Is the doctor's word final?

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Permalink Reply by Ronan O'Brien on July 3, 2008 at 12:41pm

Good find Mary. I have exchanged a few emails with Martha, the person behind the Spiritual Life of a Medical Student blog, a few times in the past. Hopefully she'll join us here some day!

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Permalink Reply by Mary on July 3, 2008 at 12:45pm

Oh, that's great! I was thinking about pointing her in the direction of Sacral Musings as clearly this is where all the cool kids hang. :)

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Permalink Reply by Jonathan Edis on July 3, 2008 at 3:28pm

Mary, how much do you know about the history of osteopathy? If you don't know much, here is a very brief snapshot on American DO's. If you're genned up on it, my apologies for boring you.

Due to a very different legal system in the USA, American DO's fought long & hard, state by state, to get the status of MD's - it was the only way that they could legally practice osteopathy. When they got it (in the 60's), they also got the right to be drafted into the US Army Medical Corps for Vietnam - lucky them.

There was also a big debate in the 20's & 30's when osteopathy split into 2 camps - the majority broadists, who wanted to bring in new medical diagnostics & treatments, & the minority lesionists, who wanted to stick with palpatory diagnosis & treatment. As a result, American DO's are involved in far more areas of healthcare today than osteopaths in the UK.

It is true that there is a problem with professional identity for Americn DO's, as they struggle to differentiate themselves from their MD equivalents; many no longer use manual treatment, though I would argue that this doesn't matter as it is thought processes that are brought to bear rather than the treatments deployed. But identity is an issue that many osteos are facing throughout the world, especially here, except we agonise about how we're different to the physios & chiropractors, who are way down the medical pecking order compared to the doctors.

So, in a way, the in the US, the DO's word can be final - in the UK, it is always the doc's.

Jon

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Permalink Reply by Mary on July 3, 2008 at 3:43pm

That's very interesting, thanks, particularly your last point which makes the situation very different. It seems a bit like Morton's Fork though - the DOs can have the final word, but if they are prescribing drugs and doing surgery do they not then struggle to find a truly osteopathic approach? I don't know... it seems from what I've heard sometimes quite difficult. I guess that's kind of what I meant by my comment - how far can allopathic and osteopathic medicine really mix? I guess this is another thread, but it seems (to my mind) a relevant tangent to Kino's original post. :)

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Permalink Reply by Jonathan Edis on July 3, 2008 at 3:57pm

Hey, tangents are good.

There is a quote from AT Still (the founder of osteaopthy) that i used in my disseration that went something like:

just like oil & water, so osteopathy & medicne can never mix.

However, he meant medicine as it was practiced in the late 19th century, before the reforms of doctors such as Sir William Ostler, who had a remarkably similar vsion to, & independent of, Still. Still was a surgeon, & surgery was part of osteopathy courses in the US from the very earliest days, along with midwifery. Therefore, he wielded the scalpel with the idea of osteopathy (surgery & dentistry are closer to osteopathy today than medicne in that we all make changes directly; the physician makes change through an intermediary - the drug - though you could still prescribe osteopathically). Idea is the key word here - it is not my hands that gets people better, but my mind - I have to think & that directs my hands, not the the other way around; therefore, the tool for the job doesn't matter.

This might upset / inspire some, so I've got my tin hat on.

I can send you loads of refernces for this, but I'll do it seperately to this if you're interested - maybe we start our own thread, as you suggest. If you want refernces, I can send them tomorrow when I'm back in work.

Jon

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Permalink Reply by Jonathan Edis on July 3, 2008 at 4:00pm

P.S. Mary

For a bit more background & context on what I've said, have a look at my longwinded post on the discussion 'Osteopathy: Minor orthopaedics or holistic healthcare?'

Jon

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Permalink Reply by Niklas on July 9, 2008 at 8:48pm

Good evening friends!
Could it be that the last word belongs to the patient?

All the best / Niklas

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Permalink Reply by Kuno on July 9, 2008 at 9:31pm

The final choice belongs to the patient. The practitioner cannot agree to do something unjustified, dangerous, or unethical, just because the patient has demanded it. Only the practitioner can determine if his own intervention is indicated (notwithstanding prevention of wrongdoing), and this determination must include the views of the patient. But practitioner and patient must both be in consent, and the patient can choose any practitioner (in private practice, at least), or none.
Is this correct?

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Permalink Reply by Niklas on July 9, 2008 at 9:47pm

This is absolutely correct. My comment was meant to bring the patient into the the discussion instead of just being the arena.

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Permalink Reply by Kuno on July 9, 2008 at 10:16pm

quite right, without the needs of the patient there is no osteopathy.

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Permalink Reply by Tom Lutener on July 10, 2008 at 8:13am

Hmm, interesting stuff. The respect for the doctor is changing, I think a bit of this is reflected in the amount of G.P's who are now setting up private practice (to disassociate themselves from some of their colleagues in the NHS). All we can do is ensure we are the best we can be all the time - continually learning is the key. I find it strange that some moan at CPD - having to do CPD shouldn't be the problem, deciding what to learn first is the problem!

I think the other point is that you see some patients who have a huge disc herniation (on MRI) and have no symptoms and you can see someone with a slight protrusion and have every symptom under the sun! Why, because it's not the disease that's the issue it's how the person reacts to it. There is always too much emphasis on "what we see" - just shows that no-one really knows what goes on inside a person, physiological, anatomically and psychologically. But the medical profession either think they do or give the impression they do - that will always be an issue. There will always be a "black or white" mentality.

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Permalink Reply by Tom Lutener on July 10, 2008 at 8:15am

One other thing. I was speaking to a medical student recently and her belief was that there shouldn't be "patient choice" as they do not understand enough to make the right decision! Brilliant!

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