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Physiatry: An Integral Part of Non-operative Care

An Interview with Dr. Joel M. Press

Image - Photo of Joel M. Press, MD
Joel M. Press, MD
Physiatrist-in-Chief, Hospital for Special Surgery
Attending Physiatrist, Hospital for Special Surgery

For a growing number of patients, attempting to match a musculoskeletal condition to the appropriate specialist has become a common and increasingly difficult task. Some are unsure whether they have a serious condition that requires surgical intervention or whether simple rest and exercise can fix the problem. Most are not aware of the full range of nonsurgical medical specialties available or how best to gain access to the physicians, nurses, physical therapists and others who provide care to people who do not require surgery.

As Joel M. Press, MD, Physiatrist-in-Chief explains, “Across departments at HSS, we share the same goal: for patients to see the right practitioner for the right treatment at the right time.” For patients with a bone or joint injury of any kind, Dr. Press advises seeking attention at an institution that emphasizes collaboration among disciplines and which specializes in every aspect of musculoskeletal treatment and recovery. “Patients with musculoskeletal injury can be assured that at HSS non-operative care is provided whenever possible and appropriate.” The majority of HSS outpatient visits are, in fact, nonsurgical.

What Is a Physiatrist?

A physiatrist is a fellowship-trained expert in the evaluation, diagnosis and non-operative treatment of spine, sports and musculoskeletal injuries. All physiatrists are trained to address a broad range of neurological and musculoskeletal diseases, as well as disabilities and impairments. In addition to having this comprehensive training, each member of the HSS Department of Physiatry specializes in conditions and injuries that affect a particular area of the body, such as the hip, knee, spine, foot, ankle, shoulder, hand and wrist.

Physiatry first emerged as a medical specialty shortly after World War II, when veterans returned with spinal cord injuries, traumatic brain injuries, loss of limbs and other musculoskeletal impairments. Physiatrists integrated their knowledge of anatomy and biomechanics with the goal of restoring function to individuals with these types of injuries.   

Today, a person treated by a physiatrist may be more likely to have suffered a sports injury or non-traumatic, degenerative conditions that occur with age and wear-and-tear. But the guiding principles that underlie patient care remain the same: to achieve symptom relief and restore function.

Direct Access for Patients

The Department of Physiatry places a strong emphasis on triage – a process in which the severity of a condition and the urgency of treatment is assessed – and on facilitating access to appropriate care. Dr. Press believes that not everyone necessarily needs to see a physician or a surgeon for their first visit. “With proper assessment by a nurse practitioner or a physical therapist, the patient can often get the attention he or she needs promptly. This is also the best way to avoid progression to a chronic problem or one that is more difficult to treat.”

To illustrate how this works, these are three hypothetical scenarios in which a person might contact the Hospital to seek treatment for back pain.

  1. A patient directly asks to see a particular surgeon or physician and is quickly provided with relevant contact information.
  2. Similarly, an individual who is referred by a health care provider (physical therapist, nurse clinician or physician) who believes that surgery is the next step is directly matched to a spine surgeon.
  3. A person who has just experienced the acute onset of back pain or sustained a back injury and does not know which kind of treatment they require is seen by a spine specialist.

The fastest solution for that third type of patient is to receive an initial evaluation by a dedicated nurse practitioner or physical therapist within 48 hours. At HSS, this can be arranged through the Physician Referral Service (PRS), which handles phone and online requests for appointments. This expedited access allows the nurse practitioner or physical therapist to help the patient receive the appropriate level of care for their injury. Depending on the nature and severity of the injury, the spine specialist will then determine whether the patient needs immediate referral to a physiatrist or to a different specialist at HSS.

If the patient is likely to benefit from a series of visits with a physical therapist, he or she may be able to take advantage of the Hospital’s 'Direct Access' program. Experienced physical therapists, who have already passed rigorous qualifying tests for certification, can treat a patient for a preset number of sessions without a doctor’s prescription.

“Many acute musculoskeletal problems are self-limited,” Dr. Press notes. “Providing direct access to physical therapy for selected, properly screened patients is one more way that the HSS team is able to respond promptly to patient’s needs.”  

Once the patient receives treatment of any kind at HSS, his or her progress is tracked continually by the spine specialist. If the patient achieves relief, then the focus of treatment turns to prevention of recurrence. If not, then the spine specialist ensures that the patient receives the next level of care as appropriate for the injury or disorder. After the patient has recovered, HSS specialists provide direction on maintaining wellness.

Integrated Care and Research

At HSS, collaboration between physiatry and other orthopedic specialties is often facilitated by the presence of physiatrists in the physical settings in which patients receive care. A patient visiting a spine surgeon, for example, can often see a physiatrist in the same suite of offices if nonsurgical care is recommended. In reverse, if a physiatrist believes a patient is in need of surgery, a simple referral to one of the surgeon's at the same location can be made. This arrangement allows for an easy transition for patients and improved communication among physicians.

In addition to acting as partners with other specialists in the delivery of care, HSS physiatrists take an active role in collaborative research, such as conducting surveys to clearly identify patient expectations and goals of care. Areas of study include regenerative medicine, a discipline in which platelet-rich plasma, bone morphogenic proteins and/or stem cells may be used to repair and restore damaged and diseased musculoskeletal tissue.

“It’s important for research teams to include members of multiple departments,” Dr. Press notes. “Bringing together different points of view helps us get a better understanding of what the research shows and which patients may potentially benefit from it.”

For more information on non-operative care or to make an appointment with a physiatrist at HSS, please call our Physician Referral Service at 877.606.1555. To make an appointment with a physical therapist through Direct Access, please call 212.224.7900.

Summary by Nancy Novick.


 

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