PM&R Resident E-Newsletter

P. Bobby Katta, JD, DO
University of Kentucky Medical Center
PGY3

"Fishing is the chance to wash one's soul with pure air. It brings meekness and inspiration, reduces our egoism, soothes our troubles, and shames our wickedness. It is discipline in the equality of men—for all men are equal before fish."—Herber Hoover

The soundtrack of a late fall morning plays as the sun peaks over the mountains in the distance, lighting the leaves in an inferno of orange and yellow. Exhaled breath condenses as it meets crisp, clear country air. Anglers from near and far stand along the shoreline to pay homage to fish and nature. The stunning scene unfolding in the shadow of the Daniel Boone National Forest is typical of any October morning in Kentucky.

It was in this majestic, yet serene setting that residents of the University of Kentucky Physical Medicine and Rehabilitation program joined members of Trout Unlimited-Bluegrass Chapter and Easter Seals of Cardinal Hill Rehabilitation Hospital in Lexington to host Kentucky’s first adaptive fly fishing event. This event was spearheaded by Dr. Robert Worthing, MD, associate professor at UK PM&R, amputation rehabilitation director of the Lexington VA Medical Center, and co-founder and instructor at TROutreach Guides LLC. TROutreach stands for Tenkara Recreational Outreach. The co-founders of this unique organization identified that adaptive equipment and cumbersome fishing gear limited a disabled person’s ability to fish. The organization formed around the belief that disabled men and women could maximize their independence by using the bare minimum of adaptive equipment and lightweight fishing gear. The organization sought to teach fly fishing techniques that would give the disabled angler a lifetime of enjoyment on the water.

The day began with a safety training session in handicap-accessible classrooms provided by the Wolf Creek National Fish Hatchery and Visitor’s Center. Disabled participants came from far and wide, some traveling great distances for this unique opportunity. The excitement in the room was palpable. During the morning briefing, participants, instructors, UK PM&R residents and Trout Unlimited members broke out and formed small groups. Naturally, some friendly competition began to develop between the groups, lending to the success of the event.

After safety training concluded, Dr. Worthing introduced the participants to Tenkara, a Japanese form of fly fishing that relies merely on rod, fishing line, and fly. This ancient art has gained significant popularity in the United States for its simplicity and effectiveness at catching fish. Tenkara requires subtle movement and minimal power to cast, making it highly efficient and effective. The rods that are used typically weigh ounces, and are very easy to handle. There is no reel for the operator to manipulate. Most importantly, the dynamics of the rod allow for the efficient transfer of energy to the line with minimal effort. The simplicity, efficiency, and elegance of Tenkara is well suited for spinal cord injured patients, amputees, patients with cerebral palsy, and multiple sclerosis. During the session, Tenkara rods were handed out, and instructors and residents worked with participants to modify the rods to accommodate for the impairments of the participant.

On the shoreline, basic instructions were given and then the teams were set loose. As the day progressed, and techniques improved, disabled participants began to rack up some serious numbers. By the end of the day, each participant had caught multiple fish. One participant even hauled in an enormous 19-inch rainbow trout. As a testament to the effectiveness of Tenkara, the disabled participants out fished every other able-bodied fisherman on the river that day. Everyone involved agreed that the adaptive fly fishing event was a resounding success. In fact, the event received such positive feedback from organizers, volunteers, and participants that Easter Seals committed to making adaptive fly fishing a quarterly event.

John S. Georgy, MD, MBA
Montefiore Medical Center/Albert Einstein College of Medicine
PGY3

Supporting Authors: Naheed Van de Walle, MD and Michelle A. Stern, MD

As physicians, we often hear of health policy and think that it’s best left for politicians as we went into medicine for patient care. However, being a part of the NY Society of PM&R and getting the opportunity to attend MSSNY (Medical Society of the State of New York) Advocacy Day in Albany, NY as a member of the NYSPMR legislative delegation, to talk about the effects of current policy on physicians with our congressmen and their health policy legislative directors was an eye-opening experience that dispelled my misconceptions. Health policy affects each and every one of us whether we are practicing physiatrists, subspecialists, medical students or residents, like myself.  

As residents, teaching patients is just one facet of an important role we are learning to play as patient advocates. As an advocate for the patient, the concerns and best interests of the patient are at the core of all decisions and interactions. While most physicians and specialists advocate for their patients, the role of advocacy in PM&R is even more pronounced. Gaining an understanding of the policies around you in our field can influence policy changes at the community, state, and federal levels to assure all patients are best served¬. As physicians, we have the unique opportunity to share our expertise, advocate for our patients, our field, and educate our lawmakers. It is important to share your voice, contact your representative, and/or lobby on legislation that affects our field, our patients, and the care we provide. Every day there are rules, regulations, laws, and programs that are being implemented and/or changed by government entities that effect the practice of not only PM&R but the entire field of medicine. Through advocacy, a physician’s rights and needs are expressed and represented. By advocating for what is and/or not an appropriate course of action, a physician serves as the expert and provides insight that would otherwise not be considered. Since we are the new generation of physicians to influence the future of health care, we need to protect the rights and interests of the patients where they cannot protect their own. Current health care policy has the potential to drastically alter our ability to provide comprehensive clinical care as physicians. Whether you are a medical student concerned about matching into a funded post-graduate training spot, a medical resident wavering in your interest in primary care due to reimbursement or a practicing physician concerned about your future earning potential, health care policy directly impacts you.

Attending MSSNY Day was a wonderful experience that helped further my understanding of health policy and gave me an opportunity to give a personal perspective as a resident physician to our lawmakers on key health issues that will affect my future and the patients I will provide care for. I look forward to contributing to the process again next year with the New York delegation. The feedback we received from our representatives and their legislative directors was very positive and they seemed to appreciate and respond well to stories of our patients and personal challenges we may face as providers due to current policies. They hope to work with us to address these critical issues. We need to continue this work in our local communities and strive to be a part of the change we hope to see in health care. We hope that you will consider becoming involved in your state’s society to advocate for PM&R and to keep informed of the latest updates affecting current policies, and will continue supporting the mission of enhancing the quality and effectiveness of health care by fostering excellence and professionalism in the practice of physiatry.

“Never doubt that a small group of thoughtful committed citizens can change the world; indeed, it’s the only thing that ever has.”—Margaret Mead.

P.S. Be sure to browse your December/January issue of The Physiatrist to learn more about the importance of advocacy and read a few interviews!