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An Open Letter to the Self-Loathing D.O. Students

Here’s a curious phenomenon I can’t help but notice as an osteopathic medical student: the attempt that some osteopathic medical students make to distance themselves from the two letters that will soon piggyback their names forever. (I’ll give you a hint: the first letter isn’t M). As a member of my school’s curriculum committee, I sent out a handful of formal and informal surveys to gather students’ input on a variety of topics. Without fail, there would always be more than a few comments like these:

“…or the USMLE’s baby cousin, the COMLEX.”

“How would I improve [Osteopathic Principles and Practice, the course]? Cancel it.”

“I think at MD schools they have to have their own med student lounge as part of their accreditation.  Why don’t we have our own?”

“Nova Southeastern University School Of Medicine” [This is from a college of osteopathic medicine student’s e-mail signature line. This entity (the “School of Medicine”) doesn’t exist.]

“The COMLEX is totally primary care focused, ’cause they want us all to become PCPs.”

The self-hate is as palpable as a side-bent thoracic vertebra in a scoliosis patient. What happened? Weren’t you out to dinner celebrating your acceptance to med school just a year or two ago? Some of us remain excited, though I’ve been hard pressed to find accurate numbers on the percentage of students who remain excited about receiving a DO behind their name rather than an MD. (I am willing to bet the number is actually quite high.)  Nonetheless, those folks may have picked their DO program for genuine osteopathic reasons, for family reasons (we have a handful of sons and daughters of DOs in my class), or geographic reasons.

Lashing Out at … One’s Own Decision?

I felt the ass-whooping like everyone else in the first years of med school, and I’d occasionally lash out inappropriately, looking for any loosely related party which I might scapegoat lest my ego bear the full burden of defeat. Nonetheless, I don’t recall ever blaming osteopathic medicine, the institution that saw something in me that would make a good physician; nor do I recall attempting to separate myself from the osteopathic part of my new identity.

Yet these generalized, anti-DO comments are just what we see with the “I’m better than the osteopathic world, though I’m also in that world” phenomenon. As I see it, by saying things like those listed above, you’re essentially announcing your post-rejection status, lashing out at what you perceive to be your “JV” team because you’re not on what you perceive to be “Varsity.”

But you are on Varsity—we all are: our US MD colleagues are, and our Foreign Medical Graduate colleagues are. Indeed, if we’re not, I should probably go apologize for the digital rectal exam I gave the other day. As I’ve happily written about before, this isn’t a zero sum game where one person’s success definitively means another’s failure. For full disclosure, I applied to both DO and MD programs, things played out how they did (DO acceptance), and I’m very happy that they did. Like everyone else, I enjoyed that bizarre dichotomy of simultaneously enjoying and loathing school in general during the first two years. DO’s claim to fame, osteopathic manipulative medicine (OMM), is no exception. I’m as much or more of a skeptic than anyone I know (my friends will no doubt agree with me), but when I can’t quite replace a displaced carpal bone in OMM, I don’t proclaim “the whole of OMM is B.S.”  My skills are what are B.S., not OMM.

Further, I hear osteopathic medical students attempt to throw the baby out with the bathwater with OMM all the time, yet are eager to use the latest drugs for a given disease even if the only data we have on that drug is that which the pharmaceutical company has released (what other data they have on the drug is a different question). The bulk of OMM isn’t based on questionable physiology, but on sound anatomic and physiologic knowledge, and the need for more data to back it (i.e., it’s easy to conceptualize that the vast majority of the principles are legit, even if we don’t yet have great data).  However, if you think cranial therapy is all placebo due to a lack of data or plausibility, don’t fall into the absolutism trap and let that tiny portion of OMM bring down NEJM-published low back treatments because you’re excited to place your own profession beneath you. Call it what it is: some parts of OMM are great, others are not. Is it so hard to say this? Again, as a friendly reminder, some drugs are great, others are not. Will you be dropping out to pursue an N.D. degree because of this?

The “DO World” and The Woman Who Offered Me Cash

I’m writing not just to speak negatively of my peers, but because I think the DO world has a lot going for it. We’re stepping on our own feet when we attempt to distance ourselves from our degrees with the self-loathing commentary, no doubt a hangover from the sting of not being admitted to our state or other MD schools (up to ~81% of us by mid-2000 figures, anyway). By mentioning the “DO world,” I don’t aim to encourage an intangible  interconnectedness of some osteopathic realm, but to promote one arm of medicine that happens to offer some unique treatments. All of us who are trained as osteopathic physicians can surely agree that we aim for the best for our patients. That includes utilizing therapies that may be a bit off the beaten path yet are no less useful. Indeed, in many cases they’re perhaps much more useful.

For instance, two days ago I ran into a patient I’d seen in the clinic just a week prior who’d been suffering from severe anxiety after the death of her 18-year-old daughter to an accident. I did a standard occipito-atlantal decompression, and she said her whole body had calmed down during that first treatment (she said it again and again with that pressured speech we’ve all come to expect of someone with severe anxiety). I knew I was supposedly “normalizing vagal tone,” but hadn’t seen it work this well since my OMM professor did it on a 12-month-old who nearly napped in front of 50 students. Did she just need to be touched by another human? Probably. But her trapezius and suboccipital triangle musculature started like rocks and ended like putty in my hands, and that second time I ran into her she offered me straight cash to OA her a second time. Again, she went from rocks to putty, and made sure I’d taught her friend how to do it properly. Do you really want to cast this aside on pseudo-academic grounds? I don’t.

To be clear, I’m not a throwback osteopath who’ll fight to the end to save “our” heritage and “our” traditions. I’ve enjoyed the education I’ve received, and with a few things being cut out, I think every MD student should be learning the same useful techniques and approaches to neuromusculoskeletal problems. Further, I do believe the AOA/ACGME merger is a great thing. I’ve never been a fan of tradition for tradition’s sake. I’ve always been a fan of hybridizing traditions for the betterment of all (i.e. more people receiving the minimum number of drugs if some form of manual therapy can fill the gap and actually fix the underlying problem). To keep this from our MD colleagues would only hurt our patient’s livers and kidneys in the name of “our” tradition.

The Merger, Osteopathic Unity and a Plea for Objectivity

If we wish to continue the momentum of well-deserved integration, I must ask that we stay as positive about osteopathic medicine as we do about pharmacological medicine. That is, be skeptical, but positive about what works. If you don’t know about a particular treatment’s efficacy, say so. Don’t claim knowledge that it doesn’t. Saying “I don’t know about that” is the objective, scientific thing to do, which is especially important coming from the people (like myself) who say we need more OMM research, and dismiss some forms of OMM on grounds that there’s “no data that it works.” Collecting negative data is easy—just scrape by in your OMM class, give poor quality treatments to a few patients, and then tell others that OMM doesn’t work, because for you, it doesn’t. This is one area where OMM differs seriously from drugs: efficacious use is operator-dependent.

So, if this applies to you also, let’s do our best to get over the rejection letters that seem to have semi-permanently colored too many of our glasses brown, because our vocal self-loathing could be holding all of us back (as evidenced by this junk Forbes blog post, which will make every DO’s skin crawl). Last I checked, we’ll all be physicians, and I’ll proudly carry DO after my name just as I would any that signified I were a physician (MBBS, MD, whatever). I urge you to move beyond those rejection letters like you did for all the DO schools you didn’t get into. In the near future we’re likely to assimilate even further with our MD colleagues, but the bizarre negativity of which I’ve written will only delay this and confuse the public about what we can offer (even if that is indeed solely standard Western medicine). Indeed, when we become more well-known is exactly the time that we need more unity, and that time is now.  I don’t want to look back on my career and think that I should have capitalized even a few solid OMM techniques that I could have taught both my MD colleagues as well as my patients to help control their health care costs, and what’s most important, their discomfort.

Author’s note: For a decade old, but still relevant and very interesting commentary on DOs, see another piece from the NEJM, The Paradox of Osteopathy

Will Jaffee, DO Will Jaffee, DO (6 Posts)

Medical Student Editor Emeritus (2013-2015)

Nova Southeastern University College of Osteopathic Medicine

Will graduated in the Class of 2015 at Nova Southeastern University College of Osteopathic Medicine, and he is now an attending in Adult Inpatient Medicine at Maine Medical Center. He went to Oberlin College where he majored in philosophy and snark. He is passionate about reproductive health, humanism, music and riding his bike as much as possible. To see more glamorous writing on science, bioethics, and unique perspectives on the training of future doctors, check out his blog, Doctor Coffee's Brain Banter.