By Dr. Stephanie Van, MS11, Georgetown SOM class of 2015
PM&R, Pain Medicine, Johns Hopkins
Wait, what is PM&R, you ask? PM&R stands for Physical Medicine & Rehabilitation, and it’s the most important medical specialty you’ve never heard of. It’s the field of medicine that helps someone recover after a functionally impactful illness or injury. As a result, it has arguably the most diverse patient population, because anyone can experience an illness or injury at any time that causes them to be more disabled than they are now. With innovations in modern medicine, more people are surviving strokes, heart attacks, brain injuries, and spinal cord injuries. This means the need for healthcare providers familiar with managing these chronic, disabling conditions has never been greater.
PM&R takes care of children born with cerebral palsy, athletes who tear their ACLs, and elderly people who become paralyzed after a stroke. PM&R takes care of amputees, wheelchair users, neurodivergents, highly sensitive people, and spoonies. PM&R is a medical field made up of multidisciplinary teams of professionals who collaborate across specialties to maximize their patients’ function and quality of life.
PM&R is the medical specialty that is best equipped to combat ableism and promote accessibility and inclusion throughout healthcare, but what’s taking us so long? There is still so much bias, ignorance, and ableism throughout healthcare. What can PM&R do as a field to set
an example for how our system can be of service to any person? Just follow these three simple steps:
1. Re-brand: Disability is Not a Bad Word
2. Promote Accessible Medical Education
3. Practice Anti-Ableism
I first heard about PM&R when I was a third year medical student applying for general surgery residency. I figured since I’m a hands-on, type A person who finds it very satisfying to quickly turn around someone’s prognosis with an operation, I thought general surgery was the field for me. Surgery can be a life-saving treatment, but oftentimes the byproduct of surgery is disability, either temporary or life-long. A surgeon can play a crucial role in helping someone not only survive, but also adjust to new disabilities. But too often, surgeons only have the time to care about numbers and outcomes, and they have less energy to help someone understand their diagnosis and maintain their function and quality of life. PM&R and Surgery could learn a lot from each other.
Sometimes PM&R is just called “Rehabilitation” or “Rehab,” but this often gets confused with “Substance Abuse Rehab” which is only a fraction of what PM&R might offer to someone. I’ve tried to come up with a better name for my specialty than “PM&R.” I used to think PM&R should be called “Functional Medicine”, but that name is taken by a field of medicine that is not widely accepted as evidence-based. PM&R Should be called “Disability Medicine”, but unfortunately, because there’s so much stigma against the word “disability,” many healthcare professionals may hesitate to name their specialty after it.
PM&R specializes in taking care of people who have been injured by disease, trauma, and bad luck. PM&R patients are survivors who have recovered and learned how to live again. PM&R patients could be our friends, our family, our favorite celebrities, and even ourselves. PM&R is there for everyone at some point in their life. So, we should just own up to what we are, and stop dancing around the “Peeyeminar” acronym that makes us all roll our eyes and feel silly when we have to elaborate on what we do. We’re Disability Medicine specialists, and why aren’t you?
What’s the best way for students to learn about taking care of people who have accessibility needs? By offering education that is accessible, and therefore equitable. Lectures can be attended virtually and recorded for later viewing, they can be transcribed using certified closed captioning, and ASL interpreters can accompany speakers. Lessons on accessible social media practices can teach future providers about #CamelHashTags and [ID: Image Descriptions] so these can be normalized throughout educational materials.
Future trainees with visual or audio accommodation needs should feel able to pursue a career in healthcare. If your medical school lectures are recorded and there’s a note taking service, that’s a great start. But if CC and image descriptions aren’t available, ask for them. If an ASL interpreter is not readily available, ask why. If you don’t know what a #CamelHashTag is, you should follow the #Disability hashtag on whatever social media platform you use the most. You’ll learn a lot about how accessible learning can be.
Future leaders in healthcare need to unlearn outdated medical jargon. During history taking, instead of describing a patient as “suffering from this disease or disability,” they can be described as “Living with this disease or disability for however many years.” Many people with disabilities live happy, fulfilling, productive lives, especially if they work directly with a team of PM&R providers. When teaching trainees about the standard physical examination, use general terminology that can apply to all people, including those who use mobility devices or assistive equipment. Give students the language to describe a prosthetic leg and a patient’s residual limb (instead of their “stump”). Normalize the importance of skin hygiene when it comes to tubes, lines, wounds, and ostomies. When things can get tense or emotional, help students understand how to de-escalate, validate, and listen to people who have experienced trauma or loss. “MR” (mental retardation) is frequently used in healthcare settings, but it is both derogatory and non-specific. When a patient presents with a cognitive disability, teach students how a specific diagnosis can indicate the best way to accommodate these patients.
And ultimately, if we want trainees to feel educated in the field of Disability Medicine, they need to learn directly from the people who have experienced disability. The medical education system should be recruiting, hiring, and promoting people with disabilities. Disabled people should be invited routinely to speak to students about their experiences with healthcare. Their feedback is invaluable, they can tell us where healthcare really needs to improve, and how.
An anti-ableism course isn’t really standard in your average medical education curriculum. And that’s why, when disabled people go to the doctor’s, so many of them ignorantly get called “wheelchair bound,” or are described as having “special needs,” or don’t even get addressed at all while their doctor talks only to their caregiver.
We need to eliminate outdated “medical” language that perpetuates ableism in healthcare. Go through your standardized forms, questionnaires, research publications, clinical documentation, and educational materials including lectures, text books, and exam questions. If you run across any words, terms, or phrases that perpetuate ableism, put it on blast and propose an alternative that is both inoffensive and more medically accurate.
Demand universal design throughout healthcare architecture like wide doorways, adjustable-height surfaces, accessible elevators and stairs, large exam rooms that can accommodate Hoyer lifts, wheelchair-accessible weight scales, and plenty of accessible parking. If your clinic space or hospital floors are not accessible to everyone, what can you do to change that? The National Council on Disability’s recent report on accessibility in healthcare might have a few suggestions.
When you realize how often and how easily ableism impacts healthcare settings, combating ableism becomes part of your every day routine. And before you know it, you’re practicing Disability Medicine.
