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Lisa I. Iezzoni, MD
Beth Israel Deaconess Medical Center Boston, Mass

JAMA. 1997;277(5):373-374.

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In Reply.

—I completely agree with Drs Gordan and Frank. Referrals to physiatrists could provide invaluable assistance to persons experiencing difficulty walking. As noted in my article, primary care physicians typically do not have specialized knowledge in this area. Therefore, establishing clear lines of referral between primary care physicians and physiatrists is essential. Primary care physicians should talk with local physical medicine specialists, learn from them about referral timing, clinical expectations, service options, and costs to patients, and develop communication channels to share care of patients.

Recent discussions with physiatrist colleagues suggest 4 additional points. First, just as in other clinical disciplines, some physiatrists develop special areas of expertise: not all physiatrists feel equally comfortable advising patients about wheelchair options. Second, finding an appropriate physiatrist is not always easy. Even some big, inner-city, acute care hospitals do not have physiatrists on staff; physiatrists may be concentrated in rehabilitation facilities, places that primary . . . [Full Text PDF of this Article]

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