physiatry
/ fizz-EYE-uh-tree (a doctor in it is a physiatrist, fizz-EYE-uh-trist) /
When you meet the doctor who runs a rehabilitation ward, you may be surprised: they do not operate, they do not mainly prescribe pills, and yet they are very much a physician. What is their specialty actually called? In North America the name is physiatry, and the doctor is a physiatrist. The word was coined in the 1930s by joining the Greek roots physis, meaning nature or the physical, with iatreia, meaning healing, so a physiatrist is literally a healer who works through physical means.
Physiatry is simply the medical practice of physical medicine and rehabilitation. A physiatrist completes medical school and then years of specialty residency learning the musculoskeletal and nervous systems, how movement works, how disability arises, and how to lead a rehabilitation team. Day to day they diagnose and manage conditions like spasticity, chronic pain, spinal cord and brain injury, and limb loss; they perform procedures such as nerve and muscle electrical testing (electrodiagnosis), joint injections, and botulinum toxin injections; they prescribe braces, wheelchairs and prostheses; and above all they set functional goals and coordinate therapists and nurses. In much of Europe and Asia the same doctor is called a specialist in physical and rehabilitation medicine, or simply a rehabilitation physician.
Physiatry matters because someone has to be the medical quarterback of recovery, the physician who sees the whole person and the whole arc from injury to going home, rather than only one organ. A common misconception is that a physiatrist is the same as a physical therapist; they are not. The physiatrist is a physician who diagnoses, prescribes, and leads; the physical therapist is a separate, highly skilled professional who delivers much of the hands-on movement treatment. The two work closely together, but their training and roles are distinct.
A physiatrist examines a man with a stiff, clenched arm after brain injury, decides the tightness is treatable spasticity rather than a fixed contracture, injects botulinum toxin into the overactive muscles, and writes a therapy and splinting plan, all in one clinic visit.
The physiatrist diagnoses, performs procedures, and prescribes; the team then carries the plan out.
Names differ by region: physiatrist (North America), physical and rehabilitation medicine specialist or rehabilitation physician (Europe, Asia). The word physiatry can be confused with psychiatry by ear; they are unrelated.