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POMA wants The Journal of the Pennsylvania Osteopathic Medical Association to be a safe space for all DOs to have a voice and be heard. Opportunities to contribute in all content areas are open to all osteopathic medical students, residents and physicians. Share your thoughts, ideas and submissions via email to [email protected].
*Views expressed in The Journal of the Pennsylvania Osteopathic Medical Association are solely those of the authors and do not necessarily reflect the opinions of the editorial board, The JPOMA, or POMA unless specified.
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Ensuring Patients Are Fed During Procedural Delays: Reflecting on the Past, Addressing the Present, and Building a Better Future
February 2025 | Vol. 69, No. 1
Written by Yasmine Saikali OMS-3, Lake Erie College of Osteopathic Medicine
In hospital settings, it’s all too easy for small oversights to snowball into major issues. One area where this happens far too often is with patient nutrition, particularly when patients are put on “nothing by mouth” (NPO) orders while waiting to see if a procedure, like an endoscopy, will happen that day. If the procedure gets delayed or rescheduled, and no one revisits the diet order, patients can go an entire day—or longer—without being fed. This is not just an inconvenience; it can have serious, even deadly, consequences.
A tragic example of this happened at Poole Hospital in the UK. A 56-year-old man with Down’s syndrome and dementia died after going without food for nine days during his hospital stay. The lack of proper nutrition weakened him to the point that he succumbed to pneumonia. This heartbreaking outcome was entirely preventable and highlights the critical need for better systems to ensure patients don’t fall through the cracks when it comes to basic care like meals.
Here’s how healthcare teams can prevent situations like this from happening in the future:
- Automated Systems for Diet Reassessment: Simple alerts in electronic medical records could remind teams to update dietary orders if a procedure gets delayed.
- Improve Communication: Ensure that all NPO orders are clearly documented and communicated during every shift. If a procedure is delayed or rescheduled, the team should reassess whether the patient can safely eat until a new plan is confirmed.
- Frequent Reassessment: Don’t leave patients on NPO status longer than necessary. If a procedure isn’t happening that day, adjust the order to allow the patient to eat.
- Involving Dietitians More: Having dietitians as part of daily rounds could help ensure patients’ nutritional needs aren’t overlooked.
- Empower Patients and Families: Patients and their families should feel comfortable speaking up if they notice meals are being missed or if there’s confusion about dietary restrictions. Their voices can be a powerful safety net.
It might seem like a small detail—whether or not a patient gets a meal—but it’s not. Nutrition is fundamental to recovery and survival. The tragedy at Poole Hospital reminds us that we must all stay vigilant, even with the basics. No patient should ever go hungry because of a preventable oversight. By prioritizing communication, collaboration, and frequent reassessment, we can ensure that patients receive the care and dignity they deserve.
BBC News: “Poole Hospital: Man with Down’s syndrome died after going nine days without food.” Link: https://www.bbc.com/news/uk-england-dorset-68251142 |
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The Under-Representation of Osteopathic Physicians in Plastic Surgery
October 2024 | Vol. 68, No. 1
Written by Nura Gouda OMS-IV, Marshall Miles D.O., Michael Karon D. O. Institutions: Gouda- Philadelphia College of Osteopathic Medicine, Philadelphia, PA Dr. Miles – Lehigh Valley Health Network, Allentown PA Dr. Karon- Reading Hospital West Reading, PA
Plastic surgery residency is arguably one of the most competitive specialties in which to match. Many factors can increase one’s chances of matching, such as high board scores, strong letters of recommendation, multiple research publications, and outstanding performance on fourth year rotations. However, while reviewing match data from recent years published on the NRMP website (1), it was apparent that one specific factor had a grossly negative association with a successful match: attending an osteopathic medical school (DO) rather than an allopathic medical school (MD). The osteopathic philosophy of medical education was created in 1874 with the intent of approaching patient health and treatment holistically, viewing the patient as a culmination of their mind, body and spirit, and practicing on the assumption that these three aspects exist synergistically (2). Additionally, osteopathic manipulative treatment (OMT), which DO physicians are taught during their training, involves the use of one's hands to understand and identify somatic dysfunction based on an understanding of the musculoskeletal system. Besides this additional training, osteopathic and allopathic medical students receive the same medical education. Integration of OMT into treatment of patients is often physician and specialty specific.
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Take the First Pitch
October 2024 | Vol. 68, No. 1
Written by Richard E. Johnson, DO
When I was growing up, I played little league baseball for about a year, it really wasn’t “for me,” so I never picked up the baseball lingo that kids that played from age 5 to 19 picked up and used as “common knowledge” verbiage.
When I got to college (last century) I joined a fraternity, and as most frats do, we played intramural softball. During our first game the “coach/brother” sent me to the plate with the charge to “take the first pitch.” Not really understanding what that meant, I swung at the first pitch, and missed. I thought the coach was going to have a cow. “What the hell are you doing, he proffered!?” To which I declared, “you told me to take the first pitch, so I did.” “No, you, dumb#*@, take the first pitch means to let it go and wait for the next one. Well, ain’t that great, be nice to know the lingo.
Moving forward about 50 years, I was recently discharged from the hospital after a 6–7-hour abdominal surgery with catheter and JP drain and about 20 pages of post op information and instructions. I read through them like a good patient and knew what it all said, my wife/intelligent and very competent caregiver, however, took it all literally and to the letter of the law, which is good, but has its downsides. The information and instructions were general recommendations for many/all related surgeries and had some conflicting information compared to what the surgeon discussed with us at my discharge visit.
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