Physical disabled doctors/residents and PM&R?

[biogirl215]

I always hear of PM&R as one of the best residency choices for docs with physical disabilities, but that confuses me... Doesn't PM&R require a fair amount of procedures, physical exams, etc. that would pose a probably for someone with impaired/no hand function? Is this not the case?

Thanks!

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[Gauss]

To clarify, some people choose PM&R due to prior experiences with rehab from whatever reason and wish to enter this field to help others with disability. I wouldn't characterize PM&R as the best field that accommodates physicians with disabilities. I've seen numerous physicians with disabilities practicing internal med, psych, OB/gyn, etc. When there is a will, there is a way.

 

[topwise]

Yeah, I agree with the above poster who said that disabled persons may be attracted to PM&R because of experiences they had with the field in the past.

However, I think at least the rehab end of the field is less physically taxing than some other specialties in medicine because the pace is relatively slow. (Not as much so for the physical medicine end.) I have a rehab attending who always makes comments about how great it is that we could still do our jobs even if we become gravely disabled.

 

[PMR 4 MSK]

I always hear of PM&R as one of the best residency choices for docs with physical disabilities, but that confuses me... Doesn't PM&R require a fair amount of procedures, physical exams, etc. that would pose a probably for someone with impaired/no hand function? Is this not the case?

Thanks!

Procedures are always optional, many PM&R's don't do much of them. Theroectically, you could have a nurse or PA do the PE, and you just be the "brains of the operation."

Hand function impairment will always be a big impairment to medicine, at least during school. After that, there's always psychiatry. I used to know a guy in Undergrad who was a nearly-blind quad from a TBI. He tried like hell to get in to med school, but no one would take him.

I've met a few paras who were in PM&R, and know of at least one quad. Go to AAPM&R annual assembly, you'll see quite a few in wheelchairs.

 

[axm397]

I think PM&R residency programs tend to try to accomodate as much as they can. We've had a few residents with paraplegia, incomplete SCIs, MS (diagnosed after starting residency), cancer, etc. We also have attendings with various disabilities (osteogenesis imperfecta, etc.) as well as nurses and other staff members with disabilities. I think because physiatrists know what kind of adaptive options are available, it is easier for programs to make accomodations. I think our residency and institution have been enriched by having colleagues and physicians with disabilities. it definitely has put a lot of things in perspective for me. It also helps patients when they see their physicians and nurses with disabilities.

We also have had some prominent physiatrists with disabilities (Dr. Strax at JFK, etc.) and they have led the way for other physiatrists with disabilities. I don't think that the practice of PM&R itself is significantly less physically demanding than other fields but accomodations can be made more easily because of the attitude and knowledge of physiatrists. True - the pace can be slower but so can the pace in other specialties like internal medicine, psych, etc. There's always the option of working part time or choosing to specialize in a less physically demanding subspecialty.

 

[Ludicolo]

Hmm.
If our field can't accomodate doctors with disabilities, which field can?

Med school and internship aside, completing a PM&R residency with a disability can be done. I had a resident with hemiparesis and impaired hand function, who met all the residency requirements necessary and graduated a few years ago. This resident had no difficulties w/ physical exam maneuvers. This was before there were computerized inpatient notes, and we were not (for logistical reasons) able to provide dictation services for inpatient notes or consults, so this person learned to hand write their notes. They performed slower than their colleagues, but all the work got done. The handwriting actually wasn't all that bad! There were concerns about procedures (injections, EMG) - we arranged for this resident to work with one of our OTs prior to any given rotation in this regard.

Once you're done with residency, you can set up your practice anyway you wish...

Don't know how helpful this would be, but the AAPM&R has a Physicians with Disabilities Special Interest Group that might be worth checking out.

 

[Llenroc]

There's an attending at Wayne State with a spinal cord injury. There's one at Emory as well.

 

[oreosandsake]

http://www.nfb.org/Images/nfb/Publications/bm/bm04/bm0401/bm040106.htm

article from the NY Times on the challenges that students with disabilities faced getting into medical school...

Western University has a Center for Disabilities in the Health Professions that was founded and run by a famous disability rights movement activist, Brenda Premo (she helped write the ADA)

Julie Madorsky used to teach here, and Jerry Lawler is a graduate of our school. Someone above mentioned a classmate with a disability that faced a lot of challenges and was not able to find a medical school that would accept him/her.

Not sure how relevant it is now that students with disabilities have trouble getting into medical school, but if you know of someone that has a disability and has run into "barriers" they should contact http://www.westernu.edu/xp/edu/cdihp/cdihp-about.xml
Brenda and the staff at CDIHP will definitely step up to bat for you.

btw, although the article states that Dr. Lawler has an interest in PM&R, I am pretty sure he is now a psychiatry resident (graduate?).

 

[MSKalltheway]

btw, although the article states that Dr. Lawler has an interest in PM&R, I am pretty sure he is now a psychiatry resident (graduate?).

Freudian slip?

Sorry dude, been studying for Step 1 too long, I just couldnt hold the pun back.

 

[ShrikeMD]

Yeah, I agree with the above poster who said that disabled persons may be attracted to PM&R because of experiences they had with the field in the past.

However, I think at least the rehab end of the field is less physically taxing than some other specialties in medicine because the pace is relatively slow. (Not as much so for the physical medicine end.) I have a rehab attending who always makes comments about how great it is that we could still do our jobs even if we become gravely disabled.

The pace is only slow if you set it up to be slow. If you are busy, the pace is definitely not slow.

As to the assertion that one still perform one's job even if "gravely" disabled, you can call me a skeptic. Alternatively, your rehab attending may have a different definition of what is "gravely disabled".

 

[biogirl215]

Thank you SO much for all the replies--they were really helpful!!

Freudian slip?

Sorry dude, been studying for Step 1 too long, I just couldnt hold the pun back.

No, I think Dr. Lawler is actually a psych resident/attending now... I usually look up what disabled med students end up doing after med school, and most seem to end up in psych (I guess it really is the most mental/"thinking" heavy speciality...?), with some in PM&R, though I did run across one qudrapalegic who went into nephrology (not sure how he would have completed the IM residency, but I guess he did...

Hmm.
If our field can't accomodate doctors with disabilities, which field can?

Med school and internship aside, completing a PM&R residency with a disability can be done. I had a resident with hemiparesis and impaired hand function, who met all the residency requirements necessary and graduated a few years ago. This resident had no difficulties w/ physical exam maneuvers. This was before there were computerized inpatient notes, and we were not (for logistical reasons) able to provide dictation services for inpatient notes or consults, so this person learned to hand write their notes. They performed slower than their colleagues, but all the work got done. The handwriting actually wasn't all that bad! There were concerns about procedures (injections, EMG) - we arranged for this resident to work with one of our OTs prior to any given rotation in this regard.

Once you're done with residency, you can set up your practice anyway you wish...

Don't know how helpful this would be, but the AAPM&R has a Physicians with Disabilities Special Interest Group that might be worth checking out.

I don't know if you could answer this or if you would even know the answer, but how impaired was the resident's hand fx? Was it on both sides (you said hemiplegia, so I'd guess not, but maybe so..?).

The pace is only slow if you set it up to be slow. If you are busy, the pace is definitely not slow.

As to the assertion that one still perform one's job even if "gravely" disabled, you can call me a skeptic. Alternatively, your rehab attending may have a different definition of what is "gravely disabled".

Just out of curosity, what would you define as "gravely disabled"?

Thanks again, all! You don't know how much I appreciate this!

 

[MSKalltheway]

No, I think Dr. Lawler is actually a psych resident/attending now... I usually look up what disabled med students end up doing after med school, and most seem to end up in psych (I guess it really is the most mental/"thinking" heavy speciality...?), with some in PM&R, though I did run across one qudrapalegic who went into nephrology (not sure how he would have completed the IM residency, but I guess he did...

Dang, I thought I had a really good joke going there for a minute...

In all seriousness, I remember correctly there is also a quad that either trained or still works at Hopkins. I saw the article on him through either a post here on the forum or coming across it in one of the online newspapers (probably both). Don't have the time to dig it up for you right now, but I'll see if i can get to it again once I can be lazy for a few days. It's quite a good read!

EDIT: The doc I'm talking about is PM&R

 

[axm397]

There is a resident with incomplete quad SCI with affected hand intrinsic function. I was his senior resident for EMGs and he was able to perform NCS, EMGs, and botox injections. He just needed a week or two to get used to holding small objects, etc. Definitely helped to have disposable electrodes so no tape and goo. He I think had a better understanding of the relationship between spasticity and function than even some of the attendings because he has spasticity himself. It was actually cool to work with him and hear his thoughts about which muscles to inject and why.

 

[Llenroc]

Charles Krauthammer is another famous quadriplegic doctor, though he was trained in the field of Psychiatry. He's now the New York Times conservative columnist, and also frequently appears on talk shows on CNN, Fox News, etc.

 

[Brooklyndo2.1]

I am about to enter into my pgy2 year of pm&r
I also have what movement disorder neurologists are describing as "idiopathic cervical dystonia" (i can get into the specifics of positioning, but it doesn't matter). I was diagnosed (self diagnosis, actually) during the morning of my first interview for rehab. I still went to the interview, etc. and I am not sure how weir I looked to the staff there or w/e. and how it affected their perception of me during the interview.
When I got back home I found my current neurologist and started treatment as well as continued on my interview trail so to speak. Of course my regimen wasn't optimized, etc. and I must have been "not myself" during the interviews.
I was concerned about revealing my new diagnosis to the programs and was advised to try it out on one to see what would happen.
What happened is that my file was closed in front of me, and the residency director or dept chair ( i dont know which one he was) told me he would not take me because I am a liability. This is verbatim.
I did not match initially, which could have been due to several reasons, many of them having to do with my disease.
It could have been that I did not go on as many interviews as I could and that I didnt really have "safety" choices on my rank list.
I still did A LOT of interviewing.
Since I had my official diagnosis and treatment rather close to my step 2 date , i was really unable to sit down and study well for the test for several reasons I think you all can imagine.
result, i failed step 2.
I dont know if programs knew this, and I only told one PD about it (she asked - I answered.) so anyway I did not match and wound up going to a program I had not considered. Looking back I think the program will be VERY good for me. On the note that I would be a liability, let me just say this : I'm waiting for my NY license to come in the mail. (translation for those that need it = passed step 2, passed step 3 on first attempt, finished internship, etc)
I know my writing here sounds (and is) bitter, but considering everything, I do believe that I have at least some right to it, especially in light of my interview experience. Liability???? heh Im pretty sure if that was a problem, than the spinal taps, etc etc (flouro guided as well as "blind" facet, z joint etc )that I got to do during internship would have been a problem and I may have not graduated internship.

What strikes me the most is that the person who told me I am a liability was a physiatrist.
I suppose he forgot who Dr Strax is. Maybe someone should have reminded him.
but anyway, my point isn't that the programs weren't understanding, or that they didn't have a valid reason to not rank me highly, or that for all that I know my situation was one of those statistical flukes, but that as a field, I think we need to recognize that doctors get sick, become impaired, but do find a way to become practicing physicians.
How do we , and I address this to my colleagues in PM&R ,at every level in their career, justify stating that our "job" is to improve peoples lives and help them overcome impairment and disability when we arent willing to do so for each other.

Disclaimer : yes a lot of this is based on one experience, but hell, it hurt, and it taught me some valuable lessons. I am not "attacking" any one person or our profession. I understand how and why the particular interviewer thought what he thought (note I did not say "said what he said"). However, I do think that we as a group need to do more to put our money where our mouths tend to be.

Respectfully
Brooklyn

 

[PMR 4 MSK]

What happened is that my file was closed in front of me, and the residency director or dept chair ( i dont know which one he was) told me he would not take me because I am a liability. This is verbatim.

Beyond the fact that it would be your word against his, did you report this to NMRP officials?

 

[Brooklyndo2.1]

Beyond the fact that it would be your word against his, did you report this to NMRP officials?

No, for the reason you mentioned.
as well as the fact that I do think he was trying to be nice about it...
(hey, thats why people "dont sue" doctors who apologize )
also, honestly I was too upset with his action, with my new medical condition, and knew that I didnt really want to go to his program all that much.
I didn't feel as comfortable in my own shoes in regard to the dystonia as I do now. And frankly, I was concerned, at the time, that maybe he was right.
Doesn't matter now though. He knows who he is, I know who he is, and I had to learn to deal with it. I knew it could happen, and I knew my reaction to it would be BAD and NOT controlled if I dealt with the situation in a formal way.

Besides,
There is nothing easy that is worth doing. (im obviously paraphrasing)
I learned my lesson. I learned about people. And, I learned about being a patient.

I'll have to send him an email and say thanks.

 

[photon]

thanks for sharing your story, brooklyn. i wish you did not have to experience these things, but it is important for us to hear regardless.

 

[Brooklyndo2.1]

thanks for sharing your story, brooklyn. i wish you did not have to experience these things, but it is important for us to hear regardless.

Photon, I just want to make sure people get that this is not a poor me story. If it was, I probably would have put something up MUCH earlier