Wednesday, February 5, 2014

Mission Impossible

It started out a typical morning -- Oh, you'd rather it was a dark and stormy night? Good idea. I like that; here goes...

It was a dark and stormy night. The wind was howling, trees swayed like hula girls (hula girls? In Maine? Maybe on a fuzzy dashboard.) and rain lashed my windshield as I pulled out of the parking lot. Eager to get home, I didn't notice the cassette lying on the seat next to me until I reached over for my gloves. It couldn’t have been mine; I hadn't listened to a cassette recording in years. Who's been in my car, I wondered, when, and why?

I pulled onto the shoulder and gave my discovery the once over. There was no label, it didn't smell like gasoline, gunpowder, or anything obviously lethal. I hadn't dallied with anyone's girlfriend, wife, or ex, and besides, the local boys wouldn't use a tape; they'd run me down with a really big truck and then shoot me for good measure. Thinking I was fairly safe, I inserted it into the player -- with my hand on the door latch, just in case. 

A dispassionate male voice I might have accused of belonging to Lawrence Fishburne under other circumstances, said, "Good Evening, Mr. Beggar. Your mission, should you choose to accept it, is to answer the question, 'What is a D.O.?' in 140 typed characters or less. Whether you include spaces is entirely up to you. For what it’s worth, your team suggested we do something physiologically impossible with this, so you're on your own. This message will self-destruct in 5, 4, 3, 2...hiss, whirrrr, click."

Acrid grey-black smoke billowed from the CD/cassette player and I swung the door wide, leaning out into the rain and coughing like Doc Holiday in Tombstone (1993) or Wyatt Earp (1994). Somebody from the AOA with a taste for cloak and dagger, I thought, who else? Talk about Mission Impossible. Wait a minute, isn't there supposed to be theme music playing? Where's the thump-thump, thumptha thump-thump signaling I'm about to do something really cool? Mmph. Budget cuts.

What made my task resemble Tom Cruise leaping from a speeding train was the subject matter. It's hard enough to express meaningfully when you've got all night. My "assignment" -- in reality, a sort of contest, but it's more fun this way -- was going to present a challenge. How can we explain the "DO essentials" to the average person for whom "doctor," often as not, refers to an MD? It's like trying to fit an elephant comfortably into a box designed for an engagement ring and expecting it to be recognizable as an elephant when the box is opened. At this point, 140 characters started to resemble the penance given a petulant soul doing time in Purgatory. And then it got worse.

Pretty much everyone agrees, the care and feeding of both types of medical doctor is virtually identical, with the exception that DOs are also trained in the delivery of Osteopathic Manipulative Medicine. On that basis, the question might be raised, why not have the same degree? By itself, is OMM sufficient reason to warrant separate licensing, specialty boards, and so forth? In other words, why not just make all physicians DOs and be done with it? I have a sneaking suspicion the American Medical Association might have something to say about that. Not to mention my best friend who is an MD and one of the most osteopathic of physicians I've ever known. Yet, even he will admit that he and I, MD and DO, are better together than we are separately, and that is due to the differences in our training, not the similarities.

Our training is the overall critical factor and if the training received by DO and MD physicians were truly mirror images, an identical designation would make lexicographic sense. Despite appearances, they are not, however, and not merely because of OMM. Osteopathic medicine is oriented differently and this takes us to the heart of the matter.

Hippocrates said, "It's more important to know what sort of person has a disease than which disease a person has." He could have been speaking as a DO because osteopathic medicine focuses on persons, both as individuals and as members of a community. It conceives of them as complex entities who experience themselves and their environment in ways inclusive of cognition, emotion, and physical embodiment. Their behavior is goal-directed and they are prone to regard the search for meaning as a sublime pursuit. Their bodies are a model of integration in which the part affects the whole and nothing affects the whole without also affecting the person whom it visually represents. Ultimately, the person is everything.

Person-centered care has become a hot topic lately, especially at medical conferences. For osteopathic physicians, however, person-centered is far more than a hot topic, it is a pervasive and all-inclusive, soul-deep conviction that conditions every aspect of the doctor-patient relationship. It isn't a practice emphasis, it is our defining feature. It isn't something we do, it is who we are.

I'm way beyond 140 characters and we haven't even hinted at the role played by OMM or the osteopathic preference for finding and treating the cause of disease rather than symptoms alone, whenever possible. See what I mean? The elephant is so big and the box so very small.

Still, I did accept this mission, so I'd better get cracking. You'll forgive me if I keep one hand on the door latch. Maybe the tape wasn't a "bomb," but that doesn't guarantee my solution won't be. A D.O. is a medical doctor, dedicated to the care and treatment of persons, in sickness and health, of all that they are and wish to become, and a great deal more, besides. 140 characters without spaces. You know, I think I'm starting to hear music.

Thump thump, thumptha, thump thump...

(Creative Commons Image by Baptigrou via Flickr) 
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