The philosophies of one age have become the absurdities of the next, and the foolishness of yesterday has become the wisdom of tomorrow.
—William Osler, Chauvinism in Medicine (1902)
The philosophy of osteopathic medicine, much like the allopathic philosophy of “scientific” medicine, has evolved significantly since the founding of the first college of osteopathic medicine in Kirksville, Missouri, in 1892. That evolution invariably resulted from new knowledge gained. Just as allopathic physicians no longer believe that bleeding, purging, and cathartics benefit patients, osteopathic physicians no longer believe that all human illness is the result of “somatic dysfunction.” Change is a natural occurrence in any philosophical system. Whether one still considers allopathic medicine “mainstream” and osteopathic medicine “alternative” is unimportant today. Unquestionably, the two philosophies have moved toward one another at a steady pace during the last 30 years—a move that is ultimately beneficial to our patients. Each profession has something to learn from the other. Osteopathic medicine today contributes significantly to the medical community as a whole, evidenced by the quality of our students and the medicine they ultimately practice following residency training.
So what is the osteopathic philosophy in 2009, and can an osteopathic graduate’s participation in an Accreditation Council for Graduate Medical Education (ACGME) residency change that philosophical belief system? It is my conviction that the osteopathic philosophy has been and continues to be firmly rooted in the basic concept that a human being is a dynamic unit of function possessing self-regulatory mechanisms with inherent healing properties, and that structure and function are interrelated to some degree at all levels. With that foundation, any rational approach to the care of patients must be based on the concept and understanding of mind-body unity, self-regulatory mechanisms, and the interrelatedness of structure and function. It is critical to understand that the osteopathic philosophy does not rest solely on manual (manipulative) medicine—a point that is often misunderstood by many of our allopathic colleagues and, in fact, even by many osteopathic physicians today. Does it mean that manipulation of the musculoskeletal system can cure cancer? Absolutely not. Could it mean that the application of manual medicine in a terminally ill cancer patient may lessen or even eliminate the need for narcotics for chronic pain? Absolutely.
In my opinion, which is based on my experience as a surgical oncologist, residency program, director, and dean, the majority of students today come to osteopathic medical school because they want to practice medicine having embraced the osteopathic philosophy noted above. As we fulfill our roles as educators in our osteopathic medical school curricula, that philosophy becomes a permanent part of the fabric of every student we graduate, and it therefore cannot be effected by residency training. Residency training, whether ACGME or American Osteopathic Association, is not meant to serve as a philosophical changing arena but, rather, as a time to hone clinical skills and critical thinking based on already firmly established philosophical beliefs. In our medical school, many of our strongest faculty who teach and model the osteopathic philosophy have trained in ACGME residencies, and, in fact, several are MDs. You don’t have to be a DO to embrace the osteopathic philosophy—you just need a willingness to consider it.
When it comes to the confidence to touch patients, osteopathic physicians may have the advantage in this clinically important area. Osteopathic physicians develop this acquired skill as a result of early exposure to osteopathic manual medicine (OMM) teachings. This “touching” experience occurs in a safe environment and goes far beyond simple physical diagnostic skills, such as auscultation and palpation. The OMM practicum experience requires students to trust one another, and the confidence engendered by that trust ultimately is transferred to patients, which greatly facilitates the physician-patient relationship.
It is inappropriate, however, for the osteopathic profession to promote a mantra that DOs are unique because we are holistic (which assumes that MDs are not). The only thing unique in medicine today is our patients—no two are alike. In both medical professions, there is a wide spectrum of personal philosophies regarding the approach to patient care. The fact that there are diverse thoughts and opinions will never change. What can change, however, is the perception that osteopathic medicine equals manual medicine—it does not. I am convinced that A.T. Still, the philosopher, physician, and father of osteopathy, would ridicule any unbridled discipleship to his concepts and principles that may no longer be valid. Certainly, his overall philosophy should remain strong, but specific tenets promoted more than a century ago have long since been abandoned by the majority of the profession—and rightfully so.
This is an exciting time in American medicine, but it is well past the time for our two separate but complementary professions to be segregated by individual philosophies. Who knows? Maybe by sharing ideas we could all learn something that would benefit our patients.
The views expressed in this article are strictly personal and do not necessarily represent those of the American Osteopathic Association, American Association of Colleges of Osteopathic Medicine, or Des Moines University.
Kendall Reed, DO
Dr. Reed is professor of surgery and dean, Des Moines University College of Osteopathic Medicine, Des Moines, Iowa; (firstname.lastname@example.org).