Post on 17-Dec-2015
Introduction to Osteopathic Medicine for Non-DO Faculty:
What Makes an Osteopathic Education Different?
Educational Council of Osteopathic Principles
Photo courtesy of NSU-COM
Copyright © 2010, AACOM. All rights reserved.
19th Century America
Age of Heroic Medicine Rise of Allopathy
Phlebotomy
Medicinals
Surgery
Founding of American Medical Association
1847
Copyright © 2010, AACOM. All rights reserved.
Becoming a Physician in 19th Century America
Attend medical school
1760 William Shippen, Jr. lectures on anatomy in Philadelphia
1765 Morgan funds first U.S. medical school in Philadelphia
1790 medical journal published in New York
Set up practice
Generally richer patients
More urban practice
Apprentice with a registered/ licensed physician
One – several years
Learn medicinals, midwifery, surgery
Mentor would sign statement
Sometimes involved test,sometimes just mentor’s statement
Set up practice
Common people as patients
More rural practice
Copyright © 2010, AACOM. All rights reserved.
19th Century America
Reactions to Age of Heroic Medicine
Alternatives to Contemporary Medicine:
Thompsonism
Grahmism
HydroTherapy
Lightning Bone Setters
Chiropractic
Homeopathic
Copyright © 2010, AACOM. All rights reserved.
A.T. Still, MD
Rural farmer, hunter, inventor, local politician
Civil War abolitionist
Personal tragedy 1864
Denounces medical treatment
Becomes a medical reformer
Copyright © 2010, AACOM. All rights reserved.
June 22, 1874
Flies high the banner of osteopathy.
Relocates to Kirksville, Missouri.
PATHYPATHYOSTEOOSTEO
Copyright © 2010, AACOM. All rights reserved.
May 10, 1892
Obtains charter for the first school. American School of Osteopathy (ASO)
“To improve our systems of surgery, midwifery, and the treatment of diseases in which the adjustment of bones is the leading feature of this school of Pathology. Also to instruct and qualify students so that they may lawfully practice the Science of Osteopathy as taught and practiced by A.T. Still, the discoverer of this philosophy.”
Copyright © 2010, AACOM. All rights reserved.
Tenets of Osteopathy
1. The human body is a functional unit. Mind, body, and spirit are interconnected.
2. Form and function are inter-dependant.
3. The human body has the innate ability to heal itself.
4. Osteopathic Manipulative Treatment is based upon individualized, rational application of the above tenets.
Copyright © 2010, AACOM. All rights reserved.
Anatomy/Development Module
Copyright © 2010, AACOM. All rights reserved.
“It is impossible for an osteopathic physician
to perform a physical examination without knowledge of anatomy.”
Copyright © 2010, AACOM. All rights reserved.
The body’s numerous and complex anatomic structures
The interrelationship between anatomy and physiology
The critical importance of the neuro-musculoskeletal system in human function
That the knowledge of anatomy is essential to the practice of medicine and surgery
The practicing osteopathic physician needs to understand:
Copyright © 2010, AACOM. All rights reserved.
Surface Anatomy Visualization
Palpation
Functional Anatomy Anatomic elements related to the body’s
biomechanical functions
Surgical Anatomy Knowledge required for surgical diagnosis and
treatment
Cross-sectional anatomy
“All osteopathic physicians use their knowledge of anatomy in practice”
Copyright © 2010, AACOM. All rights reserved.
Knee Pain Case
A patient presents with knee pain.
Copyright © 2010, AACOM. All rights reserved.
Differential Diagnosis Basic Categories
Infection
Inflammation
Tumor
Trauma
Genetic
Somatic dysfunction
Psychological
Copyright © 2010, AACOM. All rights reserved.
Differential Diagnosis of Knee Pain Includes:
Patellofemoral syndrome
Iliotibial band syndrome
Patellar tendonitis
Anserine bursitis
Meniscus tear
Collateral ligament tear – medial or lateral
Cruciate ligament tear – anterior or posterior
Osgood Schlatter
Osteochondritis dessicans
Neuropathic arthropathy
Charcot Joint
Tumor (osteosarcoma)
Referred pain (hip = avascular necrosis)
Prepatellar bursitis
Baker’s cyst (popliteal)
Septic Joint Gonococcal
Arthritis Osteo Rheumatoid Gout Septic Pseudogout Reactive arthritis (Reiters)
Medial Plica syndrome
Referred pain from back Sciatica
Fracture
Copyright © 2010, AACOM. All rights reserved.
Applied Anatomy and Knee Pain
Surface and functional anatomy are required for examination and treatment of the painful knee.
Surgical anatomy may be required for the treatment of the painful knee.
Copyright © 2010, AACOM. All rights reserved.
Osteopathic Considerations
Discussion of likely anatomic involvement in the knee pain case.
Probably will focus on functional vs. surgical possibilities.
Copyright © 2010, AACOM. All rights reserved.
Medicine and A.T. Still
“Man should study and use the drugs compounded in his own body.”
Autobiography of A.T. Still, p. 89
The basis of scientific medicine
Copyright © 2010, AACOM. All rights reserved.
Not all of osteopathic principles and practice is osteopathic manipulative
medicine.
Osteopathic medical students study all of medicine, surgery and obstetrics.
In addition, they study osteopathic philosophy, principles and practice for
about 200 hours.
Copyright © 2010, AACOM. All rights reserved.
OMM Perspective for Analyzing Patient Problems
1. BiomechanicsIs there a biomechanical component to the patient’s condition?
2. Fluid flowAre there issues with fluid flow that could be solved by releasing tissue tension and enhancing movement and respiration?
3. Nervous system, including autonomicsIs the sympathetic nervous system up regulated to a level that impedes organic or systemic function?
Are there peripheral nerve issues that can be improved by releasing tissue tension and compression?
Copyright © 2010, AACOM. All rights reserved.
Osteopathic Manipulative Treatment (OMT)
OMT is used to: Lengthen hypertonic muscles and
connective tissue.
Help joint surfaces glide more normally in physiologic motion.
Decrease pressure on sensitive small vessels and lymphatics.
Decrease nociceptive input to the CNS, which may decrease level of sympathetic nervous system activation.
Copyright © 2010, AACOM. All rights reserved.
Current Numbers
26 osteopathic colleges at 32 sites in 23 states.
About 60,000 DOs in practice.
Projection: by 2020, ¼ of all medical students will be osteopathic medical students.
Doctor of Osteopathic Medicine