In the United States there is a medical speciality called 'Physical Medicine and Rehabilitation'. Doctors who specialise in this are called Physiatrists (pronounced 'fizz-ee-at'-trists').
Physiatrists commonly see:
- Stroke patients
- Spinal cord injury patients
- Patients born with a musculoskeletal defect
- Patients who have had hip, knee or shoulder replacements.
Physiatrists deal with three types of functional loss:
Impairment - For example, when a person is unable to move a limb.
Disability - The inability to perform a task. For example, when a person cannot walk.
Handicap - For example, when a person cannot access their apartment because of stairs.
Physiatrists are Medical Doctors who have undergone four years of medical school. Following medical school the new graduate begins a medical 'residency', where the training includes one year spent developing fundamental clinical skills in general internal medicine, general surgery, family practice or pediatrics. Following this 'intern year' are three additional years of specific training in Physiatry. During or immediately after the intern year the MD must take the final step of the United States Medical Licensing Exams. During the final year of the residency the physiatrist in training takes the Licensing Board Exam for Phsyiatry. The specialty exam is repeated every ten years to make sure that all practising physicians keep up to date with techniques.
After this residency the newly trained Physiatrist may begin practice or seek advanced training in a more specific area of the speciality. This could be Musculoskeletal Rehabilitation, Paediatrics, Pain Management, Traumatic Brain Injury, Spinal Cord Injury or Sports Medicine. Many of these subspecialties have individual tests for Physiatrists to become 'certified' as a practitioner.
What a Physiatrist Does
Pain and Disorders
Physiatrists frequently deal with pain and musculoskeletal disorders. Their patients most often include people with arthritis, tendonitis, any kind of back pain, and work- or sports-related injuries. Because of the variety of injuries, physiatrists see patients in all stages of health - from professional athletes to fully paralysed patients, and from children with muscular dystrophy to elderly patients with arthritis.
In addition to dealing with a patient's loss of function, physiatrists often coordinate the long-term rehabilitation for the patient.
Complex injuries often require multiple interventions from many different areas of medicine. In these settings the physiatrist will act as the patient's advocate and administrator.
The long process of coordinating service for a patient with spinal injury, or a child with cerebral palsy, or an adult with multiple sclerosis, can be overwhelming to the patient, but also to physicians unfamiliar with the more mundane tasks involved, such as acquiring proper materials and scheduling multiple services. The physiatrist deals with nurses, physical therapists, pharmacists, physicians in other specialities, social workers and manufacturers of prosthetic devices.
Therapies and Devices
In addition to the normal treatments found in general medical practice, physiatrists use therapeutic exercises, heat, light, water, electricity, bracing, prosthetic and adaptive devices to treat patients. Physiatrists specifically deal with adaptation to disability, and to preventing complications or deterioration secondary to disabling conditions.
Physiatrists supply devices to assist with the activities of daily living and prevent these devices from causing further damage. For example, a patient with an artificial hip will need a wheelchair, but a physiatrist can also prescribe specific assistance to prevent the chair from causing skin problems, and to prevent the patient's muscles from wasting away.
The goal of the physiatrist is to provide medical care to patients who have loss of function, so that they can maximize their potential. The physiatrist may act as a surrogate social worker, psychiatrist, scheduling secretary and motor pool captain for their patients.
The physiatrist's mantra is:
Treat the patient, not the disease.