Shirley M. Johnson

Diminished Use of Osteopathic Manipulative Treatment and Its Impact on the Uniqueness of the Osteopathic Profession

Purpose To determine whether osteopathic manipulative treatment (OMT), a key identifiable feature of osteopathic medicine, is becoming a “lost art” in the profession, and whether the long-term evolution of osteopathic medicine into mainstream medicine and particularly specialization has had a similar impact on the use of OMT by family practitioners and specialists. Method In April 1998, a two-page questionnaire was mailed to 3,000 randomly selected osteopathic physicians in the United States to assess factors affecting their use of OMT. Descriptive statistics, linear regression analyses, and analysis of variance techniques were used to test for differences. Results The response rate was 33.2%. Over 50% of the responding osteopathic physicians used OMT on less than 5% of their patients, and analysis of variance revealed OMT use was significantly affected by practice type, graduation date, and family physicians versus specialists. For specialists, 58% of the variance regression was attributed to barriers to use, practice protocol, attitudes, and training, whereas for family physicians, 43% of the variance regression was attributed to barriers to use, practice protocol, and attitudes. More important, the eventual level of OMT use was related to whether postgraduate training had been undertaken in osteopathic, allopathic, or mixed staff facilities, particularly for osteopathic specialists. Conclusions The evidence supports the assertion that OMT is becoming a lost art among osteopathic practitioners. Osteopathic as well as allopathic medical educators and policymakers should address the impact of the diminished use of OMT on both U.S. health care and the unique identifying practices associated with the osteopathic profession.

Perceptions of philosophic and practice differences between US osteopathic physicians and their allopathic counterparts

Data were gathered through a random national mail survey of 3000 US osteopathic physicians. Nine hundred and fifty-five questionnaires were usable for analysis. Through open-ended questions, osteopathic physicians identified philosophic and practice differences that distinguished them from their allopathic counterparts, and whether they believed the use of osteopathic manipulative treatment (OMT), a key identifiable feature of the osteopathic profession, was appropriate in their specialty. Seventy-five percent of the respondents to the question regarding philosophic differences answered positively, and 41 percent of the follow-up responses indicated that holistic medicine was the most distinguishing characteristic of their profession. In response to the question on practice differences, 59 percent of the respondents believed they practiced differently from allopathic physicians, and 72 percent of the follow-up responses indicated that the osteopathic approach to treatment was a primary distinguishing feature, mainly incorporating the application of OMT, a caring doctor-patient relationship, and a hands-on style. More respondents who specialized in osteopathic manipulative medicine and family practice perceived differences between them and their allopathic counterparts than did other practitioners. Almost all respondents believed OMT was an efficacious treatment, but 19 percent of all respondents felt use of OMT was inappropriate in their specialty. Thirty-one percent of the pediatricians and 38 percent of the non-primary care specialists shared this view. Eighty-eight percent of the respondents had a self-identification as osteopathic physicians, but less than half felt their patients identified them as such. When responses are considered in the context of all survey respondents (versus only those who provided open-ended responses) not a single philosophic concept or resultant practice behavior had concurrence from more than a third of the respondents as distinguishing osteopathic from allopathic medicine. Rank and file osteopathic practitioners seem to be struggling for a legitimate professional identification. The outcome of this struggle is bound to have an impact on health care delivery in the US.

Sources of Information on the Health Effects of Environmental Tobacco Smoke Among African- American Children and Adolescents

PURPOSE To determine the common sources of information regarding the effects of smoking on health and their relationship to knowledge, attitudes, and preventative efforts regarding exposure to environmental tobacco smoke (ETS) among urban African-American children and adolescents. METHODS All students who were enrolled in Grades 5-12 in an urban public school district located in the greater metropolitan area of Detroit, Michigan were surveyed using a structured, written questionnaire that assessed sources of information on the health effects of smoking, as well as knowledge, attitudes, and preventive efforts with respect to exposure to ETS. The primary analytic procedures utilized in the study were correlation analysis and analysis of variance. RESULTS The African-American students surveyed in this study received information regarding the health effects of smoking from many sources, most notably television, family, and teachers. Second, students who received information on the effects of smoking on health from family and external sources (teacher, parents friend, and religious leader) had higher overall knowledge, attitude, and preventive efforts scores than students who received information from other sources (friends, electronic media, and printed media). Finally, family influence was greater when parents were not smokers, and influenced elementary students more than middle school or high school students. CONCLUSIONS The active involvement of teachers, religious leaders, parents, and other influential adults should be elicited in tobacco education and prevention efforts to maximize their effectiveness.

Students' Clinical Assessments: Are They Affected by Stereotyping?

Abstract A study was designed to determine if social work students are prone to rely on stereotypical categorizations to differentiate among patients. Students were shown a series of videotaped vignettes depicting five simulated doctor-patient interactions. The five patient-actors, whose portrayals included sociocultural characteristics, presented to the same physician-actor with a nondescript complaint of abdominal pain. The students were asked to assess each patient on various parameters. The results suggested that students inappropriately attributed both positive and negative characteristics to patients, apparently on the basis of certain stereotypes. Social work educators must address values and stereotyping in clinical assessments with their students to insure the inherent dignity and worth of clients.

Assessment of reproductive knowledge in an inner-city clinic

A number of studies have shown that misinformation and lack of information about the menstrual cycle contributes to unwanted fertility, particularly among black women. A short, self-administered questionnaire was developed and tested in an inner-city, prenatal clinic serving a primarily low-income undereducated, black clientele. Data were gathered concerning numbers of pregnancies and abortions, knowledge of the menstrual cycle, past contraceptive use, including dissatisfaction and discontinuance, and planned future use of contraception. Results showed that the majority of women had had at least one unwanted pregnancy. Their knowledge base about female reproductive function and their poor use of contraception contributed to these unwanted pregnancies. It is concluded that a few key questions can help identify the woman with special informational needs, enabling the health professional to gear educational efforts to the individual patient.

“Appropriate”; name usage: Didactic and clinical incongruity

Respectful and sensitive name usage during the initial phase of the physician‐patient encounter can set the tone for a humanistic doctor‐patient interaction. In this study, medical students’ application of previous didactic instruction regarding “appropriate”; use of names was evaluated in the clinical setting. The typical manner in which physican‐teachers role modeled this behavior was also examined. There were 196 patients, 21 physican‐teachers, and 16 medical students who completed study questionnaires. The results revealed that medical students did not employ essential concepts of previous instruction regarding name usage in their interactions with patients. Furthermore, patients’ assessments of the manner in which the majority of physican‐teachers addressed patients was inconsistent with precepts presented in the classroom. To avoid incongruity between didactic and clinical teaching, clinical faculty must be apprised of the rationale for specific didactic curricular components and encouraged to role ...