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OHPF Day 17

Optimal results are achieved when the patient takes an active role in the wellness plan. This is a phrase published in a brochure describing the details of my work. As a specialist in Neuromusculoskeletal Medicine & Osteopathic Manipulative Medicine (given my love of words, I went for the 25-syllable option when choosing a specialty) patients often present with pain, which is usually multifactorial in nature. Given that the majority of evaluations result in the use of osteopathic manipulative treatment (OMT) to address mechanical dysfunction, there can be an expectation of “fix me.” This is rarely a successful, sustainable approach.


For me, the doctor-patient relationship is an active, intentional and dynamic one. OMT is a procedure. It requires consent, an understanding of the purpose and intention, a mutual awareness of tolerance to techniques used and established dialogue to assess need for modification. The in-office treatment is largely a jumping off point – nudging the boat into the current of health but what will keep it from drifting into the banks, getting turned around or even capsizing?


Staying afloat, moving forward, reaching a desired destination downstream requires participation, the right equipment and cooperation with the entire treatment plan. Modern life is not often the gentle float I experienced in my youth up north in Michigan, where you could cross the river in a few steps and stand up at any point along the way. More often, it seems, we are faced with the Class 5 rapids I have witnessed here in Oregon, powerful, able to throw you off course, out of the boat, with hidden currents and rocks beneath the surface.

It can be helpful, even life-saving, to have a knowledgeable guide in such circumstances.




Physicians can serve in that role for their patients, providing information based on education and experience. In the boat and in the office, instructions must fall on receptive ears to be useful. There must be willingness to participate, to paddle, to hold on, to work with others involved. Most river trips are taken as a group where the choices and actions of each individual impact the whole and vice versa.


This extends the “active role” beyond the individual to the collective and the concept of cooperation beyond the interaction of the physician and patient to the broader community.

What does it mean to be cooperative? How do we experience cooperation? Is it active or passive? Is it with an enthusiastic or resentful attitude? Are we interacting with people who will make the best decisions for only themselves or for the greater good as well?


Given the potential hazards along the river of life, when at all possible, electing to partner with a leader familiar with the surroundings, conditions and safest course is wise.


Collaborating with crew mates seeking a common destination and similar level of adventure with equally matched willingness to participate fully, to the best of their ability, for the survival of the group, is ideal. Within all of this, we can only control our own paddle, position and approach in the experience.



May we be actively engaged, willing participants with cooperative support and confident leadership to successfully navigate the course of greatest health in the river of life.

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