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 becamefilled 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 wasnotontraditionalmedicaldiagnosisandtreatmentalonebutonaviewoftheindividual, 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 excitingforphysiatristsandthepeoplewetreatbutnotwellunderstoodbythosephysicians (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 rehabilitation “know-how” and science. Thus, if anyone should question the resiliency of this specialty, my response would be, “Of course, we will carry on indefinitely into the future!” One of our greatest strengths was articulated by Dr. Stuart Weinstein in his editorial in this journal [1]. He described a “tolerance for uncertainty” in our specialty. This is both a salient principle and a physician behavior that describes our path and supports our direction. In the physiatric model of care, there is almost always something we can do to helpeachpersonwesee,oftenintheabsenceofaclassicalcurativetreatmentplan.Weoften “create” options for people with impairments and disabilities, and through our tolerance for the uncertainty of their future plus our own creativity, coupled with the creativity of our rehabilitation teams, our outcomes are often beyond what could have ever been expected. This 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 the future. These include person-centered care, a focus on wellness and prevention, teamwork, functional outcomes, and independent living and quality of life.