The family physician, after seeing a patient through the acute stages of an illness and subsequent convalescence, watched him until his ultimate return to work. The patient, usually stimulated by the daily needs of life on the farm and in the home, was chiefly interested in regaining his former place in his society. As he recuperated, he could make himself useful in many simple tasks. Gradually more difficult and strenuous skills would be regained. The relationship of the family physician to the home was sufficiently direct to permit him to help substantially in the process.
Now, however, and especially in cities, the family physician can no longer help effectively in this rehabilitative phase of medical care. Many people live almost monastically in apartments like cubicles. From the hospital the inmate returns to this cell, where his metabolism can be described in terms like those used by the cytologist in describing the life processes of an erythroblast. Materials to be metabolized are delivered to the service door by the smoothly flowing circulatory system of the metropolis, and the products of this metabolism disappear down chutes, drains and pipes. Of visible motion there is none. The activities of this cell are paradoxically not active, but passive; they consist of looking at papers, listening to radios and watching television. A patient returning to such an environment from a hospital is not stimulated. He has been looking at papers, listening to radios and watching television in the hospital, too. If he gains strength, he may go out to theaters and stadiums, where he will hear and see more of the same thing in the same passive way. Little incentive develops for regaining useful skills. Seldom are there facilities for use by the patient in preparing to resume his former occupation. The physicians who may have served the patient well during the phases of his recovery in the hospital can do little or nothing for him during the rehabilitative phase.
The consequences of this are stated, with an almost brutal use of statistics, by Howard A. Rusk in an article elsewhere in this issue. Added strains are manifest both in the home, where cramped quarters distress patient and family alike, and in the hospital, where slow recoveries tie up beds. Rusk sees rehabilitation as an essential 鈥渢hird phase鈥� of medical care. The importance of finding places for the handicapped in American industry is made undeniably clear. The roles of physical medicine and of occupational therapy in rehabilitation are seen in a new light.
The interrelations of physical medicine, occupational therapy and rehabilitation are important because of their bearing on the education of young physicians. Hospital residencies may be planned to provide some training in all three fields, and credit should be allotted for such training. The three fields concerned, although they overlap extensively, have in addition certain distinctive areas of their own. The difficulties about residencies have claimed the attention of the Council on Medical Education and Hospitals, and have concerned especially the Council on Physical Medicine. The latter council recently voted to enlarge its scope and to change its name to the Council on Physical Medicine and Rehabilitation; this action should clarify some of the thinking on the subject and will help greatly in dealing with problems like that of residencies. The Board of Trustees of the 榴莲视频 has voted approval of this change of name.
Published Online: April 25, 2024. doi:10.1001/jama.2023.18291