Episode 7: Practical Applications for the Osteopathic Physician.

Hi, this is Megan Callahan, OMS2 at Leacom. This is Scholar Plus Podcast, gathering people of like minds. Here are our hosts, Michael Arlene, DO, and Bob Hostoffer, DO. Welcome to the seventh Scholar Plus Podcast. I'm Dr. Robert Hostoffer. I'm from the University Hospital's Cleveland Medical Center. What's me sitting right across from me is Dr. Michael Awain, and then here's our resident philosopher Ken Palco. Glad to be here. That's great. Yeah. Dr. Michael Awain, I'm the Associate Dean for Clinical Education at Leacom, and it's great being part of this. We began this kind of journey. Bob and I both share a real passion for looking at the osteopathic approach and the philosophical approach, because that's kind of what really is very unique, and we began this series with us kind of looking at models, looking at tenants, what this is about, and then we brought in a family physician, Dr. Lou Leone, to kind of look at a perspective from one discipline, and we were kind of going in that direction instead. Bob goes, "Wait, so we got a philosopher, so we got a professor of philosophy." There's a name college, and boy, you know, kind of went from there. Yes, I was invited to participate in one of the podcasts, and they had me come in, and again, I have no medical training. My background is a philosophy professor, something I've been doing for 31 years. And so in that early podcast, I just talked about philosophy in general. There's a subject, and of course it's an academic subject, and you can talk about the history philosophy and different philosophers like Plato, Aristotle. But also there's the applied part of philosophy, I always like to share with people that philosophy is more than just reading something in a book. It's a way of being in the world, a way of living a life. And with certain principles, the idea of questioning the world around you, keeping an open mind, you know, clear logical thinking, et cetera, we can maybe revisit some of those. And so that was that first podcast, and then Dr. Bob gave me one of AT Still's books. I'd never, to be honest, I'd never heard of AT Still. And I just, I just read through this, marked it up, and when I was reading through this, I was like, and this realization that AT Still, he is living his life as a philosopher. He's questioning the medical profession around him. He has the courage to do that. He's trying to solve, you know, diagnose the patients, and with, you know, at the time, it's considered unconventional ways to do this, you know, actually touching or laying on a hand and observation, close observation. And then after, I think my third time when it was here, and it was kind of a combination of all this, we came up with that phrase, the philosopher physician. Oh, physician philosophy. Oh, that's right. You like physician philosophy. We debated that a little bit. We're going back and forth on that. It kind of all, but it's cool. Physician philosophy. Yeah, he's beginning. Again, we gave him a cold. You didn't really have any background with that. And then when you got the book, it was just like I said, you're like a kid in a candy store. Yeah. So exciting to read. And that made a lot of sense when we came to that physician philosopher, because that's very unique. That's unique in medicine today. And the idea that I wanted to sort of bring around at this, during this session, is to talk about how we could apply it. So here we are, physician philosophers. How do we apply our philosophy to our practice? And what is it? Is it applied philosophy, philosophy in action? Where, where we headed from here. And I'd like to get some discussion on that. And I'd like to just say, too, is when we did this, that folks, no, we did a lot of focus groups around the things we have done. And these has been a year since we had our last podcast. We've been really reflective looking at this and coming back in this. And I think we're trying to hit the next level. And these were people. These were residents and students and fellows, faculty, small groups. And we kind of sort of mixed it up, tried to sort of fish out the ideas. And I know the last time we really came up with some great stuff. But Ken, what do you think about philosophy in daily use in our lives? Just in general, not medicine, just in general. So how do you do it? How do I do it? This is very apropos. The timing is pretty good because I'm, like I said, I've been teaching philosophy academically for 31 years. And this was my last year teaching. But it's not like I stopped being a philosopher. You know, I had graduation was last weekend. It's not like I'm done being a philosopher. So this is, this is a lifelong endeavor. And part of that is, is a philosopher, the Greeks had a word for this. They called it air tape. It means excellence. So living a life of excellence, whatever you choose to do, no one's going to tell you what to do. But whatever you choose to do in life, try to do it your best. And, and, and that's a daily, you keep that in mind every day. As you start, you know, start your day and your day, you know, have, have I become better at what I choose to do. So as a, like a teacher, I would ask myself at the end of the day, how did the classes go? You know, did I do my best? Was that a philosophical objective? Was that what you were? Yeah, you want to, you do the idea of like self examination. Yeah, questioning yourself. And that's the hardest thing to do, actually. You know, there's, you know, Plato's on Socrates, know thyself might have heard that phrase, know thyself. That's the hardest thing to do because it's really tough to be honest with yourself sometimes. Reflective. Yeah. Reflective. And, you know, how can I improve? What did I do wrong that you're almost giving yourself self criticism and being able to grow from that and evolve? So yeah, that's true. So is it is a physician? You know, you, you, you want to be the best physician. You can be not only for yourself, but for your patients. I like that word of evolution evolve. Yeah. And, and you know, AT, that's what he was doing. He was evolving as he talked through these things and as he wanted to do better and better and better and evolve into a, to, to the, to the profession we have, right? So maybe that's a point we have to remember is the evolution philosophy is the evolution of a human spirit. Well, yeah, it's a, it's a life-long endeavor. It doesn't, like once you get your degree, whatever your degree is in, it's not like, okay, I stopped asking questions about this. I, you know, see, and that's where that kind of intellectual humility comes in. You know, you, you, you, you have to be willing to learn and, to change and, well, in part of his being reflective too, we, one of the things when we've had these kind of focused sessions we've done and we've incorporated one of the things we've said is, you know, we're so busy doing our daily things, but there's yet to stop a second and say, why are we even doing what we're doing? And I said sometimes, you know, maybe I'm reflective, like some of my seventh decade and now I'm looking at life differently and I'm looking at those things and we try to instill on them and say, yeah, if all these things you have to do, but why are we doing what we're doing in that philosophical approach, which guides us to why the difference we're making and doing things too. And then that maybe what we're looking for in medicine, like you said, is this philosophical approach of developing excellence by reflecting on our daily lives and have we done, have we moved forward, have we gotten better? Yeah, and this, this is nothing new. I mean, these are very, this is very ancient kind of, we can call it wisdom. You look at a lot of world religions, this idea of reflection and prayer and, you know, calming yourself, centering yourself in, because life is busy, life is stressful and if you're stressed out or if you're letting your emotions get the best of you, you're not going to be the best physician you can be. You're not going to best anything you can be. I mean, I'm just focusing on the physicians, but, you know, if I'm a teacher, if I'm all stressed out and have anxiety, I'm not going to be the best I can be in the classroom. So I need to have coping mechanisms to deal with that. And again, there's different ways to do that. So applying a philosophy or philosophy in action is actually looking for continual evolution in your daily life, how you become better every day. And that may, that may be something we can apply, we can say that may be a physician, philosopher, looking for improvement in the, and reflective improvement in their daily lives. You know, if you may be like a final exam at the end of the day. Well, I like to share, sometimes with my students, you know, before at the end of your day, ask yourself some questions, you know, have I improved my mind today? Have I learned something new? Again, whatever your profession is or whatever your studying, have I improved my mind? And if you can't honestly say yes, I tell the students, well, we don't have, they don't carry dictionaries and I say keep a dictionary next to your bed and learn a new word, but now you should phone. Look up a new word, learn something so you can say yes. And then another question, I have them ask themselves at the end of the day, have I taken care of my physical body? No, have I been good to my physical body? Have I, you know, eaten good food? Have I done some type of exercise? Holistic. Holistic. Yeah, that mind body. Exactly what exactly my body spirit, where AT actually mentioned that. So maybe that's not just applicable to the patient, but applicable to the physician. Well, it has to be, yeah. to both, because it's almost, I mean, he talks about the unity mind-body spirit. But you almost, you think about the physician and the patient are interacting together. And so I think if the physician is, if their mind-body spirit is in a good place, that's going to help them be a better physician. Again, like they're going to be able to manage things like that stressful world around us. And also you have the role model, I mean, if you don't role model things yourself. And I think we're trying to, there's a big push in medicine, physician wellness and we're incorporating that. And we see these osteopathetic ideals, they say we have to also model those to patients. We want them to be in, because the idea is to help them move forward. Yeah. So maybe one part is that, you know, we're seeking the, you know, an evolution of improvement in body, mind, and spirit. Yeah. Yeah. Could be what he's meaning for us. Yeah. So it just reminds me of AT. So another question you can ask yourself is I, at the end of the day, have I improved my skills with that, whatever I'm choosing to do, have I improved my skills? You know, so if you're a musician, have you practiced, have you become a better musician? But like AT still, he would have the, his students, like learn anatomy and, you know, feel the bones, like that tactile, so that that's it developing a skill and, and you have to practice that. I remember some part in the book, he's, you know, it was kind of, it's not so much like, how many years you have to study or passing a test, it's like, okay, have you developed the skill to be able to identify, like I think he was able, he could feel certain bones with his eyes closed and tell you exactly what the bone is and seeking excellence. Yeah. And using, using senses, maybe, you know, mind, body, spirit, using sensory and developing more excellence in those skill sets. I know. I know when the students, the first week, they come, I give a lecture and most professionals and but I also have a kind of focus and they said, is every day do the best you possibly can to be the best osteopathic physician and take advantage of every opportunity and I think, but that's a life long thing, never, never ends, it never ends and I think what happens if you, you have to actively pursue that because our world is filled with so many distractions that, yeah, it's easy to go a day without improving your mind, working on your body, working on your spirit, centering yourself, working on your skills, yeah, there's so many distractions. Yeah. So it's really just, it's a really life-long learning, but life-long evolution, life-long seeking for that improvement in skill sets or improvements in our body, mind, and spirit and balance. And just the whole balance of the whole thing because that's what AT talked about as well. But then also, you know, looking for that same part and this is where this next topic comes up in the models is that looking at those components and excelling by evaluating those things, using our sensory, all the senses we have, like, I think AT didn't AT still say about the senses, utilizing all senses. Yes, not just your sight, but touch, tactile. I mean, that's what, you know, when I'm reading this, I'm like, wow, yeah, this is a physician philosophers, there's something called, like the observational process, you know, two ways you're going to acquire knowledge about the world around you. One is through your observation, and the other is through reason, you know, reasoning, rational reasoning. So you want to become the best observer you can be, and if you're just using one of your senses, you're not going to be the best observer. So touch, maybe smell, you know, hearing, and I think all of that that goes into an observational process, and then, you know, becoming consciously aware of it, because so often we go through our day and we miss things, we're not seeing things, and you know, earlier we were talking about, there's the way our mind works, there's built in bias, I mean, we can't escape bias. What we need to do is work on minimizing different biases, but we recognize it, we recognize it, and it helps you run away, yeah, exactly. So I like those ideas, so that if we have a physician philosopher, his job as a philosopher, a physician, he moves through seeking excellence every day, and reflective every day, using his observational skills, his rationalizing things, and sharpening those skill sets at the end of the day. Maybe that is what an osteopathic physician is, and then he becomes a role model for that pay for his patience, because you want everyone to improve, to evolve, and so you can relate to people too, because your physician's male, female, and different, they relate to that and see, you know, we can go through that. Being a physician philosopher is a development of being a diagnostician, a better diagnostician, you know, through looking at body, mind, and spirit, but also those observational skills, rationalization, the improvement through every day, and maybe at the end of the day say, what could I have seen different, you know, and yeah, I agree, and part of that is, if you want to be a keen observer or a keen thinker, you have to be able to relax and control your stress, control your emotions, I know, you know, we've all been students, but maybe you can recall a time when you were taking a test, and you've prepared, you've studied, you read all the material, you read the question, and your mind goes blank, and you're just sitting in teachers, like 10 minutes left, and you just can't recall it, you can't recall it, times up, you turn in your exam, you walk out the door, answer pops into your head. Well, why, because now your body's not in fight or flight, it's not stressed anymore, it's calm down, the test is over, and now you can retrieve the information. You knew it all along, it's just because your body was so stressed, you couldn't, you brainwin it and allow you to access it. So, yeah, think of it a physician, if they're going to diagnose a patient, and they're stressed about, you know, something with their family or their children or, I don't know, money stressor, if you're not controlling that, you're not going to be doing your clearist thinking, you're not going to be doing your clearist observation. So, using it inward and using it outward, you know, using it to help your body, mind and spirit here, and then utilizing it to make a diagnostic aspect, you know, improving your, every day, your diagnostic skill set, and that's what we want to do, right? Because that's our job, is to diagnose, you know, one thing that causes the most anxiety and patience is not knowing what it is, you know, they're sick, what is it, could it be this, am I dying? And then you have to come in and have to say, okay, I know what it is, you know, I can figure this out for you. That skill set, if you improve and work at it every day, and I think maybe that's what he was up to, is that body, mind and spirit is that, I have to say this, there's a, there's a doc out there who listens to our podcast and he's a surgeon, I'm just going to call him Ray, and he always reminds me, I get up on top of this, you know, lecture, and I'll say, mind, body and spirit, he'll tell me, he at AT stills always said body, mind, spirit, not mind, body spirit. Start the basis and you build up the body. So I'm done, thank you, Ray, I'm just going to remind everybody that's how we're going to be doing it. Yeah, body, mind and spirit. Yeah, thanks to Ray, we'll do that. But I think also thinking also of the novice learner initially, you know, we're just getting it, and I mean, I think it's, you know, we've had decades just now, I think now that philosophical approach, we're thinking it more conscious of now as well. So I agree. I think we've come to that point where, you know, that this philosophy has to come into action. And we, we've talked about this and I think the palpatory skills, the OMM skills, these were all things AT felt, you know, what he had in front of him. This is what he had. This is what he didn't have X-rays, so he didn't have X-rays later, it was the first X-ray in the minute in the school. But he didn't have those initially. He didn't have fancy tests and labs and genetic testing. He had his hands and he had his eyes. He had his, he had his smell. He could hear very, very rudimentary stethoscope. I mean, there wasn't a lot of these. There wasn't anything like that. So he utilized, like a philosopher, his observational skills to rationalize an appropriate diagnosis. And it all starts with the curiosity and the questioning. Yes. You have to be, you have to, you ask, okay, no, what, what is wrong with the patient? You know, why aren't they healthy? So you're asking questions and that, you know, it's probably leading to more questions and more questions. So that's that, like, that's that, that, that curiosity that, again, sometimes as we go through life, we lose that curiosity and questioning. And it's the observation, you know, the observation is, is really looking at the patient looking. Is there a house he's sitting? How's he looking? Is it, what's his coloration? What, what's going on visually? Because it gives you a lot of clues and a lot of hints of what's happening. And then you start questioning those observations. Like, you know, look, you look a little blue today. What, what's, you're not breathing well. You know, we, we talk a lot about this observational, you know, and we looked at, you look at the patient and I just mentioned, you know, if they're blue, are you breathing okay and things like that? like that, but there's this other aspect of pre-observation, I imagine, you know. So, and you had mentioned before we got on to the podcast about something about biases in observation. Could you talk a little bit more about that? Yeah. So, they're, you know, psychologists have identified many, many different types of biases. And it's, they're unavoidable, but what we could do is manage them and minimize them. And one of them that's, we're prone to is called confirmation bias. So for, I guess in the, in the medical world, again, I'm not a physician, but I imagine you get a patient's record maybe before you even see the patient and you read all, you know, blood pressure, you know, heart rate, everything, maybe other consultants. And if you're not careful, if you're not keeping an open mind, you're not aware of confirming. You, you might read the data or the reports and think, oh, I know it's wrong. Even before you've interacted with the patient and, and so you, that's why I think it, and maybe this is 80 still stresses how important it is that, that physician patient interaction. Yeah. So that you, you know, you don't tell yourself, oh, I know even before you've done the observation. So yeah, you can learn from the data or what, from what others think, but you want to confirm it with your own observation, your own thinking. I love that. I love that. I love that. I, I, I never read with people bring in, I mean, I'm just going to admit that right up. They bring in consults. They bring in everything else and I push it aside because they all haven't figured it out yet. So whatever they're doing, I don't want to bias myself with, with some of the ideas. So I, I pushed aside, I sit down with the patient. I said, and you tell me, you tell me what's been going on. It's an observant, and I'm observing them. I'm, I'm listening skills of what they're telling because, and by the time they, they, they're there, and I'm just a deviating a little bit, but by the time they get there and they've seen 20 doctors and they've said the same thing over and over again, they, they get tired of it, but by this time they're, they're going to try to be as exact as possible, especially if they know someone's listening. I don't like walking in the rooms. I know what you got. No. I'm going to have you tell me, tell me your story, and I will, and that's what AT thought. I think that, and that whole kind of idea of removing the bias, and that may be part of our ideas of moving and improving every day to be, avoid those biases, do we actually listen to the patient, did we touch the patient, did we, you know, do we have some sort of, you know, I don't want to say spiritual, but some sort of, you know, well, it, in a way, it does become spiritual. So let me, let me throw something out, and this is a little off top, maybe it's not off topic, but artificial intelligence has been in the news the last couple of years. And we're talking about diagnosing illnesses, can AI, can a machine, or will the machine ever be able to diagnose a patient better than a human or the, the physician philosopher? To the physician philosopher, we're not a machine. And there's something about, you know, yes, we're trying to think rationally, and we're, you know, we have these similar characteristics, but there's something different between a human and a machine, and maybe we, part of that is that spirit, that human spirit. Maybe we got it there. I think one thing, Bob, too, you know, your knowledge and your knowledge. So you're kind of that specialty when everything else fails, they do go to you, but also look at it still, still says he was frustrated. So he took a different view, and I think he realized that their approach, and I used to also practice and had people that failed everyone, they came to me. And you write, I think starting from scratch, because there's nuances that the way they say it, and someone else may not have hit, and now it comes through, but you have to hear, I think you, one comment you said is, I listen, and he says you'll miss those things. And I like the biases, but you can't be biased by other doctors, consultations, and things like that. But I think as we move to this, we've come through this whole seven series here, and we've talked about becoming a physician philosopher, and now we've talked about how is that philosophy come into play in the daily life, and also in our practices, and thinking about what A.T. still put in place, and sort of the idea of excelling every day, reflection on how we, what we've done, and how we can improve improving your skillsets, and skill sets, in reference to body, mind, and spirit, thinking, right, and looking inward. So inward to ourselves, body, mind, and spirit, and then also to our patients as a diagnostic, body, mind, and spirit without the biases. I think that's a good, is that what we talked about? Yeah, I like that. Yeah, I think that's what we're about to. I think that's it. I think we need to, you know, I think that the next step in this is actually then moving this into the models. Yeah, but I think we needed this preference before we could do that. I think we had a really reflective, and I'm going to have you back on that one too, because these models are sort of, and it breaks down, it breaks down the body, mind, and spirit, and also the tenets into sort of models where it's respiratory, whether it's by behavioral or whether it's neurologic, and metabolic, et cetera. So I'd like to break that down. So again, I think that that movement we're making, we're making, I think we're making a T still proud. I think he's up there, you know, saying, "Oh, that's, you got it, you got it, right?" He's got that little bone in his hand, he's on the pearly gates and saying, "That's what I said. That's what I said." So, and I feel that I think that's where we're, I want to make sure we remember that for the next podcast. Well, it's on the record now, so on the record, yeah. So thank you everyone for coming back to us after this little bit of a pause and listening to our thoughts, and I think we hit it this time. I think we've got some place to jump off of. We have a diving board to go right into osteopathic medicine and the models and the tenets and et cetera. Thanks for seeing it and hearing us at the next podcast and keep thinking about improving yourself, you know, think about the philosophical aspects of your life and just improve it every day. Do the correction. Yes, good advice. The Scholar series, including the Scholar Plus Podcast, is co-sponsored by the American Academy of Osteopathy, Lake Erie College of Osteopathic Medicine and University Hospitals.