Osteopathic family physicians embody the philosophy of whole-person care, including using a biopsychosocial approach to incorporate mental health into patient care. The creation of the Behavioral Health Integration Collaborative increased support for a system-level adoption of whole-person care in primary care settings. With the increase in both mental health symptoms and diagnoses among Americans, and the increasing support for integrated physical and behavioral healthcare in the primary care setting, this paper shares various approaches, as well as challenges to, adapting integrated care in the primary care office. This includes reviewing best practices for implementing this care approach. The two leading models for integrated care are the Primary Care Behavioral Health (PCBH) model and Collaborative Care model (CoCM). Both models include clinically embedding licensed mental health professionals into the primary care setting, thus increasing access to colleagues with this specialized approach. The PCBH model utilizes a warm hand-off approach, resulting in a collaboration between physician and mental health provider in the care of the patient. The CoCM focuses on a registry of patients who are overseen by a behavioral health manager with treatment decisions guided by a consulting psychiatrist. Blended models are also emerging to better suit the needs for different practices and the patient populations they serve. Challenges to full implementation include acquiring buy-in from practice leadership, hiring appropriately trained mental health providers, and defining billing and coding procedures.
Many osteopathic textbooks include treatment modalities and techniques that could improve frequently experienced ailments of pregnancy, such as nausea, vomiting, gastroesophageal reflux disease, constipation, and edema. However, there is little scientific evidence to support the use of osteopathy for these conditions, particularly among the pregnant population. The aim of this literature review is to identify and evaluate current evidence regarding the use of osteopathy in the management of common discomforts of pregnancy. Several search engines and journals were used to identify peer-reviewed articles written between 2003 and 2023. Eleven articles were included in total, including a variety of case reports, pilot studies, and journal articles. The results show that although osteopathy does appear to be safe to perform during the third trimester and its efficacy in the treatment of these conditions is promising, current evidence is insufficient to guide treatment protocols. Further research is needed to establish efficacy and determine osteopathic treatment regimens.
Infertility affects one in four female physicians in the United States, yet the topic of fertility among female physicians is understudied and warrants focused strategies to implement change. Factors that exacerbate the rates of infertility in female physicians include intentional delays in family planning that are driven by the length of medical training and career advancements, age, long working hours, and physician burnout. While the effects of COVID-19 on reproductive health remain uncertain, the virus may have played a role in illuminating an already existing issue in women’s reproductive health. Burnout rates among female physicians have reached record highs contributing to reproductive disorders that warrant well-deserved attention to this issue. Initiatives should focus on fertility education in undergraduate medical education, organizational-level interventions, better insurance coverage for infertility treatments, and addressing burnout. Collaborative efforts between individuals, institutions and organizations are needed to prioritize reproductive health among female physicians.
Histiocytic sarcoma is a rare and frequently missed diagnosis. With unusual and varied presentations, it typically indicates a rapid patient decline and poor outcomes. The diagnosis requires a high degree of clinical suspicion. In this case, we explore the progression of illness in a 56-year-old white male who initially presented with a 2-week history of soft-tissue nodules scattered throughout his head, neck, torso, and limbs, as well as shortness of breath and knee pain. After a thorough workup including computed tomography imaging of the neck, chest, and lower extremity, as well as a biopsy of a nodule with immunoperoxidase staining, a diagnosis of histiocytic sarcoma was established. Due to the severity of his malignancy, his hospital course was complicated by a deep vein thrombosis. Clinicians should be mindful of the risk of acute decompensation in such cases and can employ the various tenets of osteopathic theory to improve patient quality of life. Depending on the severity of illness, physicians may proceed to facilitate end-of-life measures with grace and dignity.
Chronic limb-threatening ischemia (CLTI) is an advanced form of peripheral vascular disease with high rates of morbidity and mortality. Patients often present with claudication, impaired walking, and ischemic pain. Screening for CLTI and peripheral arterial disease is recommended with ankle-brachial indexing. To prevent progression to CLTI, family medicine physicians can intervene with lifestyle modification of hyperlipidemia, obesity, smoking, and encouraging well-rounded high-fiber diets. OMT can be useful in increasing lower-extremity circulation and collateral-vessel development. If refractive to optimized medical management and lifestyle modification, surgical intervention is required. Regardless of intervention, CLTI maintains a high rate of morbidity and mortality, with halting progression being the primary objective.
