DO vs MD: Two philosophies, but both doctors

I read a tweet this weekend from a prominent political commentator disparaging doctors of osteopathy, DOs for short. He said only MDs are legitimate doctors. That’s not at all true. Let’s take a look at a DO vs an MD. There’s a difference, but it doesn’t at all mean DOs are less competent.

DOs are recognized by all 50 states and are licensed to prescribe drugs, administer vaccines, and perform surgery just like an MD. Web sites that suggest a DO is basically a chiropractor are using outdated and incomplete information. While some people consider osteopathy a form of alternative medicine, that’s an incomplete perspective. The majority of what DOs practice is completely mainstream medicine.

Why people attack DOs

I think the reason people attack DOs is largely a matter of unfamiliarity. About 25 percent of doctors in the United States are DOs, which makes them a minority. The MD title is much more common and more familiar. When someone has a bad experience with a DO, they may decide that all DOs are quacks and don’t know what they’re doing. But I’ve heard people have bad experiences with MDs and say all MDs, or all doctors in general, don’t know what they’re doing. That’s called prejudice. In both cases.

There’s almost always been a lot of misconception about what DOs believe and what they do. My dad and both of his parents were all DOs, and all of them were big advocates for the DO philosophy, because it took a more holistic approach to medicine.

It’s important to say that both MDs and DOs recognize each other as real doctors. My dad certainly preferred to be treated by a DO, and preferred his family be treated by a DO, but when the best qualified doctor was an MD, we went to see the MD. I’ve had three surgeries in my life: hand surgery performed by a DO, dental surgery performed by a dentist, and tubes in my ears put in by an MD. The MD offered to let my dad assist if he wanted. Dad declined. He was licensed as a surgeon but wasn’t good at it, and he knew it.

My family history of MDs and DOs

My great great great grandfather was Edward Farquhar MD, who practiced medicine in Ohio in the mid 1800s. Edward’s sons were doctors as well, all MDs. My great great grandfather was Isaac Farquhar MD. Isaac was a good man. He was a Quaker abolitionist who rejected his status as a conscientious dissenter, enlisted in the Union army to fight as a foot soldier, then went back to school to become a doctor after the war. His older brothers left their medical practices to become officers, while the younger Farquhar brothers fought as soldiers.

There have been a dozens of doctors with a last name of Farquhar in the United States. Some were MDs, others DOs. There’s a pretty good chance I’m related to most, if not all of them.

From MD to DO

Isaac received his degree a good 20 years before the first Osteopathic school was founded. He was too old to be a DO. His son went into business rather than becoming a doctor, but his grandson, Ralph, attended medical school in Philadelphia where he met his wife. Ralph and Elizabeth were both DOs. Ralph was a general practitioner. Elizabeth was a psychiatrist. Ralph was basically a PCP and a chiropractor in one stop, the way he ran his practice. Elizabeth practiced psychiatry by the standards of her day, differing little from how an MD would have.

My dad, Ralph, was also a DO. He specialized in radiology. He had this idea in the early 1970s that you should treat cancer with radiation to shrink the tumor, then do surgery. That was a radical idea then, when they did radiation after surgery. He published his study in 1971, and it’s a mainstream idea now.

The DO philosophy vs MD

Osteopathy’s founder, Andrew Still, recognized that the medicine that 19th century doctors practiced could do more harm than good. I don’t know for certain that my ancestors Edward and Isaac used arsenic and mercury to treat their patients’ ills, but some of their contemporaries did.

A doctor’s job, first and foremost, is to do no harm. Dr. Still was among the best of his generation in that regard. Better than his contemporaries named Farquhar. He saw that some of what he was taught was doing harm, so he sought to find a better way.

Osteopathy was what he came up with. One of his theories was that the human body is a mechanical machine, and if the bones and muscles are properly aligned, it will work better. But it’s important to note that was one of Dr. Still’s theories. He also believed proper nutrition played an important role in health. He did not reject drugs and surgery. Dr. Still’s approach was one of balance. The most appropriate, least harmful treatment might involve all four, or just one.

Today, Dr. Still would be regarded as a quack, but so would Dr. Edward Farquhar or Dr. Isaac Farquhar. They were 19th century doctors doing the best they could with the knowledge of their era. DO vs MD may have made more of a difference then, but those differences are narrower today.

It’s also important to note that Dr. Still did not reject the scientific method. Osteopathy is based on science. His ideas that worked are still in practice today. His ideas that didn’t work are not. One example is the practice of cracking a patient’s neck by tilting the head while applying slight pressure. This relieves headaches and back pain, but there is a very small chance of it causing a stroke, so modern osteopaths no longer do this.

I honestly don’t know what more the critics of osteopathy want. Osteopaths are looking for root cause, like a good engineer would. It’s a better approach than treating symptoms.

OMT: Osteopathic Manipulative Treatment

The major practice that distinguishes a DO from an MD is called OMT. This involves moving muscles and joints through stretching, gentle pressure, and resistance. The technique is similar to what a chiropractor does, and this is the most frequent source of confusion. The difference is when each will use the treatment. Some chiropractors will attempt to treat acne by giving you a chiropractic adjustment. A DO won’t use OMT to treat acne. A DO may want to adjust your diet and have you try taking supplements (especially zinc) before prescribing medicine, but if that fails, the DO will prescribe the same medicines an MD would.

My dad didn’t hold chiropractors in very high regard because of this. He saw the chiropractic approach as intellectually dishonest. For treating pain, sure. But not infections.

OMT is part of osteopathy. It’s not the entirety of it.

The wisdom of the DO vs MD

But look at the wisdom of the osteopathic approach. In the 90s, most doctors, especially MDs, treated acne with antibiotics. Overuse of antibiotics is part of the reason we have antibiotic-resistant superbugs today. By trying nutrition and supplements first, DOs were able to reduce their contribution to the overuse of antibiotics.

In my grandfather’s era, a DO would perform OMT as part of almost any office visit. But this was in addition to, not instead of, more conventional medical treatment. My grandmother rarely had any reason to do OMT since she was a psychiatrist. My dad did sometimes. If he was giving a pregnant woman an ultrasound and she complained of back pain, he’d offer OMT. His dad did a lot more OMT, since he was a family doctor.

OMT certainly qualifies as alternative medicine, but the rest of what an osteopath does qualifies as conventional medicine. And while I’ve never had a DO turn me down when I asked for OMT, it’s no longer a routine part of any office visit. Some DOs will specialize in OMT, and a DO with another specialty often prefers to leave OMT to a specialist.

A practical advantage of a DO vs MD

Here’s another very practical example besides antibiotics, where seeing a DO vs MD would pay off. Let’s say you’re being treated for pain or inflammation. The only tool in an MD’s arsenal for this is drugs, and over time, you need stronger and stronger painkillers for it. This has contributed to the opioid crisis.

A DO can treat the same problem with a combination of OMT and drugs. This approach has two benefits. First, you can use a milder painkiller, perhaps even an over-the-counter one. Second, by addressing the root cause, the treatment could have an end date. The DO theory goes that eventually the muscle and joint will relax, stop displacing itself and causing spasms, and if and when that happens, you won’t need either OMT or the painkiller anymore.

If we always used that approach to treating pain, we might not have an opioid crisis today.

Is OMT a distraction?

DOs go to school an extra year to learn OMT. It doesn’t displace any of the training a regular MD receives. And yes, this means a DO is more highly educated than an MD counterpart.

One common complaint about MDs is that they don’t learn about much other than drugs and surgery in medical school. A DO spends an extra year getting education that fills those gaps. If you want a doctor who will be sympathetic to alternative medicine and have the background to know (or figure out) what works and what doesn’t, an osteopath might be for you.

Want an example? My grandfather routinely recommended Numotizine Cataplasm as a treatment for cough. An MD would regard it as a folk remedy. I have no idea where my grandfather learned about the stuff, but generations of his patients used it, and my dad recommended it too. And when neighbors would ask my dad what he recommended for burns, he said Aloe Vera.

Osteopathy vs alternative medicine

Several years ago, I visited a DO because I had some kind of bacterial illness. I tried to fight it off on my own, but after about a month of not getting better, I decided to go see him and see if he thought an antibiotic would be appropriate.

Of course he asked how long I’d been sick, and what I’d tried. I told him I’d been sick for a few weeks, and that I’d been using a humidifier and peppermint oil to try to treat it. He nodded when I said humidifier. He gave me a look when I said peppermint oil.

“Don’t  get the wrong idea about me,” I said. “Sometimes the peppermint oil helps, but not this time. I’m not sure why it works but when it does, I do get better faster.”

He paused for a second, then said, “That’s interesting. I’m curious what that does.”

I walked out with a prescription for amoxicillin. Predictably, I felt noticeably better the next day and completely better five days later.

An osteopath will be interested in why essential oils sometimes work, but will never, ever suggest using essential oils instead of vaccinating.

Why major universities make you an MD, not a DO

The Twitter critic of DOs that I encountered dug in after a number of people, including many practicing MDs, told him he was wrong. He named a bunch of major universities and asked why they teach a program that creates MDs, rather than DOs.

The answer is rather simple. Most of those schools have medical programs dating back to the middle of the 19th century. Osteopathy wasn’t formalized until 1892. A number of osteopathic medical schools formed over the course of the 20th century, all of them accredited just like any other college or university. But the existing medical schools weren’t going to change. That’s why osteopaths founded their own schools.

While there was certainly some tension between DOs and MDs, they’re both accredited and licensed by the same medical boards. They practice alongside each other in the same hospitals. My dad’s Missouri medical license had a signature from an MD and a DO on it, as did every other doctor who got licensed that year. His Ohio medical license had signatures from two MDs on it.