Can anyone provide specifics/anecdotes of inpatient physiatry care?

[wavecrasher111]

MS3 here and did a rotation in pm&r and am still kinda confused about how valuable it is in the general inpatient setting. It honestly seemed like 75% of the cases and consults consisted of doing the h/p, refer to pt. Like, I understand there are medically complex patients, but it seemed like for a majority of patients you could have skipped the middle man and just had pt evaluate and do therapy. Can anyone comment/provide examples of the kind of management/intervention you perform on inpatient and whether my 75% number is totally inaccurate and uneducated? I loved being a part of the team caring for the tbi, sci, and medically complex patients, it just seemed like these were few and far between on the general rehab floor. I also feel that its relevant to mention that I was super torn between pt and med school so seeing the therapists actually doing the patient care and having, seemingly, the most impact on the patients return to function brought up some jealousy.

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[gainey77]

Inpatient consult is very different than inpatient where you’re the primary. Did you work with the latter?

 

[wavecrasher111]

I was mostly on rehab floor, but did tag along with some consults.

 

[PMR2018]

Inpatient consult is very different than inpatient where you’re the primary. Did you work with the latter?

It's also very different if you are the main inpatient rehab hospital for a quaternary care center or at a model system hospital compared to a general community rehab hospital.

 

[gainey77]

Consults are often disposition and PT. Occasionally more diverse things like spasticity, baclofen, and pain. Not dissimilar from many consult services: bread and butter, conservative treatment, and occasional excitement. Think of derm consults: a lot of rashes with conservative treatment and occasional SJS, TEN excitement.

Inpatient, where you are the primary, is a different ballgame. You are often thinking as the internist, pulmonologist, orthopedist, cardiologist, oncologist, neurologist, palliation doc and psychiatrist. A rehab doc at a big center must be comfortable with vents, chemotherapy, seizure, LVADs, transplants, fractures, psychosis, electrolyte disorders, and strokes. This means knowing associated medicines, radiology, emergency management, procedures, monitoring, diagnosis, and trouble shooting.

 

[wavecrasher111]

Interesting, thank you for the insight. Maybe inpatient is different at community hospitals

 

[RangerBob]

First, don't forget that we work just as closely with OT, SLP, SW, CM, rehab psych, and our rehab RNs as PT. PM&R wouldn't be as much fun without the big team we come with.

I don't refer to PT. I admit a patient to my unit after determining if they're appropriate for rehab, and I manage their medical needs. I then direct PT/OT/SLP in therapy management. I am the team leader, and if I'm not communicating regularly with my team, we're not a very good rehab unit.

I agree with most of what gainey said above--most consults are really about disposition (ie., can we take them to rehab or not), unless they're TBI/SCI, in which case we make a lot more recommendations. But we can really be a jack-of-all trades (and have to be) to comprehensively manage our patients. My only disagreement is that the physiatrists at community hospitals actually have to be more comfortable--big centers have a lot more consultants to reach out to. I don't have all that many, and we still get complicated patients.

For most, inpatient rehab seems boring. I don't do it for the "excitement." I do it because I enjoy it and it's very fulfilling to watch someone come in with a dense stroke and walk out with a walker. I enjoy getting to know my patients. I really enjoy working with my therapy team, RN team, and joking with/laughing with them, and doing that regularly. It is just such a fun place to work. Similar to FM and peds, I think it's hard to get a sense of how fulfilling the specialty can be.