Personality

[kolaas]

I´m an italian medical student, now studying in Berlin, Germany, for one year.
I got into medicine with the naiv idea of getting to know lifes as a job. Coming from a humanistic background, I first considered psychiatry, which for some reasons now scares me to death. Maybe this years of hard work forced me into the shape of the typical, traditional and stereotyped doctor but I got to the conclusion that I will be happier reading Jung in my free time, if I want.
Anyway I still tried to find something with an holistic approach , but with more emotional distance and in which you can do something with your hands. Pm&R is my first choice at the moment, since I also considered neurology for a while.
How much interesting and important do you thing is dealing with the psychological components of a disabled/impaired/ chronical pain patients in the trade of a physiatrists, in comparison to other specialties?

How much neurology and neuroscience are in there? The best parts of neuro are the thorough physical exam and the logical thinking... will I miss them?
Last, I don´t quite understand why if PM&R is so cool (as I often think), even most of the medical students either don´t know it or think it´s crazy boring. After a few talks with other doctors and students, an easy influenced person like me actually got some doubts weather to plunge into a field for a lifetime or not.
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[analgesic]

Kolaas,
Like you I was fascinated with neurology. I was a neuroscience TA at my medical school with the devout intention on becoming a neurologist. However, once I rotated through neurology I became somewhat dissapointed in the lack of therapeutic options for so many neurologic lesions i.e peripheral neuropathies, demylenating diseases, movement disorders etc.. A friend of mine recommended that I rotate through PM&R and I immediately found my calling. Neurologist and Physiatrist see the same kind of patients relatively speaking but I feel physiatry is more dynamic in that it incorporates an understanding of biomechanics and psychology that is essential to restoring humanism. I have always thought of physiatrists as integrative functional neurologists. Physiatry is such a diverse field in which you can sub-specialize in so many different areas like pain medicine, sports medicine, vestibular rehabilitation/balance disorders, spinal cord injury, or traumatic brain injury. I truly feel blessed to be a part of such a fascinating branch of medicine. Rehabilitating a pt after a debiltating event is so rewarding. Likewise, if you wish to use your hands, you can always apply manual medicine and priniciples or articular neurology to evoke plastic changes in the central neuraxis. I highly recommend this field to anyone who is interested in psychiatry or neurology. I only hope you embrace physiatry with the same passion that I have. As for physiatry's popularity, more and more medical students are becoming attracted to this field for life style reasons. Applications and board scores have been on the incline for the past couple years. I am quite sure that this year's applicant pool will be increasingly more competitive. As for your background in psychiatry, you will have plenty of opportunity to apply your knowledge to the rehab population of patients. I wish you well in your decision and hope my post has answered some of your questions.

 

[usmleed]

what you said about PM&R vs neurology is very true. I too had thoughts about joining neuro before I read about PM&R on this forum. It does seem to be more rewarding than neuro.
The thing which bothers me though, is that when I recently had the opportunity to visit one of the PM&R clinics, i found the doctors waiting for patients over there. there were no patients , niether did it look like any were coming. And this was a much advertised clinic of good repute. The physiatrist there told me that, PM&R people lost case to Physiotherapists this year, which meant the physio ppl were practically autonomous. that takes away a large chunk of patients. what do u say?

 

[axm397]

PTs do not write prescriptions, or provide medical management of patients. Patients can see both PT and physiatrists with no overlap in care. Most of the time, PTs like having MD "clearance" to proceed - I mean how would you know that the back pain you are treating with PT is not secondary to malignancy or something more serious??

In terms of waiting for patients, I'm not sure what clinic you went to but if you go to a clinic affiliated with a PM&R residency, you will see more than enough patients. (sometimes too many.)

Hope this helps.

 

[FMGP8P]

How much neurology and neuroscience are in there? The best parts of neuro are the thorough physical exam and the logical thinking... will I miss them?

Does anyone have an answer to this question?

 

[DOctorJay]

If you go into out pt you'll definitely be doing thorough neuro evals on pts. I worked in a physiatrist's office this summer and he picked up things sent to him from neuros that they didn't pick up. Lots of MRI, EMG, etc. There are lots of similarities between these fields but in PM&R you are mainly a physician of function and try to maximize the pt's functional activities.

-J

 

[cyanocobalamin]

If you go into out pt you'll definitely be doing thorough neuro evals on pts. I worked in a physiatrist's office this summer and he picked up things sent to him from neuros that they didn't pick up. Lots of MRI, EMG, etc. There are lots of similarities between these fields but in PM&R you are mainly a physician of function and try to maximize the pt's functional activities.

-J

When I did a rotation dealing with SCI we did lots of ASIA exams which is pretty neuro-based. Kinda interesting. I would say neuro is more acute based, and that they have areas that PM&R doesn't really deal with like EEG and sleep (can you see those 3Hz waves??!)

http://www.sci-info-pages.com/levels.html

 

[axm397]

I do a thorough neuro exam every day admitting patients to the TBI and stroke services. Many of the patients are followed by neurology in the acute care setting and it seems that our exams include all the elements they document on their physical exam as well as more PM&R specific tests.

So I'm talking about stuff like: sensation (including localization, light touch/pain/temperature/vibration, 2pt discrimination, stereognosis, double simultaneous stimulation, traced figures), strength, reflexes (with specialized tests as indicated for snout, suck, grasp, palmomental, hoffman, finger flexors, babinski, chaddock, oppenheim, cremasteric, bulbovacernosus, TNRs, tonic labyrinthine - don't ask me what some of these are - they're just listed on my H&P form and I have yet to have done many of them ) We also look at balance, speed and spontaneity of moovement, coordination, peripheral nerve status, cranial nerves, mini-mental exam, and a very thourough rest of physical exam (including looking for skin breakdown, spasticity, contractures, etc.)

And in terms of "logical thinking" - I'm not sure what that means - if it means being able to localize a lesion/stroke territory, I think we do that well. Identifying a level of spinal cord injury, we do well with the ASIA exam.

We also get enough EMG exposure to be able to practice EMG without a fellowship although some choose to do a fellowship.

Hope that answers some of the OP's questions.