pediatric PM&R elaborated

[vivalavie]

I'm gonna preface this by saying it is not my intention to be provocative or critical of PB&R (uy, that's always a good way to start a thread).

I'm starting med school in august and, in the course of investigating sub-specialties (I'm pretty much set on pediatrics) several people have suggested PB&R as a good lifestyle-friendly option. At first I was excited by this option, I have a close friend that is a pediatric PT, I've seen what she does and it seems awesome, and I thought physiatry would be similar but with more versatility.

When I mentioned PB&R to my PT friend she kinda flipped. She said physiatrists don't do anything, she said they're glorified PTs that don't actually do physical therapy. Now, this isn't the first time my friend has shown disdain to another profession or degree (she still thinks DOs are quacks), she's always been a bit close-minded but her opinion does matter to me, so I looked into it.

I read all the stickies on sdn and I'm still having trouble figure out what exactly physiatrists do. I've heard they're like orthopedic surgeons w/o the surgery... uhh, the vast majority of being a surgeon IS surgery last I checked, at best this makes them sound redundant and possessing of a tiny and insignificant role. I've heard they coordinate the rehabilitation of patients by diagnosing, helping with pain and sending them to the appropriate therapist (PT, OT, speach, etc.). Okay, a coordinator could be very helpful in this process, I can see that, but this seems like such a limited role as to be almost absurd. PTs are great at diagnosing MSK disorders and there are lots of docs who can do pain management.

So I'm asking... what am I missing? This is a specialty requiring four years a post-grad training and I refuse to believe it is as redundant and small as I am lead to believe. If I went into pediatric PB&R what would I be to my kids? What would my average day be like? How would I justify the existence of my profession to my hypercritical PT friend? Please know that I am not dependent on the opinions of others for my happiness, but if I can't clearly define and defend my profession well enough to explain it to her then I have to suspect that I will always have my own doubts.

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[fozzy40]

Check out this link: http://www.aapmr.org/medstu/medstuda.htm

In regards to what pediatric physiatrist does from inpatient perspective includes caring for children with acute traumatic brain injury, spinal cord injury, cancer rehabilitation, post-operative osteotomy/tenotomy for gait abnormalities, conversion disorder, just to name a few.

From what I've seen, the two big populations the outpatient physiatrist sees are cerebral palsy and spina bifida. There are a lot of problems with spasticity, neurogenic bowel/bladder, skin care, prosthetic/orthotics management, and pain management. While we do coordinate care, it's our job to make sure:
1) the patient is appropriate to receive PT, OT, or Speech therapy
2) ensure that medical management of their impairments are optimized before entering therapy. For example, your friend might have difficulty teaching transfers and walking if their bowel/bladder are not managed, their scissoring gait is not being controlled by their physiatrist, or their pain isn't well controlled.

Pediatric PM&R is true rehabilitation medicine...and awesome.

 

[PMR 4 MSK]

"PB&R" - that's Peanut Butter and Raspberry?

Yeah, your PT friend is right, we don't do anything. Except diagnose illness and diseases, prevent complications, prescribe medications, prescribe PT, do injections, implants, etc. Not much. Mostly we sit around and drink coffee while collecting checks from insurance companies for playing chess with one another.

Oh yeah, and we write orders for what we want the PT to do. That's why she hates us. We tell her her job. Instead, we should be like all the other good little doctors and just write "Eval and Tx"

She is right, we don't do PT. That's why we have PTs - to do that. When we see a patient, and feel PT will help them, we write an order for it. If we wanted to do PT ourselves, we would not have wasted 8 years of our lives learning medicine.

 

[SSdoc33]

if you like peds, definitely looks into peds PM&R. there is a huge shortage of them, and they actually can do really good work. the only physiatrists who actually knew what they were talking about in my residency were the peds guys.

spasticity work. botox/phenol injections. baclofen pump work. prescription of orthotic that actually help to patients who actually are happy. doesnt seem all that bad.

 

[vivalavie]

"PB&R" - that's Peanut Butter and Raspberry?

Yeah, your PT friend is right, we don't do anything. Except diagnose illness and diseases, prevent complications, prescribe medications, prescribe PT, do injections, implants, etc. Not much. Mostly we sit around and drink coffee while collecting checks from insurance companies for playing chess with one another.

Oh yeah, and we write orders for what we want the PT to do. That's why she hates us. We tell her her job. Instead, we should be like all the other good little doctors and just write "Eval and Tx"

She is right, we don't do PT. That's why we have PTs - to do that. When we see a patient, and feel PT will help them, we write an order for it. If we wanted to do PT ourselves, we would not have wasted 8 years of our lives learning medicine.

woah, everyone else gave good explanations, sorry bout the pb&r slip, but maybe this IS why PTs don't like you, generally they're good at what they do, capable diagnosticians and they know their field as well as their limitations, and maybe it doesn't help if you talk to them like this....

Chill, man, I qualified my remarks several times, she's always been a bit quick to judge, I just wanted to give the pros a chance to explain it to me, and I appreciate the answers the rest of you gave.

 

[lobelsteve]

woah, everyone else gave good explanations, sorry bout the pb&r slip, but maybe this IS why PTs don't like you, generally they're good at what they do, capable diagnosticians and they know their field as well as their limitations, and maybe it doesn't help if you talk to them like this....

Chill, man, I qualified my remarks several times, she's always been a bit quick to judge, I just wanted to give the pros a chance to explain it to me, and I appreciate the answers the rest of you gave.

I'm gonna preface this by saying it is not my intention to be provocative or critical of PB&R (uy, that's always a good way to start a thread).

PMR said it gruffly but appropriately. PT is PT, PMR is the practice of medicine. There is no overlap. Part of the job of PMR is to order PT and make sure the PT does what is told and not what they think is needed. When PMR and PT work hand in hand there is open communication and care is augmented. When they operate separately the PT does what they think is best and this is not always what is best for the patient.

PT is such a tiny part of what PMR does that most of us write Eval and Treat just hoping out patients make enough sessions to make the difference. When the patient comes back we make sure it is not 5 min with the ATC and 20 min on the bike. Referrals are based on taking care of our patients, not making numbers for a facility.

 

[BadHorse]

I'm gonna preface this by saying it is not my intention to be provocative or critical of PB&R (uy, that's always a good way to start a thread).

PMR said it gruffly but appropriately. PT is PT, PMR is the practice of medicine. There is no overlap. Part of the job of PMR is to order PT and make sure the PT does what is told and not what they think is needed. When PMR and PT work hand in hand there is open communication and care is augmented. When they operate separately the PT does what they think is best and this is not always what is best for the patient.

PT is such a tiny part of what PMR does that most of us write Eval and Treat just hoping out patients make enough sessions to make the difference. When the patient comes back we make sure it is not 5 min with the ATC and 20 min on the bike. Referrals are based on taking care of our patients, not making numbers for a facility.

I think I understand, obviously it would help if I could shadow or do a clinical rotation in PM&R, I guess my last question is does the field feel too narrow to you, do you get bored or is there enough diversity and problem solving going on that you feel intellectually challenged and like you're not giving the same handful of treatments and running the same tests over and over?

Edit: sorry, this is a new account I'm using, trying to figure out how to delete vivalavie... mods please don't ban me, haha

 

[fozzy40]

PM&R is probably one of the broadest fields out there. There you can practice in a variety of settings and be as subspecialized as you want. Every field in medicine has the potential to become boring with enough experience. My advice is to pick a specialty where the patient's inspire you and you will never go wrong.