Updated: Nov 13, 2019
A doctors experience in a physical rehabilitation setting.
When I was assigned to Western Cape Rehabilitation Centre (WCRC), a physical rehabilitation facility in Mitchells Plain, as a young, community-service doctor - a question I often got asked in the months leading up to that year was: “What medical role are you going to have there?”
My honest answer was that I had no idea exactly what I’d be doing, particularly as during the six years of my undergraduate degree I had received a limited education on disability and zero on physical rehabilitation medicine.
Furthermore, when asked to refer a stroke patient for physiotherapy or occupational therapy during my medical internship, my referrals would typically read: “For physiotherapy or occupational therapy of left hemiplegia (left sided weakness)” and little else!
With hindsight, these referrals indicated both an ignorance and arrogance on my part. Ignorance because I was not educated in my medical training about the different health professionals and I did not even have a basic idea of exactly what the different disciplines could do for a patient. And arrogance from my seeing myself as a doctor, a position that played a more important role in a patient’s hospital journey than that of other health professionals. At the time I probably instinctively thought: “I save lives and so I must be more important than the allied health professionals!”
Within a few weeks WCRC taught me that there is no room for any kind of arrogance in physical rehabilitation medicine. In rehabilitation medicine we are ALL a team.
The rehabilitation team is comprised not only of all the health professionals (doctors, nurses, physiotherapists, occupational therapists, speech therapists etc.) but importantly the patient themselves as an active decision-maker and participant in the goal setting process. This last component is vital to the success of any rehabilitation programme, as is the role of the family and caregivers of the patient. This is because the rehabilitation process is not only physically exhausting for the patient, but also extremely taxing on a psychological level for all involved. Family and caregivers play a vital role in providing support to help an individual manage the challenges of their journey of recovery on a sustained and daily basis.
Returning to the present, nearly five years later, I have spent my entire career working exclusively within hospital-based physical rehabilitation setting. My experience with this team framework has deepened, and with it I have learnt a few key lessons as a medical doctor.
Firstly, it taught me to view a patient in a holistic way and as a person, rather than just a physical ailment, diagnosis or set of symptoms. Second, learning to value, understand and respect the role of various kinds of health professionals is of critical clinical value for the patient in the recovery process. Finally, it has also taught me that medical doctors at current state are far from prepared for appropriate referral of patients to services in this area.
Why do I say this? My experience shows me that understanding the appropriate type of rehabilitation needs, the right time it and the best setting for it is an area for learning and specialization in itself. At present, it lies with the assumption that it is an automatic skill possessed by anyone who is a qualified doctor with an MBChB degree. In my work setting alone, I have seen numerous instances of poor decision-making and at many levels e.g. poorly timed referrals of acute patients who cannot participate in the rehabilitation process, or over-referral of minor cases who only require outpatient rehabilitation and sometimes instances even patients with no apparent need at all when evaluated. This has a negative time, cost and wellbeing implications for the patient themselves and the health system as a whole.
The Way Forward
One of the most important ways to address this gap is through boosting clinical competency in this area at a university level. Having better guidelines to work with would mean that medical students graduate with a higher level of knowledge, skills and attitudes to afford disabled patients quality healthcare. These guidelines would also help strengthen doctors’ awareness and understanding of rehabilitation medicine.This is of broader importance than the medical field itself, because literature has shown that doctors’ views and thoughts on disability and disability-related subjects can greatly influence the views of society at large. Making sure that medical students receive sufficient education on disability will ensure that as qualified medical doctors, their perception of disability and the possibilities around it will be positive, transferring greater value to all who need it.
*Dr Sarah Whitehead is a medical doctor who works in physical rehabilitation medicine. She is an aspirant PhD candidate on the subject “Proposing clinician competency guidelines for the inclusion of disability in the undergraduate medical curricula of South Africa”. She can be contacted on firstname.lastname@example.org
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