A Physical Medicine & Rehabilitation (PM&R) physician, sometimes called a Physiatrist, specializes in decreasing pain and enhancing physical function that has been affected due to disorders of the musculoskeletal system and nerves.
Listen as Dr. Rachel Heberling discusses the important role of a PM&R physician to be able to observe the total body, not just one issue and how they are able to treat their patients with non-surgical treatment options for many types of pain.
What is PM&R?
Featured Speaker:
Learn more about Rachel Heberling, MD
Rachel Heberling, MD
Rachel Heberling, MD earned her BS in biomedical engineering from Case Western Reserve University, where she graduated Cum Laude. She earned her medical degree from the University of Cincinnati, where she also completed her residency in physical medicine and rehabilitation and served as chief resident. Dr. Heberling also completed medical acupuncture for physicians training at Helms Medical Institute, an affiliate of UCLA.Learn more about Rachel Heberling, MD
Transcription:
What is PM&R?
Melanie Cole (Host): A Physical Medicine and Rehabilitation physician a PMNR specializes in decreasing pain and enhancing physical function that's been affected due to disorders of the musculoskeletal system and nerves. My guest today is, Dr. Rachel Heberling. She's a Physical Medicine and Rehabilitation physician with the Christ Hospital Health Network. Welcome to the show, Dr. Heberling. Explain a little bit about Physical Medicine and Rehabilitation, what encompasses this field?
Dr. Rachel Heberling (Guest): Okay, well thank you for having me on. I appreciate it. We have actually a really broad spectrum of treatments that we can employ for a broad spectrum of issues that can arise. Really the thing that ties everything together is that we really take a functional approach, to try to improve people's function wherever possible. So, that's kind of the unifying factor in what we do. A lot of times I like to describe, to describe our field by breaking it into the physical medicine piece and the rehabilitation piece.
Physical Medicine is really the neuro-musculoskeletal systems, and how we can apply different therapies, different exercises, different procedures etcetera, in order to address those areas, that can even include, wheelchairs or other DME, that can include other assistive devices like, bracing and AFO’s etcetera. So, a lot can go into those categories. On the rehabilitation side, those are the things that create major functional deficit. So, a lot of times that's trauma, spinal cord injuries, brain injuries, stroke, and all of that falls within the field of PMR, as well.
Melanie: So, what type of physicians are in this field, and what's the training like?
Dr. Heberling: Well our training is four years. The specialty in Physical Medicine and Rehabilitation, and we train into both impatient and outpatient field, but most of us kind of select one or the other, in terms of our area of interest. And so, for instance, I really specialize in the spine, and then also I'm able to do many of the other neurologic things that would fall into the outpatient category, and then others of us would be all inpatient, and really being working on that rehabilitation unit. When people need care right after an injury. We also are trained in electro-diagnosis or EMG’s, and that's something that we're all trained well to do, but not everybody chooses to do once we graduate.
Melanie: So, then how does PM and R have the ability to restore total function, it's said that they're able to observe the total body and not work on just one issue, Dr. Heberling. How do you go about doing that because we are made up of so many different parts of our body, and some things like brain and spinal cord injury can affect so many different aspects of a person's life?
Dr. Heberling: And that's absolutely true. And so, we do take a lot of pride in making sure that we are trying to treat the whole person, in some ways that just means that when I have a patient with both back and neck pain and knee pain, that I need to make sure I'm addressing all of those things. And our therapy prescription, for instance, might be more encompassing, so that we can address those things in concert. For instance, if we're doing some knee exercise or some quad exercises to address the knee, then we don't take into account the back, we might end up straining the back in order to try to treat the knee.
So, we need to make sure that we're kind of respecting the back as we work on the knee, and vice versa. The other big way we do that is by looking at the other factors that play into a person's life. So, if their job doesn't allow them to go to a long course of physical therapy with usual time, then we might be treating them in the office, and really teaching them a lot more during our office time, so that they can work on that on their own, rather than those additional therapy visits, or maybe spreading out the therapy in different ways. Often, it also includes addressing the social aspects and how can you build your relationships, so that you get what you need from your family, and that you can offer them what you need despite these limitations.
Melanie: What about working with other health care providers? First of all, how do you keep the primary physician in the loop, and also, with certain things, as I mentioned before, brain and spinal cord injury, for example there are bladder issues, incontinence issues, sexual dysfunction. And while you're working on this physical and physiological aspect, how do you bring in other providers, which may even include nutritional support or therapeutic support any of those?
Dr. Heberling: Well on the inpatient rehabilitation side that's the easiest because we really develop this team approach in a way that's hard to do elsewhere in the medical services, where we do have the physician plus the social worker, physical therapists, occupational therapists, speech therapist, nutritional support etcetera, all just really involved in that team approach to the patient's care, and that tends to go very, very smoothly because everybody’s all in the same place.
On the outpatient side, it's harder because we tend to have to refer people to the different places, in order to create that team approach, but we certainly do that pretty extensively. In terms of communication with the other physicians, it's certainly very, very helpful that we have an electronic medical record, so that makes the communication a bit easier. We certainly send off our reports when we have consultation reports or EMG reports, etcetera, that we make sure that those get to the people who need to know that information. And then I'm very careful whenever there's something that there is a medical issue, that may interfere with the types of things that I want to be doing by sending a message or giving a call to the physician, who's otherwise taking care of that issue, so that we can coordinate that. For instance, if we need an epidural injection for the spine, and somebody’s on a blood thinner, then we're pretty careful to make sure that we are asking the right questions to know that it's safe to come off that blood then or for a short while, in order to have that injection finished.
Melanie: So, then kind of wrap it up for us and let other physicians know, what you'd like them to know about your field of physical medicine and rehab, and when they should refer to a specialist.
Dr. Heberling: I would say that the biggest things are when somebody has an issue with function, that they need a little bit more creative approach or more options available to them. There are a lot of times when, for instance, with back pain care, that the approach ends up being surgery or no surgery and then pain medicines. And that's the whole story, and I feel like that's really missing the boat with the opportunity to improve function. Don't get me wrong some of those things are very, very necessary, but when we look at all the other things that are available to us, often we can get at the root cause of the pain in a way that, if we're just a little bit more careful and diligent with how we approach it, then we can get really good outcomes, that are more satisfactory, and with the patient more educated at the end of the process. The other times to refer to us are when somebody’s having issues with various things at the same time, where it becomes very difficult to just tackle one problem, and we really need to take that more systemic approach to it, then I think we can be very valuable in that case as well.
Melanie: And what can physicians expect from your team at the Christ Hospital Health Network after referral, and so far as communication with the referring physician, and your team approach.
Dr. Heberling: Well, we certainly will make sure that the information we have gained, and the decisions that we've made do get their way back to the primary care physician, so that they're in the loop about what types of things we're doing. And then we would just work through with that patient in order to try to figure out what the best that things are for them, and that often means that there's a variety of things that need to be done, each in their own timeframe, in order to get the best care for the patient. So, that's what we'll be working through and then we usually send a discharge note if we do get to a point where things are stable enough, that they can just receive refills, and such in a more stable fashion, then we can certainly send that patient back in, and let them know that we're not needed to be in the loop anymore, at that point.
Melanie: Thank you so much, Dr. Heberling, for being with us, it's really great information. You're listening to Expert Insight, Physician Views and News with the Christ Hospital Health Network. More information on Dr. Heberling, and all of the Christ hospital physicians is available at, TCHPconnect.org, that's TCHPconnect.org. This is Melanie Cole, thanks so much for listening.
What is PM&R?
Melanie Cole (Host): A Physical Medicine and Rehabilitation physician a PMNR specializes in decreasing pain and enhancing physical function that's been affected due to disorders of the musculoskeletal system and nerves. My guest today is, Dr. Rachel Heberling. She's a Physical Medicine and Rehabilitation physician with the Christ Hospital Health Network. Welcome to the show, Dr. Heberling. Explain a little bit about Physical Medicine and Rehabilitation, what encompasses this field?
Dr. Rachel Heberling (Guest): Okay, well thank you for having me on. I appreciate it. We have actually a really broad spectrum of treatments that we can employ for a broad spectrum of issues that can arise. Really the thing that ties everything together is that we really take a functional approach, to try to improve people's function wherever possible. So, that's kind of the unifying factor in what we do. A lot of times I like to describe, to describe our field by breaking it into the physical medicine piece and the rehabilitation piece.
Physical Medicine is really the neuro-musculoskeletal systems, and how we can apply different therapies, different exercises, different procedures etcetera, in order to address those areas, that can even include, wheelchairs or other DME, that can include other assistive devices like, bracing and AFO’s etcetera. So, a lot can go into those categories. On the rehabilitation side, those are the things that create major functional deficit. So, a lot of times that's trauma, spinal cord injuries, brain injuries, stroke, and all of that falls within the field of PMR, as well.
Melanie: So, what type of physicians are in this field, and what's the training like?
Dr. Heberling: Well our training is four years. The specialty in Physical Medicine and Rehabilitation, and we train into both impatient and outpatient field, but most of us kind of select one or the other, in terms of our area of interest. And so, for instance, I really specialize in the spine, and then also I'm able to do many of the other neurologic things that would fall into the outpatient category, and then others of us would be all inpatient, and really being working on that rehabilitation unit. When people need care right after an injury. We also are trained in electro-diagnosis or EMG’s, and that's something that we're all trained well to do, but not everybody chooses to do once we graduate.
Melanie: So, then how does PM and R have the ability to restore total function, it's said that they're able to observe the total body and not work on just one issue, Dr. Heberling. How do you go about doing that because we are made up of so many different parts of our body, and some things like brain and spinal cord injury can affect so many different aspects of a person's life?
Dr. Heberling: And that's absolutely true. And so, we do take a lot of pride in making sure that we are trying to treat the whole person, in some ways that just means that when I have a patient with both back and neck pain and knee pain, that I need to make sure I'm addressing all of those things. And our therapy prescription, for instance, might be more encompassing, so that we can address those things in concert. For instance, if we're doing some knee exercise or some quad exercises to address the knee, then we don't take into account the back, we might end up straining the back in order to try to treat the knee.
So, we need to make sure that we're kind of respecting the back as we work on the knee, and vice versa. The other big way we do that is by looking at the other factors that play into a person's life. So, if their job doesn't allow them to go to a long course of physical therapy with usual time, then we might be treating them in the office, and really teaching them a lot more during our office time, so that they can work on that on their own, rather than those additional therapy visits, or maybe spreading out the therapy in different ways. Often, it also includes addressing the social aspects and how can you build your relationships, so that you get what you need from your family, and that you can offer them what you need despite these limitations.
Melanie: What about working with other health care providers? First of all, how do you keep the primary physician in the loop, and also, with certain things, as I mentioned before, brain and spinal cord injury, for example there are bladder issues, incontinence issues, sexual dysfunction. And while you're working on this physical and physiological aspect, how do you bring in other providers, which may even include nutritional support or therapeutic support any of those?
Dr. Heberling: Well on the inpatient rehabilitation side that's the easiest because we really develop this team approach in a way that's hard to do elsewhere in the medical services, where we do have the physician plus the social worker, physical therapists, occupational therapists, speech therapist, nutritional support etcetera, all just really involved in that team approach to the patient's care, and that tends to go very, very smoothly because everybody’s all in the same place.
On the outpatient side, it's harder because we tend to have to refer people to the different places, in order to create that team approach, but we certainly do that pretty extensively. In terms of communication with the other physicians, it's certainly very, very helpful that we have an electronic medical record, so that makes the communication a bit easier. We certainly send off our reports when we have consultation reports or EMG reports, etcetera, that we make sure that those get to the people who need to know that information. And then I'm very careful whenever there's something that there is a medical issue, that may interfere with the types of things that I want to be doing by sending a message or giving a call to the physician, who's otherwise taking care of that issue, so that we can coordinate that. For instance, if we need an epidural injection for the spine, and somebody’s on a blood thinner, then we're pretty careful to make sure that we are asking the right questions to know that it's safe to come off that blood then or for a short while, in order to have that injection finished.
Melanie: So, then kind of wrap it up for us and let other physicians know, what you'd like them to know about your field of physical medicine and rehab, and when they should refer to a specialist.
Dr. Heberling: I would say that the biggest things are when somebody has an issue with function, that they need a little bit more creative approach or more options available to them. There are a lot of times when, for instance, with back pain care, that the approach ends up being surgery or no surgery and then pain medicines. And that's the whole story, and I feel like that's really missing the boat with the opportunity to improve function. Don't get me wrong some of those things are very, very necessary, but when we look at all the other things that are available to us, often we can get at the root cause of the pain in a way that, if we're just a little bit more careful and diligent with how we approach it, then we can get really good outcomes, that are more satisfactory, and with the patient more educated at the end of the process. The other times to refer to us are when somebody’s having issues with various things at the same time, where it becomes very difficult to just tackle one problem, and we really need to take that more systemic approach to it, then I think we can be very valuable in that case as well.
Melanie: And what can physicians expect from your team at the Christ Hospital Health Network after referral, and so far as communication with the referring physician, and your team approach.
Dr. Heberling: Well, we certainly will make sure that the information we have gained, and the decisions that we've made do get their way back to the primary care physician, so that they're in the loop about what types of things we're doing. And then we would just work through with that patient in order to try to figure out what the best that things are for them, and that often means that there's a variety of things that need to be done, each in their own timeframe, in order to get the best care for the patient. So, that's what we'll be working through and then we usually send a discharge note if we do get to a point where things are stable enough, that they can just receive refills, and such in a more stable fashion, then we can certainly send that patient back in, and let them know that we're not needed to be in the loop anymore, at that point.
Melanie: Thank you so much, Dr. Heberling, for being with us, it's really great information. You're listening to Expert Insight, Physician Views and News with the Christ Hospital Health Network. More information on Dr. Heberling, and all of the Christ hospital physicians is available at, TCHPconnect.org, that's TCHPconnect.org. This is Melanie Cole, thanks so much for listening.