Center or periphery? The future of osteopathic principles and practices.

Gevitz • Editorial T essay is based on a single premise: The professional health of osteopathic medicine is directly proportional to the degree to which the discipline incorporates its distinctive principles and practices throughout the teaching of undergraduate and graduate medical students, in the management of patient problems, and in practice settings. From a sociological perspective, the viability of osteopathic medicine will ultimately rest on whether osteopathic principles and practices (OPP) lie at the center of this profession’s activities or at its periphery. My goal is to analyze the current status of OPP in osteopathic medical schools, particularly in the first 2 years of the curriculum. I will also discuss how these principles and practices came to be in the state they are in today, where they may be headed, and what steps the osteopathic medical profession needs to take in regard to OPP to ensure the long-term viability of the profession. Some of the points I raise may be interpreted by many teachers of OPP as “preaching to the choir” because, on certain issues, I am sure we agree. On other matters, some faculty members and preceptors may wince as I challenge certain basic premises on which they educate osteopathic medical students. However, nociception can be part of the diagnostic and, ultimately, the therapeutic process, and I will not leave readers in anguish without providing what I think are reasonable ways and means by which more osteopathic students will embrace OPP, thereby building a stronger profession. What do I mean when I refer to osteopathic principles? Simply put, they are those fundamental tenets of osteopathic medicine that guide how a physician approaches patients in health and disease. They offer a framework on how to evaluate the myriad intrinsic and extrinsic factors that bear upon wellness and sickness. They also provide meaning to what osteopathic physicians (DOs) do to keep patients healthy or restore them to health. For DOs, these principles are especially important with respect to the formation and maintainence of a professional identity that is distinct from that of allopathic physicians (MDs).