What do you think of this...honestly...
Started by drusso
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If a patient gets relief from a LESI for their disc herniation, sometimes it's just that simple. No need to convene the multi-disciplinary team!
Most PMR practices are highly interventional and outsource to PT.
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After a careful, critical analysis of all the variables…
The author seems to suggest that PMR docs enjoy getting sh1t on by patients while anesthesia penetrates theirs.
Did grok compose this dude’s post as well?
Did Roger Chou post that meme?
a post meant to be inflammatory though i do agree with significant parts of it.
theres a reason you do a pain fellowship. its to teach those who dont know one end of the needle from the other how to do procedures while the same time teach those who know nothing of physical exam and quality of life how to follow patients. and if we really wanted to be interested in quality of life, pain doctors should also be trained psychologists and psychiatrists. and neurologists for neurologic diagnosis.
PMR plays a critical role as much as anesthesiology, psychiatry, neurology, and even internal medicine. it should be board certified Pain doctors that lead the way.
fwiw, the most interventional focused pain doctors - the biggest needle jockeys - i personally know are PMR, not anesthesia.
theres a reason you do a pain fellowship. its to teach those who dont know one end of the needle from the other how to do procedures while the same time teach those who know nothing of physical exam and quality of life how to follow patients. and if we really wanted to be interested in quality of life, pain doctors should also be trained psychologists and psychiatrists. and neurologists for neurologic diagnosis.
PMR plays a critical role as much as anesthesiology, psychiatry, neurology, and even internal medicine. it should be board certified Pain doctors that lead the way.
fwiw, the most interventional focused pain doctors - the biggest needle jockeys - i personally know are PMR, not anesthesia.
Great words that I agree intend to be inflammatory. In practice I haven't seen PMR docs practice the way that is suggested in this post. They are at least as interventional as anesthesia doctors.
We really don't need more of this. All pain management providers need to unite around barriers affecting our patients. Almost all of them will benefit from things like biofeedback and detailed psychological evaluations. Again great to say but try to get your patients there and get it paid for.
I wish that I would see more posts
We really don't need more of this. All pain management providers need to unite around barriers affecting our patients. Almost all of them will benefit from things like biofeedback and detailed psychological evaluations. Again great to say but try to get your patients there and get it paid for.
I wish that I would see more posts
AI will change everything soon. The best providers will have the best AI programs. Soon after that the insurers will insist on their use. What specialty you were trained in won't matter once AI is established as standard of care. Docs will become technicians as AI takes over the cognitive aspects of medicine. PMR vs Anesthesia will become of historical interest.
One of my good buddies is in this situation. It's not a good care model, though I have a few shots per week my partners send me (CESI only). That cartoon is BS though. On many levels, BS.
Did he happen to implant 100 stimulators in the last 6 months….
I’ve seen this too. I’ve done them in the past but not currently taking any which I know is impacting my volume, but I really prefer to evaluate someone myself before I stab them. That said, I do think in some situations it can make sense to take a direct injection referral.
you're being smart and much less likely to get sued should something go south
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This is some elite level propaganda cartoon. I literally laughed at the image. All that's missing is a halo on the PMR side and some horns and a curled mustache on the anesthesia side.
Although there is some potentially valid points about what PM&R can bring to the table, I think it is a mistake to generalize competency and effectiveness based on primary specialty. I think if you compare the average anesthesia resident to the average PM&R resident coming into fellowship, the anesthesia folks are going to be stronger in the procedures at least initially. PM&R probably has an edge in terms of MSK/physical exam
I think most of us can best serve our patients by being comprehensive but that does mean different things for different practices. For example in my practice I do osteopathic manipulation and acupuncture which is a relatively unique feature and a lot of patients find great benefit and seek us out for that. That being said I do not do neuromodulation, and some patients would benefit from that and would need to go somewhere else.
I have no superiority complex whatsoever, there are things I bring to the table that other physicians do not and many others that could say the same about their practices.
We all have our strengths and I think we serve patient's best by emphasizing our strengths and referring out for our weaknesses
I think most of us can best serve our patients by being comprehensive but that does mean different things for different practices. For example in my practice I do osteopathic manipulation and acupuncture which is a relatively unique feature and a lot of patients find great benefit and seek us out for that. That being said I do not do neuromodulation, and some patients would benefit from that and would need to go somewhere else.
I have no superiority complex whatsoever, there are things I bring to the table that other physicians do not and many others that could say the same about their practices.
We all have our strengths and I think we serve patient's best by emphasizing our strengths and referring out for our weaknesses
I think it's a valid point that anesthesia pain training is too focused on "which tool" and not enough on the big picture but the post was way too self righteous for my taste.
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I think that is right but the bigger issue is that even for those that are more "holistic" in thinking about care, the system does not pay for a lot of those therapies.
Even worse, a lot of payors say that things are helpful (like psychological counselling) and then don't reimburse.
Same, with the exception of the maybe 1 hip or shoulder IA injection I do a month which one of the Ortho guys in my group asks me to do. Anything else I see the patient first and decide for myself.
I always see them first. If we can do it same day as the consult, we do it. A lot of times surgeons still ask for intra-articular facets. Those won’t make it through auth on their documentation. I document the need for dx mbb and do the standard mbb/rf plan.
I had a PA once for a few months in my old group. I’m not gonna lie, it was glorious. He was very seasoned and competent and it was like having a junior attending to see the patients. Alas it was a short time in my career. Now I’m back to grinding out each and every patient that walks in the door
