Doctor Mike talks osteopathic medicine

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Mikhail Varshavski, D.O., better known to the world of Instagram and YouTube as Doctor Mike, spoke to a packed house at our Ohio Osteopathic Symposium in Columbus on Saturday, April 27, about social media and medicine. As a regular contributor to national television shows and online publications, Doctor Mike has established himself as a leader within the field of digital health care communications, and he’s widely known as the most-followed doctor on social media. His message to the osteopathic physicians and medical students attending OOS? Doctors need to raise their voices in the media to combat the growing amount of incorrect medical information being communicated, especially on social media.

Doctor Mike, who emigrated with his family from Saransk, Russia, to Brooklyn, N.Y., at the age of 6, graduated from the New York Institute of Technology in 2014 with a bachelor’s degree in life sciences and a doctorate in osteopathic medicine via an accelerated 7-year track. He completed his family medicine residency in 2017 with honors. He now is a board-certified family physician in Summit, N.J., who emphasizes the importance of preventive medicine, lifestyle modifications and patient empowerment through both his practice and outreach activities. In late 2015, Doctor Mike launched his own charity, The Limitless Tomorrow Foundation, and he has partnered with several other philanthropic organizations including Stand Up 2 Cancer, AmeriCares and the Susan G. Komen Foundation. In addition to his work with patients, Doctor Mike also routinely trains medical students in the clinical setting.

Following his presentation, Doctor Mike shared his thoughts about osteopathic medicine.

What attracted you to osteopathic medicine as a career?

Most kids don’t see their family members become doctors, but because I came to America when I was 6, I saw my father train as a D.O. at NYIT-COM. And me being 9 years old at the time, I witnessed his journey through medical school, residency, him practicing OMM on me. I was an athlete, so I would have injuries all the time. And he would treat them, and they’d go away. It blew my mind how a hands-on approach was a very meaningful way that you can connect with a person. You can actually treat what ails them without using medications. Now, that’s more important than ever because of what’s going on with the opioid epidemic. I have an alternative treatment plan within my toolkit that other doctors who are not trained in OMM [osteopathic manipulative medicine] don’t have. So, when I first fell in love with OMM, I fell in love with it because it worked on me, and I said I wanted to learn it. And now, I’m in love with it because it offers my patients an approach that’s proven, that works and that’s so low risk that it’s just amazing to have ability to do that.

Why did you decide to become a family physician?

Again, my father is a huge influence here. He was a family medicine doctor back in Russia, and when he came to the states, he followed the same path here as well. Watching him go through his training, I saw the connection he made with his patients. They became friends. They became part of the family. It was almost as if he was having friends come in and ask for advice, even though they were his patients. When you have that kind of relationship, that’s when you can have meaningful change. When you go see a doctor in an urgent care setting or an emergency room setting, that’s great for urgent matters, quick fixes, that sort of thing. But if you’re truly trying to change someone’s life, improve the quality of their life, extend their life, the only way you can do that is with a relationship. And the field that I saw that had that was family medicine.

You can deliver a baby, take care of the baby, take care of the baby’s parents. I’ve actually had an amazing situation where a couple came in to see me. They were having some sexual difficulties. I helped them get through that, and they were able to conceive a child. They conceived that child, and I delivered that child. Then, that child is my patient. The grandparents have now since emigrated from South America, and they’re my patients now, too. So, it truly allows me to see the scope of family medicine. That’s what I love.

Why should people who are thinking about a career in medicine consider attending an osteopathic medical school?

Because it [osteopathic medicine] offers an approach that’s truly time-tested and gives results. Connecting on a holistic level is so important, especially in the day and age we live in, where information is thrown at you so quickly. Having a doctor you can truly relate to and find common ground with is so important. They don’t just know you as your disease process or what’s wrong with you. They view you as a person first; that’s the beauty of becoming an osteopathic physician. You truly understand the art of how to take care of another human, as opposed to taking care of a disease process. And having a way to do that, through learning a skill that’s hands-on, that’s useful. Not only does it give you another tool in your toolkit, but you also become overall better with your physical exam. You learn how to palpate better. You learn that the art of the physical exam should not be lost because it carries such tremendous value. Where I trained, it was a dually-accredited program with MDs and DOs, and I saw how much more adept I was in being hands-on with my patients and knowing what was bothering them and diagnosing certain physical conditions. I think that’s tremendous advantage that people should really consider.

You completed an accelerated training program, through which you received your bachelor’s and DO degrees. The Heritage College has an accelerated program in partnership with Cleveland Clinic, the Transformative Care Continuum, through which a select group of students through which they are matched to their residency program before starting medical school. Do accelerated programs work?

They absolutely work. Having a student already pre-accepted into residency is powerful because it takes away that anxiety of, ‘Will I be able to get into a residency program? What’s my future like?’ It takes that away so you can better focus on our studies. And second, because these programs get you into the hospital earlier and seeing patients earlier, you can better connect the information you’re learning to something practical. You have a reason why learning about COPD is so important because you just saw a patient with it. When you can give it context, it’s much more powerful and motivating to want to learn that information as opposed to sitting with a book every day and saying, ‘Why do I even need to know this?’ Well, you just saw a patient with it last week, and that’s why you need to know. So, I’m a big proponent of accelerated programs.

What’s your take on the future of osteopathic medicine?

I think the future is exciting and bright because we need to train more physicians. And we need to do it quickly because there are areas of the United States where they don’t have quality access to physicians. Osteopathic physicians can reach those people and can take care of the entire family. You can do an entire community a mega service to help them achieve the healthy, happy lifestyle that everyone deserves to live. I’m a big proponent of osteopathic medicine, and I think the world is our oyster.

Learning from Cuba

Barone and Skinner in Viñales
Adam Barone, OMS-I , (left) and Daniel Skinner, assistant professor of health policy

Daniel Skinner and Adam Barone

For a week in March 2019, we were privileged to visit Cuba to learn about the nation’s health care system. Our contingent ran the health professions gambit, including people in nursing and medicine, health care administration, global health, health communication and health policy. But our mission was unified: to learn about health care in Cuba and use the experience to reflect on our situation in the United States.

While in Cuba we met with physicians (both urban and rural), diabetes and vaccine researchers, farmers, educators, medical students, HIV-AIDS patients and more. We visited medical schools, clinics, physicians’ offices, rural villages and more. We walked the streets of bustling Havana and rural Viñales. At night, we processed what we had seen and explored our thoughts – often with the sound of salsa music in the background.

Though Cubans acknowledge that their system is not perfect (and what system is?), they are proud of what they have accomplished in health care. Despite widespread poverty – compounded by a lack of resources that has been intensified by the American-led embargo – Cuba’s infant and maternal mortality and life expectancy rates are comparable to those in the United States, and lack the racial and class-based disparities that plague American health outcomes.

Cuba is deeply invested in medical education, for aspiring physicians both in Cuba and around the world. A drive through the western parts of Havana reveals a vibrant, sprawling complex of buildings immersed in vaccine and other biotechnological research. In a nation that cannot afford the high costs associated with widespread acute and chronic illness, Cuba’s focus is on prevention, from frank talk about STI prevention, to mandatory vaccines that are not part of our regular vaccine schedule in the United States – such as vaccines against tuberculosis, leptospirosis and typhoid fever – to the much-discussed treatment they are exploring for lung cancer, to genomic research that aims to prevent diseases before they arise.

Cubans emphasize the hyper-rational organization of the system’s three-level approach to health care delivery, with family physicians located in communities serving as the first point of contact (including house calls), “policlínicos” serving as a community-based second tier and hospitals serving as a last resort for cases of acute need. While Cubans are allowed to access any of these tiers at any time, most opt to utilize the system as it was intended. Few Cubans go to the hospital when they do not need to. The system incentivizes this through unfettered access and by building trust in the overall design.

A particular highlight of the trip was when we American students were afforded an hour to converse with Cuban medical students at the Victoria de Girón Institute of Basic and Preclinical Sciences.The students compared notes on their experiences. Despite significant resource differences in education systems, the students found they utilized common textbooks and study strategies. Perhaps the most important takeaway was the revelation that their lives – their aspirations, as well as challenges – were not so different. Two days later, as further evidence that friendships were in the making, the students met again, this time in an unplanned run-in at a fashionable Havana art and music center, where yet more conversation and connection took place.

Cuba has a lot to offer osteopathic medicine in particular. After all, osteopathic approaches to health care emphasize the importance of the physical exam and prevention, turning to pharmaceuticals and technologies only when necessary. In Cuba, where many drugs and expensive equipment are hard to come by, there is an opportunity to reflect on core principles and see what osteopathic principles can accomplish in a resource-poor environment. It is well known that Americans overuse medical technology and testing; in Cuba, the problem is the inverse, where the American embargo is making it hard for Cubans to get some of the medical equipment they need.

In the weeks and months to come, we plan to explore ways to strengthen connections with Ohio University and Cuba. The clinicians and researchers with whom we met emphasized their hope that we could see past diplomatic tensions and focus on mutual goals of addressing pressing health needs, such as collaborative diabetes and cancer research. Sometimes, working on common projects can serve as a kind of diplomacy in its own right. Other osteopathic colleges have found value in such connections as well. Clearly, as our experience reminded us, the future of medicine – from the training of clinicians to research – is in global connectivity.

Daniel Skinner, Ph.D., is assistant professor of health policy. He is director of Ohio University’s Comparative Health Systems – Cuba program, administered through the Global Health Initiative.  

Adam Barone, M.S., is a first-year medical student.

 

Our new curriculum is all about that teamwork

HCOM_OO1

It’s Monday morning, and the entire first-year class at Ohio University Heritage College of Osteopathic Medicine is meeting a new patient.

Spread out over three campuses in Ohio and connected by videoconference, more than 260 medical students—the first to be trained in the College’s innovative new Pathways to Health and Wellness Curriculum—are starting their week as they do routinely on Mondays: diving into the simulated patient case on which their learning activities for the week will build.

They’ve just finished a quiz to assess how well they’ve mastered assigned material—readings, PowerPoints, recorded lectures—assigned in preparation for this week’s topic. After taking the exam individually, they take it again in a standing eight-student cohort who collaborate on lab and learning activities, mirroring the way modern health professionals increasingly work in teams.

This week’s patient is visiting the doctor for a wellness check-up. A Heritage College faculty member assigns each group a question for the fictitious patient to answer. HCOM_004Another faculty member takes the role of the patient, answering students’ questions about diet, exercise, and more. The class is alive with interaction, as students chime in from their microphone-equipped stations. As the patient answers questions, students suggest further follow-up questions.

In the coming week, all the specialized material the students learn, from biochemistry to gross anatomy to social factors affecting health, will be woven into their understanding of this patient’s case.

Welcome to “Osteopathic Approach to Patient Care 1 – Wellness,” the only fall semester class on the first-year academic schedule. A course on acute illness follows in the second semester; the second-year curriculum will feature courses on chronic illness, then return to wellness.

The new curriculum, launched in fall 2018, represents one seamless arc, following patients through stages of sickness and healing.

The Pathways to Health and Wellness Curriculum (PHWC) demonstrates what medical training of the future looks like: training organized around detailed patient cases, delivered to and absorbed in teams, and designed to present information in a way the physician will use it. It abandons auditorium lectures for a “flipped classroom,” in which students prepare outside class for interactive, team-based exercises in the learning space. Information coming from formerly discrete disciplines has been merged into a holistic, practice-centric way, offered by faculty from disciplines relevant to the case.

“We are given cases with patients’ names, their whole history, their whole medical background,” says first-year student William Naber. “Together, we take the material we learned that week and apply it to the case. And we help each other understand things that we didn’t understand about the case. That’s why the teamwork keeps coming back in over and over.”

Jody Gerome, DO ’05, associate dean for curriculum, says the PHWC continues the long-standing Heritage College practice of putting students into health care spaces like clinics and hospitals from their early days, yet now it replicates such practice venues in the classroom.

This ensures that “the way that students are introduced to major concepts is through the lens of a patient experience,” she says. “The faculty build the content that they’re teaching together, as a team, and then deliver it as a team. Students are then working in teams to synthesize the information.”

Dr. Ken Johnson, the College’s executive dean and OHIO’s chief medical affairs officer, says the PHWC is integral to the school’s mission.

“It teaches students in a way that research has shown they learn best, and that prepares them for the new realities of health care in the 21st century,” he says. “The doctors we train in it are going to come out of medical school already proficient at working on a modern health care team—with the patient at its center.”

This story was originally published in the winter 2019 issue of Ohio Today, the magazine for OHIO alumni and friends.

 

3 questions all health care providers should be asking veterans

 

The 20 million veterans living in the U.S. today have specific health care needs unique to their military experiences, but research has shown that many civilian physicians feel uncomfortable or inexperienced dealing with health-related exposures and risks these veterans might encounter.

To help close this gap, Todd Fredricks, D.O. (’93), an associate professor of family medicine at our medical school, and Brian Plow, an associate professor in the School of Media Arts & Studies in OHIO’s Scripps College of Communication, created a feature-length documentary, “The Veterans’ Project,” with the goal of helping health care providers better treat veterans. The film uses real stories from veterans and health care professionals to highlight the challenges many combat and service-wounded veterans face when seeking care from military, VA and civilian health care systems.

To help physicians better understand and build trust with their veteran patients, Dr. Fredricks, a U.S. Army Colonel and medical officer with the West Virginia National Guard, has identified three simple questions that health care providers should ask all patients.

Question 1

Have you ever served in the armed forces?

Question 2

Did you ever experience any wounds, illnesses or injury as a result of your service?

Question 3

Have you registered with the VA?

These closed-ended questions help health care providers understand who the veterans are within their patient population, while giving veterans who are not comfortable with in-depth conversations about their experiences an out. To hear Dr. Fredricks explain more about the importance of asking these three questions, watch this video.

 

“The Veterans’ Project” is a production of Media in Medicine, a collaborative project led by Fredricks and Plow that brings together visual media, the arts and medicine to create and teach through storytelling. The award-winning film was shown Nov. 10 during the inaugural Columbus Veterans Film and Arts Festival, and has also been presented at the Columbus International Film & Animation Festival, the Broadcast Education Association Festival of Media Arts and the National Communication Association Annual Conference.