathic Association
and was presented by the National Research Cor-poration,
Lincoln, Neb. Study results indicated the fol-lowing:
Eighty-five percent of osteopathic physicians use
osteopathic manipulative treatment (OMT) in their
practices, with 95% of family physicians using OMT.
One-half of osteopathic physicians do not receive
adequate reimbursement for OMT.
In May and June 1998, surveys were mailed to
2756 osteopathic physicians licensed in the United
States; 710 of the questionnaires were completed
and returned, 523 of which had managed care con-tracts.
Only those indicating managed care contracts
were included.—ED
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