A.T. Still Memorial Lecture: ‘Osteopathic physicians are the physicians our nation needs’

Although A.T. Still, MD, DO, introduced osteopathic medicine during a vastly different time and health care landscape, his philosophy and teachings remain incredibly relevant today, noted Thomas A. Cavalieri, DO, during the 2024 A.T. Still Memorial Lecture at the AOA’s annual House of Delegates meeting in July.

Dr. Cavalieri, who serves as vice president and senior advisor for health care and medical education at Rowan-Virtua School of Osteopathic Medicine, also remarked that while health care in the U.S. is much improved when compared to what it looked like during Dr. Still’s time, it is far from ideal, and today’s DOs are well-positioned to lead the way in shaping a better health care system, particularly when it comes to geriatric care.

“Who better to respond to the needs of older adults than osteopathic primary care physicians?” he asked. “Our graduates are more likely to go into primary care, serve in rural and underserved areas, and have the skillset needed to care for the elderly.”

Future physicians will care for more elderly patients

As a geriatrician, Dr. Cavalieri shared his expertise on the current state of geriatric care in the U.S. With the aging population, future physicians will be spending more time treating elderly patients with complex needs, he noted.

“Many physicians, especially those working in primary care, will be spending upwards of 50% or more of their time caring for people over 65, managing medical and nonmedical needs that will pose significant challenges to older people, their caregivers and to health care providers,” he continued. “The current system is not aligned with these complex needs and is often managed with an increased number of medications.”

Some of the reasons elderly patients’ needs are not being adequately addressed, Dr. Cavalieri noted, include the fact that payment models do not support quality care, lack of access to quality primary care, a health care workforce that is ill-prepared for complex care, lack of care coordination and multiple transitions of care. All of these factors contribute to poor outcomes, he noted.

“Since it’s not possible for us to train sufficient numbers to care for the elderly population, we will instead need geriatricians to serve as educators to the physicians who will soon be spending more of their time caring for the elderly,” said Dr. Cavalieri, noting that osteopathic physicians have the skills needed to provide such education and to care for elderly patients.

Dr. Cavalier shared a current effort to provide better care to older adults: “The Age-Friendly Health System,” an initiative supported by the U.S. Health Resources and Services Administration and other organizations to ensure that care delivered to older adults is really age-friendly.

Dr. Cavalieri also broke down four evidence-based practices that he has found to be beneficial for geriatric care, which he called the four M’s, and shared how they align with Dr. Still’s teachings.

The 4 M’s

• What Matters: Taking the patient’s preferences into account, or treating the whole patient.
• Medication: Avoiding polypharmacy and medications that have deleterious effects.
• Mentation: Being mindful of patients’ mental health and their mental state; this practice aligns with the tenet of osteopathic medicine that states that a person is a unit of body, mind and spirit.
• Mobility: Making an effort to keep patients active; this practice aligns with osteopathic medicine’s emphasis on structure and function.

Fostering a patient-centered approach

Dr. Still’s approach to end-of-life care reflects many of the principles of hospice care today, as described in the book “The Lengthening Shadow of Dr. Andrew Taylor Still” by Arthur Hildreth, DO, Dr. Cavalieri noted. In the book, Dr. Hildreth recounts how Dr. Still cared for Dr. Hildreth’s father at the end of his life as both a friend and a physician.

“Dr. Still was the only physician who rendered a service that in any way relieved the deplorable condition my father was in … not only in trying to help my father through his great trial, but also, in a kindly, wonderful way, soothing the hearts of those of us who had to stand by and watch the passing of a loved one,” Dr. Hildreth wrote.

Through this story and others, Dr. Cavalieri makes it clear how the osteopathic approach to end-of-life care brings to the bedside not only a patient-centered, holistic approach, but also osteopathic manipulative treatment (OMT), which can be helpful for pain management.

“Osteopathic physicians are the physicians our nation needs to address access to care in underserved communities and the needs of the growing elderly population,” said Dr. Cavalieri. “We need to continue to expand, but of course, we must maintain quality.”

Watch the full speech in the video above.