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The DO | Opinion | Executive Director's Desk

Promoting DOs: Words, medium change, but message stays the same

It’s the most common question AOA family members hear from people unfamiliar with the profession. Whether on an airplane, at a summer barbecue, or even at a meeting of the World Health Organization, people ask, “What is a DO?”

John B. Crosby, JD

John B. Crosby, JD

(Photo by John Reilly Photography)

At the AOA, we teach the public that DOs are osteopathic physicians, and we promote the benefits of osteopathic principles and practice. But some DOs have raised an interesting question in return: What does osteopathic mean? A DO anesthesiologist may not use osteopathic manipulative treatment every day—or ever. Does this make him or her any less osteopathic than a DO who performs OMT every day? How do we distinguish a nonphysician osteopath from the United Kingdom or an MD who learns OMT techniques from a DO colleague? Are these professionals osteopathic?

What is osteopathy?

The AOA House of Delegates has been answering multilayered questions like this for many years. At its annual meeting in July, the House passed Resolution 301 (A/2010) (PDF), which revises the AOA’s position on the terms osteopath and osteopathy.

Previously, the policy stated that osteopathy and osteopathic medicine could be used interchangeably. The revised policy calls for osteopathic medicine and osteopathic physician to be used preferentially over the traditional terms. Osteopath and osteopathy can still be used in “historical, sentimental and informal discussions” and to refer to previously named entities in the profession and to foreign-trained osteopaths with a limited scope of practice.

Six AOA bureaus, committees and councils reviewed and commented on this policy’s new iteration. They aimed to preserve the traditional terms while recognizing the profession’s considerable evolution since the 19th century.

What is a DO?

DOs have progressed greatly over the years, from being manipulation practitioners to trail-blazing health care researchers. Yet confusion persists over the terms osteopathic physician, osteopath, osteopathic medicine and osteopathy—even in organizations as prestigious as the World Health Organization. The uncertainty surrounding these terms is partially explained by wide-ranging practice scopes for osteopathic physicians and nonphysician osteopaths around the world.

However, the larger issue isn’t what we call ourselves—it’s what members of the public call us, if they know what to call us at all.

Within the AOA, the Bureau of Communications and the Division of Media Relations are devoted to increasing the visibility of osteopathic medicine by educating reporters and other members of the news media, both in print and online. Through news releases, pitches to the media and advertisements, we educate the public and the media about DOs. Many DOs serve in our Media Spokesperson Network and in the Osteopathic Public Awareness Network as volunteer advocates who reach out to local news outlets to share information about the profession.

The huge boom in online social media means we now can do a lot more to promote DOs—with a lot less investment. In this technological age, we can avail ourselves of more resources than ever to promote DOs in the public realm and spread the word about osteopathic medicine.

Our online outreach extends to such popular Web destinations as Facebook, YouTube and LinkedIn. This year, we’ve posted videos featuring AOA leaders, news releases and public health alerts, among many other online outreach efforts. On YouTube, we house a wealth of public health videos featuring DOs, giving a face and a voice to the osteopathic medical profession while teaching the public about important health topics.

We’ve added LinkedIn, the online hub for professionals in all fields, to the AOA’s social network this year. Twitter has brought us closer to DOs, osteopathic medical students and friends of the profession. The DO, the AOA Grassroots Osteopathic Advocacy Link (better known as GOAL) and the AOA Greatness Corps all have dedicated Twitter feeds. And more than 5,000 people “like” our fan page on Facebook, with new supporters coming almost every day.

What is osteopathic medicine?

Questions about the meanings of the terms osteopath and osteopathy address the soul of osteopathic medicine.

Our profession’s founder, Andrew Taylor Still, MD, DO, addressed these questions in his autobiography. Chapter 8 follows Dr. Still as he starts to spread the word about osteopathic medicine. He writes about the people who called him crazy and accused him of “hoodledooing.” But Dr. Still just let his osteopathic medical skills answer for him, healing patients by encouraging their bodies’ own curative powers. More and more people began to see the benefits of osteopathic medicine.

Rather than rely on drugs and traditional treatments, Dr. Still steadfastly used OMT and the power of his hands to treat—and heal—doubters far and wide. By sticking to the fundamentals of osteopathy, he ensured the profession’s future. Just as we follow Dr. Still’s science, we can follow his example for public outreach. We won’t get noticed for being just like MDs—we’ll get noticed for being different, for being distinct, for being the best-trained physicians in the world. The AOA will continue to reach out to promote that DO difference. With your help, we can DO it!

jcrosby@osteopathic.org

13 Responses

  1. Mark E. Rosen, DO FCA on Oct. 1, 2010, 12:14 a.m.

    “By sticking to the fundamentals of osteopathy, he ensured the profession’s future. Just as we follow Dr. Still’s science, we can follow his example for public outreach. We won’t get noticed for being just like MDs—we’ll get noticed for being different, for being distinct, for being the best-trained physicians in the world.”

    Thank you John

  2. atul singh on Oct. 12, 2010, 1:44 p.m.

    “What is a DO” is a common and sometimes a diffucult question to answer as you have listed above. When I am asked this quetion, my replie is a DO is a doctor that focuses on treating the patient, not just a sympton, in other words if you treat the cause, the symptom resolves by it self.

  3. Ted Mickle, DO, MPH on Oct. 12, 2010, 2:33 p.m.

    The question of “what is a D.O.?” was being discussed 30 years ago when I entered osteopathic medical training, is a common question today, and will no doubt be problematic 30 years hence.

    The universal designator for “physician” in North America is M.D. The foreign medical graduates I work with on a daily basis who trained in former British commonwealth countries immediately abandon their MBBS [Bachelor of Medicine and Bachelor of Surgery]degrees for the universally-identified M.D. degree.

    As long as osteopathic medical colleges continue to offer the “D.O.” degree, their graduates will continue to be invisible to the general public and will find themselves spending the rest of their professional careers answering the inevitable question, “What is a D.O.?”

  4. Anonymous on Oct. 12, 2010, 6:25 p.m.

    “By sticking to the fundamentals of osteopathy, he ensured the profession’s future. Just as we follow Dr. Still’s science, we can follow his example for public outreach. We won’t get noticed for being just like MDs—we’ll get noticed for being different, for being distinct, for being the best-trained physicians in the world.”

    If we stuck to what Dr. Still founded, we wouldn’t today even be considered physicians. We only ascribe anything to Dr. Still’s “Science” because it maintains the profession and gives us something to latch onto that “makes us different”. If you were to do a survey of DO graduates within the last 5-10 years to see what percentage practice any of the skills that are actually different(OMT) from what an MD can do, I would almost guarantee your answer would be less than half. The majority of DO students today are only at a DO school because they didn’t get in to an MD school. Its unfortunate, but quite true. Thats not to say there isn’t a faction that went specifically to a DO school because that does exist, but it is a VERY small faction.

    The idea that a DO somehow is different because we view a patient as a whole person is lying to yourself. Sure, there are MD physicians who don’t practice that way(especially the subspecialists it seems-but this is also the same in the DO world). Recently there has been a huge shift to patient centered care in MD schools. In fact, an MD school close in proximity to my own DO School has an immense number of hours (more than ours) devoted to treating patients as people and not just a collection of symptoms. Whether that means they have copied our way of doing things doesn’t matter, they still do it and saying they don’t just to have something to hang on to that makes us different is fallacy.

    Why do we still, after 30 years, have to explain what a DO is? Because there is no difference, and instead of saying this, we go into some long story about Osteopathy and treating the whole person. By the time we get 10 seconds in, the person has already tuned it out. So why hasn’t the AOA done more to rectify this? Money. If more people took notice, more people would see that there is no legitimate difference, the professions would likely have to merge, and the AOA would be out of business.

    Thank you for your time, and I apologize if I have offended anyone.

    A Fellow DO

  5. Eric E. Shore, DO, JD, MBA on Oct. 13, 2010, 7:41 a.m.

    Andrew Still was an MD who became disenchanted with contemporary medicine when he lost his family to meningitis. He was searching for a more effective means of treating people and believed he found it in “Osteopathy,” which literally translates to “disease of the bones.” He was at least partially right in 1865 because classical Medicine had little that worked. Things have changed in the 21st Century.

    You asked the question in the beginning of your article; “A DO anesthesiologist may not use osteopathic manipulative treatment every day—or ever. Does this make him or her any less osteopathic than a DO who performs OMT every day?” the answer is yes. All physicians are taught to treat the “whole patient,” and anything else is a myth today. For the vast majority of DO’s we are simply “physicians,” not “Osteopathic Physicians.” Isn’t it time we brought ourselves into the 21st century and used the MD degree, along with the DO, so we can stop having to explain to the world that we are not all “bone doctors,” or “eye doctors?”

  6. Christina Lucas- Vougiouklakis DO on Oct. 13, 2010, 9:55 a.m.

    As a new DO in practice, I have found that my practice has evolved around the fact that I have been trained as an osteopathic physician AND actually use my OMT and Cranial Course (Thank you Drs Rosen and Shore! You trained me well!) training to the benefit and care of my patients. I am often asked the question regarding “what is a DO”. A short and sweet answer is that I am both a Medical and Spritual Doctor that focuses on the totality of a human being and not the disease. I provide a Handout/educational materials (thank you AOA!) and brochures to my patients which explain in more detail the distinguishing features of a DO v. Chiropractor v. MD. I believe we as physicians who believe and utilize the skills we have been taught as Osteopaths have a responsibility to TEACH and NOT criticize others for their lack of knowledge. We have NOTHING to prove. WE are not BETTER or INFERIOR to our allopathic colleagues. We simply have another tool in our box that can be utilized to improve the quality of life in our patients.

    The bottom line: “People do not care how much you know until they know how much you care.”

    Remember:
    ” No one can make you feel inferior without your consent” – Eleanor Roosevelt

  7. Richard Rapp, OMS-IV / OMM Fellow on Oct. 13, 2010, 1:51 p.m.

    If I remember correctly our profession, Osteopathic Medicine is based on these 4 tenets:

    1. The body is a unit; the person is a unit of body, mind, and spirit.

    2. The body is capable of self-regulation, self-healing, and health maintenance.

    3. Structure and function are reciprocally interrelated.

    4. Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.

    If number 3 is true, then does it not also mean that abnormal function has associated abnormal structure whether micro or macro? If number 4 is true then does it hold true that a physician who does not consider or seek to understand and treat the abnormal structure is not offering rational treatment?

    To me this means that if a patient has an upper respiratory infection and I do not ask and identify what structural abnormalities allowed this infection to take hold and/or are preventing optimal healing then I have not treated this patient rationally or appropriately.

    With a patient laying down you can diagnose and treat the thoracic inlet and cervicals with myofascial release and thoracic lymphatic pumps in less than 2 minutes, bill insurance for office exam, -25 modifier code, and OMT 3-4 body region (ribs, thoracics, cervs) procedure code, get paid an extra $35 or so for those 2 minutes, and MOST IMPORTANTLY help the patient recover!

    It can be done, it just takes willingness to be osteopathic rather than just think osteopathically. That will bring distinction as a great physician regardless of degree title.

  8. toanonymous on Oct. 13, 2010, 2:26 p.m.

    If you look at the spectrum of MD to DO school, based on achievement and selectivity, you’d find that the line that divides the MD school to the DO school does not exist. You also fail to recognize the strengths and advantages a DO school offers.

    1. The choice to apply to both osteopathic and allopathic residencies (obviously this didn’t matter to you as you probably didn’t do very well on your boards.)
    2. The highly specialized training which empowers the DO to treat and diagnose with ones hands
    3. The vantage point of being an alternative yet sufficiently competent physician.

    Please understand that the reason that the Osteopathic school (at times) has a lower standard of admission is not because they aren’t as competent or because they are academically inferior, but a basic economic concept. Once our (osteopathic) reputation gains a more distinguished reputation (coming soon), I am positive that the selection process will be indistinguishable from our MD brethren.

  9. Anonymous on Oct. 16, 2010, 6:56 p.m.

    Re: Toanonymous
    I concur that there isn’t a line that divides an MD from a DO school in terms of nearly any measure. Even MCAT scores aren’t significantly different anymore. Me “failing to recognize” the advantages and strengths of a DO school is the same problem that the rest of the world has, unfortunately.

    1. I am unsure from where you draw the conclusion that I did not do well on the boards? On the contrary, I did well on the USMLE (230s), and also well on the COMLEX (600s). I have yet to see how Step 3 went. This “choice” to apply to both MD and DO residencies really isn’t a “choice”, most will do a DO residency if they can’t do an MD residency, or fear having to scramble if they opt out of the DO match. I base these conclusions from talking to many other students during my time in that position, and now as a resident.

    2. I am glad that you have embraced OMT. I do not advocate the removal of OMT from the curricula of DO schools; I advocate that it become an elective with a certification for those who wish to follow that path. For myself and the majority of people I have spoken with, they never planned to use OMT after graduation, but went along with it because it was part of school. We would have gladly had that 6-8 hours a week back in exchange for something more medically related.

    3. I am unsure what this statement really means in the real world. “I have a different point of view than you.” Ok, sure, but I believe that would have happened regardless of the school.

    I am waiting (much like everyone else has been waiting, 30-50 years in some cases) for this “more distinguished reputation”. Good luck on that. I for one choose to be realistic. I agree that students who end up in DO schools are no less competent or intelligent than those accepted to MD schools. It is indeed purely economic, but a problem of supply and demand versus your definition. There are not enough spaces to go around, so those that fall below the cutoff from all of their MD applications end up at DO schools.

    Thank you all.

  10. Matt Ajluni D.O. on Oct. 18, 2010, 10:54 a.m.

    I think with the decreasing use of OMT one could be inclined to make the argument that the difference between a DO and MD is shrinking, and there may be some truth in that. But, to make the argument, as the “Anonymous/Fellow DO” does above, that there is absolutely no difference between MD/DO and the AOA is merely practicing self preservation by trying to highlight some invisible differences between the professions, is short sighted, and borders on absurd. Sorry if I offended you.

    Number 1. Let’s remember that a huge number of DO’s practice OMT daily, effectively and with real results for millions of patients. To say that there are many DO’s that don’t use OMT, and thus the professions(DO/MD) are the same makes no sense. In fact, they aren’t the same, in one profession, you have thousands of physicians armed with their hands curing their patients and in the other profession they do not do this. Just because some osteopathic physicians choose not to use OMT does not suddenly make Osteopathic medicine and Allopathic medicine the same.

    Number 2. Of course Osteopathic medicine doesn’t have a corner on a “patient centered” focus, and yes, Allopathic medical schools are focusing more on seeing the patient first. This is a good thing for the patient and for the health of our country. This doesn’t diminish Osteopathic medicine, it only underscores the wisdom of AT Still’s vision for the practice of medicine.

    Number 3. My last point I can’t defend with research or any studies, but it is the following : Patients like DO’s. In light of my own personal experience and via anecdotal evidence, I believe this to be true. Does this mean patients don’t like MD’s? No. Clearly many patients just love their doctor whether they be MD or DO, but there is something intangible and hard to quantify that seems to make DO’s well liked by patients. I think this transcends the use of OMT. I believe there are many reasons for this, some being the Osteopathic ethos that informs, warms, and invigorates our schools and bolsters an “Osteopathic family” within the profession that serves to produce “user friendly” physicians. Perhaps it is the PC vs MAC debate. DO’s akin to the MAC, and MD’s akin to the PC. However you explain it, I believe it is true that patients just like DO’s, and it is that which makes DO’s distinctive. And I even wrote this on a PC!

  11. Thomas John D'Amico, DO, FAAFP on Oct. 24, 2010, 3:03 p.m.

    Why does terminology matter? Why is this important to address during the healthcare overhaul of our country? Because we can’t afford not to. How the public perceives us plays into whose left standing after the dust settles in the next 5-10 years.

    Who are the new players on the field? Non physician providers, specifically NPs and DNP riding the wave of the current environment. Their rate of manufacture is twice that of a physician and are much cheaper to employ. To underestimate the leverage and threat they hold over primary care physicians would be a catastrophic miscalculation for those who have 30 years of career ahead of us.

    I believe soon the DNP degree will be treated by payers and governments as the cheap alternative to physicians in order to fill the gap in primary care that medical schools failed to fill. The public will now have and alphabet soup of providers to choose from, e.g. MD, DO, PA, NP, DNP. Is that a good thing? Not for us! The physician “brand” must be upheld before we’re substituted for a degree that purports providing more “value” for our healthcare dollars.

    Now, where does that leave the osteopathic profession in the eyes of the public at large which grossly misunderstands or are completely unaware of what a DO is? The answer…on equal footing as advanced practice nurses. DOs would be just another set of letters in the sea of primary care providers. Our distinction as complete physicians with decades of training behind our DO degree will be smeared and diluted and seen as equivalent to NPs or DNPs.

    Therefore, I believe we need to run under the MD umbrella for safety’s sake. Hard to swallow, but unfortunately true. We can’t wait as the AOA muddles with anemic public awareness efforts and “What is a DO?” brochures. We must establish in the mind of the public the fact that physicians are integral and are not substitutable for non physician providers. In my opinion, adding MD to DO (e.g. MD, DO) is a potent insurance policy for professional survival.

  12. Anonymous on Oct. 27, 2010, 11:01 p.m.

    Dr. Aljuni-

    Thank you for your response. I do not take offense, and I gladly appreciate your input. I’d rather see SOME discussion of the issue rather than none. With that said, I believe you have somewhat mis-characterized my statements. I made the claim that there is no “legitimate” difference between MD and DO. I stand by that claim. Whether it be semantics or not, I believe that it quite a different statement than “absolutely” no difference. I do believe there is a difference, but not one that justifies an entirely “separate but equal” profession. Do our patients like us? Definitely. Do they like OMT once they are introduced to it? Yes, for the most part. If, in the grand scheme of things, it is really that great, wouldn’t more people know about it? Wouldn’t word spread like wildfire similar to the latest diet crazes? Wouldn’t those who are enamored with chiropractic care (who likely outnumber those who are fans of OMT by a very large number) switch to a DO?

    Sure, a large number of currently practicing DO’s perform OMT. Is that number more than half? Not likely. Is the number of graduating DO’s that will practice OMT greater than 30%? Also not likely. So, I again ask my question: Is a “difference” that less than half of members embody still constitute a cornerstone of a profession?

    Is this similar to the Mac Vs PC debate? Sure, however Apple is one heck of a marketing machine. They have made their product sexy and attractive. The AOA on the other hand is laughable in their efforts to date, as evidenced by the remaining lack of knowledge of what a DO is.

    Hopefully we can do as Dr. D’Amico suggests and think about our future and preserving our place in it. As we are a smaller faction than just about all of the other interested parties, we must work towards better recognition before it is too late and we are forever relegated to being just another “M.D. Wannabe”.

    Thank you.

  13. Makoto on Nov. 2, 2010, 5:46 p.m.

    Osteopathic colleges present an entire body of knowledge to incoming students. This knowledge includes basic sciences and medical sciences, the former being a prerequisite to understand that latter. Osteopathy principles and practice are taught concurrently. The student body, after appropriate testing and teaching, is admitted to hospitals, community clinics, and private offices to apply their intellectual knowledge, and thereby gain clinical knowledge from clinical experience. After further testing, graduates enter post-graduate training in internships and residencies, slowly circling the drain into their area of specialty, learning ever more deepening areas of knowledge and clinical experience.

    It is the student’s choice and that alone that determines whether he or she uses osteopathic knowledge and theory. If the student does not do this (which is the majority), then it is not that “fault” of the osteopathic college, nor of the profession in general, nor even of the osteopathic student culture, which can be negative and derogatory towards manual approaches to health care. This body of students who become residents who become attendings are not the body of professionals that deserves to carry the standard of our profession, for they obviously do not practice the complete science and art of osteopathic medicine that was taught to them.

    It is for the inverse of this professional body for which the osteopathic profession exists. It is for the differentiation between those who imbibe osteopathic principles and practice and combine it with their contemporary medical science education. Where would this group be without the osteopathic designation? Is it not for the highest and deepest and evolved of our profession? Are they not the ones who should be at the forefront, the ones that inspire and provoke growth in the rest of us? An osteopathic cardiologist, osteopathic neurosurgeon, osteopathic obstetrician, or osteopathic general practitioner, all at the height of their profession, should all have equally studied, contemplated, and learned the entire breadth of knowledge that constitutes that branch of health care which we call osteopathic medicine. It is those with multiple decades behind them, yet who are still practicing, that define the limits of achievement which in the future we hope to surpass.

    Those who don’t incorporate osteopathic diagnosis into patient assessment have much to learn. Until then, stay behind the degree. Elevate yourself.

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