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“We are all interrelated.
This is the foundational basis of osteopathic medicine. Whether considering internal relationships of the systems of the body or the external relationships of a person with the world around them, connection is a key principle at the core of osteopathy.
Developed at a time when the baseline medical practice was lacking and offered as an answer to the beckoning call for a new perspective on methods of practice, osteopathic medicine is itself a call to curiosity and creativity. It is an invitation to challenge the status quo while standing in reverence of the grand design of human form and respect for the engagement with all of nature.
Is there anything about the current practice of medicine that frustrates you?
Do you notice outcomes that seem inappropriate, unfair, or discriminatory?
Considering the possibility of health, do you see untapped potential in patients?
Osteopathic philosophy offers the opportunity to see through to possible solutions.”
Amelia L. Bueche is an osteopathic physician and founder, This Osteopathic Life.
She shares her story and discusses her KevinMD article, “Expanding the osteopathic concept for the health of all things.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today we welcome back on the show Amelia Bueche. She is an osteopathic physician, and she wrote the KevinMD article “Expanding the osteopathic concept for the health of all things.” Amelia, welcome back to the show.
Amelia L. Bueche: Thanks. So good to see you again. Thanks for having me back.
Kevin Pho: So we’ll get into your article in a little bit, but first off, for those who didn’t listen to your prior broadcast, can you briefly share your story and your journey?
Amelia L. Bueche: Yes. So as you said, I’m an osteopathic physician, and my specialty is in neuromusculoskeletal and osteopathic manipulative medicine, so I do hands-on treatments with the majority of my patients. For me, it’s always been about bringing the osteopathic concept forward in new and creative ways, even outside the field of medicine.
I’ve been coaching this past year, and for me, coaching also is an expansion of the osteopathic concept. It brings forth that body-mind-spirit connection in a new way as we look at our feelings, thoughts, and actions. I’ve also been leading a class, a virtual class, as is the nature of the times, on teaching osteopathic medical students more about the osteopathic concept beyond just the hands-on care.
Kevin Pho: So ever since October, when I’ve scrolled my Facebook feed, you’ve been facilitating these virtual conversations on Dana Corriel’s SoMeDocs, which is the Doctors on Social Media Facebook group. So tell me a little bit about that facilitation and about all the doctors that you are meeting with during those video sessions.
Amelia L. Bueche: Yeah. So I’d encourage any who haven’t tuned in to check out SoMeDocs. Dana has put forth so many amazing different lecture series and tools, and this one began back in the summer as an idea. Then in October, we began to have these lessons that weren’t from physicians, and they’re called Life Lessons for Physicians. So we’ve had things from microphone savvy to difficult conversations to writing a story and telling your story. My task has been to bring physicians into that space to reflect on those words of wisdom, to bring forth their own experience, and to share their perspectives.
It’s been a really fascinating journey of cultivating that group and reminding physicians that you do have these insights, and being able to see that wisdom come through in ways that seem totally unrelated to the clinical space, right? But then we often make these corollaries to how it really does impact patient care.
What I loved about it is getting to meet physicians from all over the country, in all different areas and styles of practice, and having them come together in the different collectives we’ve had each week. They learn from one another, they bring out the best in each other, and they begin to see the wisdom that they actually have. Owning our capacity in medicine is something we’re often reasonably good at, but being able to see how we can apply that broadly has been a great expansion. So we have one more left of this series coming up next week. That’ll be our final one in the Life Lessons for Physicians.
Kevin Pho: So tell me some stories and experiences that you’ve learned from these doctors that you’re cultivating on this show, and what are some of the things that these doctors have learned from the non-physician experts that you bring on?
Amelia L. Bueche: I think learning that we can speak a little bit more spontaneously, especially when we’re coming out of our area of expertise. For example, you might be able to give a talk in your specialty off the cuff, 30 minutes, no problem. But these lectures happen live the day before the physician panel, so you’re not going to know until the day before what’s going to be said and how you’re going to reflect on it. I think it’s been a really good training space for physicians to build confidence and to trust that they’re going to be able to speak intelligently because of their life experience, whatever it is, and we can find a relatable point in another industry.
It’s also shown that we have much to learn from seemingly unrelated places. Like I said, we had a whole episode just on quality recording and microphones, and what we actually saw was how that led into a conversation about how putting our voice forward, for example, going from just a picture ad to an audio ad, actually changed patient engagement for one of the physicians. So knowing that we have so much to learn from any industry, I think, was really powerful, and it encouraged physicians to see, “I might stop and look and listen when this topic might seem totally unrelated, and find out, what can I actually learn here and bring back to quality care for my patients?”
Kevin Pho: Wonderful. And once again, there’s Dana Corriel’s SoMeDocs on Facebook. You could Google that, S-O-M-E Docs, at Facebook, and you could see Amelia facilitate the various video chats there.
So let’s move on to the article that you wrote on KevinMD, “Expanding the osteopathic concept for the health of all things.” Before you go into that article, can you explain to my audience what exactly osteopathic medicine is, and can you describe the training and contrast that with a traditional MD education?
Amelia L. Bueche: Absolutely. This is one of the assignments we have for the students, so I spend every week precepting them on this idea. My interpretation of it is that we have two choices of fully licensed physicians in the United States, DOs and MDs. DOs are 11 percent of that physician population, and they can practice in any specialty and in any state. That’s relatively new, right, that expansion of their practice, relatively recently brought into all areas.
The main distinction is the osteopathic philosophy that is taught from day zero in osteopathic medical schools, and that is utilizing the tenets. We see the patient as a whole person, body, mind, and spirit, and we notice how they relate to one another. We look at the relationships between structure and function and how we can optimize, and we honor the inherent self-healing capacity that we all have. By combining those three, we make rational treatment decisions. Sometimes that means the use of osteopathic manipulative treatments for hands-on care to remove a restriction in the body. Oftentimes it really means seeing that patient and removing the barriers to their health, whether that’s within their system or external to them.
So for me, I happen to utilize OMT predominantly with my patients. Many DOs do not, but they can still very much apply osteopathic philosophy in order to best serve their patients. What we’re seeing now in the single accreditation system is that the osteopathic concept is being expanded, and that’s really what drew me to write this piece for KevinMD.
Kevin Pho: So if I’m a student and want to go into medicine, and there’s a decision point, going into an MD program versus a DO osteopathic program, what are the factors and character traits that would lead me to go into one path versus the other?
Amelia L. Bueche: That’s a great question, and I think it’s evolving over time. Osteopathic medicine began as a question of what else can we offer, what more can we add to the current practice of medicine, and that was back around the time of the Civil War. You can think about what was happening in medicine at that time. So I would say DOs are still answering that question: What else can we offer to this space? Generally, there’s been the tendency for osteopathic physicians to go more into the primary care specialties, although that is shifting, especially, like we said, with this residency opportunity.
I would say look up the philosophy. For me, I didn’t know about it. I happened to live in Michigan, and Michigan State University has both on the same campus. I pulled up both programs, and as I read that aspect of philosophy, I said, “Oh, that makes sense. That’s how I would want to see patients.” I think it’ll resonate with you if that’s the right choice. And certainly, like this article says, MDs can also inherit and adapt to and utilize these concepts. It’s not just for DOs. That is where it began.
Kevin Pho: So let’s talk about that article. It’s titled “Expanding the osteopathic concept for the health of all things.” Now, for those who didn’t read the article, can you just summarize it and share why you decided to write it?
Amelia L. Bueche: Yeah. So it brings up those tenets, like I shared with you, about what the DOs do and what makes them distinct, and it also talks about the reasons for them. It opens and closes, kind of a palindromic article in a way, with what patients are seeking: to be seen, to be heard, to be valued, to be partnered with. Certainly, many of my allopathic colleagues would say, “Well, I do that. I work with patients in that way.” And absolutely, and that’s good news, right? This is the way we can all improve the quality of care that we’re providing for patients.
And also, if you’ve ever been frustrated with the health system, right, there are osteopathic approaches to that, to say, what is the structure and function here, and how can we actually adapt change in a meaningful way? We could also look at ourselves, right? I’ve written other articles with you on burnout, saying, what are the ways that we are listening to our own body-mind-spirit needs, and how we can honor that, and in doing so, promote our own health and naturally segue into supporting the health of our patients.
So it’s bringing forth those tenets in more tangible ways. I think sometimes when we have a philosophy, it seems unrelated to a practical measure, but actually, these concepts can be seen in any patient encounter and also, most importantly, in our own lives, for the health of physicians.
Kevin Pho: So give us some specific examples of how we can adopt these osteopathic tenets in just our daily life. So I’m an allopathically trained physician. I do internal medicine, primary care. Now, what are some specific ways that I can change and implement some of these osteopathic tenets that you talk about?
Amelia L. Bueche: Well, with patients, one thing I think of is the quality of the history taking. When we do learn osteopathic manipulative treatment, what we’re actually learning is to listen to patients in a new way. We’re using our hands to hear in their bodies, but it can cue any of us into saying, what else, what’s not being said here, and helping the patient see when a moment in time might have shifted their health.
I’ll often use the question, “When do you last remember feeling totally healthy?” They might say never, right? They might say six months ago, and you might be able to help them find out what happened six months ago. It might have been a slip and fall, right? That might lend itself to some structural restriction in their body. It might have been a loss, right, especially in this time, that really triggered a downward spiral in their health.
So I would say listening to that lens of what else: What else could be contributing here? And certainly, you could think about their structure internally. Even if, right, you’re not going to utilize OMT, your osteopathic manipulative treatment, you can notice something doesn’t seem right, right? When I do my exam, when you have your hand on their chest, when you’re listening to their heart, something doesn’t feel right, right? There’s a lot of tension in here. And you could perhaps refer them to an osteopathic colleague who might utilize OMT, or you can make a connection to that patient. So those are some ways with patients.
For yourself, the one way I really like to look at it is, in osteopathic medicine, removing barriers to health and looking in the space outside of us. So what’s an interruption to your health right now? Maybe it’s time for exercise. What’s a barrier to that, and what’s the way you could remove it to get back to the health in that space? It might be your motivation. It might be literally the access to the equipment. It might be the time in your schedule, right? And so you could apply that concept by removing any barriers to your health in the environment around you.
Kevin Pho: Excellent. And what do you see as the challenges of osteopathic medicine going forward? It’s certainly come a long way, and DOs and MDs are equal, certainly in my eyes, but going forward, what do you anticipate the challenges to be for the field going forward?
Amelia L. Bueche: I think just what you said, and I talk about this a lot with my students, with residents I train, and in lectures that I give. Equal, yes. Same, maybe not. And that doesn’t have to be a bad thing. And when we talk about equality in any situation, we happen to be the minority in medicine, and anytime we’re looking at a minority in our culture, there is this striving for equality, right? And we’re advocating for that, but we don’t need to be the same, right? And we can think of that across the board.
So to me, the challenge actually is in remembering that, for DOs to remember: Yes, we can advocate for and stay in that space of equality, meaning licensure, access to training programs, but we don’t need to be the same. And actually, offering that distinctiveness is a gift to all of medicine. Like I said in this article, we can share those concepts more broadly, and I do see that happening actually in the single accreditation system.
And so I think being willing to share the concepts is actually an invitation, but I think it’s a challenge, because there’s this desire to maybe sometimes keep it hidden, right, or maybe speak of it even apologetically. And we can say, in offering this distinction, we’re not insulting MDs. We’re not saying it’s lesser. It’s just different, right? And we have something to learn from one another. So I think we have the opportunity, but a challenge there, to be able to maintain that as we move forward.
Kevin Pho: We’re talking to Amelia Bueche. She’s an osteopathic physician, and she wrote the KevinMD article “Expanding the osteopathic concept for the health of all things.” Amelia, can you talk a little bit more about the mentorship that you do with osteopathic medical students and residents, and what are some of the concerns that you’re hearing from them, and what would you say are some of the biggest lessons that you generally share with them?
Amelia L. Bueche: Yes. When I have residents on rotation with me, it’s a one-on-one situation, and literally, I have one clinic room with my treatment table and my desk all in it, so we spend a lot of time together. What I’ve noticed happens is they learn about treating patients, but they also learn about how to cultivate their own health. Repeatedly, I get evaluations back to me that say, “By the end of this rotation, I remembered who I was as a person, what it was like to be the human in medicine, and I started exercising again. I contacted some of my friends who I had been ignoring through the course of medicine.” These are usually senior third- or fourth-year medical students that are with me.
And in the class that I’m leading right now, it is remembering, where everyone’s in the residency interview process at the moment, that they have worthiness inherent and intact, right, and they can step into those spaces, especially when they’re applying to a program that never before has had a DO candidate or admitted a DO to their residency, to own, right, that there’s trailblazing involved. You can’t avoid it when we’re 11 percent of the physician population and programs are now available that never were before. And to remember that bringing that distinctiveness with them, right, is actually an advantage. That’s a shift in mindset, because often it’s been thought of as, how can you show, right, that you’re not less than as a DO? Instead, now we’re saying, how are you equal, as you mentioned, and offering something distinct to this program from which everyone can benefit?
Kevin Pho: So you mentioned some programs never had a DO candidate before. Now, are you still seeing a general reluctance in programs when it comes to considering DO candidates, or has that mostly gone by the wayside?
Amelia L. Bueche: It’s definitely improving across the board. Like anything, there’s going to be some inertia involved in any type of change, you know, the merger, if we’re calling it that, again, single accreditation system preferred. The head of the ACGME right now, the chair, I should say, is a DO for the first time ever, and so at the upper level, that’s happening. It just takes sometimes that concentration. I happen to be in Michigan, which has a very strong contingent of DOs across the board, so it’s unusual not to have a DO in a residency program. In other states, it is rare, right? And so it does take that trailblazing mindset, and I think if we embrace that, it’s an opportunity. I see it less and less, but I don’t see it gone.
And that’s work that we have continuing to do, as we saw with the physician to the former president, who was a DO, and that led to all kinds of different press. What it illustrated for me was more opportunity to continue to educate the general public that DOs exist, that they’re fully licensed physicians, that they can be in any specialty, and that they carry forth this philosophy. So I think we have a grand opportunity ahead of us.
Kevin Pho: And for your fellow osteopathic physicians who are out there, you mentioned things like advocating for the profession. What are some ways they can do that?
Amelia L. Bueche: Well, I think speaking of who they are in their local area matters. Like we just saw, we didn’t even realize people didn’t know DOs could be physicians in the United States, because around the globe, osteopaths are not physicians. And so offering that distinctiveness, I think, is so helpful. And joining in the different organizations in a thoughtful way. We often wonder, what can these national organizations sometimes do for us? But also, it can be a platform, and there is actually room for you to share your story in these spaces. The DO, the magazine of the American Osteopathic Association, just highlighted osteopathic podcasts. So when you are speaking about the philosophy and the practice of osteopathic medicine, it will be noticed.
And so remember the different ways that you can speak out and align yourselves with these spaces that do have a larger platform. And of course, continue to nurture our students. I think, like anything in medicine, we want to see this multigenerationally, and so offering our own experience and thoughtfulness back to those who are in training can be so helpful.
Kevin Pho: And my final question, as always: What is your take-home message that you want to leave with the KevinMD audience?
Amelia L. Bueche: I’d like to encourage everyone to consider that second part of the title. How do you see yourself for the health of all things? That means lots of different things to lots of different people, but it’s the opportunity for you to live out the osteopathic concept, because that’s what we’re called to do: to see the health in ourselves and our patients, in the world around us, especially in this time. So see if you can ask yourself that question, even each day, and notice how the answer evolves.
Kevin Pho: Amelia, thanks again for being on the show, and thanks again for sharing your time and insight.
Amelia L. Bueche: Thank you so much.
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