The state of physical medicine: Evolution of care as patients survive debilitating conditions

Physical medicine and rehabilitation emerged as a specialty largely because advances in medicine allowed patients to survive catastrophic injuries, strokes and illnesses that previously would have been fatal. That created a need for specialists to help them adapt to and recover from lasting physical impairments. Today, physiatrists work with hospitalized patients from the earliest possible point in their recovery, said John C. Cianca, M.D., FAAPMR, president of the American Academy of Physical Medicine and Rehabilitation.

Medical Economics: When you mentioned about inpatient, would that be a physician who might respond to a person with an acute injury and trying to help them regain certain health while they're still perhaps hospitalized? Could you explain that?

John C. Cianca, M.D., FAAPMR: Historically, our field has dealt primarily, dealt a lot with people that come to hospital with a major problem — they lost a limb in the war, they've had a head injury for whatever reason, they've had a stroke. They have had any sort of illness, injury, that puts them in the hospital and requires an extended stay, which almost by necessity would include some rehabilitation so they could exit the hospital. And of course, that's where we came in, and we did. We still do that, and that was our entree into the house of medicine, per se. And it really arose because people started surviving these things. We invented, or we discovered antibiotics, which kept people alive, they didn't die from infections now. They lived, but they had no limb, or they had an impaired the left side, or they had a brain that wasn't as sharp as it used to be. So, what are you going to do now? That's where we came in. We helped these people accommodate to their new situation, maybe overcome it, and certainly adapt to it. And in that setting, we were working in the hospitals. The sooner that we got involved is always better, and that happens variably, depending on the environment you're in, but it's the best way for us to be involved. But certainly, as their stay progresses, we become involved, and then we stay involved after their discharge. So that's the hospital-based end of our field and how it arose and how it's changing. I think more and more people realize that sooner is better with respect to beginning, at least the footings of rehabilitation, even if it's not full on early on in the course.