Today is DO Match Day - the day when soon-to-be doctors of osteopathic medicine learn where they will spend their residency training. What's a DO? There are two types of fully licensed physicians in the U.S.: doctors of allopathic medicine (MD's) and doctors of osteopathic medicine (DO's). Today, in a special DO Match Day edition of
Progress Notes, an osteopathic medical student explains. By James Raspanti
As soon as I entered the exam room to see Jackie, I could tell she was in pain. Her breathing was short and she favored her right side. I quickly introduced myself.
“Hi Jackie, my name is James. I’m an osteopathic medical student working with Dr. Jones.”
She was a regular patient at the clinic but had never been seen by Dr. Jones. As I would soon discover, Jackie was also new to osteopathic medicine. I took a couple minutes to explain what that meant.
“There are two kinds of fully licensed physicians in the US: doctors of osteopathic medicine (DOs) and doctors of allopathic medicine (MDs). Just like the MDs you are familiar with, DOs use traditional medical, pharmacological, and surgical methods to help patients. In addition, DOs are trained to look more closely at a person’s bones and muscles. Sometimes these structures become misaligned causing pain or impaired movement. Osteopathic physicians can feel for and treat such problems with their hands.”
She gave an understanding nod and said it sounded like a chiropractor. I agreed with the comparison and moved on to my history taking.
Three nights earlier, Jackie had woken up coughing violently. While brief, the coughing fit left her with lingering pain and shortness of breath. To date, she was a healthy middle-aged woman with only a medical history of achalasia, meaning that the valve between her esophagus and stomach did not relax properly, making it difficult to allow food to flow through. This put her at increased risk for pneumonia. Fortunately, nothing about her history or physical exam suggested an infection or other serious problem. I suspected a musculoskeletal cause and decided to examine her back more carefully.
It is a common misconception that DOs only perform musculoskeletal manipulations. In fact, these manipulations, known as osteopathic manipulative medicine (OMM), are just a tool that DOs hone on top of the basic science and clinical courses all medical students take. Though DOs practice in all specialties, OMM is most often used in primary care. Osteopathic students are required to spend over 200 in-class hours practicing OMM. In OMM classes, we learn to: 1) diagnose musculoskeletal dysfunction by palpation and 2) treat musculoskeletal dysfunction with hands-on manipulation. Perhaps the most unique aspect of osteopathic training is the dedication to palpation. Learning to feel and differentiate superficial skin, subcutaneous tissue, and muscle requires regular practice.
What does an osteopath feel and assess for? Changes in tissue texture and structural asymmetry are two important exam findings. A third relies on motion testing. Detailed knowledge of anatomy tells us that the skeleton moves in predictable ways. DOs use this knowledge to find restrictions that might cause pain or decreased range of motion. Tenderness may be present as well. I found all of these in Jackie. For her, the culprit was a rib.
“You have a rib out of place. It’s possible your cough was strong enough to displace it. I think I can fix it.” She agreed to the treatment.
I had her lie face down and began by loosening up the tight muscles along her spine. They started to relax within a few minutes. I explained what was to come next - a short quick thrust into her back. I repositioned her body to help focus the force my hands would deliver. The treatment lasted less than half a second. Afterwards, Jackie sat up so I could reassess her dysfunction. I confirmed that the rib was moving better, but the real test came when I asked her to take a deep breath. It was full and painless.
Osteopathic manipulations like the one I used on Jackie are not intended to replace the tests, medications, or procedures that comprise the typical physician toolkit. OMM will not cure heart disease or slow the complications of diabetes. However, common ailments that do respond particularly well to OMM include headaches, carpal tunnel syndrome, and back pain among others. The benefits of OMM are plentiful and include the ability to offer immediate relief, decreased need for anti-inflammatory and muscle relaxant medications, and reduce the costs associated with chronic musculoskeletal problems. A well-trained osteopathic physician can incorporate OMM alongside the standard physician toolkit in formulating a single treatment strategy.
Before entering medical school, I was intent on practicing in primary care. I chose osteopathic medicine because of its focus on preventive medicine, expanded primary care training, and hands-on approach. The opportunity to practice osteopathic medicine in primary care continues to excite and inspire me in my journey as a future DO.James Raspanti is a fourth-year medical student and PCP chapter member at the Chicago College of Osteopathic Medicine at Midwestern University. He is applying for residency in family medicine and wants to practice as a full scope family physician.