Osteopathic Approach to a Patient

by Tyler Cymet, DO, FACOFP

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    00:01 Let’s talk about how we do an osteopathic exam to a patient.

    00:04 Let’s check out our patients.

    00:05 Let’s see what’s going on with an exam.

    00:08 That’s our stock and trade. That’s what we do and every exam starts with a chief complaint and a history of present illness.

    00:17 They start from the patient coming in and saying, “Here’s why I’m here,” and in their own words, they get to start the visit and they get to guide where it’s going to focus.

    00:28 The problem is, a chief complaint is subjective, it’s what the patient thinks, it’s what the patient learned from the internet, and it’s what they were told by their friends, they should focus on.

    00:39 And it isn’t always what needs to be focused on.

    00:43 It’s where we need to start. It needs to be addressed.

    00:45 It needs to be taken seriously.

    00:47 It needs to be repeated so the patient knows you’re listening.

    00:52 But we also realize that subjective is different, and every time we get a positive, we ask more questions.

    01:00 If there’s a pain; what’s the location, what’s the quality of the pain, what’s the chronology—when did it start, when is it worse, when is it better; what are the associated manifestations to it.

    01:10 So those are questions you ask for every positive and then you develop a review of each system.

    01:16 So were there headaches involved, are there pain symptoms, or are there things that make it better or worse.

    01:22 You review each positive and you get more of a picture and you round out the complaint.

    01:29 Then, once you’ve got some good clear understandings of what’s going on, you do an exam, and the exam is objective.

    01:37 That’s data we can take to the bank.

    01:41 It’s data that we see, that we are determining, that’s coming from outside the patient to either validate with what the patient said or give us another aspect of what’s going on that may be related to what the patient said.

    01:58 The osteopathic exam is a neuromusculoskeletal exam.

    02:02 It always includes a review of systems and it starts from the time the patient enters the room.

    02:08 Every osteopathic examination should be done in at least 2 positions— sitting and standing, standing and walking, and moving from side to side.

    02:17 You’re not going to get a view of function unless the person is functioning.

    02:22 So it’s not just the structure of the body, it’s not just anatomy but how that anatomy is effected by motion.

    02:30 People complain saying, “But, but, but it’s so much easier to look at it in one dimension, and when we do x-rays, x-rays are anatomic.

    02:38 We actually take the weight off of somebody to take the x-ray.

    02:41 Well chiropractors don’t. Podiatrists don’t.

    02:44 They want to see the anatomy in action and we can actually request that we look at flexion and extension views of the cervical spines.

    02:53 Let’s see the motion of it.

    02:54 Let’s examine it in activity and not just the anatomy of it.

    02:59 So the ONMM exam is a dynamic exam.

    03:03 It’s an exam that starts from the beginning of the interaction with the patient.

    03:07 Watch the patient stand up.

    03:09 Watch the patient move.

    03:12 And one of the things that I like to note, and take a note in my mind, is this person functioning comfortably? Do they look comfortable or uncomfortable? And it’s not just the look on their face, it’s the fluidity of motion.

    03:28 And I’m going to introduce Fryette’s laws here.

    03:32 Fryette’s laws talk about motion.

    03:34 For a body to be efficient, if you sidebend right you rotate left.

    03:39 You displace the force and the weight amongst as much of the vertebra as possible and that means that a person is healthy.

    03:48 If somebody can’t use their muscles well and they need to use their larger muscles, they’re going to override some of the suppler movements and they’ll sidebend right, rotate right to use the larger muscles to push up.

    04:01 That’s someone who’s going to look uncomfortable, who’s going to look weak, and you know they’ve got problems that are going beyond pain they may be presenting with and it may be weak muscles, it may be hypertrophied muscles, it may be nutritional, and it may be hormonal or endocrine.

    04:21 Those are all things you need to look at.

    04:24 So the musculoskeletal functioning, whether they’re in neutral mechanics or non-neutral mechanics, tells you a lot.

    04:33 And we have a 10-step exam as a way of examining people that can give you all the information you need to see if the person will benefit from the treatments we have to offer them because you don’t treat somebody without a diagnosis and you don’t diagnosis somebody without examining them and getting their history and doing a physical.

    About the Lecture

    The lecture Osteopathic Approach to a Patient by Tyler Cymet, DO, FACOFP is from the course Osteopathic Principles and Tenets.

    Included Quiz Questions

    1. Chief complaint and history of present illness
    2. Diagnostic impression
    3. Review of systems
    4. Physical examination
    5. 10-step exam
    1. From the time the patient enters the office
    2. From the time the patient's chief complaint is explained
    3. From the end of the review of systems
    4. From the time vital signs are measured
    5. From the beginning of the 10-step examination
    1. 10 steps
    2. 5 steps
    3. 8 steps
    4. 12 steps
    5. 15 steps

    Author of lecture Osteopathic Approach to a Patient

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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