N&V Editorial: Physical Medicine and Rehabilitation is Empowerment Medicine

News&Views Issue 60 Editorial by André Thevenon

This issue of News and Views contains the results of a French nationwide survey of the perception of PMR held by French medical students, residents and other physicians from all specialities (read full article). The survey’s results challenge the image that we have of our profession.

Yes, the survey was performed in France, and the perception and social representations of PMR doubtless differ markedly from one country to another. However, many of my non-French colleagues have told me that (i) they have difficulty having their field of competence acknowledged by the medical community, and (ii) many learned societies and professional bodies in the field of PMR spend a great amount of time justifying their existence and promoting the role of the specialist PMR physician through their guidelines.

Residents have only a vague idea of which pathologies we treat but do at least acknowledge our ability to coordinate a multidisciplinary team, our holistic vision of the patient, and our role in long-term care and support. Above all, however, we come across as second-class, “sluggish” physicians driven by our own quality of life!

That statement is, of course, unfair and does not take account of our role in acute care (well described in Henk Stam’s new book) or the many diagnostic and therapeutic procedures that we can perform. Only our clinical activity in rehabilitation centres appears to have been noticed – and even that is not well understood!

How, then, can we improve things? In my opinion, by no longer positioning PMR as “handicap medicine”. A handicap is not a disease and does not require a medical specialty. This focus on handicap also gives us the image of a simple support provider, a medical version of a social worker or a simple coordinator relying on paramedical skills.

In fact, PMR physicians are specialists who improve their patient’s performance to a better control of all aspects of daily life. Regardless of whether a patient undergoes heart transplantation or a hip replacement, and if his/her physical capacities are still limited after the operation, he/she is referred to a PMR physician. If a person with traumatic brain injury cannot resume a normal social and professional life after acute recovery, it is to us that he/she will be referred, and we will help him/her perform better. Our role in improving performance explains why our speciality is so close to sports medicine.

Of course, for some very major handicaps, the objective will simply be to make the patient comfortable and enable the best possible quality of life. But all medical specialities have a contingent of patients who cannot be cured or who will not respond to treatment.

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