Physical Medicine and Rehabilitation

In attempting to return to normalcy, everyone I spoke to had the same advice: Get a good neuropsychologist and get a good PM&R (Physical Medicine and Rehabilitation) doctor. I was lucky in that not only were my neuropsychologist and PM&R clinicians considered top notch, but they were also wonderful to work with during my recovery. I decided that this post should be dedicated to the field of PM&R. I also asked my PM&R physician to write a short blurb surrounding his care for me and his thoughts on my situation.

PM&R journal
PM&R journal

———- The Field ———-

Like many fields in medicine, the definition of PM&R medicine is broad. In essence, the aim of this branch of medicine is to restore function and improve the standard of living in those with either physical impairments or disabilities (or both). Many people (residents included) think that ‘PM&R’ stands for ‘Pain Medicine and Rehabilitation’[1]. While it is true that part of what a PM&R physician deals with is pain, the field involves much more—the scope of the field is much broader. In attempting to restore function in those with impairments or disabilities, a PM&R physician may see a patient who suffers from carpal tunnel syndrome in the morning, then a stroke patient in the afternoon. The field is a relatively new one, gaining notoriety after World War II, with the treatment of many injured soldiers.

Funny comic about the field.
Funny comic about the field.

——- Traumatic Brain Injury ——–

One of the patients these physicians treat, are patients with Traumatic Brain Injury (TBI for short). This fit my case perfectly, as the mass and the removal of it had resulted in the symptoms I have today. Technically, stroke patients also fall into this category. The role of the PM&R physician in these patients is to help them regain any functional ability that may have been impaired due to the injury. Depending on the specific deficit, a PM&R physician may refer the patient to a speech therapist (many stroke patients have speech deficits after the injury) and to a neuropsychologist (to aid with the evaluation of any possible cognitive delays). Every case is different, and requires specific tailoring and management for the optimal care of the patient. My case was easy and difficult at the same time: easy in that I required every kind of therapy, and little to no thinking (hopefully) was involved in this aspect of my care.[2] My case was difficult in that this occurred during my medical residency, creating many intricacies in my care.[3]

——- Dr. Michael Andary ———-

Dr. Michael Andary
Dr. Michael Andary

My first experience with Dr. Michael Andary actually came prior to my surgery and diagnosis. I was working on the inpatient service at the time (seeing patients in the hospital). On one of our patients there was a question of who the admitting physician was to be.[4] I remember it clearly, the residents (not wanting to do all the extra paperwork) had our supervising physician and then Program Director (a legend at Sparrow) directly telephone Dr. Andary in an attempt to clarify the situation (in reality we hoped that Dr. Andary would say, “sure thing! We’ll do the admission and all the paperwork that goes with it.”) Unfortunately, the result of this conversation was that we were to ‘admit’ the patient. It wasn’t this end result that sticks out in my mind however. I had never seen our supervising physician, I’ll call him Dr. Bond back down as he did. I could not hear the other end of the conversation, but from Dr. Bond’s responses I could tell what was being said between them:

Dr. Bond: “Say Mike, that patient in room 525? We are under the impression that we don’t’ have to admit her. Since you guys are managing her care shouldn’t you admit her?”

Dr. Andary: Inaudible.

Dr. Bond: “No I understand Mike that that’s how it’s always been, but we’d gladly see her as a consult[5] but seeing as you’re the main managing physicians it seems to me that you should admit.”

Dr. Andary: Inaudible.

Dr. Bond: “Ok Mike, I understand, we’ll go ahead and admit the patient.”

I was taken aback. Dr. Bond was well known and respected around the hospital and community. Who was this Dr. Andary who had ‘fought back’ and won? My curiosity was piqued. It was around then that I began to hear much of Dr. Andary and his own legend. He was well known around the PM&R community as one of the top physicians in his field. When I told the PM&R physician in Ann Arbor of my plans to become a patient at Sparrow Hospital his first response was that “Oh great, you’ll be in good hands with Dr. Andary.”

My first encounter with Dr. Andary as a patient came during his rounds. He was blunt, but honest. He had me perform a series of cerebellar tests, one of the tests having me run my heel up and down the opposite shin. “C’mon faster!” he implored. Of all the clinicians I have seen he remains the only one to tell me and my wife that he does not expect me to return to 100%. I see several possibilities with this: either the other clinicians think the same thing but do not want to tell me this, or Dr. Andary is truly the only one who believes this. While I hope that Dr. Andary is wrong and that the second alternative is the case, the rational side of me tells me that when it comes to medicine Dr. Andary is rarely ever wrong.

After my discharge, one of my many clinic visits included a trip to the Sparrow PM&R clinic. Here I would be seen as an outpatient, in the controlled setting of their clinic. Dr. Andary knew of my desire to return to residency and patient care, he entered the room and immediately said, “Chris, I know you want to come back. I believe that you can and will. I am on your side and will fight for you till the end.” Ever since this visit he has been deeply involved in my return to residency.

—– Blog ——–

Dr. Michael Andary
Dr. Michael Andary

A few months ago I asked him if he would write something for the blog. I asked that he focus on the aspects of my care that centered around my return to residency. This is what he wrote:

Dr. Chiou has worked hard to improve his motor control, cognition and ability to integrate information. It is now time to see if he can perform work specific tasks and finalize the skills, and neurophysiological connections to return as an effective physician. Much like a golfer learns to golf by practicing that specific sport, it is now time for Dr. Chiou to practice his specific job and see if he can return as an effective physician. If he can psychologically adjust to the slower pace, and adjustments, I believe he has an excellent chance to return to work as a physician. Michael Andary M.D. M.S.

 

[1] Actually, the joke about PM&R in medical circles is that it stands for ‘Plenty of Money and Relaxation’.

[2] Thus far, I have been seen by a Neuropsychologist, Family Doctor, Neurosurgeon, Neurologist, Ophthalmologist, Physical, Occupational, Speech, and Vocational Rehabilitation Therapists.

[3] In fact in a meeting with both of my PM&R physicians they (both very experienced physicians) stated that while they’ve aided in the return of many physicians back to work, this was the first case of a medical resident attempting to return to work that they had encountered.

[4] Often in the hospital there is much ambiguity surrounding this question. The bottom line is that being the ‘admitting physician’ requires more ‘paperwork’ including all the admission documents.

[5] In the hospital the order ‘consult XXXX’ is often written (or typed). This simply means that the managing physician is requesting the expertise of another physician. For example, if a patient under your care suddenly develops chest pain, a cardiologist might be consulted.

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