Rehabilitation Medicine

Why choose to work in
rehabilitation medicine?

This page discusses what Rehabilitation Medicine, a secondary care medical speciality, has to offer. It is entirely personal, based on my own experiences and perspectives. I hope to convince you that it offers endless possibilities, and that you will never feel bored. There are new challenges every day, and it is rare to be faced with the same problem twice. After 41 years, I am still learning and I am only to aware that there is more about rehabilitation that I do not know that I do know. Rehabilitation has taken over my life! (Why else would I start this website at the age of 72 years?)

Like most doctors, I entered medicine with a commitment to help patients. Once I was being interviewed for a job in Boston (US) by a famous American neurologist, who asked “And what are your research interests?“. Rather primly and embarrassingly I said “Oh, I am only interested in helping patients, not doing research.” To which he replied, kindly “Yes, that is an excellent ambition but I think you’ll find that you will get bored of it after a while!” I did not get the job, I did do research, but I have never become bored by clinical work.

So rehabilitation is likely to remain an interesting area of work for your professional lifetime. Why does it remain interesting?

Rehabilitation is perhaps the speciality that takes a holistic view of the patient. Of course, many individual doctors do take a holistic view, and in some specialities such as psychiatry and palliative medicine, a holistic approach is common. Nevertheless, doctors practising rehabilitation must be holistic because it is based on the biopsychosocial theory of illness, and this requires the doctor (and all other team members) to consider every aspect of a patient’s situation. It is person-centred.

Rehabilitation focuses on disability, and disability refers to (functional) activities that are altered or limited or even no longer possible as part of a patient’s illness. Activities are goal-directed behaviours, which immediately requires you to consider and explore a patient’s goals. It also requires you to consider a patient’s context – what is going on in their life, what is their physical environment, and so on?

Therefore, even in a clinic with everyone having the same disease, the actual problems you need to consider differ from patient to patient, which is very different from clinics in most specialities.

Many doctors fear not using or developing their clinical skills. In fact, your medical knowledge and skills are used extensively. Your diagnostic skills are vital, for three reasons.

Patients arrive with a diagnosis, but this is often incorrect and you need to be alert to this. Sometimes it is a relatively minor detail that is incorrect, which nonetheless may be important. Not infrequently either the presented diagnosis is wrong, or another additional diagnosis has been overlooked but is a major contributing factor.

Patients also develop new symptoms, and you need to be alert to the development of new diseases or complications of a known disease. The challenge arises because the patient will already have many symptoms and signs. Many patients may have difficulty communicating. You need to know when to reassure, and when to investigate.

Third, often other team members bring up or mention in passing, clinical observations they have made or report what a patient has said. You need to be alert to these comments, knowing when you should look further and when you can re-assure.

From a clinical interest point of view, you will see many rare diseases or unusual signs that are often not seen by others. This is because rare diseases are often disabling and patients are referred for rehabilitation – and continue to be seen in rehabilitation services for many years. Doctors coming up for examinations, such as the PACES examination, find neurological rehabilitation clinics and wards invaluable as a source of unusual clinical signs or diseases.

You will use other aspects of your knowledge and skills to support the team. You are the only person in the team with in-depth knowledge about drugs and diseases and need to educate team members in relation to the particular patient. You will always need to review drugs taken critically; you will be able to give a prognosis; you will know what problems are likely, advising the team what to look for; you will know when an observation made by a team member raises concerns.

Other aspects of being a doctor in rehabilitation are shown here:

There are many other fascinating and challenging aspects:

  • the opportunities for research are endless, and range from basic neuroscience through to epidemiology and health services research;
  • legal and ethical problems are common, and involvement in practical discussions about law and ethics in relation to your patient make you think – and learn;
  • if you are or become interested in NHS management, developing services etc, your skills give you a head-start over others;
  • and, if money interests you, giving opinions on ‘condition and prognosis’ in personal injury claims provides an income, combined with very interesting ethical, legal, and clinical questions.

In summary, rehabilitation medicine offers you the opportunity to meet interesting patients and clinical challenges every day, to participate in or undertake interesting research, to learn about law and ethics as part of your routine work, and to influence local and national policies. You will not regret choosing it as your speciality.

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