So, just what is physiatry (fizz-EYE-ah-tree)? Psychiatry? No. Physical therapy? No. This is a common query. You might know physiatry better by some of its other names. It’s known officially as physical medicine and rehabilitation, or PM&R; some casually refer to us as “rehab doctors.” As a fourth-year medical student entering the field, I have learned that there is much more that we can do among patients and healthcare professionals to improve the understanding of physiatry—and, most important, of why we are needed.
In short, we help our patients get back to a higher level of physical functioning. Whether you are an 18-year-old with a spinal cord injury suffered while surfing in Bali, a 40-year-old dad who gets shooting leg pain when walking with his kids, or a 95-year-old woman suffering pain while reaching for dishes on the top shelf, physiatrists are here to help. It’s a team effort as we work with specialists in physical therapy (PT) and occupational therapy (OT), social workers, and community organizations to help our patients achieve their physical goals. We work across a wide spectrum of functionality, successfully treating those who are limited in even the most basic movements while also keeping some of our most impressive athletes healthy and strong.
Optimizing the Patient’s Functions
An example from my time on the wards might best clarify what we do. Mr. Smith (a real person, but a fictional name) was brought into the hospital by his son for slurred speech and left-sided arm and leg weakness. After admission, Mr. Smith was found to have had a brain bleed, or stroke, that had stabilized, and he was seen by a team of neurologists and internal medicine physicians. Early during his hospital stay, he was also seen by a physiatrist. This rehab doctor assessed Mr. Smith’s physical functions before the stroke and afterward, and, most practically, asked him about his priorities, as well as what he did at home and for work. Once Mr. Smith was deemed medically stable, he was transferred to an inpatient rehabilitation unit. During his stay, he participated in physical therapy to learn to walk with his new cane, worked with occupational therapists to feed and clothe himself, and spoke with a social worker about finding an apartment that didn’t have stairs for him to climb. During inpatient rehab, he was seen daily by a physiatrist, who adjusted Mr. Smith’s subacute-stroke care needs, optimized his chronic medical management, and tailored his PT and OT goals to help him reach a projected discharge date.
Physiatry and Interdisciplinary Follow-Up
What I love about PM&R is that the role of a physiatrist seldom ends at discharge. After leaving the inpatient rehab unit, Mr. Smith saw an outpatient physiatrist who monitored his progress. During these visits, careful attention was paid to outpatient PT and OT recommendations. (A patient’s perspective on his or her recovery also allows the primary physiatrist to make further recommendations about where there’s room for improvement.)
In addition, the physiatrist worked with specialists in custom orthotics to build an ankle support to help counter Mr. Smith’s residual foot drop. Over time, the physiatrist may choose to inject Mr. Smith’s arm with the botulinum toxin to prevent the formation of any contractures or permanent stiffness that would limit how much he could extend his arm. Using this interdisciplinary approach, outpatient rehabilitation brings together multiple specialists to aid in Mr. Smith’s recovery, ultimately bringing him closer to living an independent and fulfilling life.
One thing holds true in the world of PM&R—no two physiatrists are alike. Many dedicate their lives to the world of inpatient rehab, treating everything from spinal cord injury to traumatic brain damage or even pursuing newly established fields such as cardiac and pulmonary rehabilitation. Others choose to take care of patients in an outpatient environment; for example, by treating spasticity in children with cerebral palsy or performing X-ray-guided spinal injections on patients suffering from chronic pain.
While the world of rehab is rapidly expanding to accommodate the needs of our quickly aging population, it also continues to grow in the world of athletics, where we serve as team physicians and consultants to a wide variety of athletes, from youth to professional. So whether you are a patient weak from a long hospital stay or an athlete with leg pain, remember that a physiatrist can help.
We are here to make you the very best version of yourself.