What role do doctors have in healing?

I have been thinking on the role of doctors in healing.  I wish to share with you why I think doctors DO have a role in healing.  Pain.
  That's it.  Pain.
  Oh, and if the doctor thinks osteopathically, then there is more.
  My reasoning actually goes right back to my diagram of the mind-body-spirit triangle.


Pain is located near the body.  That is pretty much all a physician can help with.  The emotions and STRESS, located between the mind and spirit, is good with counseling and perhaps psychotherapy.  The bad habits we get into, such as addictions and bad sleeping habits, are between the mind and the body.  The motivation and frustration lie between the body and spirit.  Of all these, pain is pretty much the only thing a physician can help with.

I am biased and I simplifying this as well.  But, why else do you go see the doctor?  Their knowledge is their trade, for which you hand over a monetary equivalent.
 
As an osteopathic physician, I can help people heal themselves with a skill called osteopathic manipulation.  I can also help them understand the relationship they have with their mind, body and spirit, and direct them in a path of healing.  If they listen and get better, I get the credit.  If they don't listen and don't get better, I get the credit.  If I treat them with osteopathic manipulation and they get better instantly, or progressively, I still get the credit.  I win most of the time!  If all I did was throw a prescription pad at them, and entertain them until they get better, then I might get credit sometimes, probably for something I didn't even help with.
 Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.   VoltaireI try to direct my patients and act as a coach.  I cheer them on.  I help with the pain.  I encourage them, I give them hope and something to focus on other than pain.  And they get better.  I am pleased I can help them.  I think that I am lucky to be able to help my patients.  I am lucky to be an osteopath.

Next step in improving

I want to share my second step in the Mind-Body-Spirit aspect of healing.  Let's start with a patient.
  She is a young lady, overweight, who hurts a lot.  She is on Methadone, or a long acting pain medication and goes daily to a clinic to be given her medication.  She smokes cigarettes and lives with her parents, her boyfriend and her son.
  I had previously discussed the mind body spirit approach discussed in the previous posts.

My next step is to give focus to improving the patient.  I use gioals - written and reviewed, as a way to focus the patient and to lay out a path of healing.  Since I do the same thing myself, I don't feel hypocritical AND I have experienced it succeeding.  

  The Goals are listed in the order of SPIREOF.

S - Spiritual

P - Physical

I - Intellect

R - Relationship

E- Emotional

O- Occupational

F-Financial

  I didn't develop this list myself, but rather I got it from someone who got it from someone.  

How this works:

  First, the goals are done for daily, weekly, monthly, quarterly, yearly, 5 year plans and 10 year plans.  I will focus mainly on the daily portion.  

  Since the Spirit portion of my chart is truly the Spirit within the individual, and not a religious object or theory, it works for everyone.  The Spirit is Life.  It is what animates our bodies and what hurts when we are yelled at.  When our focus is on ourselves, we become a "Natural Man."  (This idea comes from the Book of Mormon, in the Book of Mosiah, which I recommend for everyone to read the about God and improving.)  "The Natural Man" is the selfish part of us, that totally turns in and focuses on ourselves.  To improve the spirit, we need to look outwards and focus on others.  We need to sacrifice, volunteer, or help others.  By doing so, we help ourselves feel better.  This is a gift, that by giving to others, we give to ourselves.  

  Under the Spiritual portion of the list, we write down what we are going to do to improve our spirit.  This can be volunteering, sharing, complimenting people or even donating.  Religious activity fits there, if it is used to improve yourself.  Time and sincerity are more effective than money, as a general rule.  

 Looking up, I see this is getting long.  I will continue next time on the rest of the series.

Osteopathy in the Emergency Department

  I wanted to share an experience with you that happened to me over the weekend, which needed a different kind of manipulation.  I say that tongue in cheek, since I feel osteopathy is a mindset and not just a physical medicine modality. In plain English, I do more than just pop joints.

  I work in the Emergency Department in a couple of places and love it.  I like helping people.  There are many that come in with minor stuff, but they need help too.  This last Saturday I helped many such people.  However, I also had a patient who came in, who needed my help. 

  The ambulance brought in a lady, who was about 32 to 33 weeks pregnant, and in labor.  She had been having contractions all day and when she decided to go get checked out, her water broke.  It was her second baby and since babies are supposed to stay inside mom until 40 weeks, it was early.  The ambulance brought her to me, since I was the nearest physician.  The next closest Emergency Department, and the next nearest Neonatal Intensive Care Unit was 30 minutes away.  

  Usually, we can do a quick assessment and send the patient on her way to the experts.  However, this patient was too far along.  That, and with baby being so small, I was concerned that she would deliver in the ambulance if I sent her away.  Oh, and mom also told me that the baby was backwards on the last ultrasound.  

  I did my check and baby was indeed backwards and going to be out really soon.  Unfortunately, we don't normally deliver babies at my hospital and my surgeon would not make it in time to do a C-section.  We gathered what troops we had and got ready.  Trust me, I was on the phone with the high-risk OB doctor down the road and he stayed glued to my ear during this time.

  Now, it is said that the universe provides for everything.  I give credit to God, since I know him better than the universe.  Either way, earlier that day, on my trip up to work, I asked myself what to review (since I have a 2 hour drive).  I reviewed codes and then, based on a random thought, glanced through breach deliveries since I hadn't reviewed that in a while.  Boy, am I glad I did.

  Babies that age are small, yes, but the head is as big as the body and tends to get stuck.  I got everything out up to the head and it indeed got stuck.  I was getting desperate as eternities passed and I couldn't get baby out.  I used every trick I knew of, including several that one of my attending physicians mentioned way back in residency.  This physician had delivered a breach baby and the next day gave an excellent lecture on it to us.  I had that in my head the entire time.

  We got baby out after about 16 eternities and two gallons of sweat.  The baby girl was not moving, not breathing, was more black than pink, but did have a heart beat.  I immediately switched to resuscitation mode and hoped the mom would be ok.  The nurses did a great job in assisting the mom and myself.  I also had an internal medicine doctor there, who quickly learned what I wanted to do and did it without complaint.  We also had two EMTs from the ambulance, who were my extra hands.  As a team, we worked on the baby.  She lost her heartbeat after two minutes, so I started CPR.  Babies need oxygen, so I intubated her and we got her heartbeat back.  Yay!!  We all wanted to cheer.

  I did the resuscitation in the room with mom and dad watching.  I wanted them to see everything we did for their baby because to me, uncertainty and lack of information is the worse situation to be in.  We worked on the baby for 49 minutes before the team from the NICU transport team arrived.  I was glad to get up off my knees and to pass the baby on to them.  

  Then, I sat down with mom, dad, and grandparents and explained everything I did.  A cynic might say I did it to lessen the chance of me being sued.  Although that thought was always present, I did it because I would want someone to do it to me if I were in that situation.  As I explained everything, they sure seemed receptive.  

  I sent them both off to the hospital and wonder how they are doing.  I don't think I can just call up and check on them.  

  How did osteopathy play into this?  I used body mechanics and function to get that baby out.  I used physiology and knowledge to save two lives.  I was a physician, receptive to learning and responsive to inspiration.  There are only two Emergency Medicine trained physicians at that little hospital, and she came on the day when I was there.  

  My colleagues all congratulated me on the save, but I felt more humbled to be part of a bigger picture and accept the congratulations humbly.  It was a neat save.  I never did a CV4 or myofascial release, but I acted like I feel a doctor should, which is osteopathic, too.

  Thanks for sharing in my story.  My thanks goes to God for the knowledge, my team for support and the baby for fighting on!  

Electronic Medical Records - the switch

  Electronic Medical Records (EMR) are supposed to make the physician more productive.  I did my Emergency Medicine residency on one.  But then, that is misleading because each institute that I rotated at had a different system.  Not only that, but the adult Emergency Department at one place used a different EMR than the pediatric Emergency Department at the same place, right across the hall. 
  There are quite a few EMR companies out there, with big names and bigger price tags.  I would like to just touch on a few of the problems and how it plays into my work as a physician.
  First, the learning curve is rather big.  Trying to teach an old doc a new trick is difficult.  Teaching that old doc to use a computer on top of that is also difficult.  At my current work place, we are being trained on an EMR system that will be replaced in less than ten months.  So, all the old docs get to learn TWO systems in less than 10 months.  Welcome to efficiency. 
  Speaking of efficiency, everyone knows that we will need extra time to get used to it and productivity drops by at least 50%.  Yay, we lose 50% of our money and increase the risk for billing errors for 2-6 weeks. 
  Another problem lies in the audience for the EMR.  Most of the hospitals choose an EMR based on billing, not ease of use or 'doctor friendliness.'  So, the ones who bring in the money for the group or hospital get a crummy EMR forced on them by the administration, which does not bring in any money at all.   Hopefully, you can see the potential for conflict and ill feelings.
 
  All in all, EMR is here to stay.  Or to be erased by a virus.  Or a power outage.  Or user error.  And what about those old antique charts that we are trying to get rid of?  We have them filed away, just in case.

The "A-Ha" Moments in Medicine

I wanted to jump ship and jump to a different topic than the last post by sharing what my colleague Dr Bell calls the "A-Ha Moment."  I use her words as they describe the feeling that really gets a physician excited.
  These moments are the few times in the day or month that a physician feels like he (or she) really helped someone.  Most of my "A-Ha" moments come from using osteopathic manipulation in the course of treating a patient. (Please keep in mind that being a good osteopath is more than just doing manipulation.  It involves the mindset and process behind the treatment.)

  I had one just this last week.  A lady came in in pain, with muscle spasms in her back and hips.  She had seen her doctor and was recommended to see me. I had just had two tough patients that were not getting better and was feeling a little down.  Listening to her problems, I came to believe I could help her!  In fact, I drew for her a diagram of her muscles in spasm according to what she had said and it matched exactly.  I was able to relax the muscles and she felt much better.  I walked out of the room doing a fist pump and feeling like I was a good osteopath again.

  My first true "A-Ha Moment" came while I was doing a family practice rotation in Pikeville, KY.  I was there to sneak all the learning I could from Dr Ed Stiles, and still see if I liked the program enough to apply there.  I was "shadowing" a resident (following him around like a shadow) when he got behind.  I was bored and quickly took him up on an offer to see one of his patients, while he finished off another.  The lady was there for the results of her thyroid test.
  I glanced at the chart (like a good ER doc) and hustled into the room.  Talking with her, I quickly found out that she had no energy and that her wedding ring wouldn't fit on her left hand because the hand was swollen for some reason.  Our conversation from there went something like this:
  "Ok," I said.  "Having a low thyroid level will make you feel pretty tired.  In addition, it also will make your hair feel course and thick, and also decrease your libido.  Does any of this seem familiar?"
  She stared at me like I was crazy and said, "You described me to the tee!"
  Feeling more confident, I did a quick physical examination and found her collar bone (clavicle) to be very restricted on the left, with her left 4th rib also posterior, or pushed back.  There was some bones in her neck stuck in rotation to the right, or away from the problem.  As such, I offered her my reasoning, again, paraphrased at follows.
  "If your thyroid is off and you are feeling lousy, that will not enhance an already low libido.  If your husband is typical of most men, then he will not be the most understanding of your decreased attention to him.  That stress, which affects your ribs here, combined with the dysfunction in your neck and collar bone, will all pinch down on the blood supply to your arm, blocking up the returning blood.  That is probably why your hand is swollen.
  "Now, if that is true, then let me fix this... and this... and this..." I fixed the problems in her collar bone, neck and ribs and stood back.  "I am willing to bet you, now, that your wedding ring will fit."  Indeed, her hand was visibly smaller than prior to treating her.  "Do you have any questions?"
  She shook her arm and rolled it around then looked me right in the eye and asked, "Where are you going to practice?"
  I walked out of there on air, told this to the bored resident and got her a prescription for some thyroid medication.  I am still willing to bet that she had a great response to that medication.  I couldn't follow up on her, due to heading out for another rotation, but I never will forget that feeling when she asked me where I was going to practice!  I felt like I succeeded!  That is an "A-Ha Moment."

  I hope all doctors have these moments scattered throughout their day.  It makes medicine so much fun!  They are fun to share and fun to remember.  It keeps me moving when the patients seem to be stuck on "whine" mode.  Best of all, it makes it fun to be here.

Mind, body, spirit - pictorially

I have so many ideas to write about.  I wanted to add two pictures here today in an attempt to explain an osteopathic approach to health and healing.  Dr Edward Stiles teaches the paradigm of medicine that the presence or absence of disease does not dictate the presence or absence of illness.  Basically, your body plays a role in whether or not you get sick.  Why is it that some people get sick and others do not?  Why does pneumonia kill the children or elderly and not the healthy 20-something?

HOST + DISEASE = ILLNESS.  

We will talk more about this later.  On to my pictures.  Keep in mind, these are talking only about the host.

I am combining multiple ideas and trying to simplify them into two pictures.  The first is a depiction of an inner expression of ourselves.  People are a combination of mind, body and spirit.  Some health care providers try to be "politically correct" by saying "bio-psycho-social," but I prefer the words of Dr Still, the founder of osteopathy.  This simple diagram shows the 'interconnected-ness' between the body, mind and spirit.

The other diagram is the inverse or the outer expression.  If you view these two as the Ying and the Yang of Traditional Chinese Medicine, it might make sense that the outer expression of the person is what we see: the "strong" or the light.  The inner expression is the "weak" or the dark/deep aspects of ourselves.

I view the body as a self regulating organism, capable of self healing, formed with intricate concepts of tensegrity that acts as a whole unit. The spirit is the intangible unit of ultra fine matter that exudes a force with magnetic-like properties, interacting with a higher, guiding power to connect with the body and other people, animals or environments around us.  (This is the part of us that hurts when we fail or get punished.)  The mind is a process of mentation that is direct-able, that integrates all sensory input and filters it through our personal experiences and spiritual awareness to produce a reaction or direction the body is to go.

The ideas behind these concepts will fill several other blogs!

The nuts and bolts concept here (or key idea as I was taught) is that we are complex!  The Outer Expression is what moves us to action.  Emotions play a huge roll in this.
  If we start in the left arm between mind and body, I feel that this is where habits come to play.  Our thoughts proceed our habits, which are enacted by our body and negatively become addictions, while they can also positively become skills.

  The right arm between mind and spirit is where emotions and the complexities originate.  Provided the body's influence of hormones, chemicals, cancer, addictions and so on do not interfere, then positive emotions become intuition and instinct.  Negatively, I feel this is most likely where psychologic disorders originate.

  The arm between body and spirit is where our motivations play the biggest role.  With positive energy, these motivations become our "righteous anger" or driving force.  (I feel at a loss for better words in English, so please comment.)  Negatively, motivations become frustrations, which "hamstring" us and leave us going nowhere.

The Inner Expression changes significantly.  I am at a loss of words how to describe it yet, but perhaps you can teach me!
  The left arm between body and mind represents our knowledge.  Used positively, it becomes wisdom, allowing us to understand all things, even those that we don't quite "know."  There are some who may say this comes from a connection with a Higher Power, and I would agree.  But, if knowledge leads to conceit or arrogance, the knowledge becomes foolishness.  How many of us know physicians who "know it all?"

  The right arm between mind and spirit is inspiration.  In a positive setting, this becomes hope.  In a negative setting, it becomes doubt.  Often, the mind plays the devil's advocate to our spirits optimism.

  The bottom arm between body and spirit is faith, or belief.  Used in a positive setting, it grows into charity. Negatively, it becomes selfishness.

We all have all aspects within us.  I have only scratched the surface.  There are many more connections I would like to explore.  I am hoping I can tie this all in to my theory why "Psycho-Somatic Reflexes" work and why they are predictable and mappable.  (More on this - promise)

Thank you for sticking with me.  Please keep in mind, these are my ideas that I am actively dwelling on as I round on patients. Please post the feed back on your ideas and I will happily consider them!

Still Learning!

As some of you may know, I am doing a "Fellowship" or an extra year of residency in osteopathic manipulative medicine in Maine.  I have been lucky enough to be exposed to many different styles of medicine in the three months I have been here.
  When I first came into the residency, I thought I was pretty good at what I did.  Thankfully, I have been reminded how much more I need to learn.
  The first example came from a local doctor (only 50 miles away), who showed me the connections in the body that fascia makes.  Fascia is the thin filmy stuff you pull off of the chicken with the skin, just before you cook it.  Since seeing the connections, I have been treating problems at a deeper level and have been able to help patients "cure" themselves faster!  I feel like I have gone from a treatment approach to a fixing approach.
  The second example is that of natural hormones.  I am finishing a book on natural hormone replacement since I want to know everything.  I had a didatic session (training session) with a physician who does "Functional Medicine," which is where he tries to heal the body prior to throwing a pill at it.  My eyes were opened at the almost Eastern thought process this osteopath has!  He has a back log and wait of 3 months to get in to see him.  You can see his office's website here.
  Why does this matter?  I want to be the best physician I can for my patients and I want them to get better.  It is oxymoronic to say that I want them to not need me again, but that is my goal.  Here, I have been humbled by two areas of knowledge where I was previously (and currently) lacking.  I love to learn and I found once again that the art of osteopathy cannot be mastered in such a little time.
  I have been showing the myofascial level of knowledge to the student physicians who rotate with me and I have been learning as a result.  I love teaching and encourage all who come through with me to touch their patients.
  There is so much left to learn that I hope I never stop learning.  Someday, sometime, I may need an osteopath to treat me and I want them to be as hungry for knowledge about treating the body as me!
  As a side note, I have been asked what my purpose is in writing this blog.  I hope to encourage other physicians to touch and treat their patients, but also, I hope to show non-physicians that the body is so complex that it takes a long time for a physician to learn how to treat it.  I guess, I could say that I am selling encouragement!
  I hope to bring in pictures, more stories and examples into this blog.  Please leave feedback and suggestions!
thanks, Michael

The Power of the Body to Heal

I just got done treating a young woman who has had the hiccups (hiccoughs) for the last eight months.  She unfortunately has a bad case of acid reflux or heart burn and that is causing her to hiccup.  She is on very strong anti-stomach acid medication trying to control this.  She even skips meals to avoid the heart burn and the ensuing hiccups.
  It is funny that just last week I learned about a different focus of medicine called Functional Medicine that tries to heal the body first and that then takes care of things like acid reflux and fibromyalgia.
  Simply put, if we let your body heal before we try to throw a pill at it, your body tends to heal.  There are many herbs, vitamins, nutritious foods and enzymes that can allow for healing.  It does tend to decrease the need for elixers, potions or other medications.
  The osteopathic medical community claims to think in terms of the patient being composed of mind, body and spirit.  As such, I believe it is important to heal the body before attempting to throw a pill at it.  If I only knew everything, then I could cure everyone.  With osteopathic manipulation, I examine the patient's body to find areas that are not moving appropriately and attempt to nudge the body toward health.  I also try to treat the mind and spirit, which tends to set me a little to the side.
  An example of treating the mind and spirit comes from another patient from today, who was involved in a motor vehicle collision where she was rear ended on the highway when the traffic in front stopped and the car behind didn't .  She has had popping and cracking in her neck and shoulders, but her pain had essentially gone away with a previous osteopathic physician treating her.  A majority of what I did today was to relieve the connections of the emotional aspects of the accident that her body was hanging on to.  She cried a lot, but felt better when done.
  Our bodies can heal.  Our bodies want health.  I believe that seeing an osteopathic physician, like myself, can help you improve in your healing process.  Unfortunately, this art of medicine is not as common as the prescription pad kind, but it is worth it to find an osteopath that treats to help you get better.
  You might be able to find one if you follow this link.  I would certainly be willing to help you find one.
  Please stay tuned for more thoughts on healing!  Please leave questions and comments.  This should be able to accept all comments now!  Pictures and perhaps even video coming soon!

Osteopathy, Powerful Medicine

  There are many ways of doing the exact same thing.  This is a mindset that I have that I try to teach to everyone I work with.  I would like to share with you some ideas on healing that haven't been presented to the masses yet.

  I am an osteopathic physician.  I work mainly in the Emergency Department, being trained that way.  Currently, I have limited my outside work so I can return to a "residency" and do another year of training so I can become certified in the dying art of Neuromuscular Medicine aka Osteopathic Manipulative Medicine.  This is usually abbreviated as NMM/OMM.

  I would like to start with a little background of my art (art of medicine) and then share with you weekly the difference an osteopath can make.

  Osteopathic medicine was started by a country doctor who was tired of the medicine of his time not doing any good.  Andrew Taylor Still was born in Kentucky, mainly grew up in Missouri and was practicing in Kansas when disease took the lives of most of his family.  During most of six months in a depressed funk, he started asking himself why he lived and they died.  (I am paraphrasing the story; it actually is really good.)  He developed manual medicine skills that were so powerful that he was excommunicated from his church where he was a lay minister, simply for "practicing the laying on of hands."  He found a place in Missouri that simply ignored him and there he built a following of patients so powerful that three trains a day of patients were coming in to see him or his students.

  The MD (or allopathic) physicians have tried to rule the medical pie since the American Medical Association was created.  The DO (or osteopathic) physicians have been trying for years to show that they are as good or better than their medical cousins, sometimes by leaving behind their skills in osteopathic manipulation.  Now, DO's have been accepted as full physicians, AS LONG AS they don't do that voodoo medicine.  Just look up quackwatch!.  Many MD's are suspicious of this manual medicine that they haven't learned.

  BUT!  Now the MD world is taking to the Neuromuscular Medicine/Osteopathic Manipulative Medicine and requesting it be used!  Currently, I just finished working a month with a mentor and attending physician Dr Beck at the Maine Medical Center.  Dr Beck is an Emergency Medicine physician, who morphed into doing in-hospital osteopathic manipulation.  He has been doing only in-hospital treatments over the last five years.  We treated patients in the hospital with problems ranging from back pain, to respiratory failure, to narcotic withdrawal in neonates!  We treated up to 1/10th of the hospital census at any day this month.  Maine Medical Center is a large tertiary center (which means it is a huge hospital with hundreds of patients in all fields of medicine).  His service is getting larger and larger.

  What I would like to share with you over the next many weeks is just how osteopathy is more than a word, but a mindset and an art.  Please, leave feed back and questions!  I don't promise to know everything, but I would like to share what I am passionate about.

Respectfully, Michael Chipman, D.O.