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Is A Physiatrist What I Need?

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    Is A Physiatrist What I Need?

    Dear SCI Nurse,

    My brother is about to come home out of a nursing home he's been in for almost 3 years - in two weeks. Our state has finally approved sitters in his home and I'm seizing the moment to help him acquire a better life.

    I have been told previously on this web site by a nurse that he doesn't need a general practitioner tending to him. I agree fully, as the three previous GP's he's had do not understand him or his illnesses very well. They lack in treating him like a human and talking to HIM when addressing a situation. Also, lack patience when he's bad and act like he's imposing on them when he calls them (which he does too much, I'm sure). I need a new primary care physician, but don't know what specialty field to start looking in. Someone told me a "physiatrist" might be the answer.

    My brother is a very bad patient when in hospitals, some around here won't even admit him, sent me word they didn't want him back in their facility due to his behavior issues. HIs BEHAVIOR has always been the issue. When he's sick, his behavior is sicker. I told him one hospital didn't want him anymore and he asked "what did I do to them?" He actually didn't seem to remember what he'd done last year when admitted there. His short term memory is not good. I really believe he suffers from TBI, but has never been diagnosed. He IS on Cymbalta and Seroquel for this.
    He saw a psychiatrist this year who told him he just needed "somebody to talk to about coping with his situation".

    My brother has made himself an undesirable where medical professionals are concerned thus far. I must now go 50 miles down the road to get him a doctor and a hospital for admission, when there are two hospitals within 20 miles of us now.

    Any suggestion for a PCP would be appreciated.


    I see a physiatrist for my PCP and I would recomend it. He's a lot more familiar with my issues and it makes everything simpler not having to go to a GP first and then get referred, and he can script things like chairs and whatever SCI related tests and things I need done.

    Every so often he refers me to an internest for regular GP checkup stuff(blood tests,shots etc.) but the physiatrist can do these too.

    Also I see a Urologist familiar with SCI bladder issues on a regular basis and I've found this to be really important as so many of our problems are kidney/bladder related


      If you can find a physiatrist who does primary care (not all do) that would probably be best. He will also need a urologist, and a clinical neuropsychologist would probably also be a good idea to help you and him learn less mal-adaptive behaviors. Even with TBI, such behaviors can be learned. Did he ever have any TBI or SCI rehab?

      You can find a list of board certified physiatrists for your area here:

      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.


        thanks for input

        Thank you both for your input.

        To SCI Nurse KLD,

        My brother had not had much of ANY kind of rehab. He had exhausted his Medicare days while in hospital for initial injury and was so weak, weighed only 98 lbs, had a feeding tube and trache when I acquired him only 4 weeks of rehab. It was too soon, he stayed in bed many days not able to get up for the rehab they were wanting to do for him. They did swallowing exercises and range of motion, that's about it. Put him on a mat and worked him out a couple of times, ordered him a good power chair w/hydraulics (best thing anybody ever did for him) that he could run with his small amount of elbow arm movement. Never went back for rehab. I requested it many times, but never got it because he'd usually overstayed his medical days available with UTI's, bowel problems, sepsis, etc. that goes along w/being a quad. Then, one day they told me he had "plateud" (that is a word I've become to hate) when the therapist at the nursing facility didn't want to give him daily physical therapy I'd worked on his PCP to order for him, and I was told that the nursing home aides could give him "range of motion" exercises from now on. They never did.....another story in itself. I've come to despise nursing homes.......sad....

        My brother has a neuro doctor that tends to his baclofen/morphone pump refills. He's the ONLY doctor that I truly believe understands about SCI. He's seen a good urologist at one of our larger hospitals that I can depend on, I think.
        I have located three physiatrists in a larger city about 40 miles from us. I am going to call them since you've said they may be the right way to go. I was waiting on you to reply, thank you very much. I was thinking about maybe telling the physiatrist that I would use a GP from this area for writing orders for home health and such, and use the physiatrist when problems arose that were out of the normal realm of things, (like UTI's and hospital admits). Do you think that would be OK, especially if physiatrists normally aren't PCP's.?
        Thank you for your response!


          It sounds like your brother's nreuro doctor might be one to ask for suggestions of a physiatrist. Mine by the way does not handle primary care.
          T7-8 since Feb 2005