What is Osteopathic Medicine?

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I remember when I was first accepted into medical school. I couldn’t stop talking about it. Many of my family and friends were excited and had so many questions. After telling them I was going to Georgia Campus – Philadelphia College of Osteopathic Medicine (GA-PCOM), the follow-up question was always, “What is osteopathic medicine?” If I had a dollar for every time someone asked me that question, I’d be halfway done paying my student loans back. (Ok, not really.) I still giggle when I think about the first time I told my mom about osteopathic medicine. She said, “osteo-what?” The look on her face was priceless.
whatchu talkin bout meme

I was once clueless about osteopathic medicine, myself. I had heard of it before, but was not well informed of what it actually is until I went to graduate school in Philadelphia, PA. I was a member of the Minority Association of Pre-medical Students (MAPS) and was exposed to osteopathic medicine at a medical conference at the main campus of PCOM. I learned about the history, principles, and training of osteopathy. While there, I also saw osteopathic manipulation demonstrated and my curiosity was piqued. After shadowing physicians who practiced osteopathic medicine and seeing the benefit their patients received, I was convinced that going to an osteopathic medical school was just the thing for me.

To fully understand what osteopathic medicine is, you should know a little bit of history. Andrew Taylor Still, MD, DO, is considered the “father of osteopathic medicine.” In 1854, Still was granted the MD (Doctor of Medicine) degree at age 26 in Missouri. MDs were trained in American Orthodox Medicine (now allopathic medicine).
Dr. A.T. Still (Image from Missouri Digital Heritage)

Between 1859-1864, he lost his first wife and 3 of his children to the meningitis epidemic that hit the country during the time of the Civil War. Still also served in the Union Army, and as a surgeon’s assistant he saw that orthodox medicine wasn’t working. In fact, it was doing more harm. He wasn’t satisfied with drugs and unnecessary surgical procedures so he set out to study medicine again by reviewing chemistry, physiology and anatomical dissections. He believed that the human body had the ability to heal and care for itself. He used his hands to diagnose and treat his patients.

In 1874 when he tried teaching his new ideas to the traditional medical community he wasn’t well received. A.T. Still later founded his own school in 1892, the American School of Osteopathy (now A.T. Still University). Over time, his practices  gained traction and many other osteopathic schools begin to open around the country.

The field of osteopathic medicine faced opposition from the traditional medical community, but by 1973 osteopathic physicians were allowed full unlimited practice rights for the first time in all 50 states, with licensure in Mississippi.

In 1980, the first residency in OMM (Osteopathic Manipulative Medicine) began at the Philadelphia College of Osteopathic Medicine in Philadelphia, PA.

As an aside, Walter C. Ehrenfeuchter, DO, FAAO began training that year in the residency program and served as the first resident in the history of the profession in Osteopathic Manipulative Medicine. Dr. E (as we call him) has taught OMM for over 30 years. Currently, he is the Professor and Director of OMM at the Georgia Campus of PCOM and I am proud to have trained under him. He is awesome! Shout out to Dr. E!

Let’s move from the history of osteopathy to its training. There used to be a big stigma associated with DOs in the medical community. The MD vs DO comparison led some people to feel that DOs aren’t “real” doctors, and that they aren’t properly trained. That can’t be further from the truth! As a DO, I have the degree Doctor of Osteopathic Medicine. Just like someone with an MD behind their name, osteopathic doctors are fully trained, licensed to practice in all medical and surgical specialties and subspecialties, and are licensed to prescribe medicine. Additionally, DOs have 200+ hours of training in OMM incorporated into our curriculum. So if anyone tells you that DOs aren’t “real”doctors, you can now properly inform them of the truth.

So now that we’ve cleared that up, what exactly is OMM? I’m glad you asked. Well, from A.T. Still’s teachings, osteopathic medicine was born and 4 major principles emerged:
  1. The body is a unit.
  2. Structure and function are reciprocally related.
  3. The body possesses self-regulatory mechanisms.
  4. The body has the inherent capacity to defend itself and repair itself.
Those of us who train at osteopathic medical schools understand this and we learn to use our hands to diagnose and treat dysfunctions of the neuromuscular skeletal systems. We use a holistic approach to treating a patient, rather than just focusing on alleviating the symptoms of a disease. The best way to understand it is to look at an example:

Let’s say I have a patient who presents with shortness of breath but their lungs are completely healthy. Dysfunction of the muscles attached to the ribs can prevent the ribs from moving properly (called a rib dysfunction), which prevents the diaphragm from moving correctly. All of this can create a pressure gradient in the thoracic cavity that prevents the lungs from filling fully during inhalation. It’s an intricate and interesting concept, and as a DO I have the ability to diagnose this problem using only my hands. Because I know which muscles are attached to which ribs, I can use my hands to feel those muscles while my patient inhales and exhales. I can determine which rib is dysfunctional or out of place. After making this diagnosis, I can then use my hands to apply pressure and manipulate the problematic muscle and put the rib back in place. This is a simplified example, but hopefully it helps you to better understand OMM.

Knowing that I can provide this type of treatment option to my patient, along with traditional methods of medicine, is what makes me proud to be a DO. I like to tell my patients that as a DO I have a set of extra tools in my medical toolbox to use when providing them with the best care I can.

I remember when I first saw OMM being performed at that MAPS conference in Philly. Years later, I am still fascinated by osteopathic medicine and am proud to be among many others who have earned the degree Doctor of Osteopathic Medicine.

If you’re still wondering about osteopathic medicine, here are a few links that may be of interest:

**Much of the history provided in this post was summarized from one of my 1st year med school lectures:
 Ehrenfeuchter, Walter C. “Osteopathy’s Place in American Medicine.” Powerpoint Presentation. GA-Philadelphia College of Osteopathic Medicine. Suwanee, GA. 29 August 2011.

-thedoctorjb

 

FEET in your SHOES

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Dr. Seuss - road

Many of us can recall our favorite books from the brilliant Dr. Seuss. He has been quoted for years and is still relevant today. The aforementioned lines from, “Oh the Places You’ll Go,” is often echoed at graduation ceremonies and other milestones when one enters a new phase in life. I agree with Dr. Seuss that we have the ability to choose our destiny in life. However, I strongly believe that we become who we want in life not of our own volition alone, but rather due to the influence of those who have traveled similar roads before us.

One of my biggest inspirations has been my mentor, Dr. C. I remember the first time I met her. I had just come from a six month leave and was excited to be back on rotations, especially OB/GYN. Usually, I’m nervous on the first day of a new rotation but once I met Dr. C, my anxiety turned into curiosity. I was eager to know more about this lady who was petite in stature, but stood strong in knowledge, wisdom, and influence. I’m not sure if it was because she is young and relatable or what, but we just clicked. I learned so much that month. Not only how to diagnose and manage specific conditions, but I also saw first hand what it means to connect with your patients. The relationships that Dr. C had with her patients was intriguing. She had ways of relating to women of all ages, backgrounds, ethnicities and personalities. She was unrelenting when educating her patients. I watched her encourage women to lose weight and take better care of their bodies. I listened to her conversations with young teen mothers, in which she showed no judgement, and extend compassion and kindness.

In one month Dr. C taught me so many things aren’t found in the pages of medical journals and textbooks. One of the most important things I learned was self confidence. She saw something in me that I did not even see in myself. After struggling to pass my board exam, I started to doubt myself and was tip toeing on a tightrope of self pity. Dr. C poured into me and shared her story with me. Everyone has a story and sometimes you don’t realize what drives them until you know what they have been through. Such was true with Dr. C. She shared her testimony of how she faced many obstacles and setbacks in her career. Nonetheless, she persevered and later ended up as chief at her residency program and is now distinguished in her field. She helped me to stop feeling sorry for myself, shake back, and get my rear in gear. It was what I needed at just the right time to push me to keep pressing toward my goal of graduating from medical school. In my eyes, Dr. C was superwoman, like literally. I witnessed this lady function off of 3 or 4 hours of sleep, perform early morning surgical procedures, take her children to school, see patients in the clinic, pop in at a rotary club meeting and then manage to make it to see her daughter cheer before heading back to the hospital…all in one day! She definitely has some Black girl magic and I was proud to learn and glean from her.

It’s been nearly 2 years since that OB/GYN rotation, but we still share a bond that I will forever be grateful for. We don’t always get to catch up via phone conversations, but she often sends texts with pictures of her children, who I absolutely fell in love with. She sends me articles that she has published and magazines that she is featured in. She even gave me a list of fun places to check out during my upcoming vacation. If I need her, I know I can count on her.

Good friends of my family have a 16 year old daughter who has an interest in pursuing a career in medicine, and I now have the privilege of being her mentor. Every time we talk, I think of the suggestions and recommendations that I received from Dr. C. More importantly, I am reminded that the life I live and my encounters with others will probably teach my mentee more than any of the advice I give her.

So yes, Dr. Seuss, I do have brains in my head, and feet in my shoes; however, the path that others’ shoes have traveled continues to shape me into who I am today. If you have a mentor or someone who has motivated you in some way, give them a call or send them a text today just to say ‘thank you.’ Who is your mentor and why? Let me know in the comments.

-thedoctorjb

COMLEX/USMLE Preparation and Test Taking Tips

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It’s that time again, I know all of you 2nd year medical students are probably freaking out right now because your board exam is right around the corner (if you haven’t already taken it). I have put together a list of tips that helped me along the way. Now, I don’t claim to have the BEST suggestions, but given the fact that I had to take that stupid exam more than once, ya girl can tell you a thing or two. By the way, I only took the COMLEX exam and not the USMLE, but I’m sure there is some general overlap in the way you would prepare.

1. Probably the most important piece of advice: FIGURE OUT WHAT WORKS FOR YOU!

People learn in different ways, so know that what works for your friend may or may not work for you. I fell into the trap of asking all of my classmates and upperclassman their study strategies and tried to make them my own. Some of their tips work and some didn’t. Just keep that in mind moving forward with this list.

2. Manage your time wisely.

Create a study schedule and stick to it as closely as possible. I’m an Excel person, so I made a spreadsheet. I allotted a specific number of hours for each subject, giving the most time to my weaker subject areas. Regarding your study schedule, do not set yourself up for failure. Allow yourself some time to do things that you enjoy. For example watch your favorite 30 minute TV show (no binging though) or work out. Trust me, if you don’t have some sort of balance you will go coo coo for coco puffs.

3. Don’t use too many resources.

I found, through trial and error, that when I was using too many resources I became overwhelmed and actually was studying less efficiently. After narrowing things down, this is what I used for Level 1:
First Aid for the USMLE
Doctors in Training (DIT)
COMBANK and COMQUEST question banks
OMT Review by Savarese (the green book)

I would advise going through First Aid multiple times. It’s pretty much the Bible for board prep. I took mine to my local office supply store and had them cut off the binding and put spiral rings in it. That make it easier to navigate. DIT was helpful, but I only used it for Level 1. Some of the videos are a tad bit corny, but hey, the info sticks. I really like the study guide workbook that comes with it. Now for my osteopathic people, there are multiple articles and reviews all over the interwebs that list the advantages and disadvantages of COMBANK and COMQUEST. I used them both for Level 1, but only COMBANK for Level 2. I like them both, but for different reasons. Here is a good in-depth review of both from Alex at Medical School Success. To the USMLE folks, I can’t give my two cents about Kaplan question banks but I did use UWorld for Level 2 (but only for a few weeks). In my opinion, the questions are good for reinforcing general clinical knowledge, but if you are using UWorld to prepare for COMLEX, they way in which the questions are asked is not a good reflection of how they are asked on the COMLEX. Regarding OMM on the COMLEX, if you go through the OMT Review book and do multiple runs of the OMM questions from your question bank of choice, you will be fine.

For Level 2 CE, you will be learning on rotations so study and review for whatever rotation you have that month. I used Step Up to Medicine and Master the Boards. I also did an OMT refresher with the Savarese book and used COMBANK again.

4. Do as many practice questions as possible.

Once you complete all of the questions in a particular question bank, do them again. Repetition is key here. When first starting off, I did questions to coincide with the topic I was studying. Later on, I did them in random mode. As test date approached I used the timed mode to get used to going against the clock. When reviewing the questions, I strongly recommend that you go over every single answer choice for each question, no matter if you answered it correctly or not. Trust me, it helps. Additionally, take a few practice assessments before the real exam. You can buy the COMSAEs from the NBOME website or purchase the assessments from COMBANK. It’s cheaper to use the latter.

Note: The following applies to preparing for the COMLEX Level 2 PE:

5. Practice your history taking, physical exam, and OMT skills with classmates/friends. 

I used the COMLEX Level 2-PE Review Guide and went through all of the clinical cases. I also wrote a practice SOAP note for each case and did it timed on the NBOME website here. I made a habit of typing the assessment and plan first, before typing anything else. That way, if I ran out of time typing, at least I would have that filled in. This came in handy when I took the real exam. For OMT, I focused on mastering a couple of techniques from each body region. Again, repetition is key so once you do the same techniques over and over while practicing with someone you will be fine.

Now, a few tips for test day.

6. On the night before the exam, relax and get a good night’s rest.

Yea, it’s common sense, but you do NOT want to be tired during an 8 hour exam. By relax, I mean don’t spend the final 3 hours before bed studying. Do something to ease your anxiety, like watch your favorite movie before bed.

7. Eat breakfast on test day, and bring lunch.

Be sure to eat a good breakfast, but don’t go to IHOP and get a stack of pancakes before heading to the test site. You don’t want that postprandial sleepiness (aka food coma) to kick in while you are only 2 hours into the exam. Bring something light for lunch for the same reasons as above. Additionally, don’t drink too much water because unscheduled bathroom breaks will take away from your test-taking time.

8. Don’t spend too much time on one question.

If you are unsure of an answer, choose something, mark it, keep moving to the next question and come back to it later. You still have a chance of getting points if you guess correctly. That’s way better off than leaving an answer blank then possibly running out of time to come back to it.

9. If you fail it’s not the end of the world.

Trust me, I know. If you find yourself in this situation, do a self evaluation to figure out what went wrong. See what subjects you performed poorly in, and get back in the saddle. Start to prepare to take the exam again, and be confident.

10. When you pass the exam celebrate and know that your hard work paid off.

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-thedoctorjb