Physical Medicine and Rehabilitation: The Specialty You Should Know Better
by Andrew Woods, DO
She was 72 years old, six days out from a left MCA stroke and her hospitalist was trying to determine the next steps. The acute drama had passed. Her imaging was reviewed. The anticoagulation and secondary prevention were initiated. Medically, she was“ stable.” But she could not transfer out of bed without maximal assistance. She had moderate aphasia and could not reliably follow two-step commands. Her swallowing was impaired. Her family was asking the hard questions: Would she walk again? Would she go home? Would she be able to talk to her grandchildren?
This is where Physical Medicine and Rehabilitation( PM & R) comes in. Despite its breadth and impact, PM & R may be the least understood specialty in medicine, even among physicians.
What We Are( and Aren’ t)
PM & R is a specialty board certification that requires four years of residency after medical school, with subspecialty fellowships available in spinal cord injury, brain injury, sports medicine, pain medicine, pediatric rehabilitation and many other areas. We are not physical therapists. We are physicians. We diagnose, manage medical complexity, prescribe, perform procedures and coordinate the full arc of a patient’ s functional recovery.
Our training spans the neurological, musculoskeletal and cardiopulmonary systems, with a particular emphasis on how disease and injury intersect with a patient’ s ability to function in daily life. That last point is the crux of what makes us different.
The PM & R philosophy, distilled to a sentence: we ask not only,“ What disease does this patient have?” but also,“ What can this patient do, and what’ s getting in the way?” Function is our primary outcome measure. Whether we’ re managing a 30-year-old with a traumatic brain injury, a 65-year-old runner with a torn rotator cuff or an 80-year-old stroke survivor, the clinical question driving us is always,“ What does this person need to do, and how do we help them get there?”
The Breadth of the Specialty
PM & R’ s scope is genuinely broad, which is part of why it’ s hard to summarize in a hallway conversation. On the inpatient side, we’ re heavily involved in stroke rehabilitation, traumatic brain injury, spinal cord injury and complex neuromuscular conditions. We manage the medical complications of disease and dysfunction, including spasticity, heterotopic ossification, neurogenic bladder and bowel, and autonomic dysreflex-
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