Question for Knowledgable D.O. Students

[InNY]

The reason why I am considering D.O. over M.D. is because of the whole fact that I think the M.D.'s are too quick to push pills and go by facts and figures, than to consider the person's lifestyle and how that impacts his/her health.
Here's a situation for you. My mother has high blood pressure.She just found out about it a few months ago, but we suspect she's had it awhile, but the doctor never told her. She's on a medication to control it.It works for awhile, then the dose has to be upped. The thing is, at home she monitors her B.P. and it's pretty good, but when she goes to the doctor, it's high.I believe it's just anxiety(she gets nervous when she has to get checked by the dr., but otherwise her B.P. is fine).She told the doctor the factthat it's fine at home, but he is too nervous to take a chance, so hejust ups her medication to be safe. The doctor is a good guy, but he's not much of a believer in holistic medicine. I am though, and I've gotten my mom into it too.
What would a D.O. do in a situation like this? Take her anxiety into account and try to help her work on it to lower her B.P. I'd really like to know-would a D.O. do the same thing as an M.D. in this kind of situation?

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[Henry]

What I have learned is limited. However, I remember that in my OMT class, we learned about OA decompression. It will stimlate the vaguws nerve and therefore, regulate the heart rate. I don't know what will a DO do if he consistantly find that your mother has high BP. But I will at least relax her first and recheck the heart rate.

I learn that if a patient have three consecutive high BP measurements amoung three visits to the doctor, it is considered as having hypertension.

 

[DOPhD student]

Do NOT believe that OMT can do anything for hypertension. A DO cannot treat any internal pathology including hypertension by manipulating the OA to activate vagal tone. A DO cannot treat your mother's hypertension any differently than any good MD can, other than possibly hold her hands for this so called "hands-on-healing". OMT is effective in treatment of musculoskeletal disorders (mainly in improving ROM), nothing more. When you said you chose a DO over an MD, I didn't know what you meant. If you chose a DO over an MD for treatment, that's fine. He's a good choice of a doctor as any, but if you chose a DO career over an MD, I would advise you against it unless you're really into the osteopathic philosophy and manipulation. I made my choice and you should do the same very carefully.

 

[Gregory Gulick]

DOPhD Student, you sound very disappointed with your education. In the past, your messages were full of enthusiasm. Now they are rather pessimistic. Why the change of heart?

 

[cliff]

Look up 'white coat hypertension.' It is a documented phenomena which basically states that people's BP rises when confronted/interacting with medical professionals.

 

[Jack DOe]

DO/PhD is right. There is no documentation of any OMT being useful in treating hypertension. In my school, OMT was never taught as something to replace normal medical treatment. Only as something to augment it. Disbelieve all those that say that OMT can replace the accepted medical therapies, because OMT is very specific in scope and therapeutic affects. Rarely is OMT used as a primary treatment (the exception is in obvious articulator or myofascial somatic dysfunctions), but is an added tool that can be used in accessing and treating a patient. However, what InNY is asking is will a DO take into consideration her anxiety felt by visiting the doctor. Well, they should, but some do not. In addition, some MD's will also consider it. It really depends on your doctor. DO's do have the added aspect of interelatedness emphasized in their education but do not cornor the market on this philosophy or practice. Each individual doctor is just that, an individual.

[This message has been edited by Jack DOe (edited 02-07-99).]

 

[drusso]

I agree with the above posts. OMT is not a modality for systemic illness. It is mostly an adjunctive therapy for musculoskeletal injuries. While it is sometimes used in an inpatient setting it is not intended as a curative intervention. The osteopathic profession needs to do a better job educating the public about the indications, limitations, and contra-indications for OMT.

Unfortunately, I think that there is a false perception that if you see a DO for a sore throat he's going to perform some manipulation in an effort to make it better!

 

[justwannabadoc]

I am currently interested in going into orthopedics. It seems like OMT would be great for this field, especially sports medicine. Can anyone comment on this?

 

[Doreen]

I also want to enter into orthopedics, whether it be sports medicine, physical medicine and rehabilitation, or orthopedic surgery and I believe OMT is essential for that field of medicine. Anyone else agree/disagree?

 

[justwannabadoc]

Hi Doreen. It sounds like you're a future student. I'm certainly no expert since I haven't had an OMT class but based on what I know, I don't think I would say that it is essential for ortho. I would however say that it could be a great asset. I believe in taking the least radical approach possible. This includes the use of medications since all have side effects, no matter how minor. If OMT can help resolve a problem, great. I'm really excited about learning this art. Best wishes in your pursuit of ortho.

 

[edgar]

Doreen & Justwannabedoc,

My mentor is an orthopod (orthopaedic surgeon) and chief of orthopedics at a private hospital in the SF Bay Area. He is also a clinical professor of medicine at UCSF. Anyways, when I told him I was applying to osteopathic medical school he told me he wish he knew how to perform OMT. I didn't press him on why he wishes he knew it, but I would at least think that OMT training would allow the doctor to better diagnose ortho problems and be able to do manipulations on sore joints and muscles. What is interesting was how this doctor's practice used to be set up. This group of all MD surgeons used to have a DO who was a PM&R specialist. When this DO was around, they used to refer quite a few patients to him for treatment of painful musculoskeletal injuries. The staff misses the DO very much because he seemed to able to do miracles for their aching necks/backs as well! Sorry, I can't give you any specifics but this DO had left the practice before I started interning/working at the ortho clinic.

EDGAR

 

[Gregory Gulick]

Physical Medicine and Rehabilitation (PM&R)is a field packed with D.O.s. In this field, D.O.s seem to be able to snag what some of you would consider "high profile" residencies with little difficulty. This is probably because, if I am not mistaken, some manual medicine is taught in the PM&R residency -- and well, the osteopathic physician has hopefully already mastered that aspect of treatment.

I tried to connect to the American Academy of Physical Medicine and Rehabilitation website this morning, but I couldn't get online. The address is www.aapmnr.com and last time I was there that had the abstracts available from their last conference. Check out how many osteopathic physicians are listed as authors of those papers. I would say the osteopathic profession was well represented.

Ironically, while this may be the field in which osteopathic physicians simply excel, it is not emphasized in the osteopathic profession. This is attested to by the fact that there is only one AOA PM&R residency. Therefore, D.O.s usually must go the allopathic route for GME training.

 

[peter]

I believe there are a few approaches: what happens is your mother's BP goes high when she is at the doctor. It may be worth exploring how to present information that it is not always high; or discuss taking the BP at intervals, or after she has settled. There are also approaches within cranial osteopathy which take account of the functioning of the cerebellum and the tent, and treat through the IVth ventricle of the brain.. I suggest you contact member of the sutherland society in US

 

[justwannabadoc]

Thanks for the info, Edgar and Gregory.

Edgar. I assume your mentor is an MD amd he supports your desire to pursue the DO path versus the MD path. The reason I mention this is the continued discrimination against DOs in many areas of the country (check out the "Discrimination of not?" post by DOPhD under "Everyone"). Does the hospital that your mentor is at have an ortho residency program? Does he or anyone know of any DO grads in an ortho MD program and does he feel that DOs could make a significant contribution to ortho? Gregory has already stated PM&R is a perfect niche for DOs and I feel ortho is as well.

 

[peter]

In addition, I believe that OMT is not the only mode that an osteopath uses to treat. Look at the history of osteopathy, and what did A T Still and Littlejohn in UK both treat? From my reading they treated people with asthma, cholera, TB etc. This then brings up the question: what goes on in treatment? And how does one enhance what the body is doing? And what are the effects of an intervention? ...

 

[edgar]

Justwannabedoc,

My mentor is an MD. The hospital he is chief of orthopedics at is a private not-for-profit hospital that used to train ortho residents from UCSF but I think they stopped doing that for a few years now. It may be difficult for a DO to get into an ortho residency because it is a surgical specialty. DOs run into the competition problem because you usually do 5 years of general surgery training, and then you do a fellowship in ortho. If you go to Medstudents.Net, there is a section that talks about interns/residents. I was bored one night, so I searched the ortho residency links and I did find a DO graduate who had finished an ortho residency in an MD program. You can also check out Gregory's "NEW" osteopathic links, there is a doctor by the name of Dr. Adam Goldstein who is a 1st year general surgery resident at the University of Illinois (MD residency) and a grad of NYCOM. He is very helpful, you can send him e-mail but it may take a week or so for him to respond because of the time demands of his residency. And you are correct, I still think there is discrimination by MD residencies in consideration of DOs for appointment as housestaff officers. It's all about how these programs have so many MD applicants, and it kind of makes sense for them to take their own before admitting DOs. Ask Dr. Goldstein about his experiences during his residency interviews.

EDGAR

 

[edgar]

Justwannabedoc,

I forgot to add that my MD mentor was very supportive when I told him I was going the DO route to becoming a physician. He told me that it doesn't matter where you go to medical school, as long as you stay in the states and go to an AMA or AOA-approved institution. My interest is in family practice, internal medicine, or pediatrics, so I think I will compete well if I want to do an ACGME residency. But if you are set on doing an ACGME surgical residency, the odds are stacked against you. My friend is a 2nd-year general surgery resident at Highland Hospital in Oakland, CA, a teaching hospital of UCSF and UC Davis Schools of Medicine. She says she has not yet been in contact with a DO graduate doing a surgical residency. Things may change in the next few years, but if you want to be a surgeon, you need to highly consider doing an osteopathic surgical residency because MD programs just don't seem to accept many DOs.

EDGAR

 

[justwannabadoc]

Thanks Edgar. It's too bad that DOs are still being discriminated against. I understand somewhat why MD programs would want to take in only MD graduates but why only do it for surgical residencies? It seems hypocritical to exclude some DOs but welcome others. I wouldn't say that I'm set on doing an MD ortho residency. I'm not even 100% sure that I'll be going into ortho. True, I am extremely interested in and fascinated by this field so chances are, I will, but since I haven't even started my medical education yet, I woudn't say that it's set in stone. I do however want to find out how DO ortho programs compare to the better MD ones. I took a peek at the DO programs and quite frankly, most were at hospitals I have never heard of. This obviously is no way to judge how good a residency program is so could you tell me what you know about them or where I can get more info on them? It doesn't matter whether I go into a DO or MD program as look as I get great training. Also, you referred to the program as 5 yrs general surgery plus one year of fellowship. Were you referring to a DO program? The MD program here is internship year of general surgery and 4 years of strictly ortho. It is encouraging that more MDs are beginning to appreciate DOs and what they can do. I was also wondering if you know of any DOs on clinical or faculty staff at some of the major hospitals in your area. I plan on practicing strictly in the hospital setting and in a metropolitan area so it's important to know whether or not this could pose a problem as well. I'll check out those links you provided. Thanks again.

 

[edgar]

Justwannabedoc,

I certainly am no expert in orthopedic surgery postgraduate programs. I believe my MD mentor did general surgery training at University of Texas-Houston and went on for more training at UCSF. I do know he had a general surgery background, like most orthopods. And fellowships often last for more than 1 year, more like 2-3. I got a brochure from the US Army on postgrad programs, and they said for ortho you do a full 5-years of general surgery and then get additional ortho training. That is another route to go if you want to be an orthopod, you can do a military residency, and they are ACGME-approved. Many DO orthopods seem to do their training in the military. In regards to DO residents near the Bay Area, I don't know. I hear there are DO residents at UCSF and Stanford, but I don't know if they are surgeons. MD Surgery residencies are MUCH MORE competitive than say, Family Practice, and so that is why there is more discrimination against DOs. When you think about surgery training, you usually think about powerhouse research med schools, and DO schools often do not have this research reputation.

If you do go into orthopedic surgery, about 50% of your time is in the hospital and 50% of your time is in the office. Orthopods often set casts, give injections, and do pre-op and post-op histories and physicals. I actually liked working in the ortho clinic, the doctors actually had extensive patient contact and the clinic, and the surgeries were very interesting. I have seen arthroscopies and a hip replacement myself. It is a very messy speciality though. Blood flies all over the place during surgery, and the cauterizing fries the persons blood vessels shut, and keeps them from bleeding. You can imagine how bad that smells.

Maybe you could call up or e-mail the American Board of Osteopathic Orthopedic Surgery or the American Board of Osteopathic Surgery. They can probably give you much better information from me. Also check out my bud Gregory's "osteopathic links" on this website. There are some orthopods there as well.

EDGAR

 

[justwannabadoc]

Most MD ortho programs are first year of general surgery followed by four years of ortho specific stuff. I actually spent quite a bit of time myself with two orthopods, one general (who no longer did surgery but continued to see patients in clinic) and one trauma. It really wasn't bad. Maybe it was because I was expecting far worse but the drilling and cauterizing didn't bother me much. Then again, I wasn't standing right over the patient either. You must have seen a total hip replacement. I saw a hip replacement and it was fairly clean. I think it's only the total joints that are incredibly bloody. I don't think I want to do that. I would rather not do surgery wearing a space suit. Thanks Edgar.