I've been trying to educate myself on PM&R. I'm interested in helping people with spinal cord injuries, after some recent experiences in the ER. Most PM&R FAQs I've read describe things poorly in very abstract terms (i.e. "PM&R is an exciting, vibrant field concerned with quality of life issues pertaining to personal mobility and fitness").
Anyway, what exactly does a PM&R doctor do in a typical encounter?
Do you take H&P, and how long do you spend on it? How detailed is it?
What do you do next?
Do you do a procedure? Do you do physical therapy? How much time do you spend with these people.
depends on setting and patient population
- for inpatient - example spinal cord injury (SCI) - need to know how to do ASIA exam (American Spinal Injury Association), complete neuro and MSK exam in addition to comprehensive physical exam. Detailed history including a much more detailed social history than a typical int. med history - ex. occupation, what kind of house/aptmt/condo, stairs? previous functional status. Any adaptive equipment? etc. etc. then come up with goals of where u want the patient to be when they finish in pt rehab. For stroke pts, need to do an even more thorough neuro exam incl looking for apraxia, aphasia, neglect, mini mental, etc. to assess cognitive status. follow them daily to assess for medical issues like spasticity, bowel/bladder, psych, sleep, as well as complications like PE, DVT, pneumonia, UTI, stroke, bleed, etc. etc. Also meet/talk to families as we go along to make discharge plans and help them cope with changes.
for Peds patients - need to know "primitive reflexes", developmental milestones, abnormal development, spasticity, dystonia, different syndromes, ortho procedures in peds pts, PALS stuff - like seizures, etc.
For out-patient - for example - I am on my chronic pain rotation. we spend 1 1/2 hr with each new evaluation which is NOT typical of a private practice pain program. We get a full history incl. all the typical stuff - onset, duration, etc. etc. Look at how pain affecting pt - sleep? mood? social? work? pain disability index, etc. Litigation? worker's comp? Ask about treatments/meds already tried, physicians and other professionals they've already seen. Comprehensive review of systems, comprehensive physical incl complete neuro and MSK exam. (concentrating on area of pain but also up and down kinetic chain) come up with recs - pain program - full or partial? therapy only? meds only? psych referral? intervention - like injections? etc. etc. if they enroll in the full pain management program (PT, OT, Voc Rehab, Therapeutic recreation, aqual therapy, relaxation, biofeedback, psychology, and medical) we see them 3x a wk to check in on them and make any meds changes as necessary or order new tests (MRIs, xrays, EMG/NCS, etc) So need to know how to read radiographic images (basic MRIs, x-rays, etc.), do EMG/NCS, when and how to do interventions (like joint injections, botox injections, spinal injections, etc.).
Not all typical of private practice PM&R docs but if you know how to do the most complete version - then you can adjust as necessary when you get out to practice. Hope this helps
