Do the majority of your patients "get better"?

[surftheiop]

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Im a college junior getting ready to apply for medschool and I've been lurking through all of the specialty boards just so I can start seeing which specialties I want to be keeping in the back of my mind.

Physiatry seems very interesting from what I've read the last couple months, but one thing I haven't been able to get a handle on is do your patients often "get better" or is most of your time spent trying to lessen/holdback inevitable chronic conditions for as long as posible?

Just to clarify with an example, I have had asthma since age 4 or 5, but its very well managed by my allergy doc and doesnt effect me at all really, so even though I have a semi-chronic condition I would consider that I "got better" for the purposes of this question.

 

[MSKalltheway]

Just to clarify with an example, I have had asthma since age 4 or 5, but its very well managed by my allergy doc and doesnt effect me at all really, so even though I have a semi-chronic condition I would consider that I "got better" for the purposes of this question.

Depends on your definition of "got better".

Based on your example, most of medicine is managing a chronic illness so that if you took away treatment, you'd probably get worse. Like your asthma, if you took patients off anti-hypertensives, diabetes meds, seizure meds, etc. you presume they would get worse (and often do). PM&R is a little bit different in this respect, at least at times.

PM&R is focused more on quality-of-life and function, so physiatry is often more focused on helping you deal with whats left and helping you to be functional despite any impairment that you have (which would include neurological, musculoskeletal, cardiopulmonary, or even pain) so they can remain as independent as possible. Sometimes you are able to fix your patients as a result of your efforts to improve QOL, sometimes they have reduced symptoms, and at times you cant do much of anything but help them work around the problem.

PM&R def does not afford a surgeons outlook on patient care, and what I mean by that is that "they came to me broken, and I fixed them". Doesnt always work like that in this field. Its not that it wont happen, it does a decent amount, you just cant always expect that to be the case! Part of what I found to be awesome about working with physiatrists is that they can fix things when no other doctor can fix them, and when several other specialties have given up.

That said, my seniors I'm sure will clean up any mess that I have made in responding to your post. As a side note, I think its wise for you to investigate which field to go into now. Dont spend any significant time on this, its one of those things you can do when you find yourself staring at a wall on a Tuesday night. If you can figure out by the time you get to third year of med school if you'd rather be that surgery gal or that physician guy, I think you'll be in good shape. Shadow, shadow, and shadow some more when you have time, and see tons of stuff, its the only way youll make a good, informed decision. I tell you this because early on in med school, I feel like certain faculty here gave a few of my classmates bad advice to wait until 3rd year to figure it all out, or they just blew it off until later. Then they freaked out come 4th year cause they were very conflicted on specialty choice, when they should have been getting specialty focused LORs, writing a personal statement and working on the app. I dont fault my 'mates for it, its a very hard decision to come to...which is why you should do it sooner rather than later!

Best of luck!

 

[SSdoc33]

Depends on your definition of "got better".

Based on your example, most of medicine is managing a chronic illness so that if you took away treatment, you'd probably get worse. Like your asthma, if you took patients off anti-hypertensives, diabetes meds, seizure meds, etc. you presume they would get worse (and often do). PM&R is a little bit different in this respect, at least at times.

PM&R is focused more on quality-of-life and function, so physiatry is often more focused on helping you deal with whats left and helping you to be functional despite any impairment that you have (which would include neurological, musculoskeletal, cardiopulmonary, or even pain) so they can remain as independent as possible. Sometimes you are able to fix your patients as a result of your efforts to improve QOL, sometimes they have reduced symptoms, and at times you cant do much of anything but help them work around the problem.

PM&R def does not afford a surgeons outlook on patient care, and what I mean by that is that "they came to me broken, and I fixed them". Doesnt always work like that in this field. Its not that it wont happen, it does a decent amount, you just cant always expect that to be the case! Part of what I found to be awesome about working with physiatrists is that they can fix things when no other doctor can fix them, and when several other specialties have given up.

That said, my seniors I'm sure will clean up any mess that I have made in responding to your post. As a side note, I think its wise for you to investigate which field to go into now. Dont spend any significant time on this, its one of those things you can do when you find yourself staring at a wall on a Tuesday night. If you can figure out by the time you get to third year of med school if you'd rather be that surgery gal or that physician guy, I think you'll be in good shape. Shadow, shadow, and shadow some more when you have time, and see tons of stuff, its the only way youll make a good, informed decision. I tell you this because early on in med school, I feel like certain faculty here gave a few of my classmates bad advice to wait until 3rd year to figure it all out, or they just blew it off until later. Then they freaked out come 4th year cause they were very conflicted on specialty choice, when they should have been getting specialty focused LORs, writing a personal statement and working on the app. I dont fault my 'mates for it, its a very hard decision to come to...which is why you should do it sooner rather than later!

Best of luck!

ill clean up the mess

the answer is "yes"

 

[surftheiop]

Also what age groups make up the largest volume of your patients?

 

[RUOkie]

Also what age groups make up the largest volume of your patients?

Most of my patients are between the ages of 9-99 😛

(no seriously, the great majority are between 50-80, but I see people as young as 8-9y/o and as old as 103😱

 

[drusso]

Some of my patients "get better," and others just "get different." 😎

 

[surftheiop]

Some of my patients "get better," and others just "get different." 😎

Could you explain this a little more? I imagine psychiatrists might say something similar and I sort of know what it means in that context, but not so much in this one.

 

[PMR 4 MSK]

I look to do one or more of a combo of:

Improve pain
Improve function
Improve quality of life

It's a rare pt that I cannot do at least one of them. A rare exception was seen by me already this am - 28 yo female injured her shoulder at work lifting a light weight. MRI shoulder (with arthrogram) shows mild tendonsosis. MRI C-Spine normal. Neuro exam normal. Pain with all range-of motion of the shoulder, diffusely tender. 3 months PT, multiple meds and several injections have not done a thing, and every time she comes in, she complains she's worse. I declared her at maximal medical improvement and released her with permanent restrictions. Now she can move on with her lawyer, negotiate a monetary settlement, and then maybe she'll get better.

 

[drusso]

I look to do one or more of a combo of:

Improve pain
Improve function
Improve quality of life

It's a rare pt that I cannot do at least one of them. A rare exception was seen by me already this am - 28 yo female injured her shoulder at work lifting a light weight. MRI shoulder (with arthrogram) shows mild tendonsosis. MRI C-Spine normal. Neuro exam normal. Pain with all range-of motion of the shoulder, diffusely tender. 3 months PT, multiple meds and several injections have not done a thing, and every time she comes in, she complains she's worse. I declared her at maximal medical improvement and released her with permanent restrictions. Now she can move on with her lawyer, negotiate a monetary settlement, and then maybe she'll get better.

Based on your lack of objective evidence for pathology (presumably also including EDX)--or at least objective evidence only for minimal pre-existing/degenerative pathology (shoulder tendinosis)--what basis do you have to give her any permanent restrictions? How do you know that she's not either crazy or lying?

 

[RUOkie]

Based on your lack of objective evidence for pathology (presumably also including EDX)--or at least objective evidence only for minimal pre-existing/degenerative pathology (shoulder tendinosis)--what basis do you have to give her any permanent restrictions? How do you know that she's not either crazy or lying?

+100!

FCE with validity measures, case closure, no IR

(sorry for the threadjack!)

 

[drusso]

+100!

FCE with validity measures, case closure, no IR

(sorry for the threadjack!)

Of course FCE's are not perfect either. I'm just playing Devil's Advocate. I try to give my patients the benefit of the doubt, but I'm amazed at what gets "rated" as an industrial injury with impairment sometimes.

 

[PMR 4 MSK]

Based on your lack of objective evidence for pathology (presumably also including EDX)--or at least objective evidence only for minimal pre-existing/degenerative pathology (shoulder tendinosis)--what basis do you have to give her any permanent restrictions? How do you know that she's not either crazy or lying?

Very good! She is either lying or crazy, I favor crazy. The game I play with WC, since they won't pay for psychiatric consults, is make clinical/opinion-based decisions, then when they ask for clarification or dispute, get the FCE. Otherwise, if I order an FCE right now, I'm guaranteed it will exacerbate her pain and I'll be expected to work it up further and prolong my agony.