bad outcomes?

[predodoc]

---

Members don't see this ad.

I've recently become very interested in PM&R but one concern I have is that I won't be able to handle the very sad situations. I saw "Million dollar baby" and thought the ending was very depressing.I know that most specialties deal with bad outcomes and depressing situations but some much more than others. The answer most of you will give me is" It depends what you like to see". So my question is what kind of patients do the large majority of PMR docs see and how many end up having bad outcomes?

 

[Llenroc]

In inpatient rehab. most patients don't really have phenomenal outcomes, especially the ones with strokes and spinal cord injuries. For that matter, typical outpatients that you would see (back pain, neck pain) rarely get cured either, though the ones with carpal tunnel syndrome can have good outcomes with surgery.

Maybe there's better outcomes in sports medicine.

 

[topwise]

It really varies and I can only speak for my own residency, not The Real World. Some people, especially some of the young brain-injured patients, end up making incredible recoveries and it's really uplifting. Other people don't do as well. Some people don't recover any function, but learn to use and accept what they have, which I count as a positive outcome. Most of the patients we take are ones that are expected to benefit from the rehab, so we're set up to have better outcomes. I haven't had any "Million dollar baby" endings. Still, there are a lot of really tragic cases that I will never be able to get out of my head. The worst for me was doing peds. And as a result of some of the things I've seen, you will never EVER get me on a motorcycle.

In terms of depressing, I found my medical ICU time in internship light years more depressing than most of the stuff I've seen PM&R residency.

 

[WaterAvatar]

In inpatient rehab. most patients don't really have phenomenal outcomes, especially the ones with strokes and spinal cord injuries. For that matter, typical outpatients that you would see (back pain, neck pain) rarely get cured either, though the ones with carpal tunnel syndrome can have good outcomes with surgery.

Maybe there's better outcomes in sports medicine.

Geeez.. you make it sound so hopeless. Why would people go into PMR then?

 

[Disciple]

I don't know,

Why would people go into Hospice/Palliative Care, or Oncology?

When it comes to disabling conditions (and this includes chronic pain), small improvements can mean alot to some patients.

 

[rehab_sports_dr]

As for SCI:

I love the movie "Million Dollar Baby"- great movie. However, it does not reflect the reality of caring for patients with SCI (at least my experiences).

On the other hand, the movie "Murderball" very much DOES reflect the reality of SCI patients (in fact, I did help cover one of the guys in Murderball when I was on call at Kessler). If you have never seen Murderball, run to your videostore or Netflix queue and watch it now. Everyone I know who sees it is reminded about why they wanted to be a doctor in the first place, and a physiatrist in particular.

SCI, in my opinion, is NOT a terminal diagnosis. That is the whole point of PM+R, and what makes it so great to be a physiatrist. While the impairments associated with a condition like SCI may be non-reversible, the function of the patient is not limited- people can do anything, as in the case of SCI patients becoming rugby players.

As for other aspects of rehab- they are all inspiring. I see mostly outpatient musculoskeletal patients now, but the model is the same. The model of looking at a person, sizing up their limitations, learning their strengths, and figuring out how to help them function with the extent of their capacities- it's a great way to interact with patients.

While I'm at it, I'll put in a plug for academics here too. The same model applies to medical student and residents education- all students have their strengths and weakness in terms of learning style. So, trying to determine your students limitations and work within their strengths to maximize their abilities- it just makes every day fun and satisfying.

Long winded answer- being a physiatrist is inspiring and fun on a daily basis. Go rent Murderball. Like Million Dollar Baby, it should have won the Oscar if it didn't get robbed by the Penguins (it lost best documentary to March of the Penguins). If you do rent it, make a point of watching the special features- the doo-wop with the Kessler nurses singing to the patients is awesome.

 

[fozzy40]

I guess it really depends on how you look at things. For me, PM&R is best suited for those who are optimists. In rehab, I feel that the focus is on what the patient has vs. what they have lost and how we can improve their function and quality of life. I find myself very motivated and uplifted by many (not all) of my patients on the inpatient rehab floor. We all take for granted the our abilities to do the most mundane things i.e. button our shirts, walk up and down stairs, brush our teeth, etc. To watch a patient face adversity daily, work on their deficits, and wake up the next day to do it again...it's a testament to the human spirit everyday...cheesy but it's why I love it🙂

 

[PMR 4 MSK]

I've had many worse cases than "Million Dollar Baby." But if that's what bothers you, don't do that aspect. you get trained in all aspects of PM&R and then get to decide how you want to practice it. We tend to see more chronic than acute patients, and no matter what the disorder/disease/problem, chronic ones have worse outcomes than acute.

Re: "Murderball" - I know a lot of those guys. I used to referee Quad Rugby in the 90's when it was just comnig out of it's infancy as a real sport. I watched it grow from about 20 teams in the nation to 50 - 60, I'm sure it's even more now. Joe Soares was an ******* back then even. The movie shows him to be an even bigger weanie now and a crybaby as well. He was known to argue every call made against him. Sore loser.

I went to school with Kevin Orr (U of Ill). He couldn't play quad rugby since he had no real impairment of the UE's (arthrogryposis), but was world-class in track. Ironically, his twin brother played for the regular/able-bodied rugby team. Kevin's put on some weight since college... In college, he was quite possible the strongest guy in a wheelchair I've ever known. I once watched him race a quad across the gym floor, Kevin out of his wheelchair. The quad was a 2.5 in quad rugby terms (about what Mark Zupan is now), and Kevin dragged himself just with his arms, about as fast as I could run. Kevin won. He could also run/walk handstand-style across the gym floor, his thin legs dangling in the air. Ahh, the memories...

Mark Zupan was injured after I stopped ref'ing (after I started residency), and his story of his injury and rehab/recovery is awesome in it's intensity. You'll meet a lot of people with tales like that in PM&R and in wheelchair sports. Mark is little bit more, how shall we say, intense, than the average quad rugby players, but I've seen worse.

If you ever get the chance, go see quad rugby played live. If you're an MD/DO with rehab experience, you can be a certifier who decides what level (0.5 - 3.5) a player is. There are lots of opportunites to get involved with that and other wheelchair sports. I used to help out with W/C basketball, track and other sports.

 

[predodoc]

Thanks everyone for the great responses. I will definatly rent Murderball. I guess the only way Ill really know if I can handle the tough situations that come with SCI and strokes is to do a rotation or shaddow a PMR doc. Even if I dont go into PMR I still think what you guys do is awesome. Keep up the good work.

 

[predodoc]

I have no Idea why it gave me an angry face. I cant find out how to edit it. Anyway.🙂

 

[drusso]

Here's the deal: You will see some pretty amazing things in physiatry; you'll also see a lot of heart ache. What always struck me as the most human thing about the "physiatric continuum of care" was watching families, spouses, and patients cope with illnesses and disabilities.

You will see families rally around loved ones and you'll see families flat out abandon loved ones: Sure, everything is hunky-dory in life until grandma is found face down in her Frosted Flakes. Then, faster than you can say, "They're Great!!!" out come the nursing home brochures. I've seen patients served with divorce papers on the rehab unit.

It will make you pause. It will make you think a lot about what kind of spouse you want to marry and what kind of family you want to raise. It will make you think about the implications of "heroic medicine." It will make you think about end-of-life care. It will make you think about quality of life.

When traumas roll through the ED and through the OR everyone is focused on "saving a life." When those same patients roll into the rehab unit, the focus is on saving "quality of life." It's not a big adrenaline rush. No one is interested in making TV programs about it. There's a not a lot of high-tech, gee-wiz gadgets to grab your attention. But, it's real life and it will make you think.

 

[caedmon]

Here's the deal: You will see some pretty amazing things in physiatry; you'll also see a lot of heart ache. What always struck me as the most human thing about the "physiatric continuum of care" was watching families, spouses, and patients cope with illnesses and disabilities.

You will see families rally around loved ones and you'll see families flat out abandon loved ones: Sure, everything is hunky-dory in life until grandma is found face down in her Frosted Flakes. Then, faster than you can say, "They're Great!!!" out come the nursing home brochures. I've seen patients served with divorce papers on the rehab unit.

It will make you pause. It will make you think a lot about what kind of spouse you want to marry and what kind of family you want to raise. It will make you think about the implications of "heroic medicine." It will make you think about end-of-life care. It will make you think about quality of life.

When traumas roll through the ED and through the OR everyone is focused on "saving a life." When those same patients roll into the rehab unit, the focus is on saving "quality of life." It's not a big adrenaline rush. No one is interested in making TV programs about it. There's a not a lot of high-tech, gee-wiz gadgets to grab your attention. But, it's real life and it will make you think.

Great point about the spouse. We often bring up the term HLSI as a plus in the category for good outcomes. (HLSI= High Loving Spouse Index)

 

[drusso]

Great point about the spouse. We often bring up the term HLSI as a plus in the category for good outcomes. (HLSI= High Loving Spouse Index)

...don't forget the "at least one anti-gravity knee extensor" factor and bowel and bladder continence conversion factor. We had it figured out like this:

%Home = Loving spouse index + (1- % quadricep weakness) - (1 - (1/(frequency bowel and bladder continence))*2

 

[drvlad2004]

Murderball was an awesome movie. Dr. Kirshblum at Kessler made a guest appearance. I have been volunteering as an assistant coach for a Long Island wheelchair basketball squad, which travels all over the country. It is so inspiring and amazing in what they do. I feel slow and oftentimes inept when I put myself on the wheelchair against those athletes. Tennis has been my longtime passion. Any resident or student should go check out wheelchair tennis also.