MD DO What’s the Difference?

S.Q. Lapius was uncomfortable.  When possible he wrapped warm towels around his neck and shoulders, encouraged me to rub in pungent liniments, and much of the time wore a neck collar to brace his tortured muscles.

“You have not been very sympathetic, Harry,” he reminded me when I grumbled about being interrupted for the umpteenth time to apply a light massage.  “After all, a whiplash injury, although not serious is exquisitely painful.  You should try one some time.”

“I will,” I promised. “as soon as I get a chance to stop suddenly in front of a speeding car.  It’s just that the opportunity hasn’t come along –“

“You can jest, Harry, but if it weren’t for old Spiney I’d be flat on my back.”

“Spiney?  The Osteopath?  Don’t tell me you have been seeing him.”

“He has been good enough to take me on as a patient.”

“Simon,” I laughed.  “That’s a heresy.  You will be drummed out of the medical profession.”

“Perhaps,” Lapius countered, “but from what I have been reading lately, Spiney may be drummed out of osteopathy.”

“You josh.”

“Of course I josh.  I’d even laugh if it didn’t hurt so much.  But in any case, Spiney, with his manipulations, have helped some.  He’s an excellent physician, of course, and I am glad that the hospital has granted him privileges.”

“Why not.  There is hardly a whit of difference between an osteopath and a medical doctor.”

“Well the American Osteopathic Society would have us think differently, Harry.”

“How so?”

“Haven’t you read about the case of Gary Ferris, the graduate of an osteopathic school who took his internship and residency training in medical institutions?  He can’t get a license either as an M.D. or a D.O.”

“That’s ridiculous.  How did that come about?”

“The Osteopathic society wouldn’t allow him to be licensed because he failed to take an internship in an osteopathic hospital.  They claim that there is a fundamental difference in philosophy that can’t be bridged.” 

“So why not let him practice as an M.D.?”

“Simple, Harry.  He hasn’t got an M.D. degree.”

“But if he has completed residency training in medical institutions, he is practicing as an M.D.?”

“Of course he is, but only a medical school can confer an M.D. degree.”

“I thought that the osteopaths wanted the privilege of being able to become associated with medical institutions.  After all, their schooling is almost identical.  As a matter of fact, if I remember correctly, Andrew T. Still, the founder of Osteopathy was himself a physician.”

“True, my boy.  But it is asking too much for the leaders of the profession of Osteopathy to declare null and void the basic philosophy of osteopath, that skeletal misalignments are responsible for a considerable proportion of aches, pains, and even certain diseases.  The august leaders would be liquidating their own profession, and you can hardly expect them to do that.”

“So poor Ferris is caught in a political bind that really has nothing to do with the practice of medicine.  After all, osteopathic education is identical with the medical education, except for token reference to manipulation.  Osteopaths practice all specialties in the conventional manner.  Certainly there is no manipulation in psychiatry or gynecology.  And there is not too much difference between the techniques of the medical physiatrist or gynecology. “

“True, Harry, but none of it helps Ferris.  He is caught in a web of laws and domains, power struggles and simple jealousies.  For years the osteopaths have been proclaiming that they are a profession of medicine but suddenly as soon as the get the medical profession to agree with them, the osteopaths declare there are irreconcilable differences.”

“Well, maybe there are.  Why did you go to Spiney instead of to a medical doctor to get your neck treated?”

“Because his manipulations help me.  But that represents only a small part of his practice.  Fundamentally, he practices medicine in the same manner as you or I.”

“Then why don’t the physicians accept manipulation into the practice of medicine?”

“I think we would, Harry,” Lapius said wincing a little to remind me that his neck was still painful, “but we won’t accept the theoretical basis behind it.  In other words, it is helpful in some cases, but the medical profession can’t accept the unproved concepts that the osteopaths advance to justify skeletal derangement as a basis of disease.”

“Boy, this argument sure gets remote,” I offered.

“Yes, remote and unreal.  The training opportunities in medicine are far more numerous and offer higher skills than those in osteopathy.  But a band of zealot leaders will deny these advantages to the graduates of their own schools in order to preserve differences between the two professions that are not pertinent.”

“Perhaps the medical profession could bend somewhat to resolve the differences.”

“I don’t see how they can bend much more than they have.  Perhaps they can work some means of providing the osteopaths who have trained in medical institutions with licensure as M.D.’s but this would involve legislative action.  The medical profession, stodgy as it may seem at times, retains its paramount position in the healing arts, because it never was wedded to a single doctrine, but changed its concepts as scientific advances logically indicated.  Osteopathy has tried to do the same, but have remained anchored to the cultish theory of Andrew Still.  Only if that anchor is cast adrift, can the two professions be merged.  And I am afraid that the leaders of osteopathy won’t permit that.  They would be out of a job.”

“It’s quite a mishmash.”

“You are so eloquent, Harry.  Would you be good enough to give me a light massage?”