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Osteopathic Care and Procedural Skills
Overview
Osteopathic physicians must provide osteopathic medical care that is person-centered, compassionate, safe, effective, evidence-based, timely, efficient, and equitable in order to promote health and the body’s self-regulatory and self-healing nature. Osteopathic physicians must consider social determinants of health in providing these elements of effective osteopathic patient care, as appropriate to their scope of practice, to all patients in varied clinical settings, including outpatient, inpatient, home care, and virtual settings, across the life cycle.
This patient care involves determining and monitoring the nature of the patient’s concern or reason for presentation; appropriately incorporating osteopathic principles, practice, and OMT; and implementing effective, equitable, timely, evidence-based, and mutually agreed-upon diagnostic and patient care plans, including appropriate patient education and follow-up.
This includes performing all other diagnostic and therapeutic clinical procedures essential for the area of practice. In the delivery of the highest-quality patient care, promotion of wellness, and prevention of disease, osteopathic physicians must be able to participate as members or leaders of interprofessional health care teams and foster effective communication with and among other professionals. Interprofessional team outcomes will be mapped primarily to the systems-based practice domain (Domain 7).
Required Elements
DEFINITION
The osteopathic physician must effectively gather accurate, essential data from all sources, including the patient, secondary sources, health care records, and physical examination (including osteopathic structural examination), regardless of an individual’s unique characteristics.
MEASURED OUTCOMES
The osteopathic physician must:
- elicit the patient’s view of the concern or reason for presentation.
- elicit the essential information that contributes to a patient’s presentation, including medication and allergy histories, social history, family history, sexual history, developmental milestones, and past medical and surgical histories.
- elicit a comprehensive and person-centered history, including symptoms, psychological factors, cultural considerations, need for interpretive or adaptive services, and community/social factors, from the patient and other sources as appropriate and in a timely manner.
- determine the patient’s living circumstances and the depth and scope of their support community.
- elicit essential information regarding
- the mechanism of injury and disease presentations and/or biomechanical influences that contribute to the patient’s condition.
- adapt the gathering of information effectively to the situation and interview relevant individuals in various clinical settings, which may include patients, family members, caregivers, and other members of their support community.
- gather information regarding health promotion and disease prevention through medical history-taking and physical examination regarding the biomedical, biomechanical, and biopsychosocial issues that contribute to health and disease.
- explore the patient’s beliefs, concerns, expectations, and literacy about health and disease while considering contextual factors such as their age, gender, culture, literacy, sexual orientation, spirituality, and economic background.
DEFINITION
The osteopathic physician must formulate a differential diagnosis based on the patient evaluation and epidemiologic data, prioritize diagnoses appropriately, and determine the nature of the concern in the context of the patient’s unique circumstances and in a variety of health care settings.
MEASURED OUTCOMES
The osteopathic physician must:
- generate, assess, and test appropriate hypotheses while gathering information about the patient and during their physical examination.
- generate and prioritize an appropriate list of potential diagnoses given the patient’s history, physical examination findings, and other available data. This process should include biomedical, biomechanical, psychosocial, and cultural factors.
DEFINITION
The osteopathic physician must perform basic clinical procedures essential for the generalist practice of osteopathic medicine while respecting and considering the diverse backgrounds, identities, and personal circumstances of all patients.
MEASURED OUTCOMES
The osteopathic physician must:
- perform a complete physical examination including evaluation of each of the body areas (head, neck, chest, abdomen, genitalia/groin/buttocks, back/spine, and upper and lower extremities) and organ and body systems (constitutional; cardiovascular; ears, nose, mouth, and throat; eyes; genitourinary; hematologic/lymphatic/immunologic; musculoskeletal; neurologic; psychiatric; respiratory; and skin).
- perform an osteopathic structural examination and OMT.
- employ effective hygiene practices, universal precautions, and medical aseptic technique to minimize the risk of infectious transmissions.
DEFINITION
The osteopathic physician must provide diagnostic information; develop a safe, evidence-based, cost-effective, equitable, person-centered care plan; and use all ethical and appropriate options for the goal of relieving physical and psychological distress. Within the context of evidence-based and cost-effective care, the osteopathic physician must assess the patient’s motivation, willingness, and resources to implement and adhere to the diagnostic and therapeutic plan.
MEASURED OUTCOMES
The osteopathic physician must:
- use an unbiased and collaborative approach with the individual and their support communities to develop a care plan that addresses their unique circumstances and maximizes adherence to the plan.
- apply an osteopathic approach to develop a care plan that may include orders, prescriptions, and OMT.
- incorporate nutrition, lifestyle, and body-mind-spirit unity into care plans based on individual circumstances and beliefs.
- identify, ethically address, and appropriately relieve suffering and distress while maintaining patient dignity and respecting the unique aspect of their circumstances and lived experiences.
DEFINITION
The osteopathic physician must assess the patient’s health literacy and understanding and must counsel and educate the patient accordingly.
MEASURED OUTCOMES
The osteopathic physician must:
- explain the nature of the patient’s concern at a level commensurate with the patient’s health literacy.
- describe diagnostic procedures, therapeutic options, and care plans at a level commensurate with the patient’s health literacy.