Letters to the Editor  |   July 2006
Tracing the Decline of OMT in Patient Care
Author Affiliations
    Scarborough, Me
Article Information
Osteopathic Manipulative Treatment
Letters to the Editor   |   July 2006
Tracing the Decline of OMT in Patient Care
The Journal of the American Osteopathic Association, July 2006, Vol. 106, 378-379. doi:
The Journal of the American Osteopathic Association, July 2006, Vol. 106, 378-379. doi:
To the Editor: Norman Gevitz, PhD, offers a complete review of the philosophy and practice of osteopathic medicine in his editorial in the March 2006 issue of JAOA—The Journal of the American Osteopathic Association (“Center or periphery? The future of osteopathic principles and practices.” 2006;106:121–129). My father and I practiced osteopathic medicine for almost a century combined, and I have seen and experienced many of the changes in the osteopathic medical profession that Dr Gevitz so accurately describes and fairly interprets. 
When I was an osteopathic medical student during the 1940s, the clinical instructors in college described both the drugs and the techniques of osteopathic manipulative treatment (OMT) that they used to address specific problems with their patients. Later, as medical specialization became more complex, courses were taught by specialists who did not use OMT in their practices or mention it in the classroom. 
At the time of my internship in 1945, there were “routine orders” in osteopathic hospitals that applied to all patients but were not written in the patients' medical records. This system of patient care allowed providers to make individual decisions regarding such actions as changes in diet, complete blood cell count, and daily OMT. Because of these routine orders, interns and residents administered OMT to each patient every day using their own preferred techniques. Many staff physicians, including general practitioners and surgeons, also administered OMT to their patients. 
Although the OMT used by different osteopathic physicians varied in technique, it was usually nonarticulatory in nature. For example, a physician might use rib raising to improve lung function, the lymphatic pump and freeing-up of the clavicular area to aid in lymph flow, and cervical relaxation and lumbar paraspinal relaxation as needed. Occasionally, mobilization techniques were also used. 
Daily administration of OMT had many advantages. The patients enjoyed and appreciated the attention and the physical contact, which helped boost the reputation of osteopathic hospitals. The interns learned more about the patients and developed an appreciation for both the psychological and medical value of OMT. There is much anecdotal evidence than patients recovered more rapidly, required fewer analgesics, and felt better after receiving OMT. 
The routine orders began to lose their validity in the 1950s and 1960s, when various forms of hospital insurance and Medicare went into effect. To ensure that the hospital and its physicians were financially reimbursed, new requirements stipulated that there be a formal order for any OMT procedure, evidence justifying the use of the procedure, and evidence in the patient's medical record that the procedure was performed.1 These requirements posed problems not only because many DOs did not issue formal orders for OMT, but also because OMT would probably not be reimbursed by insurance policies, many of which did not allow the participation of DOs. 
As hospital care became more technical and inpatient stays became shorter, osteopathic physicians came to ignore the real advantages of OMT in aiding in recovery from the presenting complaint. Also ignored were OMT's role in aiding recovery from the secondary effects resulting from bed rest and technical testing, as well as the primary and secondary effects of surgical procedures on the sympathetic-parasympathetic balance.27 
As a result of these changes within the healthcare industry, osteopathic medical students lost the opportunity to develop skills and confidence in osteopathic manipulation and philosophy. 
When I was in the early years of my office practice, the typical osteopathic physician attempted to analyze the reason for a particular medical problem and, by appropriate manipulation, restore the patient's normal nerve, lymph, and blood supply. “Find it, fix it, and leave it alone” was the prevailing philosophy in osteopathic medicine in the 1940s. 
Osteopathic manipulation was a common part of patient care when my father practiced osteopathic medicine, from 1910 to 1960. In fact, many of my father's patients scheduled regular appointments for OMT to maintain their health and normal body function. With some exceptions, every patient received OMT in addition to prescriptions or other medical procedures. The manipulative techniques used could be specific for the patient's problem or they could be part of general osteopathic treatment. 
As DOs became more specialized and as more fancy drugs were developed (and as pharmaceutical companies were permitted to advertise their drugs to the general public), more patients ended up leaving their osteopathic physician's office with a handful of prescriptions on their way to a massage therapist for muscle relaxation therapy. In order to receive OMT from an osteopathic physician, patients increasingly have had to schedule appointments with the shrinking number of DOs who specialized in manipulation. 
It is true that the traditional osteopathic medical approach of determining the cause of a problem requires more concentration and intellectual acuity from the physician than simply writing a prescription targeting a specific symptom. It is also true that administering OMT requires more strength, coordination, and time than writing a prescription. Yet, using OMT to eliminate the cause of a patient's problem and normalize the inherent functions of the body could result in long-term improvements without adverse effects, drug interactions, or toxicity to the body. 
Are we leaving behind the most physiologically sound approach to maintaining patient health that has ever been proposed? Are we teaching our students about all the latest medicines but relegating the teaching of OMT to almost an afterthought? Is there no longer any effort to integrate palpatory diagnosis and the value of osteopathic manipulation into the total care of the patient? 
It seems that Dr Gevitz has raised important questions in his editorial. I hope that educators, clinicians, and continuing medical education programs will all take a long, hard look at where the osteopathic medical profession is headed. 
 Editor's note: The letter by Dr Richardson continues a discussion that began in the Letters to the Editor section of the June 2006 issue of JAOA—The Journal of the American Osteopathic Association with letters by Myron C. Beal, DO, MS (“Maintaining competence and leadership in manual medicine.” 2006;106:318–319. Available at:; Mark Tosca, DO (“Future of osteopathic medicine depends on investing in graduate medical education.” 2006;106:319. Available at:; and Humayun J. Chaudhry, DO, MS, SM (“Suggestions and questions for osteopathic medical education.” 2006;106: 319,357–358. Available at:
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