Archive for Osteopathy

Letter to C

The previous post regarding my frustration with the preceptor I had during family practice rotation was immature and out of control, but one of the purposes of this blog is to vent my anger safely. Below is a more mature and appropriate letter I wrote as a final catharsis for this situation. I’m not going to actually send it to him thanks to feedback from a good friend and my own better judgement. Still it felt good to write it.

C,
I feel like I need to talk to you. I realize email is not the same as
talking, but it’s the best I can do right now and besides, I have a very
difficult time talking to you directly. You tend to talk “at” me rather than
with me, not recognizing what I’ve said and this causes me to shut down. Not
to mention the fact that I tend to cry easily, which is due to both my low
threshold for crying and your approach to personal encounters.

I am still in pain from how you confronted me on Wednesday. I was already in
a precarious position in regards to my confidence about my chosen profession.
You say you want to help, but then you offer medication, a band-aid. You
admit to not understanding me, so then how can you help me? I purposely chose
not to share myself with you because I knew you wouldn’t understand and my
sharing was not a required part of the rotation. I was supposed to learn
family medicine from your perspective. That’s it. If we had connected, I may
have shared more about myself, but we didn’t connect. I admit that breaking
down crying before seeing a patient is not healthy, but would you rather me
walk around like a robot and have no feelings? I’m a sensitive person and
most of my patient encounters were very positive with people wanting me to be
their doctor. I obviously connect with patients. It didn’t seem like you
perceived that in me. You only saw my faults and the first step in helping
someone is seeing what they are good at and what they have to offer.

I am also angry about your perception of Osteopathy. Healthy skepticism is
important to maintain integrity in our profession, but you completely
disregard everything about Osteopathy that I hold dear. It would be one thing
if you were just my FP preceptor, but you are also our OMT preceptor. I have
a hard time forgiving this. Since beginning school 3 years ago I have
experienced so much disappointment in the Osteopathic profession that I have
reached my limit. I can forgive DOs who spend their lives completely immersed
in the allopathic world, becoming experts in their fields who do not use OMT
(i.e. Dr. O, nephrologist). And, I have a huge amount of respect for FPs who
try to incorporate OMT into their practice even though my imagine of an ideal
FP DO is one who only uses OMT for all issues.

I am stubborn, idealistic and possibly delusional, but there was a time when
Osteopathy thrived and I am on a quest to find that “essence”. I don’t want
to settle for mediocrity. Much of my depression and anger stem from this
disappointment and then having to traverse the medical school jungle anyway
because I’m so completely in debt.

I have my issues and I am constantly working on them. Every counselor I have
ever seen has said I have great insight and if I had felt comfortable enough
to talk with you, you would have noticed this too. C, there were a few
moments I actually learned something from you. However, those moments are
overshadowed by me learning to interact with you without being completely
overcome by insubordination. You are the first person I’ve worked with where
I felt so strongly. I may be part of the problem, but you have also
contributed to the dissonance in our relationship.

MG

Advertisements

Correct response?

Is it better to cry or hold it in?

Should a person with depression take antidepressants if they don’t want to?

Is it healthy to receive feedback from someone you don’t get along with?

I consider myself a fairly mature person.  However, when it comes to interacting with one of my preceptors, I became very immature: passive aggressive, non-communicative, angry.  He’s often telling patients with psych problems that they need to let out their emotions and then when I cry he says I’m depressed and need to try medication.  I refuse to discuss my issues with him because he’s a complete ass and yet thinks he knows what’s best for me.  We last worked together and he gave me feedback on Weds.  I’m still upset by what he said to me.  There was no way to win.  I hated him and yet he was my primary preceptor.  I couldn’t exactly be honest or else I’d be called insubordinate, which wouldn’t be the first time in my life.  So I played the passive aggressive game, which makes me hate myself and him that much more.  I know I have issues.  We all have issues.  I don’t want to do pelvic exams and I get overwhelmed with emotions when I have to do it.  I used my reaction as an indication NOT to go in to family practice and yet he says there is something wrong with me and questioning me belonging in the field medicine.  Would it be better if I was a robot and did everything I was told without feeling a god damned thing???  Besides, I don’t WANT to be an MD.  I want to be a DO.  I want to analyze problems based on the anatomy, the blood/nerve supply and venous/lymphatic drainage.  THAT IS WHAT I WANT and yet he (the DO hired to teach us OMT) doesn’t fucking believe in Osteopathy!!   IT makes me want to scream so loud that I burst my own ear drums.  There’s something wrong with me?  He should look at his own lazy ass and say the same fucking thing.  Thank goodness there were some DO’s throughout the year who were able to teach me something and give me their thoughtful feedback regarding the present state of Osteopathy.

Please pardon my profanity.  It took me 2 days to recover my shattered self-esteem and now I’m just writhing with anger.

Full Circle

My last post received an invitation to join an online discussion forum about Osteopathy (sacralmusings.com).  The cool thing is I already met the fellow who created sacralmusings online last year through another online social network.  He had invited me to join the site when he created it, but I was feeling overwhelmed starting rotations and never got around to it.  So, I went to this site and checked out the conversations going on there and decided to join when I saw my blog posted in one of the discussions, presumably from the same person who invited my to take a look.  How cool is that?  Small world!!

On another thread, I’ve been emailing a DO in NYC adn we had a rather extensive conversation yesterday.  He pushes the envelope in regards to the “energy medicine” side of Osteopathy, but he also has a very mechanical approach to patient care.  Every new patient receives an evaluation for a heel lift, not based on leg length discrepancies or x-rays showing sacral base unleveling.  He approaches heel lifts from a thoroughly function stand point.  By putting his hands on the patient’s hips and SI joints and then shifting their weight from side to side, he can tell which side is “functionally” lower thereby requiring a heel lift.  He then proceeds to find how much lift the leg needs to reach a functional equilibrium with the other leg.  This adjustment allows the patients to self-correct throughout the next week to month with alleviation of symptoms.  They come back for a readjustment, sometimes the same leg needs more or less and sometimes the lift is required on the other side!  How wild.  Now THAT is something I can wrap my head around.  I want to learn it and teach it to every osteopath out there!!

Breast Cancer and OMT

I have to do a project during my FP rotation. I’m considering doing OMT and breast cancer because in my reading, Dr. Still and Dr. Hildreth both reported having good success treating some breast cancer issues. And the reason Osteopathy was legalized so early in North Dakota was because a politician’s wife (who had breast cancer) was treated with OMT. I can’t seem to find any research on this topic other than lymphatic techniques for lymphedema s/p mastectomy. Is there any research out there?

New connections

I just received a new connection to a DO in New York, NY! The Medicine Lodge Clinic, Inc: Integrating Traditional Healing and Osteopathic Medicine. I might spend some time down there just before my COMLEX PE exam in August. And it might be possible to live with a woman at a Sufi Center in Albany, NY during my ER rotation in Pittsfield, MA (The Berkshires). As a birthday present to myself I signed up for a yoga retreat at the Kirpalu Yoga Center, which also happens to be in the Berkshires. I think this is going to be a good year.

Who’s the teacher?

Today there was a minimally inspirational OMT lecture on ENT (sinusitis, otitis media, allergic rhinitis). The material was so repetitive it was hypnotic. I became my exasperated, insubordinate self. I could have given the same damn lecture and workshop- myofascial release of the thoracic inlet, cervical soft tissue, OA release, condylar decompression, sinus effleurage, lymphatic pump (upper thoracic and diaphragm doming). The one technique I didn’t remember was massaging the jaw to help the eustachian tube to drain. What is wrong with telling a story about patients who found this helpful?? Isn’t that why you’re a DO? So you actually use these techniques on patients that need it, right? Why not share some patient stories!!!!! I have multiple theories why this is not the case:

1) The DO does not actually use these techniques and just had to give a lecture

2) He was not bright enough to include the stories

3) He thought the stories were not “scientific”

4) He thought WE might think the stories were not scientific

So far, 4 out of 4 of my classmates learn better when taught by “I had a patient who…” rather than “The scientific studies show…” Stories (aka anecdotal evidence) has its place in education.

Then this evening I went to a more informal discussion where we were read some of AT Still’s work for the purpose of discussing it. Of course, I was the only one who actually read it. The discussion took on numerous direction other than what I wanted, which were stories of using OMT to help patients. The group consisted of myself, 3 residents and one young attending DO, so the depth of experience was limited. It ended up being more of a venting session or talking about energy rather than anatomy and even about less AT Still. When the residents left I stayed and talked with the attending because I had a lot to say. Unfortunately, he did not have much to say that was helpful or enlightening. I thank him tremendously for having these discussions and giving me a little outlet and another opinion. Bless his heart.

For the last 2 years I have been thinking about OMT in the beginning vs. OMT today and no one has yet to give me an adequate answer regarding why the huge difference, why DOs are not “Meccas” for the sick like Kirksville was, why the prominent “ten fingered” DOs are more concerned about their subjective feelings rather than with the anatomy of the patient and why would these DOs send a patient to their PCP because of a suspected thyroid problem rather than treating the thyroid with OMT???? There’s a patient on the psych ward who has hyperthyroidism and I wish I was working with a competent DO who would treat him with OMT. I’ll be damned if I ever ask to treat a pysch patient with OMT in the hospital!! That would be so inappropriate, but I think about it…

Mood disorders

I read the chapter in my psychiatry textbook about mood disorders and I swear I’m an experiential learner.  My mood has been up and especially down during the last couple of days.  I’m trying to write an essay about Osteopathic history and it is hard to reign myself in when I start going off on my rants.  Its good to have a guiding topic to focus on to keep me in line.

I think I strained the muscles around my hip during yoga a couple of weeks ago (so much for the peace of mind!) and I keep telling myself I have to sign myself up for a OMT session with one of the fabulous DOs at the clinic, but I so damn shy!!  Grrrr.  Then that brings up my shyness with patients and my anxiety about wanting to do OMT, but not trusting myself to be able to help.  Its ridiculous.  I go round and round until I get dizzy.  During the Tuesday when we have clinic I simply focus on landmarks, common diagnoses and “treat” with various modalities I’ve grown comfortable with, but I feel like I’m short-changing the patient.  I may be making a difference, but I’m not diagnosing the primary lesion/restriction, treat that and then move to the next.  I feel so inadequate.  It’s awful.  I’m such an advocate for Osteopathy but then I can’t even DO it!!  I’m a ridiculous oxymoron.  I know it just takes seeing lots of patients and I’ll get there eventually, but I wish I was there NOW!!

So impatient….and full of “buts”.  Oh lord.

I’m going  dancing all weekend!!!  🙂

Real?

For all my ranting about the medical community/school, etc, I wonder how my analytical side would have faired in a more rigorous environment, challenged to hone my skills and answer pimping questions.  Today I sat through almost 4 hours of touchy-feel-ly discussion between the residents (mostly the international medical graduates-IMGs) and the faculty of the Maine Darthmouth Family Medicine Residency.  The program has become known for its laid-back, open-minded program.  The IMGs were concerned that people were excited next year’s intern class had no IMGs, which turned into this huge discussion on ethnic diversity, benefits of IMGs and disadvantages, blah, blah, blah.  Some points were valid and interesting, but I was not interested in sob stories.  I feel like such a hard-ass.  I greatly admire the IMGs for coming to the US for their training despite being away from their home culture and familiarity, but why are they so upset if the patients can’t understand them or ask where they’re from?  I wonder what it would be like in a place that doesn’t allow this kind of belly-aching.  Where the goal is teaching/learning and patient care.  Would I feel just as alienated because of the lack of human relating or would I be more comfortable?

Last thought (has to include Osteopathy, right?): there was some discussion about the prejudice against DO’s and I was wondering if ANY of the DO’s or OMS’s feel discriminated against because they want to treat a patient (regardless of disease) with manipulation.  To be honest, I feel like my education has discriminated me against Osteopathy because we have to behave and think like medical students.  And yet one of UNECOM’s goals is innovation in health care.  Did they ever consider that returning to our roots would be an innovation at this point???  It kind of makes me laugh and cry and go insane, but I have to be careful because I’m on my psychiatry rotation and they might not let me go home!!!

It is completely ironic that I have to “get through” my education without getting the education I really want.  Although, maybe next year…maybe I’ll find people who treat all diseases with manipulation and can talk to me about the anatomy…maybe next year…

A surgeon’s perspective

It is so interesting to get different people’s opinions of me.  I was evaluated today by the surgeons I’ve been working with.  They labeled me as quiet, reserved, passive, even mousy.  They were concerned I would not make an impression on people where I rotate or do my residency.  This is interesting for 2 reasons: first, they are surgeons and by definition they have to fairly out-going and aggressive.  For goodness sake, they are cutting people up!!  Therefore, they don’t understand introverts.  I am an excellent listener, thoughtful and compassionate.  I wasn’t able to show them these qualities in the OR other than listening to people yak, in which case they don’t notice anyone is listening as long as no one else is talking!!  Plus, they didn’t see me in lectures where I regularly answer questions or ask questions of the instructor while most other students sit passively through the lectures.

Secondly, the OR was an extremely intimidating place for me, so I naturally shut down until I became comfortable and understood my position.  Once I became comfortable, I didn’t have many questions because surgery became rather boring to me.  Once patients are scheduled for surgery, or yet, as soon as they are referred to a surgeon, the course of action is fairly straight forward.  I asked a few questions that I thought were intelligent, but I didn’t ask the questions like, “Do you think OMT instead of surgery could help facilitate the healing of this [fill in the blank]?”  “Should we do soft issue OMT to the thoracic and lumbar paraspinal muscles to help this patient regain bowel function?”  “How about suboccipital release for all the patients who are intubated?”  What’s really ironic is that Inland Hospital is the only Osteopathic hospital left in Maine, but you’d never know this by the way it is run…

Medicine…

I was reminded after my last post that allopathic medicine has quite a bit to offer patients.  I do believe that, especially in the case of emergency situations.  Today I saw a woman prepared to be air lifted to Bangor from Waterville because she had a rupture thoracic aortic aneurysm with right hemothorax.  It was an intense experience and I was the official glove provider.  🙂  My emphasis on this blog is in regards to all that allopathic medicine cannot do or does not understand: assisting the body heal a diabetic foot ulcer by stimulating circulation or alleviating an asthma attack by putting your hands on the patient’s ribs.  Natural, common sense approaches to patient care.  I’m learning about fluid management, electrolyte disturbances, surgical patient perioperative care, which is useful.  The constant question in the back of my mind is how many of these procedures are actually preventable given appropriate Osteopathic management?  Breast biopsies, cyst/abscess removals, I even wonder about appendectomies.  The key word here is WONDER.  Until I get significant experience, I plan to practice as expected.  My constant curiosity, analytical ability and faith in the body to heal itself given the right circumstances will continue to gnaw at the back of my mind.

« Previous entries