To the Editor:  

Reading the letter section in JAOA—The Journal of the American Osteopathic Association has become as entertaining as reading the same section in my local newspaper. There have been a number of recurring themes in recent JAOA editions, including debates over the use and efficacy of osteopathic manipulative treatment (OMT),^1-5 changing our DO degree designation,^6-13 and the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) vs the United States Medical Licensing Examination (USMLE).^14-19 All of these themes seem to be related to a crisis of identity in osteopathic medicine. 

In addition to these JAOA letters, an article in a recent edition of the alumni newsmagazine of the A.T. Still University of Health Sciences-Kirksville College of Osteopathic Medicine²⁰ discusses the diminishing use of OMT. According to the article, after osteopathic medical students get into their clinical years, they virtually never consider using OMT—and this avoidance of OMT apparently continues for the rest of their careers. Houston, we have a problem! 

In the February 2011 JAOA, an osteopathic medical student suggests a method of improving the examination process by allowing osteopathic medical students to take the USMLE as the main competency examination and then take an adjunct test to cover concepts unique to osteopathic medicine.¹⁷ His letter is followed by rejoinders from other authors defending the COMLEX-USA.^18,19 Incidentally, the Kaplan board review process is all about examinations—not competency. Good physicians are born with it, while the rest study their books so that “no child is left behind.” Examinations are mandated by political bodies to certify that we can practice medicine, but the examinations are no guarantee of professional competency. 

The letter by Arnold Melnick, DO,¹² also in the February JAOA, makes an interesting point regarding the public's confusion about what an osteopathic physician is. (Although osteopathic physician is the currently preferred term in our profession, I do not find the term osteopath objectionable.) Perhaps the public is confused about what DOs are because we are confused about what we are. 

The various recent letters and articles on the apparent identity crisis in osteopathic medicine lead me to think of the cartoon character Pogo, who is famous for making the observation, “We have met the enemy and he is us!”