Function:
what we give
to all of our patients.
it is our organ system
alone.
Function.
It gives our patients
reasons not to quit.
Activities of daily life
restored.
Function.
Is Taken away,
by injury, disease,
accident, degeneration,
cancer.
Function.
A goal fulfilled;
rehabbed with diligence.
Physiatry is our calling
to heal.
The following 4 Cinquains are a poetic ode to the residency I chose to pursue of Physical Medicine & Rehabilitation (PM&R) also colloquially known as “Physiatry”.
One of the most common misconceptions about Physiatrists is our function and purpose. It is not too uncommon to be consulted within the hospital about patients and accidentally being mistaken for Physical Therapy. The frequency of this misclassification likely stems from our relatively young existence as a specialty born out of spasticity management in patients returning from the 20th century World Wars. The medical complexity of these patients created a cross road specialty between Orthopaedics, Sports Medicine, Neurology, Pain Management, and Palliative Care Medicine. And while these specialties have clearly defined organ systems like bones for Orthopaedics and nerves for Neurology, PM&R does not share this luxury. Instead, function became the specialty’s “organ” as it guides the rehabilitation techniques and medical decision making to help our patients improve.
Our ethos of “functional medicine” is reflected clearly in the first three cinquains. It is specifically expounded upon in the second cinquain where we as physiatrists look to optimize and restore patient functionality. Many times the injuries that our patients suffer can be quite devastating as exemplified in the third stanza. Injury and disease patterns that we commonly treat include Spinal Cord Injuries (SCIs) and Traumatic Brain Injuries (TBIs) which commonly result as a function of traumatic injuries and motor vehicle accidents. However, the burden of disease in our patient population can also extend beyond trauma and can involve Neurodegenerative diseases such as Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS), and even cancer. The sobering nature of these terminal diseases can place an emotional toll on clinicians and patients alike given the lack of curability and survivability.
Due to the gravity of these diseases, we as a specialty turned to functionality as our north star for treatment. In this context we frame rehabilitation in terms of patient-centered goals specific to what they want to do and how they want to live. We have specified fields of rehabilitation to help augment their treatment to reach their functional goals. This can take the form of specific subspecialties to include Cancer Rehabilitation, Brain Injury Medicine, and Sports Medicine. We work with them as part of a comprehensive treatment team to diligently improve their quality of life following their new diagnosis.
From this standpoint, we as Physiatrists strive to integrate more life into our patients’ years. As stewards for rehabilitating our patients as a whole, we cumulatively work to heal the organ we champion as function.
Image credit: Forest by Cat Burston is licensed under CC BY 2.0.
Resident Physician Contributing Writer
Walter Reed National Military Medical Center
Ervin (Erv) is beginning his general intern year at Walter Reed National Military Medical Center and recently graduated from the Uniformed Services Univerity of the Health Sciences in May 2022. While in medical school, he was the co-director for the on-campus peer-led curriculum aimed to foster conversations about diversity, bias, discrimination, and inclusion in both medicine and the military. His interests include medical education, promoting diversity, and utilizing the arts to augment the healing nature of medicine.