Osteopathic care in unexpected places

Osteopathic Manipulative Medicine is a foundational practice for those with an osteopathic medical degree (D.O.), but it can be a foreign concept for physicians with an allopathic degree (M.D.). The two approaches to medicine have a contentious history, with osteopathic physicians facing decades of discrimination, even being labeled a cult by the American Medical Association in the first half of the twentieth century. Over time, the division between the two schools has lessened, and osteopathic medicine is now respected within the medical community. The primary remaining difference between the two schools is the training in Osteopathic Manipulative Medicine (OMM), but even that is starting to cross the barriers between the two schools.

OMM in allopathic care

Drew Duerson, M.D., a sports medicine physician at Nationwide Children's Hospital in Columbus, remembers looking into medical school in his home state of Kentucky. At that time, there were three options: two allopathic schools and one osteopathic. Duerson chose The University of Louisville School of Medicine. He says that he didn’t even consider the University of Pikeville – Kentucky School of Osteopathic Medicine as an option, as in his viewpoint, it was the last resort option.

“That was my ignorant impression of osteopathic schools,” Duerson said. “Knowing what I know now and doing what I do now, I would almost go back in time and go to Pikeville or OU and start my journey from there.”

Duerson’s first exposure to OMM care was during a sports medicine fellowship at Nationwide, where he worked with Eric Bowman, D.O., a Heritage College alumnus. He saw how Bowman and other D.O.’s were able to both diagnose and provide hands-on care for their patients, something he felt was missing in his work.

“As a sports medicine physician, I feel like I was making diagnoses that required a referral to, typically, a physical therapist to treat that diagnosis. That left me a little empty,” Duerson said. “I love my job; don’t get me wrong. But there was a part of me that felt like I could do more, that I could treat with my own hands, in my own clinic, without burdening the patient to go see another clinician.”

When Bowman eventually left Nationwide for another opportunity, Duerson saw the gap in care that was left.

“That’s where I really started to look harder about how I could fill that void,” Duerson said. He first signed up for weekend classes that introduced the concepts of OMM through OhioHealth and the University of Michigan. He established a base with the weekend classes, but still wanted to learn more about OMM. Duerson reached out to Shawn Kerger, D.O., Chair of OMM Department at The Heritage College, whom he had met during the weekend OMM classes at OhioHealth. Together they worked out a plan and in the fall of 2022, Duerson enrolled in OMM classes at the Heritage College alongside first-year medical students. For the next two years, he attended the OMM classes on the Dublin campus of The Heritage College.

Duerson was surprised by how much he could feel when palpating patients. “I can really feel through the different layers, from skin to superficial fascia, to subcutaneous tissues, muscles, to deep fascia – all those things that, to me, in the allopathic world nobody talks about. So that was a huge surprise.”

Being the self-described “non-traditional old guy in the room” allowed Duerson to learn alongside the students while also encouraging them about their future careers. He hopes that he was an example to them, not only about the importance of continuing education, but about how valuable OMM can be.

“This is a skill that you don’t want to lose. It’s something that you want to learn well now but also continue to practice as you go through your early training and career,” Duerson said. "It's a great advantage (OMM skills) that they will have over their peers coming out if they hone these skills."

OMM in urology

As a urology resident at Loyola University Medical Center in Illinois, Mallory McCormick D.O., a 2022 graduate of the Heritage College, is accustomed to being an outlier in her department. Only around 2% of urologists nationwide are osteopathic physicians, and only 12% are female. Because of this, she has learned to advocate for herself and her patients.

“I’ve been at hospitals where D.O.s in surgery are not as common, so you have to pitch it from an anatomy standpoint, or say hey this may not do anything, but I’m not going to hurt them by trying so I don’t think it’s a bad idea,” McCormick said.

McCormick’s OMM training allows her to take a different approach than her M.D. colleagues when treating patients. Instead of subjecting a patient to a more invasive examination, she can palpate and determine a possible source of the patient’s symptoms. It has also allowed her to offer Osteopathic Manipulative Treatment to pregnant patients who are wary about taking certain pain medications because of side effects.

Overall, McCormick’s M.D. attendings have welcomed the different perspective she brings to patient care. She says that her biggest advocates in urology have been allopathic physicians. Once, a patient came in complaining of pain related to a non-obstructing stone, which does not typically cause pain. Upon examination, McCormick found that the patient had a tight band of muscle that was causing the pain. The M.D. she was working with spoke to the patient about OMM, assuring that McCormick was specialized in this area, which made her “an asset” to the program.

“It’s validating to know that people do listen to you,” McCormick said.

McCormick has noticed that interest in osteopathic care is on the rise among allopathic physicians, even within medical school. She volunteers for an elective course that teaches OMT at the Stritch School of Medicine at Loyola University Chicago, an allopathic school. McCormick says the students are impressed that D.O.s learn OMM along with everything else taught in medical school.

The students’ interest in OMM early in their medical education along with Duerson and other allopathic physicians seeking out OMM training speaks to the change of attitude towards osteopathic care.

"There's a lot for the allopathic schools to learn from the osteopaths," Duerson said. "From day one I started looking at patients in a different way. I've now introduced the osteopathic exam into my normal exam.

This application aligns with how McCormick feels about OMM exams.

“It doesn’t matter if you’re an M.D. or a D.O., you need to know how to examine your patient. I feel like the ability to understand how the structure and functions interrelate can really help with a physical exam,” McCormick said.

Duerson said that he now questions why OMM concepts were left out of his education, but he is grateful that he was able to take the classes at the Heritage College. He encourages any allopathic physicians who are curious about OMM to take a weekend course to learn the basics and expand their skill set.

"I love learning, I think most of us in medicine do," Duerson said. "It's something that you can pursue. There's always skills that can be added, no matter what. Don't get too complacent. There's always room to improve and things to learn to better care for our patients."