Do You Know the Function Man? – Physical Medicine and Rehabilitation

I frequently find myself having to explain the field of physical medicine and rehabilitation (PM&R) to the public, and sadly to a lot of healthcare professionals as well. If a cardiologist is a “heart doctor,” a pulmonologist is a “lung doctor,” and an orthopedic surgeon is a “bone doctor,” then what do you call a physiatrist? I would call us “function doctors.” While that title is not as flashy as the other ones, it is equally important. The old adage is that nobody knows what a physiatrist does until they need one.

Our job is to help restore function to patients with disabilities. We typically work hand-in-hand with a multidisciplinary team that may include physical therapists, occupational therapists, speech and language pathologists, recreational therapists, orthotists, prosthetists, clinical psychologists, social workers, vocational counselors, massage therapists, chiropractors, acupuncturists, or other doctors such as orthopedic surgeons, anesthesiologists, neurologists, rheumatologists, psychiatrists, or internists. Needless to say, a major prerequisite for being a physiatrist is being an excellent team player.

The physiatrist is like the conductor of an orchestra. We are the gatekeeper to a group of professionals who are good at what they do, but don’t necessarily know what the other people in the team do or how that affects the patient. The brass section doesn’t particularly care about what the strings are doing, or even know the first thing about how to play a violin. However, if the brass section is playing too loudly it can undermine what the strings are doing, and compromise the score as a whole. Only the conductor, who understands the bigger picture of the symphony, can put that whole puzzle together. In addition, the physiatrist brings their individual expertise into the picture. In particular, patients with heavily disabling injuries like traumatic brain injury (TBI) and spinal cord injury (SCI) are more or less managed exclusively by physiatrists (and the team that comes with them).

Because disability has so many faces, the field of PM&R has many facets to it. A general physiatrist is expected to know and master over a dozen disciplines including TBI, SCI, stroke, amputations, burns, musculoskeletal medicine, sports medicine, pain management, neuromuscular disorders, electrodiagnostics, cardiopulmonary rehabilitation, and pediatric rehabilitation. Since it is almost impossible to master all of these disciplines, most physiatrists end up subspecializing in 1 or 2 of them.

So what does all this mean to you? If you have any type of limitation in your activities, a physiatrist would be able to help. Not hitting that golf ball as far as you used to? Having trouble walking two city blocks when you used to be able to walk for miles? Is that pain in your knees really making it tough to climb a flight of stairs? Are you finding yourself having difficulty with swallowing foods? Any of these problems can be addressed by a physiatrist. We are here to help you function as well as your body will allow, and provide equipment and strategies to work around the things your body won’t allow.