Peter Carter, Osteopath, The Medical Sanctuary
OMT is the heart and soul of osteopath. It is what osteopathy is all about. Take away OMT form Osteopathy, and what are you left with? Without OMT there is no “Osteopathy”. (1)
Without Osteopathy we are left with the standard medical system that is prevalent today – a soulless, uncaring, expensive, technological production line, featuring a kaleidoscope of questionable theories and therapies. Let us always remain aware of the reasons why we personally chose to become osteopaths in the first place.
We will always need emergency medicine, surgery and strong pharmaceuticals. People will continue to have MVA’s, CVA’s, MI’s and all the manner of catastrophic health events, despite all the best education. Let us remember, however, this is not our primary focus as osteopathic physicians. Remember, as Korr(2) said, “The neuromusculoskeletal system is the primary machinery of life.” We, as osteopathic physicians, should be concerned with the primary machinery, not the secondary visceral systems which are the focus and infatuation of standard medicine today.
Sure, when a person’s heart stops beating they need immediate crisis care, but why did their heart stop beating? Unless we go beyond the immediately obvious effects, we will never get to the cause of the problem of medicine today. Let us not always think and act in crisis mode.
Remember also that ultimately, sooner or later, most of the patients will die from something, despite all our good efforts. If you please continue smoking, drinking and eating to excess, and not exercising, what do they say will happen? If a person drives a car at 190kph in an inner city area, what do you think will happen when they hit a concrete pylon? Let us aim out efforts at improving the quality of life and at longevity with quality, not just putting Humpty Dumpty back together again when he falls off the wall.
OMT is primary medical practice – everything else is secondary. It is like a car with a wobbling wheel. Better to correct the wheels with OMT while they are still wobbling, than to wait until the wheels fall off, which is standard medicine today. Better not to think of the patients that you have saved, cured, healed, fixed or rescued today, but rather to concentrate on the patients that have been spared from undergoing unnecessary suffering in the future. “An ounce of prevention is better than a tonne of cure.” Obviously no caring practitioner would deny that surgery, chemotherapeutic, or any other types of therapies are essential or desirable at certain times. What in important is the OMT is seen as the treatment of first choice in every area where it is possible to be used, and that it is used in every circumstance where I could be used, instead of having to rely on other therapeutic interventions as a first choice option, with OMT as a backup or after thought.
In the area of holistic, cost-effective health care delivery, this idea has not been tried or delivered to the general public anywhere in the world that I am aware of at the present time. One can only know what is achievable with OMT when it is practised to its fullest extent. To have a healthy care system that would deliver this with the full range of medical care behind it would be ideal. Osteopathic medicine would be administered by a hard core of OMT practitioners as front like primary physicians, with secondary backup by all other medical specialist and hospital facilities, not the reverse.
All of us, as members of a health care profession, and as tax paying citizens, are aware that the cost of standard medicine is ballooning out of control. This is due to many factors, one whish is the increasing technological sophistication of diagnostic gadgetry. All of us are also aware, as osteopathic practitioners, of the many new patients who visit out clinics ever week armed with a large portfolio of X-rays, CT and/or MRI scans. These people have undergone numerous diagnostics procedures with the resultant finding oh “nothing remarkable”. These patients are then given a short series of OMT and find that their previously unexplained symptoms vanish. This the application of no more technologically sophisticated machinery than ten fingers and a good history taking accomplishes what thousands of dollars of tests and from multi-million dollar machines could not do.
The information that the average G.P doesn’t know about treating spinal pain from an osteopathic point of view could probably fill several books, just as what the average practising Aussie D.O. doesn’t know about cardiology or gynaecology from a medical point of view could fill several more. The point is that medicine today has become such an enormous field that, evening an ideal would of a totally integrated osteopathic medical system, no single person could hope to know everything. Even in this ideal system we would still be only a small part in the overall scheme; so essentially our position will not be much different from what it is today. Just locating all our services together in one hospital building will not necessarily change out roles that much.
So it is important for us to understand our role in the overall scheme of health care, to be aware of our limits, and to know what is achievable for us as a profession, rather than to indulge in wishful thinking for the future. With this focus we can deliver the highest quality health care for outpatients. After all they are the reason we exist!
When looking at our role in the medical system of the future, we should be aware that today’s standard medicine offers little relationship between disciplines. There is little common ground between say cardiology and dermatology, or geriatrics and obstetrics and gynaecology. OMM however, is the most inclusive field of medical endeavour, as it has something powerful to offer all these areas. This is especially so because OMM has no absolute contraindications, only relative contraindications to the use of specific types of OMT at certain times.
Standard medicine, by comparison, suffers from specialisation, even though this specialisation is a necessary evil. Specialisation inevitability gives rise to compartmentalisation and vice versa. The danger of osteopathic medicine is that OMM will come to be regarded as a speciality and become a separate entity with itself rather than as an integral part of every patient’s treatment regime.
How about us as an Australian profession accepting that we are already specialists? What we do is very special, even unique, ad we are good at it. On a worldwide scale, I estimate that there is one OMM practitioner for every million people on earth. Just think about that for a moment.
It will be a long time, if ever, before we have a full system of osteopathic specialists in place even if we start full tilt on a programme in this direction right now. It is something that we do not have the resources for today, but we can only plan and dream about for the future. The size of our market place is too small to accomplish these goals. This isn’t America with 260 million people; 36,000 licensed D.O.’s and a hundred year history of osteopathic education. The budget for Kirkville college alone is about US$80 million per annum. We need to look at what is realistically achievable and desirable for the Australian profession. Do we want out osteopathic students to do a three to four year medical course, then four years at osteopathic medical school, then three more years of hospital training to become an osteopathic G.P. when they can go to university for five years and do a standard medical degree; OR do we design a course that better sits out Australian reality? Let us look at what is necessary and relevant undergraduate training and prepare out students for a greater range of postgraduate possibilities.
There is a vast difference between learning to diagnose certain conditions, and understanding that they may need, or definitely do need, surgery, and learning to perform the actual operation. By the same line of reasoning, one can learn to prescribe pharmaceuticals, but one doesn’t have to actually dispense them. Please forever keep us away from free samples handed out by the drug companies.
However about training osteopathic G.P.’s? They would be physicians capable of giving a patient a full examination, including internal procedures, conducting neurological examinations and diagnostic tests, able to draw blood samples, interpret pathology tests and radiological procedures. They would have pharmaceutical rights, with full referral rights to specialists and surgeons as required, PLUS they would then do OMT as an integral part of patient’s treatment experience, not just pay lip service to it. Certainly we are capable of upgrading out skills and standards, and we must do this as a matter of course because, as the field of medicine continually expands, we must expand with it or risk becoming dinosaurs. For this, compulsory continuing postgraduate professional development for active practitioners and continual adaptation and improvement of our undergraduate training is essential. Let us train our graduates to the highest possible level, but avoid the production line of “uncaring, elitist, straight from High School with a high TER score, medical graduates.”
With regard to the future of the undergraduate education, we as a profession and as a society do not have the resources to train our future physicians extensively in OMT and then have them not utilise these skills to their highest extent. We cannot afford to have waste these valuable skills but their moving into areas whereby, by their own admission they are likely to employ little or no OMT in their future practices.(3)
Let us also avoid the mistakes of the American system where some- not all – students use their osteopathic training as a back door into medicine, with OMT as just another hoop they have to jump through before they can graduate. How about a five year undergraduate course with the same level of training as a standard medical degree, then a compulsory three year residency with an experienced OMM practitioner? This much be completed before any possible progression to specialist training. I would also suggest this to the Americans as a positive step towards reforming their system and helping to return it towards a more hard-core OMT orientation.
Privately, and sometimes publicly, man Americans D.O.’s will tell you that they have trouble finding someone who can give them a decent OMT. They will concede that in the most basic way their system has lost the plot and that their finest people are involved in a courageous uphill struggle to return their system to its roots. One only needs to read the American Academic Journal or newsletter to be aware of this.
If we are to have a strong international identity and unity as a profession, it needs to be based on honesty of communication by all parties. This means that the American D.O.’s need to come clean with the awareness that all is not necessarily rosy in their system because they are fully licensed physicians, and that all our Australian problems will be solved if we follow suit. Nor should we accept being regarded as second class citizens in the international osteopathic community just because we are not fully licensed physicians.
In comparison with out American colleagues, with equal time in practice, Australian D.O.’s would compare very favourably when it comes to our manipulative skills and our understanding of Osteopathic philosophy and principles and their practical application. Indeed, recent trends have shown that there may be many things we can teach our American colleagues. All that we are lacking as a profession is a large cadre of elder statespersons who have spent and continue to spend, their lives practising, teaching and researching Osteopathic Medicine, i.e.: Kimberly, Korr, Fryman, Wales, Becker, Lay, Fulford, Walton, Johnson, Mitchell, Greenman, Cathie, Gryette, Ward, etc.
Let us look at what is appropriate and valuable for Australian conditions and acknowledge that it is also possible that other countries may learn from what is good in our system:
Our ability to deliver quality, low cost health care that makes a real difference to many peoples lives.
Our ability, through the quality of out OMT to alter our patients’ perception of what we can do, thus educating them that Osteopathic medicine is something different and special.
Our ability to make very comfortable incomes doing what we love with very little legal, bureaucratic or logistical inconvenience.
Our extremely low rate of malpractice insurance and claims.
Much has been made of alienating members of the osteopathic profession at large by criticising American non-OMT specialists over their lack of OMT usage. This is not meant as a criticism of individual practitioners per se, but as a legitimate discussion of what type of treatment is relevant to the public at large for health maintenance.
One could argue with a plastic surgeon of any philosophical persuasion on the relative appropriativeness of the use of certain procedures. Certainly one would not want to deny a horrible disfigured MVA or burns victim the benefit of reconstructive surgery, but is it appropriate in the overall scheme of health care delivery, on a social scale, to have such highly trained and skilled people occupying operating room time and space to preform surgery on people to improve their physical appearance and/or sexual desirability, purely as an expensive exercise in personal vanity? Just because a person can purchase a medical procedure does not validate its existence or importance.
On the issue of scientific validity, this is a lot like economic rationalism – one of the all pervading “truths” of today’s acceptable beliefs. One can use statistical analysis to prove almost anything, just as one can justify anything, just as one can justify anything if one’s frame of reference is small enough. In the same way, it is possible to use economic parameters to justify the provision or withdrawal of essential public services, medicine being a prime example.
Remember that when Dr A T Still first proposed this “ideas” they were certainly not considered “scientific”, or valid in any way, by the esteemed learned individuals of his day, perhaps with the notable exception of Thomas Edison, an outspoken supporter of Osteopathic Medicine. Perhaps it takes one genius to recognise another.
The vast majority of our patients do not read scientific journals, or care about the evidence of out research projects. What they care about is the results and, when they positive results from OMT, they will support Osteopathy by voting with their mouth, feet and wallets.
This is what made Osteopathy what it is today, and what will keep it progressing strongly in the future. Let us turn our attention to producing the highest quality OMT practitioners so that this trend will continue. Yes, we need research, and it is all very valuable, but the only research our patients need to know is the OMT works; doesn’t have a whole range of questionable side effects, and doesn’t cost thousands, is not millions, of dollars to administer. This is the message that governments also need to hear.
When talking scientific validity one only needs to mention a few words like thalidomide. All kinds of “scientific” test and research was done prior to the introduction of this substance of therapeutic use. With all kinds of excited, well intention expectations of its effect in relieving human suffering. Unfortunately when it was used on real live persons, the results were disastrous. If this were on isolated example, one would not be so concerned, but unfortunately “medical” history is filled with many such examples. One is able read in history of many examples of scientific method which proved mathematically that heavier than air flight was impossible; smoking cigarettes was good for you; that the earth was flat and the centre of the universe, etc, etc.
Finally, registration board separation is essential to ensure the possible fruition of the above outlined plans, and to give the profession total control over its won destiny. By having our own board controlled by the profession we can effectively side-step many potential obstacles, although I will expect difficulties. If they don’t happen, then that is good, but better to be forearmed, expecting trouble, and having it not happen that not to expect it and be unpleasantly surprised.
We can then define what are acceptable Osteopathic training standards and practice rights. Whatever we want to happen, we just vote for it ourselves at a board level and then get the government to give its “seal of approvement”. In this way we can represent ourselves to the public in a new and totally different way. Then all we have to do is to educate the public that this is what we are, and this is what we do. In fact I would suggest that we prepare for this expanded role by doing our best to practice like this now, i.e. like alternative G.P.’s. This course we can only each individually do to the limits of our education and abilities, and collectively to the current legal limits. All the more reason for postgraduate education to increase our education and skills.
However, I feel this is essential to prepare the ground for the future and to alter the public’s perception of us away from one of spinal joint mechanics. It is not enough to pay “lip service” to our philosophy: we must actually deliver it in out practices everyday. It is not good enough to think Osteopathically, we must act Osteopathically. Then we will have the legitimate ground with the relevant government bodies to be given the expanded rights that we are seeking.
REFERENCES
Privet conversation Dr. Anne cooper D.O. 1996
“The Physiological Basis of Osteopathic Medicine” –Korr 1970
Ostium article “American Academy Convocation” –Terence Vardy D.O. 1997
Osteopathic Medicine – “An American Perspective” – Dr. Andrew Sclar D.O., A.O.M.R., 1998
Copyright © Peter Carter, D.O., D.H.M., M.A.O.A, 1998