Monday, April 11, 2005

looks good to me!

neuro is done! what the hell am i supposed to do with my time now?

oh, right. OMM

it's funny how OMM tends to be my least favorite part of school. 2 days a week we have to dress in shorts and sports bras (or no bras for those with penises) and check for somatic dysfunction, aka you done fucked your back/ribs/pelvis. then we try to fix it, using various methods ranging from shit that is basically massage to hardcore neck crackin'. it's the only class we've done straight since last august.

just so you know : i believe i run halfway between "i'm only doing this shit cuz i couldn't get into an MD school" and "oh my god who gives a fuck about biochem? let's find your cranial rhythm!" on the osteopathic student spectrum. some of it is complete bunk, and some of it works really well.

that being said, something that bothers me is how subjective our diagnoses are. although you can't deny that some of us are running around with dysfunctions (i happen to have a massive rib/scapula thing going on right now), it's pretty fucking obvious that there is some fudging going on by the students when we diagnose and then retest after treating. simply put- we move our hands when our hands are suposed to move- "hey look! a positive standing flexion test!" and we don't move our hands when they aren't supposed to move -"hey look! the patient's tranverse processes are equal at T6 after i treated them!"

i see it happening, and feel it when i'm the patient. i have had scoliosis, an anatomical short leg, my entire ribcage stuck down on the left, and too much paravertebral fullness to quantify. i can tell you all of those are bullshit diagnoses, although the short leg somewhat satisfied my desire to be more pirate-like. some things do come up over and over, like a flattened thoracic kyphosis and my left shoulder being higher than the right in comparision to my head. these things i'm sure really are there. when a classmate (very much an OMM master) found my bad shoulder/rib thing today, i was ecstatic not merely because it hurt and i wanted it fixed, but because i hadn't told him where the problem was.

and i know i must fudge shit all the time, especially when i'm finding a diagnosis hard to ascertain. it's totally unconscious for the most part for all of us, but it's disconcerting to say the least. it's just like back in my neurodiagnostic days when we had a borderline EMG, and depending on the doc, it would either be a positive finding or a negative finding. the thing that always bugged me was that the result affected the patient's outcome, sometimes being one of the factors that helped the orthopaedist decide on whether to do surgery or not.

this early on in my career, thinking that a diagnosis i give can have such a serious effect on the patient's clinical course it frightening. when i was volunteering at one of our clinics a couple of weeks ago, i checked a new patient's BP. lo and behold, it was high. we presented to the doctor, and she went in, talked to the patient, and was writing up a scrip for an anti-hypertensive when i asked her sheepishly to re-do the BP reading, just in case. she did, and the reading was almost exactly the reading i'd gotten. i felt stupid for being such a pussy and doubting my skillz, but i also didn't want any patient to walk out the door with a prescription they didn't really need for a malady they didn't really have.

since OMM was our first clinical exposure and continues to be most concentrated doctor thing we do, i think it's natural at first to let what you should find influence what you do find. i just hope we can find the real shit in a couple of years, when it's important and not a matter of getting it done so we can the fuck out of our sports bras.

3 Comments:

Blogger Dreaming again said...

I just found you from Mudfud ...I don't mean to sound dumb ... what is OMM?

oh, and as far as the MD/DO thing, I don't know about most places in the country, but where I live, they seem to have the same respect & all practice side by side. Most clinics in town have MD's & DO's working together.

I have many specialists ... it seems half my docs are MD's and half are DO's. Not even real sure, which are which for some of them ..come to think of it. I know my PCP is DO, my neuro is MD, my rheumy is MD, and my urologist is DO ... beyond that ... I'd have to look it up.

6:01 AM  
Blogger Dreaming again said...

This comment has been removed by a blog administrator.

6:09 AM  
Blogger the jerk said...

oh hey! sorry i didn't get back to you before! OMM is Osteopathic Manipulative Medicine, which is the thing that makes DOs different from MDs (or so they tell us constantly). it's manual medicine techniques to treat muscle and joint problems, as well as assorted referring visceral maladies.

8:40 AM  

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