Osteopathic Philosophy and Osteopathic Approaches to Practicing Medicine

Hi, this is Megan Callahan, OMS2 at Lecom. This is Scholar Plus Podcast, gathering people of liked minds. Here are our hosts, Michael Rowan, DO, and Bob Hostoffer, DO. Hey, Mike, we're going to start this Scholar Plus with talking about what we really intend to do. We really intend for all these series to relate to. So the intention is to reflect on osteopathic philosophy between specialties. I think this is really helpful. You and I have always discussed how people approach us and say, you know, you guys are different. They look at us. And I think defining what is unique about osteopathic physicians and our approach really comes down to this philosophy. And there's a few areas that kind of help us give a framework around it. And that is, you know, the five models we have and the tenants. But I think part of this, I think, whole series, we're going to look at all these specialties you talked about is, how does everyone look at that? Because I don't think just you and I can get the answers, but I think we can kind of start it. I think you're right. And we can't be just defined as OMM. Yeah. It has to be more. There has to be a value deeper than OMM. OMM works. I love OMM. You know, I've had it. But I think there's a lot more value to who we are as a profession. And I want to do that. I want to bring that out. I want to bring that out with every specialty, with the family docs, the OBs, the dermatologist. How do you do it? I mean, is it pushing the computer aside and looking at your patient eye to eye and asking them, how was their day or is it something different? Is it touching the person or is it everything? What are we? Yeah. I think getting to that and I think you just as a look to see, like, how do we become this unique physician? How did we approach things differently and uniformly seeing it with osteopathic physicians? People say, they say you guys because they see this that there's a common something they look at and it's not as tangible folks. But I think that's one of our ideas is kind of define how we perceive that that makes this different. It's always tough, right? So you're basically trained to be a scientist, you know, basically trained to understand things, you know, that can be measured, right? You can't measure philosophy. You can't. I mean, you have to, you have to use it. You have to do it. You have to be it. You have to be it. And so then in order for us to define it, you have to ask you, how do you do it? And you have to go back to, you know, where with A.T. still said, you know, in his philosophy of mechanical principles of osteopathy, you know, he said, man's a triune. He said, you know, everybody says, this is sort of a tagline for every institution out there. As you think about mind, body, and spirit, in the 1890s, he said it first. He said it first. He said first, there is a material body, second, the spiritual being, third, a being of mind, which is superior to all vital motions and material forms, whose duty is to wisely manage this great engine of life. He said it. And I'm not quite sure why we don't grab this as saying, you know, you all want to say, but we practice it. And we've been doing it for a hundred years, yeah, a long time, more than that now, more than that. Yeah. And I think the other thing is the models. And they mean that's a framework. And I know that when they published foundations of oscumedis and they said, we've got to have a better way of defining it. And you and I both had a long career where we've worked with our colleagues or alipathy colleagues and describing to the public, like, how does this stuff work? How do we approach things in doing it? And the models gave us a nice framework looking at that. And we had five kinds, five of these models, I mean, that biomechanical, postural, neurologic, respiratory, circulatory, metabolic, and behavioral. And those give us kind of a framework to begin that kind of discussion. Yeah. You know, I agree. And I think when you look at that, it really describes the body. It really is the intent of A.T. still is to look at them and we use those models to see people differently. And you know, truthfully, using those make us a better diagnostician. I mean, that's what it is. It's a more comprehensive look at people because it looks at all components that they can be, you know, things can evolve with the patient. So what do you think about the biochemical? Yeah. Well, I think we're looking at here. There's different terms here. And it includes kind of a postural model of looking at, and you got to go back to an A.T. still was around. I mean, he first identified osteopathy in 1874. And then that was during the mechanical age. So structure and function was very important. So historically, you know, why would this kind of the primary one? And a lot of people, this is the one they kind of look at as the sole thing. They didn't realize we're beyond just that. But this, that structure and function, how it looks at, again, we think a posture and motion because those are the activities of every living being themselves here. And we look at how all this really brings all themself together. And you know, I think this, but this is kind of the core foundation is the other people look at because it's the most tangible for them to understand. You know, I don't, well, I can't move here and doing that. It's a little more concrete and a little more pedestrian kind of view of things. But it's a good starting point for a lot of people to understand the application of kind of osteopathy concepts. Right. Clinical setting. Right. And I think when we, you go to all these models, like the next one is neurologic, there is a connection. So the biomechanical, the muscles that connect the entire body, the nerves that connect the entire body. So it's all about these connections. And so this model, the neurological, this is about coordination. It's about integration of body functions. It's about protective mechanisms and sensations. But again, these are, you can't separate these out. I mean, we can, we can imaginearily put them on and make five out of them, but they're all interrelated. And this neurologic also more to that. I mean, that's the whole concept we have underneath that of like that reflex arc. You know, how do we understand we see a patient that comes in who, you know, even all about the colleagues had it, but we kind of defined it more with it, like, for example, that they have, you know, discomfort in the right kind of inverse capillary and same boy, you know, associated with, you know, gallbladder doing themself here, we, but we see that even more so with multiple conditions, that visceral somatic relation of somato, visceral relationship. So, so we see how that plays, you know, the autonomic person, the person who's just hyped up and they're, they're not relaxed. It's affecting them and how they're doing and approaching. And it's accelerating some of the clinical conditions they have, you know, and you know, we move into that circuitory or the respiratory circulatory issue. And this again, this is, you know, AT still, you know, said that if you open up the circulation, the body has its own ability, hill itself. It's so true. I mean, the immune system functions on the circulatory system. Yeah. Well, I think, yeah, I think this is, I went to Des Moines University back in the day. And one of the people who were there, and unfortunately, had died before I got there, but was just phenomenal guy. Just felt bad. Never met him. Was G Gordon Zink, D-O-F-A-O. He, he was one of the first people that really took this next level. He looked at the respiratory circulatory model. He started looking at the diaphragms and really defined it more. He did a lot of work on pacing some pregnancy. Again, a physiological change. I did OB for 15 years. So, for me, I was a great application of osteoporosis, but showed how the diaphragms, how they reflect things. And the other thing with this is not just respiration, circulation, but also fetus lymphatic those low pressure systems. But those are clinically easy things. Patients who had cellulitis, had different areas themselves by using osteopathic makeup of treatment. How it altered that and doing things and seeing it. But also, gosh, when you treated someone, they said, I can breathe again, you know, again, but that also affects their psyche. So, again, we talked about OMT, osteopathic manipulative treatment. OMM, osteopathic manipulative medicine. We're using the diagnostic capacity, but osteopathic princel and practice also look at that whole global thing and the philosophy and how it impacts us and doing it too. Right. And so, that respiratory effort, that motion of in and out of the lungs and that pulling this low-pressured system of lymphatics and cells and again, it goes into this metabolic fish and moving these items throughout the body and provides. So, if it doesn't do that, if it doesn't do that, those areas can become ill. So, I think this metabolic one is just so important for me because as an immunologist, I think it just, it tells you that, you know, that yes, the body has that inherent ability. Yeah. Well, you mentioned right, you know, you're at the metabolic that whole model itself, especially that's something you see a lot because it does look those immunological factors. And it's interesting. I'm sure you looked at still because immunology wasn't defined in the 1800s, but still talked about it. He kind of described, there was more going on that they didn't have access, but he looked at elements which really evolved into immunology by seeing there was some enhanced ability to body and healing itself and doing it. And that was really immunological function that hadn't been defined at that time. Well, I mean, you have to remember that the germ theory wasn't even around. Yeah. You know, it may have been in Europe, but it didn't get to the whole of the United States yet. So, understanding how bacteria, you know, caused infection, that wasn't there. There weren't stethoscopes. There weren't antibiotics. There was this process and AT stills look at that looked at this and said, you know, there is something about blood. There's something about this lymphatic structure. There's something that courses through the entire body, healing and fighting for the body. So I think he was really ahead of his time. And I think, again, definition like, you know, metabolic is focusing on that relationship between metabolic immunological factors and the individual's energy supply in order to influence the individual's adaption. Now, that's a nice definition, but I'm a runner, you know, if I have trouble with my quad, I'm not running very well. I'm putting more energy into it and going through it. I'll say, and it starts impacting how my immune system is going through it. I'm kind of putting more of a toll on it and doing it. So for not structurally working together, it causes kind of themself here. And that's that whole energy balance and regulatory and activity and inflammation, digestion. I mean, absorption, nutrients, all these things, the metabolic impact. And again, that moves into this next section of behavioral. You can't separate that. There is such a membrane or connection between how people feel mentally and how they will fight infection. I came back with you talked about the initial votes you talked about from still, where you started defining and going through it. I mean, how many patients that we've been with, that we see emotional response to doing things going on? Because you, how can you, we're not robots, you know, but I think also because it's just in our face that we think of these things, it just innate to us to look at and self-ospectic physicians. And it talked about looking at that whole physical, psychological, behavioral, social spectrum, and it's getting a therapeutic relationship we have between the patient and physician. But for us, it's just innate as part of what we look at that whole person, how things are impacting on the self. And we know patients, there's all these factors, they look, they're anxious, they're stressed, they're worked, they're family, they're intimate relationship, they're substance abuse, do the exercise or attitudes or beliefs. In fact, our ability to heal, to help people and then to move forward. I agree. I think if you're there as a, as a physician, you're sitting on one side, the patient sitting on the table, or land, and how, how do they look? I mean, they're, you know, how's their affect? How are they sitting? How are they structurally sitting? How are they breathing? You know, they, you know, the, the ideas and how they're putting together their own disease and how do we interpret their language? Are they, they hold themselves and yourself, you can see their affect, do they look like they're just timing, to look like there's energetic, they're, you know, you can tell. And I think, you know, I think because what's unique is we really spend time looking at those aspects. Yeah. And, and I think when you look at these models and, and you, then you go to the tenants. And, and AT, you know, again, these were built after AT, but, but he really looked at these as the body is a unit, the person is, is a, is a unit of the body, mind and spirit. So he, you kind of have to pull those models together. You have to pull them all together and look at them interrelated. And that was your quote. Yeah. That was the quote you did where he described it. And we had to make it more succinct, you know, for, for, for, for practical purposes. But he was, he was discussing and he going through it because that, that full unit and limit himself here. But also, again, this is before, you know, really defining immunology. Then he said the next one, which is kind of big thing with you. The body's capable of self-regulation, self-healing and health maintenance. That's that whole immunological kind of function that we didn't describe. And also just how we work. Yeah. I mean, this, what's really interesting about this is that there are, I mean, within the body and I'm just going to pull some immunology, there are chemokines. There are chemokines that are inflammatory that will bring things to destroy a bug. And there are chemokines that are only astatic. They, they're, they're to build. They're, they're to bring a cells into a tissue to build. That's, that's what he's saying. But we can, I mean, for healing, for health, the immune system wasn't known that. Well, it's funny. He had one quote that was, "Many patients survive because the doctor's carriage was late." Yeah. I remember that quote because I think a lot of times is that we get the people to chance to do their own thing. And I think when you talked about that self-regulation, I think of things that, you know, some things we just feel like interfering. We got to do all this stuff. And sometimes our stuff is helping the person to get to a better state to heal themselves. And you know, this, this idea, too, of structure and function are reciprocically interrelated. And you can take that down to the, to the molecular level. I mean, if a receptor isn't, if it's mutated, the structures abnormal, the function's going to be abnormal or not work at all. You can take that to so many different levels and in, in, whether it's, it's at that molecular level or it's with, to a lot more gross and anatomical level. Well, one of your strengths in, you know, your side patients and you've helped many of them with me is, you know, as we become, as we go on time, we have pattern recognition. We see things and going through it. And I think what a lot of people miss with the structure and function relationship is sometimes they may come with one thing and you're looking at something else and people like, why are you looking here? I came for this thing because they missed it. That's how we are. We look, because we see beyond it. We see a pattern of other things going on in that person and now that structure and function that maybe this portion of the body is bothering, but really we see the problem somewhere else. At many times, a student says, look and showing patients, they said, you know, come in here, this right side of your body's body, but I'm finding all the problems on your left side. Because that's where it comes and you have to, you can't be focused, you know, you can't just be so narrow-minded, you have to open and look more to see where things are going. And it's sort of that rational treatment, you know, based upon these understandings of the basic principles of body unity, self-regulation and the interrelationship of structure and function, exactly bring all three of those, to love tenants together. Yeah. And I think that one has to understand that, you know, the way that a person talks to you is they're not talking to you textbook. They're not, you have to really take what they say and interpret that into what disease pattern that's going to be in your head. So that's that's that mind part, that's just talking to them and listening. And then what happens when you listen to them? Because I know as a patient, I'm coming in with a lot of anxiety, I'm coming in and I am anxious about what's happening to me. And no one's explained that to me, no one's talked to, no one's listened to me and interpreted my listening, my what I'm saying. And by that you relax the patient, the anxiety drops. You can look and say, yeah, I get it, I understand. And if at the very least you repeat what they tell you, the level of anxiety drops. And all of a sudden things become clear because they can, in their mind, their symptoms complex become, have more clarity because they're not trying to deal with a frustration of communicating to the physician. Well, I think, you know, through the tenants, the models think one thing we've always talked about is, as a profession, it's more community based and it's more patient centered. And it's always been that approach. And not seeing other physicians aren't. It's just that it just kind of built into the very beginning. And I do think in the beginning, you know, when you begin an osspetic medical school and in the beginning, you're going in all mem labs and you're touching your colleagues. And all of a sudden you break barriers and all of a sudden you, it changes how we relate to patients. And that physical component is important. Yeah. I mean, touching. At the very least, you can put your hand on the guy, you know, or the girl before you leave, you know, just at least touch. There is a compassion going through a connection. And that touch relates a lot. I mean, it moves. It's just not just the talking aspect, but I just connected with you. Yeah. Very important. So with that, like with all these things, we've just got done talking about the models and the tenants and what AT Stills philosophy was, I think the true meaning of what we want to do with Scholar Plus, this podcast, is to explore how other specialties utilize these concepts that we just talked about. And then in some of them, I want to know, in some of the people, the specialists that we're bringing through, I want to know how they, you know, look at the osteopathic learning environment. How do they, you know, produce this content? How did you teach it? How did you train some of them there? How did they become? How do you change them? How do you change them into, and not just, you know, I think we really, in my opinion, I want to really change you into a person. I don't, I don't want you to be, you know, I want you to remove the doctor's coat, and I want you to be a person, just like that guy on the table. You're one on one. And if he can see that person and you, I think he will tell you more about himself. Well, that's a vulnerability. Vulnerability. But that takes a lot of, that takes a lot. It takes a bit because your confidence and your priority is not your own ego. It's really the patient and, and I think we have a unique way. But you're right, let's, I think working through different specialists, I think again, people come back, you're a different specialist and I've been a background in, but people always said to us, there's something about you guys. Yeah. So there's a general thing, but I think they're specifically how people look at that in different specialties, teasing that out is going to be, I think, a lot of fun. So I really think that's what the focus is. And after every podcast that we make, I hope we learn a little bit more about ourselves. Yeah. Well, gee, thanks for being with us. Thanks for listening to us and I hope you'll be able to join us in future Scholar Plus podcasts on osteopathic plus. That's great. Thanks again for joining us. The Scholar series, including the Scholar Plus podcast, is co-sponsored by the American Academy of Osteopathy, the Lake Erie College of Osteopathic Medicine and University Hospitals.