The rehabilitation model of care: when old becomes new.

The key to our future is found in the values of our past. As physiatrists, we have consistently deployed through rehabilitation care what is becoming the mainstream of health care and needed now more than ever. Today, physiatrists have the opportunity to lead the way. Yes, we are a small specialty, but one with a big idea. Recall the beginning of physical medicine and rehabilitation (PM&R). The polio epidemic had swept the country. Young men, catastrophically injured, survived a world war to return home. With the advent of antibiotics and improved acute medical care, suddenly the population became filled with survivors—people with disabilities. However, the health care providers of the time were unprepared to help people in that predicament. A change from the traditional model of medical care was needed. That change was the development of specialists who could help people living with disabilities to live their lives with quality and dignity, to participate in family and community life, and to contribute once again to society. These specialists became known as physiatrists, and the specialty known as PM&R was born. The foundation of PM&R had a number of basic tenets. Physiatrists focused on peoples’ abilities—and possibilities—no matter what type of injury or disease a person may have experienced. Seeking ways to improve function and quality of life was key, and the focus was not on traditional medical diagnosis and treatment alone but on a view of the individual, that individual’s role in society, and ways that individual could participate. This philosophy freed physiatrists from the limits of medical knowledge because finding or developing a means for someone to participate in society can be limitless! This approach was certainly exciting for physiatrists and the people we treat but not well understood by those physicians (and patients) wedded to the “cure” mentality. Physiatrists are in the luxurious position of having an armamentarium of the breadth of traditional medical knowledge plus the ehabilitation “know-how” and science. Thus, if anyone should question the resiliency of his specialty, my response would be, “Of course, we will carry on indefinitely into the uture!” One of our greatest strengths was articulated by Dr. Stuart Weinstein in his editorial in his journal [1]. He described a “tolerance for uncertainty” in our specialty. This is both a alient principle and a physician behavior that describes our path and supports our irection. In the physiatric model of care, there is almost always something we can do to elp each person we see, often in the absence of a classical curative treatment plan. We often create” options for people with impairments and disabilities, and through our tolerance for he uncertainty of their future plus our own creativity, coupled with the creativity of our ehabilitation teams, our outcomes are often beyond what could have ever been expected. his tolerance for the uncertainty also makes us highly adaptable as specialists. We are the chameleons” of medicine and can apply what we do to almost any condition. The basic tenets of our specialty are timeless, very applicable today, and will carry us into he future. These include person-centered care, a focus on wellness and prevention, eamwork, functional outcomes, and independent living and quality of life.