I agree with M3... As a PGY2, I think it really is site/attending dependent. Some attendings really do not want to handle "medical problems" (mostly private MD/DOs) and others do NOT consult anyone (even to the point of doing extensive sharp bedside debridement of wounds for SCI patients- that kinda made me nervous!!!).
In my experience, at private hospitals, every service gets consulted for little things and rehab basically leads the rehab team and ANTICIPATE medical problems that would effect activities. I guess there is a "network" that goes on among the attendings, but I will not go into that.
In the County or the VA system, we manage EVERYTHING until we really run out of options.... Acute pain management so the patient can participate, Blood transfusions if needed for anemia causing fatigue or SOB, Initial W/U for Chest pain on the rehab floor, Orthostatic intolerance, Fall work-up, Depression, DVTs (refer out PE's), WOUND management and referral only for SURGICAL DEBRIDEMENT, CHF treatment with diuretics (refer out for thoracentesis if needed) as we get lots of CABG patients, spasticity management if needed with medications or BOTOX... These are just some of the things we do on a typical general rehab rotation where the attendings let you run the floor.... But most importantly we are trained to RECOGNIZE and ANTICIPATE the complications that can typically occur in the rehab patient. It can get rather busy, but if you catch these things before your patient crumps, and you manage it early and effectively, the patient can participate in therapies and have better outcomes in the end.
You are also expected to know the REHAB that goes on, but that is another topic that I can go on and on about... for example (a simple one)... there are certain goals that need to be achieved for the best possible outcome of a Total Knee Arthoplasty (bread and butter PM&R patient). In order to achieve these goals, the patient must be ABLE to participate in aggresive AAROM, Balance, Progressive ambulation, strenthening and transfers... But if you, the Physiatrist, do not effectively manage acute pain (off the PCA pump), do not catch a slowly decreasing H/H (common in a knee replacement), or an infected incision or a UTI, your patient will NOT achieve the expected REHAB goals and usually functional outcome is worse!!!! I can go on and on about this now that I have experience on the rehab floor, but let me stop here unless y'all have questions.
Initially I had the same concerns and questioned the PM&R doc's importance. Now I know that we are probably the MOST important kind of physician (BIASED, OF COURSE) in ensuring the best possible FUNCTIONAL outcome of all PATIENTS!!! The best surgeons can do a wonderful job on a knee, but if the rehab is not done properly, then the patient might as well not have undergone the surgery!!!!
This is my PGY2, two cents on inpatient rehab... I welcome comments or additions from fellow residents!
