In upcoming issues of the JAOA, we will publish evidence-based clinical reviews that address the timing of treatment for venous thrombembolism, a patient-centered approach to the management of atrial fibrillation, dermatologic infections in competitive athletes, and a nonpharmacologic approach to the management of insomnia. In these articles, readers will note myriad connections to the tenets and thus a uniquely osteopathic perspective on the topics.
All of the articles in this new section will hold in common a foundation of scientific data as evidence. Health maintenance and recovery from disease, which includes prevention, will play a smaller role in some topics, and therapeutic lifestyle changes will be much more important in others. In each case, we have asked our authors to focus on the patient as an organizing principle.
Readers should not misinterpret me by taking any one of these tenets out of context as a sole, defining element of osteopathic medicine. For example, evidence-based medicine is not the invention of osteopathic medicine, though Dr Still did found this profession based on his observation that the treatments of his time did not work and caused more harm than good. Had evidence-based medicine been an operative term at that time, it is intriguing to speculate whether Dr Still would have embraced the idea.
I have heard many DOs report that they, compared with our allopathic brethren, tend to be much more focused on the care of individual patients. In fact, there is a healthy, creative tension between the practice of evidence-based or guideline-based care and the treatment of patients. Research studies involving upwards of thousands of patients provide treatment guidelines in which the relative risk reduction may actually be fairly small. And still, the practicing physician may be faced with a single patient and the question of what will work best for him or her. Sometimes the medical evidence is conflicting or yields uncertain results for specific subsets of patients. For this reason, we have invited seasoned authors to provide a perspective on this evidence base, tempered by their own extensive clinical experience.
I have been aided considerably by four section editors and an advisory council. These individuals have come from some of the top osteopathic and allopathic medical institutions in the country (
Figure 2). During our monthly teleconferences, I am awed by the depth of medical knowledge of these colleagues, by their enthusiastic commitment to the advancement of osteopathic medicine, and by the broad creative thinking that they bring to this new
JAOA section. All of us are eager to identify the best and brightest of the young writers and clinicians within our profession. We hope to receive a vigorous response to the articles in this series, and we look forward to suggestions and recommendations for topics and potential authors.
This series has other objectives. That is, we are hopeful that this series will help define our tenets and principles and establish our identity as a profession. Moreover, the osteopathic profession has its historical roots as a reform of medicine. Perhaps lulled by our success as practicing clinicians, at times I worry that we have lost our spirit of inquiry and our perspective of challenge to the status quo.
There is much about the practice of medicine in the United States that would benefit from the viewpoint that osteopathic medicine can provide. We owe it to ourselves and to the public to do a much better job of defining the best practices.