For about the last 25 years since I've been a physiatrist,
I've been explaining myself.
We are a small specialty.
We've been around since the 1930s
with the polio epidemic and veterans of World War I.
We are about 80 training programs across the country.
I think the confusion between physical therapy
and physical medicine and rehab is long-standing.
And physical therapists now get a doctorate
in physical therapy,
but physical medicine or rehab providers or physiatrists
have doctorates in medicine or osteopathy.
I think physiatrists are excellent diagnosticians
because we listen to the patient
and we take your perspective.
Or I'm here
because I can't play piano for 20 minutes,
like I want to,
or I want to play with my grandkids,
or I've been stuck at home with COVID
and I sit at my computer.
I'm having trouble with arm pain or back pain.
A physiatrist is a specialty.
It's a four-year training program after medical school.
We're also called doctors of
physical medicine and rehabilitation.
The training includes inpatient classical rehabilitation.
Things like patients after a stroke or a spinal cord injury
and what their particular needs are
as well as outpatient expertise
in non-operative musculoskeletal care
and neurological problems.
My particular area is outpatient.
I do non-operative care for pain problems.
I tend to work in the middle of the body
with the abdominal pelvic area,
where you might have problems with pain,
difficulty going to the bathroom
and other sorts of things.
A physiatrist focuses on function.
We are not specific to one sort of organ
or one part of the body or one type of tissue.
So seeing a physiatrist allows you to get
a really integrative and broad view of your problem.
So we're a great person to see for simple problems -
I sprained my ankle - or really complex problems.
I've had back pain for 20 years.
I've had this many surgeries.
I've tried all these types of procedures.
And we do an expert hands-on physical exam
that really takes that anatomic rendering
and then makes it important for how a person presents.
If you're having trouble,
you've already seen other people, you had the surgery,
it really didn't fix your problem,
or no one's really understanding what's going on,
or you don't feel like people are listening to you.
Patients will face things like
"I've always thought those two things were connected,
but I couldn't get my doctor to really go there with me."
So to really honor what the patient knows
and then to ask clarifying questions,
those kinds of questions really help the physiatrists
understand what tissue's at risk,
how is it accommodated
and how can we help you move forward
with the goals that you have in mind.
For the visit, it's really important
what historical data you bring with you
as well as the story that you bring with you.
So a lot of people that we see will be
maybe the second or third provider.
So you already will have some tests done.
You'll have some X-rays, some imaging.
So we will have you walk,
we'll have you bend,
we'll have you go from sit to stand.
We'll check your sensation,
we'll check your muscle strength.
We'll use a little hammer to check your reflexes.
Then we'll do some special maneuvers at the joint itself.
We will unload the joint.
We will load the joint, and all these maneuvers
are to help us understand,
is there a tissue that's not working well?
At the end of the exam,
I'll tell you about what things
I think we need to worry about.
I will tell you whether your old imaging
sort of supports or does not support
what I was thinking, how your exam supports
or doesn't support,
how I might need an X-ray or an MRI or a test like an EMG,
which is a special test of your nerve function.
And then you'll leave the office,
usually with some recommendations for imaging, lab work,
probably physical therapy.
As physical medicine or rehab physicians,
we love to work with others.
It's part of our personality trait,
which makes it nice as a patient
because we love to work with you.
But we also know that we need sometimes
physical therapy, occupational therapy.
I need to have really good spine surgeons
because I see a lot of back and neck pain
and they need to have me
because they see a lot of back and neck pain
that doesn't need an operation.
I work with urologists,
gastroenterologists, gynecologists,
urogynecologists for problems around
the center of the body, abdominal pain.
A physical medicine or rehab spine physician
may spend half of her day in the surgery center,
under fluoroscopy giving spinal injections
to relieve nerve root pain -
we'd call that a radiculopathy or pinched nerve -
or putting cortisone in the little facet joints
of the lumbar or the cervical that low back or the neck.
A lot of folks in the department, including myself,
do joint injections.
We also do a lot of what are called trigger point injections
to muscles that have these tight bands
and these trigger point areas.
No matter which way it goes,
you need something done urgently
or goodness, this is just degenerative changes.
We'll give you an assessment.
We'll give you a plan, and you'll feel better
and move better.
That's very humbling to hear the great things
and the not-so-great things
that happen to people and to be entrusted,
to take that information,
to bring my knowledge and then to come forth with a plan.