Psychiatry

When approaching the door leading to my office, patients often look at the signage and proceed to ask one of the most frequently asked questions I receive: “What’s a D.O.?”

Several books and articles exist on explaining the background, history, and differences between being a D.O. (Doctor of Osteopathic Medicine) versus an M.D. (Doctor of Medicine).  Also, debates on which degree is better persist, though I personally find the feeds quite annoying and amusing at the same time (mostly because I remember diligently reading these forums before applying to medical school, which were predominantly biased towards M.D., but I’m able to confidently say that myself and all of my classmates/colleagues that I know of from my D.O. program turned out just fine).  So let me be clear that my purpose is NOT to exacerbate the debate between which degree to choose, but rather convey what being a D.O. means to me.

But first, let’s get the basics down regarding the two degrees (if you’re already aware of the basic similarities/differences, skip to the next paragraph):

• What’s the same:
  • both undergo four years of medical school education (some schools actually offer both MD and DO programs where students attend the same lectures/classes, such as Michigan State and Rowan University).
  • both undergo the same amount of residency training depending on the program
  • both are fully licensed to practice medicine in the United States
• What’s historically a bit different:
  • Different licensing exams: DOs take the COMLEX while MDs take the USMLE
  • DOs receive > 200 hours of osteopathic manipulative medicine training; MDs do not.
  • DO programs are historically known to accept the non-traditional applicant (for example, the average age of students are a bit older, may be non-science majors, or seeking a second career)
  • In 2008, 7% of practicing physicians in the U.S. were DO graduates and 68% were graduates from a U.S. MD schools (I tried to find more recent statistics, but couldn’t find an accurate source)
  • Osteopathic medicine is distinct in its philosophy that “all body systems are interrelated and dependent on one another for good health” (American Association of Colleges of Osteopathic Medicine)

I applied to both MD and DO programs for medical school and remained open to attending either one.  I interviewed at both types of programs, but only received acceptance letters from DO schools.  Perhaps I didn’t have the highest MCAT scores, GPA, or my interview responses weren’t impressive enough?  Well, whatever the reason, I was just happy that the DO admissions committee gave me the chance to prove that I’d make a good doctor.

The whole concept of a more holistic approach to medical practice offered by DO programs sounded ideal to me, yet at the time I was more focused on getting through school and graduating rather than on how the philosophies would impact my practice as a physician.  After graduating from medical school, I had the option to apply to either DO or MD residency training programs.  I applied to both, yet decided to pursue the osteopathic route when I heard about the opportunity to be a part of the first osteopathic psychiatry residency on the west coast.  As the oldest of 33 grandchildren, it was inherent of me to jump on the opportunity to help trailblaze a new program (my program director nicknamed me Hiawatha).  I knew that my decision posed potential limitations in obtaining a future job since a few organizations still don’t accept psychiatrists certified under the osteopathic board.  However, I took the risk because I saw more value in being the first to graduate from and help shape a new, developing program.

For me, being a DO fits my personality and what I’ve grown to stand for in my practice: being integrative, holistic, and preventative.  I truly believe that without such an emphasis on integrative medicine as one of the main tenets of the program, I wouldn’t be the physician that I am today.  Therefore, it’s no wonder that 50% of the graduates from DO programs become general practitioners (family practice, internal medicine, emergency medicine, etc).  I initially despised having to attend osteopathic manipulation classes, and even failed my very first practical exam.  Yet, the hands-on approach made me unafraid to touch my patients.  Each psychiatrist is different, but for the most part human touch provides a sense of comfort and connection.  A few of my patients politely ask for a hug, and if appropriate, I unhesitatingly oblige.

And in some unique way, I feel that being a DO caused me to work harder in a field predominantly filled with MDs to make my presence and way of practicing known.  When a large, metropolitan county declined to consider me for a job due to my credentials, I utilized the rejection as motivation to persevere rather than a barrier.

And most importantly, I used to feel bombarded by the numerous, large framed portraits of osteopathic medicine’s founder, Andrew Taylor Still, MD, which hung in almost every corridor of each osteopathic institution.  However, after feeling frustrated with several aspects of current practices in medicine, I’m undoubtedly far more appreciative and understanding of AT Still’s motivation in the 1800s as an MD to create a method of practice that rose from adversity (he lost 3 of his 12 children to viral meningitis with no method of saving them even as a physician himself) and frustration (an over-dependence on medications and the sometimes harmful medical practices of the time).  I actually wish his story was more widely publicized because he epitomizes successful individuation from mainstream medical practices amidst much scrutiny and opposition.

In the field of psychiatry, where Western medicine can’t always explain nor provide the most adequate treatment via pharmaceuticals, wouldn’t it be great if we had more modern day AT Stills to branch off and create a newer system of viewing and practicing mental health?  I’m truly frustrated with the current practices particularly the overemphasis on medications alone.  The number of overdoses (100 people die from drug overdoses everyday in the U.S.), medicated children as early as infancy, continue to rise.  Medications are only one component of treatment, but greater emphasis should be placed on developing resiliency, acknowledging the individual’s unique traits, and treating the person holistically rather than symptomatically.

AT Still put it best when he said the following:

“An absolute demand for revolution is before us at this date and time, for there is a demand for a progressive step in the line for treating disease.  For a number of days I have been haunted by the feeling that we are in danger of getting into a rut unworthy of higher consideration than should fall to mere imitation.  Let us not be governed to-day by what we did yesterday, nor to-morrow by what we do to-day, for day by day we must show progress.”