Physiatrist

A physiatrist helps people with functional problems in daily life resulting from an illness or accident. These may include relearning how to walk, getting dressed without help, doing household tasks independently, and returning to work or sports in an adapted way.

What is a physiatrist?

The goal of a rehabilitation program is to help people become independent again and function as well as possible. Some people become completely symptom-free and can do everything again after extensive practice and training. Others must learn to cope with their limitations in order to achieve the best possible result, with or without assistive devices.

This usually involves diseases or serious injuries after an accident that affect the musculoskeletal system. The physiatrist does not primarily treat the disease or injury itself. Other medical specialists, such as the neurologist, orthopaedic surgeon or trauma surgeon, do that. The physiatrist mainly focuses on the remaining functional problems.

Conditions in which a physiatrist specializes include:

• Amputations (removal of a body part).
• Diseases of the nervous system, such as multiple sclerosis (MS) and brain tumours.
• Organ conditions, such as heart, lung or kidney diseases.
• Congenital and acquired brain injuries, such as oxygen deprivation at birth or a stroke later in life.
• Severe physical injuries after an accident.
• Congenital abnormalities, such as scoliosis or clubfeet.
• Chronic pain.
• Joint conditions such as rheumatoid arthritis.
• Spinal cord injury caused by a broken neck or back.

A physiatrist works in a hospital or rehabilitation centre. There, they work closely with medical and paramedical disciplines, such as other doctors, physiotherapists, occupational therapists, speech-language pathologists, psychologists and medical device technicians.

What does a physiatrist do?

The physiatrist oversees the rehabilitation program from beginning to end. They may be the lead physician or a co-treating physician, in which case several doctors work together with the same patient. The ultimate goal is to reduce or prevent functional problems as much as possible.

Some duties of a physiatrist include:

• Coordinating the rehabilitation program.
• Analysing gait patterns.
• Setting treatment goals.
• Preparing a treatment plan.
• Managing the rehabilitation team.
• Regularly monitoring and discussing progress.
• Administering injections, such as pain medication, an anti-inflammatory or Botox to reduce muscle tension caused by spasticity.
• Ordering rehabilitation aids such as orthopaedic shoes, prostheses (artificial arm or leg), splints and wheelchair adaptations.

How do you see a physiatrist?

A physiatrist becomes involved when other doctors reach the limits of their fields. They may have tried everything, such as medication and/or surgery, but you continue to have problems with daily functioning. A family doctor or medical specialist can refer you to a physiatrist.

What is a first appointment with a physiatrist like?

You do not usually see a physiatrist without prior care. A lengthy hospital stay and/or a long course of treatment with other doctors generally comes first. The physiatrist has all this information but still wants to hear from you what your specific request for help is.

The purpose of the first appointment is to determine what you can do at that time and what the goal of the rehabilitation program will be. The physiatrist asks many questions, performs a physical examination and may conduct additional testing. This may include X-rays, a scan (MRI or CT), movement analysis or an ECG.

The physiatrist discusses treatment options with you and your loved ones. Achievable goals are set for physical, psychological and social functioning.

How can you prepare for your first visit to a physiatrist?

• Prepare a list of questions at home. Also write down symptoms affecting physical functioning, your medical history, surgeries, therapies you have followed and medications you use. This helps you remember everything.
• Think about the treatment goals you want to achieve. Do you want to relearn how to walk with a leg prosthesis, or return to work without pain?
• Bring someone close to you, such as a partner, good friend or adult child. They can listen and remember what is said. If you cannot clearly explain what you want and can do, it is important that someone can speak on your behalf.