Tuesday, April 20, 2010

OMM: A Rite of Passage

A physician professor and med students learn a...

Yesterday I alluded to rites of passage, those actions we undertake enabling and symbolizing our transition from one phase of life to another. For osteopathic medical students, the study of gross anatomy -- laying hands on the dead -- is paralleled by osteopathic manipulative medicine (OMM) -- laying hands on the living. Touch is not only a characteristic element of osteopathic medical practice, it is a powerful element in doctor-patient interaction. Researchers have recently demonstrated, for example, how touch is capable of communicating a fairly wide range of emotion. Learning to touch and be touched is another one of those rites of passage my classmates and I have shared.

If you were to think this should be no big deal -- people touch each other all the time -- you'd be mistaken. It is a very big deal. For one thing, most of us are accustomed to physical contact that is generally restricted to family, friends, or intimate partners. Deliberate and prolonged contact with a stranger? That's definitely something else. And when we begin medical school, even though we are classmates, we're still relative strangers. Becoming comfortable placing our hands on someone we scarcely know is as important as developing expertise with the techniques of treatment.

I imagined, being somewhat older than most and having had experience physically assisting patients, I would have an easier time with this whole thing. Did I ever have a lot to learn. During our first lab I was paired up with a younger female classmate and truthfully, I suddenly felt very shy. I tried not to let it show, but it was difficult, to say the least. I'd never touched someone in quite this way, using my fingers and palms to become aware of muscle tension, noting how the quality of the skin on the arms differs from that along the back or neck. It was really very intimate and yet, non-sexual, at the same time.

Being touched by her was just as unnerving. I'd been an osteopathic patient on several occasions, so the experience of being palpated and manipulated wasn't new. But this involved being explored in a similar non-specific manner as I had employed with her. It's hard to describe the experience; it was comfortable and yet, I felt vulnerable. Not unsafe, I don't mean that, but vulnerable in the sense of letting go of being in control. I think that's the core issue for anyone in this position and being there is how we learn to identify and empathize with our patients.

When the question is raised, what distinguishes osteopathic from allopathic physicians, the answer usually entails a reference to the practice of OMM. Although I've said that myself, it's really too mechanical an explanation. It would be more accurate, I think, to say we're trained to use touch in the promotion of wellness and well-being. Having had this experience, I sort of feel sympathetic toward MD students who don't have the same opportunity. It's so extraordinary, without it medical school would seem impoverished. As it is, we're a lot richer because of it.

(Public Domain image of students learning Osteopathic Manipulative Medicine via Wikipedia)
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