The DOs: Osteopathic Medicine in America

Preface & Acknowledgments

PREFACE & ACKNOWLEDGMENTS I first became aware of the existence of the osteopathic medical profession during the summer of 1974. I was meeting my friend David, who was soon to graduate with his MD degree from a Chicago medical school. We were going to play tennis. The court we had reserved was still in use, and while we waited for it we got into a conversation in which I brought up the subject of “occupational role duplication.” I was a sociology graduate student at the University of Chicago and was interested in the phenomenon in which one profession offered a range of services to the public that overlapped with services provided by one or more other professions. I was curious about the political and legal aspects of how groups carved out and maintained role boundaries. I knew a little about health care services, particularly that several professional groups competed with each other, causing considerable conflict between them in regard to what should constitute their respective domains and scopes of practice. I thought my medical student friend could offer a helpful perspective based on his background. My first question to David concerned the struggle between ophthalmologists and optometrists. The former went to medical school and claimed the entire clinical field regarding eye care. Optometrists, who were trained in their own schools, were licensed, entitled to use the title Doctor, and were doing refractions like the ophthalmologists. Optometrists , as I recall, were then seeking changes in the law to extend their scope of practice to allow them to use drugs to dilate the pupils in order to diagnose glaucoma and other eye diseases. My friend told me what he knew about optometry and why the Illinois State Medical Society was opposed to any expansion in optometric practice rights. I then asked him about the shifting practice boundaries between oral surgeons (trained in dental schools) and MDs who specialized in head and neck surgery. After he gave me an informative answer, I inquired about professional conflicts between podiatrists and orthopedists. Podiatrists, who had long confined their interventions to diseases of the foot up to the ankle, wanted to change their scope of practice to include the knee, and some wished to extend their involvement to the thigh (a sort of professional gangrene, I thought). Once again, my friend confidently and competently answered my questions about the boundaries and divisions between these two groups. Before I could ask my next question, David looked at me warily and said, “Please don’t ask me to tell you what the difference is between an MD and a DO!” After a pause, I had to inquire, “What’s a DO?” He replied, “An osteopath.” I looked at him blankly and asked, “What’s an osteopath ?” My friend rolled his eyes, thought a little, and finally said, “Well, DOs are licensed to practice medicine like MDs. They treat the entire body. However, they have their own colleges, hospitals, associations , specialty boards, and their own journals. They use medicines and surgery, but they also employ spinal manipulation. They are like us but different. That’s all I know and you would have to ask somebody else for more.” At that point, the tennis court came open, we played our match, and the subject was dropped. Being a graduate student I thought (incorrectly) that I was quite worldly, so it caught me by surprise that I had never heard of osteopathic medicine. The next day, simply curious, I strode into Regenstein Library on the University of Chicago campus seeking further information. I found nothing during that particular visit. Back in the sociology department I asked my graduate student friends and a few faculty members whether they had heard of osteopathy, and none of them responded affirmatively. On the way home that evening, I came to the conclusion that my friend had played a little joke on me—there was no such thing as a DO. Nevertheless , when I got home I thought of one last resource. I went to my copy of the Encyclopedia Americana, which was then at least twenty years old, and to my surprise I did find a heading “osteopathy.” While brief, the entry essentially confirmed the outlines of what my friend had said about the profession. It noted that there were then six schools of osteopathic medicine , one of which was in Chicago. Turning to the phone book, I found the address and was amazed to find that this school—the Chicago College of Osteopathic...