Client choices among osteopaths and ordinary physicians in a Michigan community [1]

The U.S.A. has a “plural medical system” in which the most successful unorthodox subculture is osteopathy; however, it is perhaps also the least different from orthodox medicine. Yet the differences are significant. This study shows how client perceptions of osteopathic physicians (D.O.s) and ordinary physicians (M.D.s) influence the utilization of health care services; thus it deals with interrelationships between characteristics of clients and of practitioners. The study of a small Michigan town where clients have approximately equal access to the two kinds of physicians is based on interviews with a random sample of residents. A substantial fraction of the clients say that they do not perceive any difference between D.O.s and M.D.s. Among those who do perceive a difference, M.D.s tend to be rated in the abstract more highly than D.O.s. Nevertheless, more clients utilize D.O.s than M.D.s, and relationships with D.O.s are longer in duration. Most clients recognize the widespread belief in exclusive legitimacy of M.D.s, even if it does not convince them. Yet despite the ideological dominance of M.D.s, clients pragmatically favor consultation with D.O.s.