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[Dr. Bruce Banner]

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[Ogliodendrocyte]

I started a PM&R interest group at school not too long ago to try to bring more exposure to medical students early on. I have organized physician panels, resident panels, even procedure nights so students can have a feel of what PM&R is. I even try to connect medical students with PM&R physicians to shadow. The up side is a lot more people know about PM&R now, the down side is a lot people still don't understand what physiatrists actually do even after shadowing and rotating. Any ideas on how to promote our field better?

There is an amazing podcast called the undifferentiated medical student where they interview different specialties to get a look at what its like. There's one on PM&R and it's probably the most informative piece I know about pm&r

 

[DMBandFan86]

The answer depends on who you work with:

I have worked with PM&R attendings who do little else but say hello to the patient every day (if even that much).
I have worked with attendings who only manage bowel/bladder, pain, rehab-related issues and have a hospitalist do everything else for medical management, pulmonologist for trach management, other specialists for specific problems, etc.
On the other hand, I have worked with attendings who do just about everything and only consult a hospitalist or specialist for complex problems.

 

[DMBandFan86]

Well in the first scenario you need a resident to make it work so that the patient is still being taken care of. It is pretty much the extreme of bad medical education, but I see it happen...

Rehab-related issues are the bread and butter of PM&R. Hospitalist don't get trained in rehab, thats why it takes a specialist.

The main rehab units are TBI, stroke, SCI, general, oncology. Patient's are technically supposed to be 'medically stable' to go to an IPR unit so they don't need daily insulin adjustments or BP medication adjustments, IVF's, lines and drips, etc. We generally utilize the ED for medical emergencies that come up.

Brain injury/stroke: How do you treat a disorders-of-conciousness patient versus a higher rancho level. How do you get brain injury patients on the road to being awake and recovery. We deal with medications (neurostimulants, mood stabilizers), spasticity management, procedures (TDCS, botox, joint injections), agitation management, paroxysmal sympathetic hyperactivity, hypercalcemia, chronic respiratory failure, disordered sleep/wake cycles, depression, pain, dysphagia, aphasia, etc etc.

SCI: same thing: spasticity management, bowel/bladder management, neuropathic pain, chronic pain issues, power WC equipment, AD, may get a vent patient etc.

general rehab: mostly poly-trauma, joint replacement, amputation, debility, transplant recipient patients. Acute on chronic pain is mostly what we treat here.

oncology: sees a lot of brain injury and SCI patients from cancer.

 

[RangerBob]

As a student interested in PM&R, maybe I just don't see much of a value of inpatient pm&r docs that are one of the first two scenarios you listed. I have a good grasp of what the outpatient practice looks like for pm&r, but the inpatient practice is just so nebulous to me. If you don't mind elaborating, what prevents the pm&r doc from being replaced by an IM doc on the inpatient rehab unit? And can you give some examples of some "rehab-related issues" that you referred to?

This is a problem in both outpatient and inpatient rehab--often people will ask why others can't do our job. Such as neuro doing stroke rehab, ortho doing MSK/sports, etc. I would personally actually argue that inpatient rehab is better defined than outpatient, which is still a growing field (and the source for most of the new interest in PM&R).

Other specialties can often do part of what we do, but none have focused on training in the maximization of function. That's what our specialty is about--function. IM are great at IM, but they don't know how to manage spasticity, optimize bowel/bladder, and coordinate the interdisciplinary team like we do. I'm sure they could (and some do) learn, but we can learn IM as well.

 

[j4pac]

A good start would be capitalizing on the greatness that is Shaquem Griffin. It’s pretty rare for one of these stories to become national news...Christopher Reeves and Jim Abbott come to mind.