What is PMR? What is a physiatrist and what do they do?
– “Pain doctors”
– “Doctors of Physical Therapy”
– “Those guys who do injections”
-“Sports Medicine Physicians”
If you are a PM&R doc, you are probably cringing as you read these quotes, but have likely heard them before. If you are not a PMR doc, then you probably were thinking these quotes, but I write this article to hopefully enlighten you, in a non-offensive sort of way. Let’s be real, this specialty is fairly new and not well recognized. So it is fair that many are unfamiliar with what a PMR doc does, or can do.
From Wikipedia: Physical medicine and rehabilitation (PM&R), or physiatry (pronounced /fɨˈzaɪ.ətri/), is a branch of medicine which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician who has completed training in this field is referred to as a physiatrist. In order to be a physiatrist in the United States, one must complete four years of medical school, one year of internship, and three years of residency. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system (such as stroke patients).
From The American Academy of Physical Medicine and Rehabilitation: Rehabilitation physicians are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move.
From The American Board of Physical Medicine and Rehabilitation: Physical medicine and rehabilitation (PM&R), also referred to as physiatry, is a medical specialty concerned with diagnosis, evaluation, and management of persons of all ages with physical and/or cognitive impairment and disability. This specialty involves diagnosis and treatment of patients with painful or functionally limiting conditions, the management of comorbidities and co-impairments, diagnostic and therapeutic injection procedures, electrodiagnostic medicine, and emphasis on prevention of complications of disability from secondary conditions.
Physiatrists are trained in the rehabilitation of neurologic disorders, and in the diagnosis and management of impairments of the musculoskeletal (including sports and occupational aspects) and other organ systems, and the long-term management of patients with disabling conditions. Physiatrists provide leadership to multidisciplinary teams concerned with maximal restoration or development of physical, psychological, social, occupational and vocational functions in persons whose abilities have been limited by disease, trauma, congenital disorders or pain to enable people to achieve their maximum functional abilities.
The best way to describe PMR is a specialty that focuses on diagnosing and treating movement and functional disorders without surgery. Cardiologist specialize in heart issues, renal guys (and gals) on the kidneys, and PMR physicians on the nervous and musculoskeletal system, seeing that both of these systems are intimately involved in movement. In addition, often the best medicine for treatment is exercise. Therefore, we are experts in prescribing physical therapy, occupational therapy and speech therapy.
When it comes to diagnosis, PMR physicians typically focus more on the history and physical than other specialties. Often we can reach a diagnosis without imaging or diagnostic studies because good PMR physicians are experts in anatomy and neuromusculoskeletal physiology. When imaging is needed to confirm a diagnosis, EMG/NCS, x-ray, CT and MRI are often used.
I think of PMR as two different tracts. You can do Inpatient Rehab, or Outpatient PMR. Inpatient rehab actually involves more medicine than anything else. Therefore, we are also medicine docs. Outpatient PMR definitely is more focused on the musculoskeletal/neural side of PMR with frequent use of therapies, medications and interventional procedures to maximize mobility and function.
Finally, yes, there is the pain side of PMR. No, we are not pain dispensing docs that lose their licenses after a few years (most of us, at least). As we all know, not every condition can be fixed with therapeutic modalities, surgery or non-narcotic medications. Therefore, some patients need narcotic pain medications to be able to function and contribute to society. Like anything else, there are those patients (and docs) who take advantage of the system and end up in trouble. But again, this is rare.
So, I hope this helped clear up the PMR mystery. In a nutshell, if your patient has a problem with movement or function that is non-surgical, send them our way!