WHAT IS A PHYSIATRIST?

A Physiatrist, pronounced "Fizz ee AT trist", is a physician specializing in Physical Medicine and Rehabilitation. As the population of American ages, and as people survive conditions that once would have been fatal, and as quality of life is an increasing concern, the field of Physiatry is moving to the forefront of medicine. The speciality serves all age groups and treats problems that touch upon all the major systems in the body.

HOW DID THE SPECIALITY DEVELOP?

The field of Physical Medicine and Rehabilitation (PM&R) began in the 1930s in order to address musculoskeletal and neurological problems. It broadened its scope considerably after World War II, as thousands of veterans came back to the United States with serious disabilities. The task of helping to restore them to productive lives became a new direction for the field. The Advisory Board of Medical Specialities granted PM&R its approval as a speciality of medicine in 1947.

WHAT TYPES OF CONDITIONS DOES A PHYSIATRIST TREAT?

Physiatrists are physicians who treat a wide range of problems from sore shoulders to spinal cord injuries. The focus of the speciality is on restoring function to people. Physiatrist treat acute and chronic pain and musculoskeletal disorders. They may see a person who lifts a heavy object at work and experiences back pain, a baseball player who sprains an ankle and needs rehabilitation to play again, or a knitter who has carpal tunnel syndrome. Physiatrist's patients also include people with arthritis, tendinitis, any kind of back or neck pain, and work-and sports-related injuries.

Physiatrists treat very serious disorders of the musculoskeletal system that result in severe functional limitations as well. They would treat a baby with a birth defect, someone in a bad car accident, or an elderly person with a broken hip. Physiatrists also treat people with spinal cord injuries, brain injuries, strokes, amputations, cancer and multiple sclerosis. All require a long-term rehabilitation process.

WHAT IS THE PHYSIATRIST'S ROLE IN TREATMENT?

A Physiatrist may treat patients directly, lead an interdisciplinary team or act as a consultant. Here are some scenarios that illustrate the varied roles of a Physiatrist. A carpenter is lifting some heavy wood when he feels pain in his lower back and down his leg. He sees a Physiatrist who does a thorough history and physical examination and performs all the testing needed to make the diagnosis of herniated disc. The Physiatrist develops an appropriate treatment program, monitoring and adjusting it as needed. With this treatment and rehabilitation program, the patient does not need surgery.

A woman in a diving accident has a spinal cord injury and is paralyzed below the waist. The Physiatrist assesses her injury and with the patient and a team of health care professionals determines the course of her rehabilitation. The Physiatrist treats the array of medical issues that occur as the result of the spinal cord injury, and also leads the interdisciplinary team to enable the woman to reach the highest level of functioning possible. The team varies in composition depending on the needs of the patient. In addition to other physicians, the team may include health care professionals such as nurses, physical therapists, occupational therapists, social workers, neuropsychologists and vocational counselors.

A baby is born with cerebral palsy. The Physiatrist is called in as the expert who advises on the correct treatment and rehabilitation that can affect the rest of the child's life.

HOW DO PHYSIATRISTS DIAGNOSE?
Physiatrists' diagnostic tools are the same as those used by other physicians, with the addition of special techniques in electro- diagnostic medicine like electromyography (EMG), nerve conduction studies, and somatosensory evoked potentials. These techniques help the Physiatrist to diagnose conditions that cause pain, weakness, and numbness.

WHAT KINDS OF TREATMENTS DO PHYSIATRISTS OFFER?
Physiatrists offer a broad spectrum of medical services. They do not perform surgery. Physiatrists may prescribe drugs or assistive devices, such as a brace or artificial limb. They also use diversified therapies such as heat and cold, electrotherapies, massage, biofeedback, traction and therapeutic exercise, as well as, certain injection therapies.

WHERE DO PHYSIATRISTS PRACTICE?
Physiatrists practice in rehabilitation centers, hospitals, and in private offices. They often have broad practices, but some concentrate on one area such as pediatrics, sports medicine, geriatric medicine, brain injury and many other special interests.

WHAT KINDS OF DIFFERENCES DO PHYSIATRISTS MAKE?
Because it is the concern of the Physiatrist to restore patients to maximum function, the difference they make can be dramatic. In the case of the herniated disc, the Physiatrist not only takes care of the acute problem, but also treats the patient until he or she returns to optimal function, usually without surgery. The Physiatrist also teaches the patient how to prevent the injury in the future. Another example is that of a broken hip in the elderly. Physiatrists can provide aggressive rehabilitation so patients can walk and even exercise again.

And because the Physiatrist is concerned with all areas of rehabilitation; physical, social, vocational, and medical, the quality of life is significantly improved for patients and their families.