Physiatry and Physical Medicine are relatively new medical sub-specialties that offer soldiers, boomers, athletes and people living with chronic pain the opportunity to extend the life of the physical body.
Thanks to medical and health advances, people are now living longer; it is common knowledge that the rapid increase in the number and types of medical treatments has been saving lives. What is less obvious is that many surviving patients must now live with a disability.
With well-being a growing concern in an aging population -- one that increasingly survives its health problems -- a new type of doctoring, born from the rehab needs of WWII soldiers, focuses on improving quality of life and increasing physical function.
Physiatry – The New Kid on the Block
Physiatry is a rapidly growing medical specialty that addresses physical functioning of seniors, the disabled, people with degenerative diseases, and those with mild to severe injuries. Physiatry picks up where the family practitioner leaves off. This kind of doctor may treat a stroke patient, an athlete with a back injury, a brain injured soldier returning from Iraq, or may oversee a therapeutic exercise program for a heart patient. Often, the physiatrist coordinates the treatment plan for chronic pain patients. More and more, people are seeking physiatrists for musculoskeletal problems, including back and neck pain.
According to a survey conducted by the American Board of Physical Medicine and Rehabilitation (ABPM&R), approximately two-thirds of those questioned had health problems that could be treated by a physiatrist, for example, spinal arthritis, work-related back injuries or spinal cord injuries. Yet only 1% had heard of the medical specialty.
The Patient As Person Approach
The physiatrist is a full-fledged medical doctor who has passed a certifying exam given by the American Board of Physical Medicine and Rehabilitation (ABPM&R). While he has all the credentials necessary to treat patients with (or at least refer them for) invasive procedures, much of the focus is on a non-surgical approach to care. This means that a physiatrist will prescribe conservative care and medication, exercise, and holistic treatments for their back and neck patients, before suggesting surgery.
The physiatrist takes a whole-person approach to his patient. Andre Panagos, MD, physiatrist and director of the Sports and Spine Medicine of New York says, "Surgeons are trained to be meticulous technicians, rather than counselors. By contrast, the physiatrist is the type of doctor who is trained and has time to listen to his patients, to help them sort out options for the direction of their care. Often the physiatrist leads a multidisciplinary treatment team that may consist of other doctors, physical therapists, occupational therapists, social workers and holistic practitioners. In the age of increasingly complicated treatments, this multidisciplinary approach yields benefits for both the patients and the health care community."
Panagos says that physiatry encompasses many disciplines concerned with pain and function, for example, by borrowing techniques from neurology, neurosurgery, rheumatology and orthopedic surgery. The physiatrist, as a quality-of-life doctor, will work with a spine patient. The goal is to take a patient-as-person approach when determining the best course of action.
A Short History of Physiatry
Physiatry got its start during World War II, when Dr. Howard Rusk, an Army Air Corps medical doctor concerned about the dignity of injured soldiers, began treating them with innovative methods that included psychological, emotional and social aspects of healing. In his career, Dr. Rusk functioned not only as a doctor, but also as an advocate for soldiers with disabilities. Physiatry has now started to address the effects of sedentary living on the musculoskeletal system. To this day, however, the work with soldiers continues, and physiatrists see patients who have traumatic injury of all kinds, including spinal cord injury and brain injury. Physiatrists also treat stroke patients.
With approximately 7,000 physiatrists practicing in the United States, this medical specialty is a small field and a well-kept secret, Panagos comments.
Rusk, Howard, A. (1901-1989), Papers, 1937-1991 (C3981). Western Historical Manuscript Collection-Columbia. University of Missouri.
Howard A. Rusk, M.D. (1901-1989) Founder. Rusk Institute of Medicine at NYU website.
PM&R Specialty Background. American Academy of Physical Medicine and Rehabilitation website.
Dr. Andre Panagos. Phone and email interviews. 2008.