How do you deal with sad cases / poor prognoses?

[nerve zapper]

I'm a M4 planning to go into PM&R. On a subspecialty inpatient PM&R service this month and we have some extreme cases that have been haunting my dreams. I've seen end stage cirrhosis, CHF, COPD, etc on IM clerkship as well as traumas, bad cancers, etc on other services during M3 year. But something about seeing patients with very poor functional prognoses daily and watching them struggle to cope mentally is really getting to me.

Does this feeling get better? Is this something I would have to learn to deal with if I pursue this field? Could I avoid such profoundly sad cases by specializing in other areas of PM&R?

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[j4pac]

I'm a M4 planning to go into PM&R. On a subspecialty inpatient PM&R service this month and we have some extreme cases that have been haunting my dreams. I've seen end stage cirrhosis, CHF, COPD, etc on IM clerkship as well as traumas, bad cancers, etc on other services during M3 year. But something about seeing patients with very poor functional prognoses daily and watching them struggle to cope mentally is really getting to me.

Does this feeling get better? Is this something I would have to learn to deal with if I pursue this field? Could I avoid such profoundly sad cases by specializing in other areas of PM&R?

It’s challenging. But you just have to remember that you’re a physician and you’re there to help these really unfortunate people. It’s a very rewarding job but you definitely can’t take it too personal and must find a balance outside of work. Most sub specialists in PM&R work at building up patients at their nadir. Sports Med is different. Their patients are typically high functioning and you are trying to keep those patients at their zenith. I find value with both sides of the coin.

 

[RangerBob]

I find PM&R patients much less depressing than others. At least most of our patients get better. Peds PM&R can get really depressing, and some brain injuries/anoxics can be pretty depressing too, but overall I find the field far more optimistic and hopeful than just about any other field.

Unless you're doing well-checks 24/7, or working in a field where you can really dissociated yourself from the fact your patients are people (like radiology, pathology), I don't think you can get much better than PM&R.

I can't tell you how thankful my patients are. They come to rehab after a massive/disabling event, and the vast majority leave much better than when they came in. How many doctors can say they guided a patient through a process like that? Seeing them daily, being there to watch it all and stand by their side?

 

[drg123]

I find PM&R patients much less depressing than others. At least most of our patients get better. Peds PM&R can get really depressing, and some brain injuries/anoxics can be pretty depressing too, but overall I find the field far more optimistic and hopeful than just about any other field.

Unless you're doing well-checks 24/7, or working in a field where you can really dissociated yourself from the fact your patients are people (like radiology, pathology), I don't think you can get much better than PM&R.

I can't tell you how thankful my patients are. They come to rehab after a massive/disabling event, and the vast majority leave much better than when they came in. How many doctors can say they guided a patient through a process like that? Seeing them daily, being there to watch it all and stand by their side?

That's a great perspective @RangerBob Thanks for sharing. Makes me excited for my inpatient rehab rotations.