Defining osteopathic medicine

What is osteopathic medicine? A unified definition is desperately needed

Our profession will begin a slow decline if we cannot decide on an explanation of who we are and how we practice.

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Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

What is osteopathic medicine? We could probably wallpaper the White House with the number of pages written on this topic. But as this profession moves forward in a new era of a single GME accreditation system, it is vitally important that we come together on a unified definition.

We have never been stronger in terms of percentage of graduates, positions within influential bodies such as the Accreditation Council for Graduate Medical Education (ACGME) and placement in residencies. Yet we will begin a slow decline if we cannot decide on an explanation of who we are and how we practice.

My reading of osteopathic history is that, early on, we were focused on being distinctive from the standard practice of the day. This included, for many, being “drugless practitioners” who relied solely on manipulation, nutrition and hygiene as therapeutics.

Post-Flexner, and especially post-World War II, we had many more opportunities to enter the mainstream of medicine but were prevented by prejudices coming from the American Medical Association and its members.

During that era, as we strove for equality, it was important to de-emphasize our differences in order to emphasize our similarities. Thus, several generations of DOs forwent their manipulative training and embraced the “medical model” of patient care.

Today, however, as we are probably as close to equality as we are going to be, we are now able to return to our distinctive practice, equal but different. Now is the time to embrace the osteopathic model of care.

Defining osteopathic medicine

In 1903, Guy Dudley Hulett, DO, a student of A.T. Still, DO, MD, defined osteopathy this way:

  1. Cure is the prerogative of the organism.
  2. Functional disorders will be self-adjusted except where complicated with or dependent on structural disorders which are beyond the limits of self-adjustment.
  3. Removal of structural disorders constitutes the treatment.

It is clear that the early osteopathic physicians focused on the use of the musculoskeletal system to assist with the homeostatic systems in the body. They also were attentive to diets, exercise and many other inputs into the patient’s system.

This attention to the body’s ability to heal, and the implication that an illness was a result of a disruption of the body’s healing capabilities, is today called by many names: preventive medicine, lifestyle medicine, etc. Today they are recognized as an emerging focus of care.

The other key tenet of osteopathy is the celebration of the triune nature of the person, body-mind-spirit. Early osteopaths were very interested in the treatment of mental illness, such as it was, and they recognized the key interactions between the physical state and the mental state of the patient.

Early influences

Dr. Still’s father was an itinerant pastor, traveling around the Plains states on a regular circuit.

This early influence was paired with what he learned from the Native American children he grew up playing with regarding the unity of nature, to create a spiritual philosophy that helped form the basis for osteopathy.

Today this unity of the person is celebrated not just in psychiatric specialties, but also in approaches such as trauma-informed care, narrative medicine and others.

I hope that my point is clear. While the tenets of osteopathic philosophy are not unique, there have been and are today other physicians and practitioners who use one or more of our foundational principles.

An inclusive approach

What makes osteopathic medicine special is its focus on whole-patient care, inherent health and structure and function. That others might practice similarly does not change the fact that we have been teaching and practicing this way for more than 125 years.

If osteopathic medicine has something important to offer to the practice of medicine (and I hope most of you reading believe it does), then it is important that we stake our claim to this philosophy. Not in an exclusive way (as we and others have done in the past) but in an inclusive, expansive way.

If there are physicians who want to practice osteopathic medicine, let them become a part of our “team.” Let them take osteopathically recognized ACGME residencies, become AOA board-certified, attend AOA continuing medical education events, and research and publish in the Journal of Osteopathic Medicine.

We should accept anyone who wants to practice good osteopathic medicine, just as Dr. Still was willing to accept anyone, man or woman, into his American School of Osteopathy.

In a new public awareness campaign, the AOA is attempting to highlight what makes DOs unique by emphasizing the empathetic, health-focused and self-healing aspects of our philosophy of medicine.

But they don’t go far enough. There is no mention of manipulative treatment, and the messaging is not forceful enough in promoting the historic nature of osteopathic distinctiveness.

Finally, by focusing too closely on the initials after the name of the physician, the AOA doesn’t create the inclusivity that is key to the continued promotion and growth of our profession.

I believe that the osteopathic profession is ready once and for all to declare what type of medicine we practice. Osteopathic medicine has been defined since the beginning of our profession as incorporating body-mind-spirit and lifestyle approaches to medicine, and it is time that we claim that definition.

Related reading:

Future osteopathic physicians embrace growing lifestyle medicine field

Osteopathic Pride campaign celebrates being #DOProud

11 comments

  1. Guy Farmer DO

    Let me first say that I am DO trained all the way through my general surgery residency. My father was a great physician and a MD. I was heart broken to see that we were not going to have our own residency programs. I know we were smaller but we did good work and were more broadly trained. I went to our own meetings where the DO speakers put down our own specialty programs. I am afraid that the DO will be busted down to a level just above the nurse practioner and will eventually be a referral base for our MD counterparts. Please tell me I am wrong.

  2. Michael Neeki,DO,MS

    Let me start by thanking the author on his visionary ideas and the fact that over the past decades the medical care in the United States have been moving toward osteopathic philosophy of the “whole-patient approach”. I chose freely and consciously to be a DO based on that philosophy and the fact that my training would give me more comprehensive skills to help my patients. More than theories that will be redundant in the actual practice of medicine. Osteopathic medicine will need to integrate into the advances in medical care and delivery, yet continue to show that value to patient who are seeking more than someone who could write a prescription.
    Osteopathy need to be part of our personality and our commitment to humanity. As a EM trained physician for the past two decades, I still find the time to treat patients who need that specific osteopathic touch. My MD partners are amazed by that skill set and often request that for their own friends and family members. Stay proud and please know that we are not seeking recognition by others but our patients and humanity.

  3. Richard A Uhlig

    I am a retired D.O. with 50 years of general-family practice. At the beginning of my practice as well as near the end, I had people asking me what an Osteopath was? The confusion over the name, it seems to me, results from the meaning; Osteopath literally means “bone disease.” Some thought I was an orthopedic doctor, other that I was a chiropractic doctor and I’ve heard D.O.’s referred to as “rubbing doctors.”
    With PA’s, NP’s, PT’s all petitioning legislators for independent practice rights without physician oversight, we could soon find ourselves several rungs down on the health care ladder.
    Bless A.T. Still; however, we must realized that times have changed. If you want to do structural medicine or biomechanics, do it without hanging the millstone of nomenclature around our necks.
    It’s time for a better, less confusing, more modern name.

    1. Gayle D. Bounds D.O.

      Dr. Still said that he derived the word “osteopathy”, from “osteo” and “PATHOS” , to FEEL the Bones.

  4. Michael Uphues, D.O.

    During the pandemic all true Osteopaths should have been on the frontlines emphasizing the importance of diet, exercise, proper supplementation with, at least Vitamin D, Vitamin C, Quercetin, and Zinc as well as at least 25 other therapeutics that have been proven to work not only observationally and anecdotally, but also through randomized controlled trials. Unfortunately, most Osteopaths fell in line with the false narrative instead of leading as true Osteopaths.

  5. Wade Hopper

    DO’s are practicing physicians who receive specific training in therapeutic touch.

    A common thread across DO curricula is instruction in manual manipulation. Touch can convey powerful emotions and can have soothing, healing properties when applied with the correct knowledge and intent.

    I agree DO’s have a “holistic approach” however I have always thought that makes for a nebulous definition because any medical practitioner, DO or not, can practice with a “holistic approach.” I personally do not wish to imply that perhaps DO’s are more “patient-centered” than care providers of any other background or degree.

    Much of what is marketed as “making DO’s unique” is really just … high-character, humanistic qualities that a lot of people strive to embody, regardless of profession. In other words, blanket statements. I do agree that if we can better define ourselves, we can better preserve what is distinct about our osteopathic heritage.

    I am a third-year osteopathic medical student. Thank you for writing this article, Dr. Loveless – you have spoken gracefully on the meaningful topic of professional identity.

  6. Richard A Uhlig, D.O.

    Some medical textbooks and the NCBI calls the effects of thyrotoxicosis on the eyes a “ophthalmopathy,” the effects on the skin an “dermopathy,” the effects on bone an “osteopathy.” Clearly, the term “osteopathy” is ambiguous and often misleading, except for us insiders who appreciate what Osteopathy really is: a holistic approach to the patient by doctors who have had excellent training in schools of Osteopathic Medicine. We osteopaths understand and appreciate what “Osteopathy” is, but the general public is in large measure confused and mislead by the term.

  7. Richard W. Koss, DO

    Thank you so much for your timely article! You have pointed out that Osteopathy is again at a crossroad for our very survival. We are now on the historical path of Homeopathy which was the preeminent medicine of the late 1800’s. Once Homeopathy joined with the up and coming AMA they were slowly marginalized, denigrated, and now with the closure of Hahnemann University Hospital in 2019, Homeopathy (only in this country) has been relegated to the dustbins of history. Since the 1950’s as the Osteopathic profession sought after “full practice rights,” it achieved this at the expense of Osteopathic Philosophy, practice, and Osteopathic manipulative medicine. The AOA leadership and sad to say much of the DO’s today fully embrace the Allopathic model and marginalizing and denigrating of OMM. So now with the single pathway in ACGME we are at the crossroads of our existence. How does it feel now that many non-physicians (PA, ARNP, OD, ND, etc.) are wanting “full practice rights?” Without prescribing rights and hospital privileges who are we??
    As you so rightly stated there was no mention of OMM/OMT in the new “Branding Campaign” which the AOA paid millions of our dues for. As one of my recent students who is soon to graduate stated in this discussion: “If you have to resort to a branding campaign you have lost your identity.” Furthermore it is the constitutional duty of the AOA to educate the public of what Osteopathy is… unfortunately I am out of allowed space….

  8. Richard W. Koss, DO

    My main concern that is one of the sources of our identity issues is:
    If you cannot get paid for your services you don’t exist. By federal law which gives the rules under which the CMS (followed by all insurance companies) states that only curative treatments involving the musculoskeletal will be paid for. Meaning that no “maintenance care” will be paid for and the auditors are very watchful of this(personal experience). In my opinion this is very discriminatory for our profession. All chronic care (diabetes, HTN, RA, etc) is chronic care! With the “primacy of the musculoskeletal system” taught in OMM class Osteopathy is done from the start. Furthermore, all body workers are lumped together as equal: DO, DC, PT, etc, are put in the same reimbursement category. Training has nothing to do with competence. Research means nothing as payments are designed to “hold down costs.”
    I am hopeful that someday DO’s will fight for their right to practice their craft. This includes myself who for 40 years practices Osteopathic medicine. I welcome the opportunity to dialogue with anyone in the profession to reclaim our identity as founded by AT Still, MD, DO. He gave us Osteopathy, it is up to us to move it into its rightful place in the Healing arts and science!

    1. M. Shane Patterson

      I too am frustrated with the lack of support for the practitioners in the DO community by the organizations which are tasked with that duty. I’m concerned that the reason we are contorting ourselves to define who we are, as a profession, is that we will not be allowed to exist if we state the obvious objective of our profession. That being: We are a profession dedicated to PREVENTION of disabling maladies. This includes honestly advocating for and educating people about things that are good for us as opposed to treating maladies after they have happened. We take a moral and ethical oath to do precisely this, NO insurance or business entity is so constrained. The ways this can be accomplished are extensive, but is not limited to OMT, healthy diets, exercise, clean water and food, proper sanitation, good rest and ensuring a family environment in which to safely raise children and thus require a broad spectrum of well educated people to educate the population. None of these goals are reimbursable under current coding. This profession must fight for what Still actually advocated: Prevention and the advancement of the healthy human condition. Still was a pioneer. I would also present Dr. John Harvey Kellog of Battle Creek, Mi as one of those pioneers who garnered an extensive following including presidents and business luminaries who subscribed to a preventive and healing concept. he also succumbed, but the principals live on, as does human nature. Is the sky blue?

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