Though only one day in, it was with a sense of familiarity that we gathered in the hotel lobby and walked together to the day’s destination. It is worth noting, Columbus has proven a lovely starting point for the program – beautiful architecture, easy walkability, city bike share, river walk for an evening run, endless restaurants and a 32-room bookstore – a life-size maze with shelf after shelf housing every genre of literature one could imagine. I look forward to the opportunity over the course of the year to explore more of the hometowns of our Colleges of Osteopathic Medicine.
Breaking the typical behavioral pattern of students in the classroom, everyone took a new seat, orienting to the classroom and one another from a new angle, our vantage points shifting physically and mentally through the process of becoming fellows. We jumped into analysis of health policy proposals, researching the context, identifying stakeholders, anticipating the consequences, suggesting possible modifications. It was an enlightening lesson in looking beyond the surface level, the importance of specificity and prioritizing the bigger picture, solving problems from a broader perspective for optimal sustainability.
As our trio of speakers moved through, there was an incidental alliteration of themes – evaluation, efficiency, equity and eligibility. The first in particular illustrated the prime position osteopathic physicians have to expand philosophy and principles of practice to a wider scope of issues, including the successful development and implementation of health policy.
In our earliest days of education in the osteopathic manipulative medicine lab, we are instructed in palpation, assessment, diagnosis, treatment and re-EVALUATION of patients. In every patient encounter these dozen years into practice, I evaluate the response to treatment – visually, manually, verbally – is alignment improved, is motion improved, is pain less, is the patient able to function better? Sometimes the answer is no to one or all of these and this leads to reassessment, further treatment if indicated, a shift in the investigation to additional testing as necessary or referral for external evaluation or additional alternate therapies as appropriate.
There is pressure on physicians to have the answer, to get it right every time. While it is certainly important to be accurate, up-to-date, informed and thorough, it is also crucial to be human, honest and humble, particularly when the outcome is not perfect. Evaluation revealing a result obtained other than that which we anticipated – perhaps a lesser version or, sometimes, entirely the opposite – can feel like a failure. This is a most unwelcome sentiment, the fear of which can lead to omission of evaluation entirely. This apprehension and avoidance can be severely limiting – of potential growth and learning and from trying again in the future.
We must be willing to critically examine results, compare them to anticipated outcome and, when there is a dissonance, have the confidence and competence to find out why, make adjustments, assess, apply and evaluate again. Anything less is a guess, a hope, an assumption and is a disservice to our patients, our profession and ourselves.
Let us expand the application of that original lesson in osteopathy – assess, diagnose, treat and evaluate, knowing that the result is not an end point but a step on the path of progress.
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