Consultant physicians working with patients - Royal College of ...

Consultant physicians working with patientsand others. The ability to facilitate these meetings is animportant consultant skill. Communications betweenprofessionals and patients are highly developed andinclude evaluations of rehabilitation goals. Consultantsin RM use educational approaches to help patients andfamilies, often raising their expectations of potentialachievement, and to support self-management. Patientsupport groups can be a major help in rehabilitation.Consultants in RM typically have close relationshipswith local groups, and many work with national patientor carer-led organisations.Rehabilitation must always consider other peopleimportant to the patient. The separate needs of carersmust be appreciated, but balancing the interests of theindividual patient with those of others can pose ethicalchallenges when the disabled individual has reducedcapacity. An important challenge for RM consultants isto understand the needs of people from differentreligious, cultural and ethnic backgrounds. RMfacilitates innovative approaches, with a great deal ofexpertise on cultural differences within the specialty;however, the cultural responsiveness of rehabilitationservices needs further development.4 Interspecialty and interdisciplinaryliaisonMost aspects of RM require an MDT. Evidence for ateam approach comes from research on acquired braininjury and MS. 8,9 The key to MDT working is thatprofessional roles are flexible, with the needs of adisabled individual superseding disciplinaryboundaries. Interspecialty links are strong throughoutrehabilitation, and links with primary care andcommunity services are particularly important duringcommunity reintegration. Social services work closelywith RM teams, alongside education, employment,housing and legal services, and voluntary agencies.Neurology and neurosurgery interact closely with RM inmanaging long-term neurological conditions. Vascularsurgery interacts specifically with RM for amputations.RM works closely with orthopaedics and neurosurgeryin the management of patients following severe trauma.Other joint work with RM consultants includes: managing handover of young disabled people frompaediatrics to RM managing spasticity in collaboration withgeriatricians working with surgeons to plan procedures andpostoperative rehabilitation following spinal or jointsurgery and tenotomies sharing care with gastroenterologists duringinsertion of feeding tubes obtaining support from otorhinolaryngologists inthe management of tracheotomy working with anaesthetists in the management ofcomplex pain collaborating with psychiatrists for patients withneurological conditions, including traumatic braininjury, functional disorders and Huntington’sdisease working with urologists in the management ofcontinence working with palliative medicine consultants in themanagement of people with rapidly progressiveneurological conditions (eg motor neurondisease).In the community, RM makes rehabilitation expertiseaccessible to disabled people and provides an interfacefor specialist community professionals, as advocated inSupporting people with long-term conditions. 10 Ways ofworking with GPs are constantly evolving, asrecommended in a joint statement by the Royal Collegeof Physicians (RCP) and the Royal College of GeneralPractitioners. 11 General practitioners with a specialinterest (GPwSIs) in RM participate in many stages ofrehabilitation.5 Delivering a high-quality serviceWhat is a high-quality service?A high-quality RM service provides equitable access tospecialist services for all, including those with the mostsevere disabilities. The services described here must beavailable within reasonable distance of a patient’s homerather than exclusively in specialist centres.Home-based intervention is therefore essential.Inpatient and outpatient services must be available forthose with brain or spinal cord injury, other acute orprogressive neurological conditions, limb deficienciesand rarer disabilities. Stroke rehabilitation should beprovided either by the RM service or with RMconsultant input. A consultant in RM must be involvedin providing complex assistive technologies, includingenvironmental controls and special seating.RM services must be based within a well-managed,adequately resourced MDT. Factors that determine206 C○ Royal College of Physicians 2013