With COMLEX now behind you, it is time to start learning some clinical medicine. One area in which many osteopathic students have trouble is using OMM in the hospital. Many students are afraid to ask attendings permission to perform simple techniques. So here are a few tips to help you get the ball rolling.
Don’t be afraid to ask.
First off, do not be afraid to ask. All DOs and osteopathic students are guilty of poking fun at osteopathy from time to time but do not forget that it is what makes us different. While attendings may not perform techniques themselves, there are very few who will not respect a student who wants to try. If your attending or resident is an MD and you think a patient would benefit from a treatment, explain to the attending what you are going to do first. Some are not only willing to let you do it, but may want to watch to see what osteopathy is all about.
Keep documentation simple.
Documentation can seem like a challenge when performing OMT. Remember this is not a COMLEX exam, there is no need to document that the patient is T10 N SLRR. Write a procedure with the old adage in mind “keep it simple stupid.” Rather than documenting every somatic dysfunction that you find, simply put positive TART in the region that you find it. When documenting techniques, it is perfectly acceptable to list what you did. Always remember to add a one-liner indicating how the patient tolerated the procedure.
Keep your hands where you can see them.
There are a couple of simple rules for performing OMT in the hospital. Avoid HVLA, remember these people are acutely ill, so limit yourself to indirect or gentle direct techniques. Secondly avoid putting ungloved hands anywhere you cannot see them. This is tip is more for your sake, and trust me when I say you won’t make that mistake twice. OMT in the hospital challenges you to modify your techniques due to space limitations of tubes, lines, and the inability to get behind the bed. That being said, be careful and avoid OMT over areas with tubing, drains, or dressings. The last thing you want to do is accidently pull a line.
This stuff works.
In the words of a beloved attending at PCOM, paraphrased to keep things PG, “This stuff works.” Practicing OMT has the advantage of learning what normal tissue feels like, which is beneficial regardless of your specialty of choice. It also gives you the chance to really connect with a patient. The more they trust you, the more they will share. There is a therapeutic benefit to touch. Whether that benefit comes from actually balance the autonomic system or from giving a sick person a little one-one-one time, I don’t know. But I am sure that nothing bad can come from laying your hands on a patient.