Philadelphia College of Osteopathic Medicine - Synapsis Yearbook (Philadelphia, PA)

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WelWm hiladel Jia FRANK L.RIZZO, MAYOR r 1 P m Ss iE 1 l| Wv

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PROLOGUE: State of the Art In 1974, The New England Journal of Medicine published a special article entitled, Trends in Gradu- ate Medical Education and Specialty Certification (N Engl I Med 290: 545-549, 1974), a tracking study of U.S. medical school graduates. They find, Of the 1960 graduates ... 99 percent entered residency, 86 percent completed residency . . . and 73 percent had achieved specialty certification. In addition, they point out that, The overwhelming motivation for graduate education and specialty certification . . . together with a shortening of formal medical educa- tion, and approva l of the specialty of family practice (1969), warrant the conclusion that during the 1970 ' s, virtually all United States graduates will undertake residency training and seek specialty certification. This report and a recent redefinition of the es- sentials of medical education form a policy statement which affirms that undergraduate medical education prepares the student for further education in a gradu- ate program and not for the independent practice of medicine. Either these conclusions are in error, or we, as osteopathic physicians, must seriously consider our present identity and our presumed usefulness and acceptability to American Society. Our training, which mandates a rotating intern- ship, is conducive to advancement in graduate osteo- pathic residency programs, and is largely directed towards the preparation of primary care physicians whose approach is to be holistic, with concerns not limited to mechanisms alone but also with the indi- vidual and his environment. Our osteopathic medical education includes both a philosophy, which is well known to us, and an assumption that the training of a physician is a process which never nears completion, but which proceeds after didactic, clinical and intern- ship training, with much dependence upon the experi- ence gained from patients at the bedside. There exists opinion that osteopathic medicine adopted this role as primary care clinician when that area of patient concern was abandoned as specializa- tion and ultraspecialization became commonplace among allopathic physicians since the Second World War. Yet, the maturatibn of osteopathic medicine over the past one hundred years has progressed as though it were fed a diet of sound and cohesive ideas rather than having scavenged the remnants of medical opportunity. The concepts with which we have learned to approach a patient are holistic. We now think of a patient as an integrated unit, indivisible into sepa- rate parts. The osteopathic specialist is derived from this fundamental precept. Our philosophy, which as students, we viewed as a catechismal burden, prevents that development of a heart, or gut, or bone specialist. From our midst, only an osteopathic physician may emerge; and as a specialist he may be well versed in cardiology or gastroenterology, etc. Modern osteopathic ideology and practice differ greatly from that which sprang from the doctrines of Andrew T. Still in 1874. Though he utilized drugs and surgery, many diseases were thought due to ab- normalities in or near joints and that the treatment for these diseases is the correction of these abnormalities. By the Mid-20th Century, our pattern of practice had undergone considerable change. We have become eclectic; retaining the concept of the spinal lesion but recognizing that physical, chemical, nutritional, hor- monal and immunologic factors influence the state of health and that improved drugs and contemporary surgical competence are necessary and d esired modali- ties of treatment of many dieases. The modern osteopathic physician has become a unique individual. Borne on the arms of an educa- tional system which diverged from and opposed the prevailing concepts in therapy and diagnosis during its infancy, today osteopathic medicine recognizes an interdependence with allopathic medicine. Medicine has progressed rapidly and effectively in the past one hundred years; diagnostic methods have become exacting; therapeutic modalities have become com- patible with physiologic principles clarified since that time. The osteopathic philosophy is now one which may be played in concert with the precision of allopathic medicine. Our role as primary care physician is fortified by the existence of men in medicine whose work pro- vides research, improvisation and specialization. We are able to employ diagnostically and therapeutically the most excellent from the entire spectrum of medi- cine while at once creating a most intimate relation- ship with our patients. We have become the craftsmen at the level of the object. We are the first physician. As students of osteopathic medicine we have been taxed with the burden of understanding some complexities associated with our profession. Origi- nally, Andrew T. Still created opposition by his refusal to employ many drugs then commonly used. The efficacy of agents then employed is so question- able that his non-pharmacologic therapies were by comparison the sounder. When pharmacologic, bio- logic and synthetic materials improved and became available, the osteopath avidly employed these agents. Undeservingly, he was given a stigmata as only a manipulating therapist. Much of the significance of his earlier non-pharmacologic modality was forgotten. Compare the benignancy of manipulation with an armamentarium of polypharmacy, bleeding, purg- ing, blistering, leeching and puking, in use up to the time of the Civil War. Ouinine was consumed in great quantities for any fever and calomel was used so