Integrating Osteopathic Philosophy in Cancer Care

Assessing patient experience of the tenets of osteopathic medicine

CONTEXT

Previous studies document that both osteopathic physicians and third-party observers identify an approach to the patient that is consistent with the philosophy and tenets of osteopathic medicine, often without investigating whether patients identify or are satisfied with it. Osteopathic physicians and the medical education community understand the distinctiveness of an osteopathic approach to the patient. Understanding the outcomes of an osteopathic approach to patient care includes confirming whether patients experience the tenets of osteopathic medicine in physician visits and, if so, how it relates to their experience of physician empathy and satisfaction with the visit.

OBJECTIVES

The objectives of this study were to assess patient experience of the tenets of osteopathic medicine, physician empathy, and satisfaction with the visit and to compare the results for patients who saw DOs with those who saw MD physicians.

METHODS

More than 2000 patients at four outpatient clinic facilities were surveyed after a clinical visit on 22 prompts regarding their experiences of physician behaviors, physician empathy, and their own satisfaction with the encounter. Adult patients who were treated by an osteopathic or allopathic physician for a nonemergency encounter and who were not pregnant were included in the analysis. Survey results for 1,330 patient-physician encounters were analyzed utilizing linear regression models comparing constructs representing patient experiences of the tenets of osteopathic medicine (Tenets), physician empathy (Physician Empathy), satisfaction (Satisfaction) with the encounter, as well as additional demographic and encounter variables.

RESULTS

Approximately 23.8 % of patients approached during the study period completed a survey (n=2,793), and among those, 54.7 % of patients who consented to the study and who saw a physician provider (n=1,330/2,431) were included. Significant (p≤0.01), positive associations among patient experiences of Satisfaction with the visit and Physician Empathy were observed among those who saw both DO and MD physicians. Patients experienced the Tenets during encounters with both DO and MD physicians, but linear regression showed that their experience of the Tenets was significantly (p≤0.01) and positively explained by their experience of Physician Empathy (β=0.332, p=0.00, se=0.052) and Satisfaction with the visit (β=0.209, p=0.01, se=0.081) only when the physician was a DO.

CONCLUSIONS

Patients identified physician behaviors consistent with the Tenets and positively associated their experiences of Physician Empathy and Satisfaction with the visit regardless of physician training background. Patient experience of the Tenets significantly explained their experiences of Physician Empathy and Satisfaction after visits with a DO but not after visits with an MD.

A Missing Voice: The Lingual Complex and Osteopathic Manual Medicine in the Context of Five Osteopathic Models

The five osteopathic models recognized by the American Association of Colleges of Osteopathic Medicine guide clinicians in the evaluation and therapeutic choice which must be the most appropriate concerning the patient's needs. Skeletal muscles represent an important interpretation, such as screening and treatment, on which these models are based. A muscle district that is not considered by the usual osteopathic practice is the tongue. The lingual complex has numerous functions, both local and systemic; it can adapt negatively in the presence of pathology, just as it can influence the body system in a non-physiological manner if it is a source of dysfunctions. This paper, the first of its kind in the panorama of scientific literature, briefly reviews the anatomy and neurophysiology of the tongue, trying to highlight the logic and the need to insert this muscle in the context of the five osteopathic models. The clinician's goal is to restore the patient's homeostasis, and we believe that this task is more concrete if the patient is approached after understanding all the contractile districts, including the tongue.

Osteopathic Principles: The Inspiration of Every Science Is Its Change

The Educational Council on Osteopathic Principles (ECOP) annually renews and reviews the fundamental osteopathic principles that Dr. Still left behind for osteopathic medicine (OM). These tenets represent a guide and rationale for the osteopathic manual approach. The non-profit research organization, Foundation of Osteopathic Research and Clinical Endorsement (FORCE), which was founded in 2013 under the auspices of different international professionals, wishes to propose changes to these principles based on scientific knowledge, which did not exist in the nineteenth century, as well as all the information discovered subsequently. The proposal is not a constraint, but a further stimulus to improve the vision of OM. We believe, in fact, that a principle or a point of view never ceases to evolve: the inspiration of every science is its change.

The Five Diaphragms in Osteopathic Manipulative Medicine: Myofascial Relationships, Part 2

The article continues the anatomical review of the anterolateral myofascial connections of the five diaphragms in osteopathic manipulative medicine (OMM), with the most up-to-date scientific information. The postero-lateral myofascial relationships have been illustrated previously in the first part. The article emphasizes some key OMM concepts; the attention of the clinician must not stop at the symptom or local pain but, rather, verify where the cause that leads to the symptom arises, thanks to the myofascial systems. Furthermore, it is important to remember that the human body is a unity and we should observe the patient not as a series of disconnected segments but as multiple and different elements that work in unison; a dysfunction of tissue will adversely affect neighboring and distant tissues. The goal of the work is to lay solid foundations for the OMM and the five-diaphragm approach showing the myofascial continuity of the human body.