Find It, Fix It, and Leave It Alone

There are certain expressions within Osteopathic tradition that define who we are and what we do. Dr. Still’s famous quote, “Find it, fix it, and leave it alone” summarizes three fundamental Osteopathic principles. On the surface, this famous excerpt seems easy to understand. Beneath the surface, this triadic statement demands an in-depth discussion, because there is an implied multiplicity of meanings.

Find It

The first aspect of this triad is easy to appreciate and offers no philosophic argument. To “Find it” means to make a distinct diagnosis. In the ideal situation, before an Osteopath can adequately treat, we must have a specific diagnosis. Any treatment aimed at a vague diagnosis or at symptoms often fails to find it’s therapeutic mark.

Dr. Still once said, “I want it understood that I look upon the treating of effects as being as unwarranted as it would be for the fireman of a city to fight the smoke and pay no attention to the cause that produces it.” If we only diagnose and treat the smoke (effects) and fail to identify and put out the fire (cause) we are doomed, at the worst, to clinical failure or, at the best, to superficially addressing symptoms. Osteopathy is philosophically based upon making an accurate diagnosis, i.e. to “Find it.” Dr. Still identified that distortions of the musculoskeletal system and fascia, create obstructions to fluid dynamics (arterial and venous blood, lymphatics, cerebrospinal fluid, and extracellular fluid) and interferences with nerve function thus creating the context for disease. By treating the context for disease, we address the cause or the fire. By applying interventions only to symptoms, i.e. the smoke or effects, we usually do not impact cause, and the fire of disease spreads.

“Find it” contains three essential Osteopathic principles. To “Find it” means to have an intimate understanding of anatomy; to absolutely respect the pathophysiologic laws of cause and effect; and to know the difference between normal and abnormal in a human body.

To “Find it’ means to place our “thinking, seeing, feeling, and knowing” hands, as William Sutherland, DO once said, on our patients in an intelligent and caring manner and then perform, what is now called, a physical exam. It also means to gather a history from our patient. By combining the multi-level information received from the history and physical exam we then make an Osteopathically oriented diagnosis.

Fix It

“Fix it” respects that patients come to us because their innate healing mechanisms are not effective, are insufficient, or are obstructed. Patients come to us because they need help and they are not able to “Fix it” themselves.

“Fix it” implies the common Osteopathic principle that physical biomechanical distortions or dysfunctions contribute to the earliest causes of the later manifestations of disease. To “Fix it,“ in the most obvious case, means to remove the material or physical obstructions and distortions that adversely effect function.

There are also categories of Osteopathic Treatment that address a problem in a non-mechanical way. These Osteopathic approaches work with subtle biologic phenomena that have become distorted in their relationship with material elements and with function. A non-mechanical Osteopathic Treatment is devoted to assisting the patient’s body in achieving wholism by primarily accessing the non-material field. We can apply “Fix it” in either a biomechanical way or in a non-mechanical manner.

The problem with “Fix it” is that it disproportionately depends upon the physician actively repairing or renovating. It implies that the physician is doing the work of healing. Most of 20th century Osteopathy has been dedicated to the “Fix it” subdivision of the triad. “Fix it” is Osteopathic technique. Technique is not Osteopathy! To focus on “Fix it” is to be an incomplete Osteopath.

The other potential problem with “Fix it” is when Osteopathic technique is applied in a cookbook fashion. When the same routine or formula is given to every patient, without regard for the Osteopathic requirement of “Find it,” or making an accurate diagnosis, then the therapeutic depth of an Osteopathy Treatment is not achieved. Osteopathy works best when each patient is treated as an individual and each treatment is unique to that person’s necessity.

Leave It Alone

What makes Dr. Still’s triadic quote complete is the “Leave it alone” aspect. “Leave it alone” indicates that we must trust that Nature’s remedies will do the healing. “Fix it” does not heal! “Leave it alone” heals! Dr. Still stated, “You as Osteopathic machinists can go no further than to adjust the abnormal condition, in which you find the afflicted. Nature will do the rest.”

“Leave it alone” asks that we absolutely respect that Nature “does the rest.” It is not the Osteopath who does the true work of healing. “Fix it” does not heal, Nature does!

“Leave it alone” demands that the physician must get out of the way and allow the patient’s inherent therapeutic processes to unfold. It is not the ego based will-power of the Osteopath that restores a patient to health, it is the power of each patient’s self-healing mechanisms that do the work.

Physicians who believe they personally fulfill every aspect of the triad, “Find it, fix it, and leave it alone,” are at the best delusional and at the worst arrogant. Genuine healing, demands that the doctor endures a deliberate style of waiting for, whatever category of healing to occur. Dr. Still said, “Give Nature the ascendancy.” This means we must trust that Nature is the controlling influence or is in position of power to heal.

Conclusion

One of the meanings of the word triad is in reference to a chord or harmony in music. “Find it, fix it, and leave it alone” is an Osteopathic chord that has a unifying tone.

“Find it, fix it, and leave it alone” offers each of us a template in our work as Osteopaths. This template only works when “Find it” and, especially “Leave it alone,” are absolutely respected. If the Osteopathic profession concentrates on technique, or the “Fix it” component, then the person performing the procedure, is not a true Osteopath; they are only biomechanical technicians.

Steve Paulus, DO