Most people don't know that Ron Hirschberg has an undergraduate degree in Cultural Anthropology from the University of Vermont. This has helped him in creating and defining his unique role of Physical Medicine and Rehabilitation PM and R consultant within the acute care community at MGH.
In 2 1/2 years, Ron has established a significant presence of PM and R at MGH, working primarily with the Trauma Team to introduce rehabilitation to improve patients level of function and to get them to the next appropriate level of care. 'The value of PM and R is in most cases more than the initial consultation', Hirschberg says. 'The impact in the acute setting can be largely in the follow-up, helping the clinical team and family to better understand how function is affected as patients move through the disease process'.
Hirschberg's advanced training in neurotrauma and neurorehabilitation has given him a better of understanding of where rehabilitation should start. The starting point of rehabilitation has grayed over the years, with advances in research and the impact of acute care length of stay and insurance requirements. It makes sense that rehabilitation and begins at the point of injury itself, and that is when we need to start to facilitate recovery. Ron describes his role in 3 ways: to assist with primary management of trauma recovery and disease, to remove barriers to participation in rehabilitation (e.g. level of alertness, pain, mobility, infection, etc) and to assist with disposition of the patient.
Consider some of the patients that Ron has helped recently. A 19 year old male who suffered a MVA resulting in a significant diffuse axonal head injury with severely limited functional abilities. This young man was back and forth between MGH and an inpatient rehab facility as the clinical teams managed his complications from seizures and brain swelling. His insurance eventually denied his return to the rehab setting, stating that he had used all of his rehab days in the process. Ron was able to thoroughly review the case, adjust his medications to maximize participation and convince the Medical Reviewer that this young man only effectively used half of his rehab days; he is now back in rehab.
Or the case of a 50 year old marketing executive who suffered an anoxic brain injury as a result of an MI while working out at the gym. His deficits were primarily cognitive but a major barrier for him to return to work. His insurance denied an inpatient admission but Ron and the patients family advocated that intensive cognitive rehab was what he needed for any possibility of returning to work. The insurance company approved, and the man is now back to work.
Eileen Hughes, Manager of MGH Case Management Support, praises Ron's ability to identify and 'build the case' for the next appropriate level of care. 'Ron helps our staff understand what level of care is appropriate, and provides a better transition for the patient and family so they can achieve the best outcome'. She describes another case of a young gunshot victim who lived in New York. His injury occurred in Boston so he ended up at MGH, but ideally his rehabilitation should occur closer to his family and support systems. After a complex acute course, Ron was consulted and was able to help get him into a rehab facility in New York, despite a barrier with payer source.
Other case managers confirm these sentiments. Karen Hawko, who works with trauma patients on Ellison 7, says that Ron is extremely effective dealing with families in crisis. He helps them to understand the functional impact of the injury, as well as the progression and eventually prognosis. Karen, as well as White 12 case manager Kristin Sybertz, comment on the value that he adds to the clinical team by teaching them to look for the 'rehab moments'. His advocacy focus is on what the patient can do, not what they can't do. This outlook, combined with the expert medical management and case management from the MGH teams, result in better outcomes for patients.
Dr. George Velmahos, MGH Chief of Trauma, Emergency Surgery and Surgery Critical Care, sums it up well. 'Ron's contribution is significant not only because of the sheer magnitude of the service he provides but more so because of the way he provides it: with grace, kindness, decisiveness, effectiveness'.
Ron would like to see this model of PM and R replicated in other settings, and reports that it is beginning at Brigham and Womens with another Physiatrist, Dr. Jason Frankel. Ron also hopes to someday see a fellowship created at MGH for PM and R. Until then, he continues to learn, to teach, and to help every patient achieve the best possible outcome.