At Philadelphia College of Osteopathic Medicine (PCOM), the education of future osteopathic physicians begins not only with scientific and clinical training, but also with a foundational philosophy that defines the profession: the Tenets of Osteopathic Medicine. These tenets, defined by the American Osteopathic Association (AOA), serve as guiding principles for how osteopathic physicians understand, evaluate, and treat patients.
PCOM faculty members offer insights into how each tenet is reflected in the training of osteopathic physicians and the delivery of patient care.
From day one of medical school, PCOM students are introduced to the osteopathic philosophy during orientation and early coursework. David B. Fuller, DO, FAAO, FNAME, professor in the OMM Department at PCOM, emphasizes that this first tenet forms the foundation of patient care: “The osteopathic approach focuses on the person that has the problem and not just a problem in isolation,” he said. “Each person consists of a spirit and mind that are housed in the body.”
Marla Golden, DO, MS, FACEP, dean of the Doctor of Osteopathic Medicine program at PCOM South Georgia, expands on this: “What we think and believe have great influence on our health.”
Golden notes that treating patients as whole individuals means recognizing the psychological, social, and spiritual factors that impact wellness.
“If a patient has been told there is nothing further that can be done or they believe they will never get better, they will not actively participate in their own care plan and healing,” she explained. Acknowledging the patient’s mental and emotional state becomes part of the therapeutic process.
This second tenet underpins the osteopathic view that the body possesses inherent mechanisms for healing.
“Osteopathic manipulative treatment for patients benefits them by facilitating the inherent ability for the body to heal itself,” Fuller said. He explains that this support can take many forms: removing restrictions and restoring normal motion of joints, balancing the autonomic nervous system, improving lymphatic drainage, maximizing arterial supply and venous return, and improving functions across the musculoskeletal system.
As a clinical example, Fuller references the healing of a sprained ankle. “The body will go through stages of healing, including the initial inflammation to stabilize the joint and facilitate recovery of ligaments and joints.”
Golden emphasizes that osteopathic physicians are taught to identify and support these natural processes, rather than immediately turning to interventions that may override them. She encourages practitioners and patients to consider the approach of working “from the skin in”—taking a stepwise, conservative approach that may alleviate problems without invasive procedures.
The connection between the body’s structure and its function is central to osteopathic diagnosis and treatment. Fuller offers the example of carpal tunnel syndrome, where structural restrictions in the wrist and surrounding areas affect nerve function. By using osteopathic manipulative treatment (OMT), DOs can treat restrictions involving the carpal tunnel and address related lymphatic and circulatory components to decongest the area.
“The increased area of the carpal tunnel (structure) improves the function of the median nerve that travels through the tunnel,” Fuller explained. “As the function of the carpal tunnel improves then there is continued improvement in the structure in a feed-forward progression of improvement.”
He also cites thoracic outlet syndrome as another case where altered structure—tight muscles and restricted joints—compress nerves often causing tingling, numbness, and pain in the hand.
“The function of the nerves are compromised by the altered structure of the thoracic outlet,” Fuller said. “Treating such patients with OMT removes or reduces these restrictions, improving the function of the nerves going to the arm and hands.”
Golden notes that PCOM’s training emphasizes structural assessment from the outset.
“Nothing substitutes for a good physical exam that starts with observing the patient first with our eyes as to how they move, how they walk, how they sit, their posture, their basic structure and how they exist in an upright position in a field of gravity,” she emphasized.
Following the initial observations, osteopathic physicians conduct a complete physical exam using their hands to detect differences in skin, ligaments, tendons, and bones. This thorough assessment informs a treatment plan that may include OMT to optimize structure and enhance health.
In the osteopathic model, treatment is not symptom-driven but principle-driven—rooted in the understanding that the body is an integrated system.
“Osteopathic physicians are trained to take a comprehensive approach to the patient and to look for underlying causes of patients’ problems rather than focusing on symptom management,” Golden said. “Once an underlying cause is determined and treated, the need for additional symptom management is unnecessary.”
Osteopathic physicians aim to treat not only the immediate problem, but also the broader underlying factors contributing to dysfunction by restoring balance and supporting physiological processes.
According to Golden, osteopathic medicine differs from other medical models in that it inherently involves more time with patients, deeper relationship-building, and a broader consideration of factors influencing health.
“This builds a strong physician-patient relationship, represents an additional layer of care and concern, and enhances patient outcomes,” she said.
For those unfamiliar or skeptical of the osteopathic approach, Golden stresses the importance of open dialogue and education.
“It’s important to meet patients where they are,” she emphasized. “Open dialogue with information and instruction go a long way, as does the patience to honor their concerns and build the trust required for patients to feel comfortable with any treatment recommendation”
PCOM’s commitment to osteopathic principles ensures future physicians are prepared to provide care that addresses the whole person—supporting health through the interconnectedness of body, mind, and spirit.
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