I had spent the last two years in undergraduate pre-medical courses after quitting my investment banking job in order to go to medical school. It had been an interesting and circuitous route to medical school and I was now in the required meeting with the pre-medical student advisor. This was a moment that I had delayed given the rumor that the advisor was less than cordial. After she went through my transcript, she asked about the way that I thought medicine should be practiced. After hearing how my desire was to help people live a healthier/happier life while minimizing risks she suggested that I look into the osteopathic medical school in Ft. Worth. I was a little surprised that she would suggest the osteopathic school since it was common knowledge among pre med students that students went to osteopathic schools because they didn’t have the grades to make it into an allopathic school and my grades were just fine. I am happy she made the suggestion though.
After researching osteopathy, it didn’t take long for my mind to open to the possibility of becoming an osteopath. The holistic education, which includes the allopathic systems based approach to medicine and increased attention to the musculoskeletal component of any disease process as well as a more holistic mindset, appealed to me. I contacted the osteopathic school in Ft. Worth, TX and they put me in touch with a professor in the osteopathic manipulative medicine department, Dr. Russell Gamber. He invited me to come shadow him for a day in his clinic and at the end of the day he asked me to lie on the treatment table to be treated. At the time, I was having low back pain that was severe enough to keep me from wearing a belt, as the pressure from the belt increased my pain. Dr. Gamber found something on my left iliotibial band and he went to work. After a few minutes, my low back pain decreased and my leg rotated laterally with just the force of gravity. It was by no means a miracle cure, but I did get off the table feeling better and I was able to start wearing a belt again. I was converted to osteopathy.
Throughout medical school I constantly had to fight against the temptation of studying without skepticism. There is an expectation that students will master an exceedingly large amount of information. Medical school is jokingly compared to drinking water from a fire hose. It would be easy to focus only on blindly memorizing the information that was placed in front of you as opposed to questioning the validity and usefulness of that information. For example, the seventh report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation and treatment of high blood pressure is the guideline that clinicians use for hypertension. This guideline is 65 pages long and discusses in detail everything associated with hypertension, from accurate blood pressure measurement to pharmaceutical choices in special situations. Of those 65 pages, there is exactly one paragraph and one table focused on the very first intervention that the guideline suggests, lifestyle modification. The table indicates that lifestyle changes may decrease the systolic blood pressure by anywhere from 21 to 55 points. Based on this, making lifestyle changes alone would place many hypertensive people in the normal blood pressure category. How much time is spent teaching medical students about lifestyle changes? If I remember correctly, I was given a CD to look at and was told to study it on my own at home. There is even less attention paid to exercise in medical school. Not much time is spent teaching this information because the proficiency tests don’t focus on testing this information. However, I took time away from studying other subjects to focus on lifestyle changes. I did this because these changes allow people to decrease their health risks without increasing risks from pharmaceuticals or surgeries. If I am going to try to “first, do no harm”, then I need to attempt to help people live a healthier life and not depend on pharmaceuticals as the first line of defense.
This blog post covered how I ended up at an osteopathic school and how I approached my studies while I was there. I’ll follow up next time with a discussion of how osteopathy and a skeptical approach to medicine can benefit my patients.