By the time I see a patient, it is not uncommon that they've seen between 10 and 15 physicians. In addition, they've also seen a lot of other treatment specialists. In this next section, I will try to explain the what each specialist does and how that relates to head injury. Each discipline is listed alphabetically.
Dietitian-- A dietitian or nutritionist may sometimes get involved in your case. Following a head injury, you may not be as physically active as you used to be. It is not uncommon for people to gain weight following a head injury. The dietitian or nutritionist will help you to a more healthier diet and the means to lose those extra pounds.
Ear, Nose and Throat Doctor (ENT)-- In a car accident, you may smash your nose or take a blow to the front part of your head. Many people experience difficulty breathing because the cartilage in the nose has been crushed; they may snore a lot more, or they may have multiple sinus infections. Some of these sinus infections can go on and off for a long period of time. As a result, you may be sent to an ear, nose and throat physician.
Insurance Adjuster-- This is someone who is not in the medical system directly, but who has a great deal of impact on your care. This is someone from the insurance company who has the responsibility to figure out what medical bills they will pay for. They will not pay for treatments that are unrelated to your accident or for pre-existing illnesses. Because many insurance adjusters have hundreds of other claims, they may hire a case manager. Generally this is a nurse who has prior experience in dealing with head injury. A case manager may come to your home to take a lengthy history from you and discuss your injuries with your doctor. The case manager functions as an advisor to the insurance company; however, it is the insurance adjuster who finally authorizes or denies treatment.
Internal Medicine-- A good way of thinking about this physician is to look at what is inside or "internal" to your body (dealing with your guts and organs). Internal medicine deals with the complex interaction of systems inside your body. This doctor is usually a consultant rather than someone who follows your care from start to finish.
Neurologist-- This is a physician that you're likely to see following a head injury. A neurologist deals with the brain and nerves. The neurologist is usually a consultant rather than a primary doctor for head-injured patients. The most common problem that neurologists deal with is headaches. Neurologists also deal with seizures. The neurologist may give you a test called an EEG. This measures electrical activity in your brain to see if something abnormal is going on. If you do have a seizure, the neurologist is likely to give you anti-seizure medications to help control seizures.
Neuropsychologist-- A neuropsychologist is a psychologist (See Psychologist) with advanced training in how brain injures can effect behavior. The neuropsychologist gives tests that are very sensitive to the effects of a brain injury. This testing will locate areas of the brain that may be damaged. Many neuropsychologists are also involved in planning treatment strategies to improve thinking in damaged areas of the brain. Because recovering from a head injury is extremely stressful, some neuropsychologists also do counseling to help the head-injured person and family members to deal with the recovery process.
Neurosurgeon-- This is a surgeon who does surgery on your brain or nerves. In the early stages, you may have a bruise on your brain. If you put pressure on the brain, you can stop important parts of the brain from working (e.g., parts that control breathing or being awake). In the early phases of a head injury, a neurosurgeon may be needed to stop bleeding in the brain. Because they are surgically oriented, they tend not to follow brain-injured people over long periods of time. You may be referred to another doctor for your long-term care.
Nurses-- Nurses are there to carry out medical orders and apply medical treatments. They interact with you daily. They get you up, they give you medications, and they'll chart how you are doing. Nurses cannot prescribe medications; that must be done by a physician. There are nurses who have gone for additional training. They are often called clinical nurse practitioners. Doctors come to rely heavily on their input.
Occupational Therapist (also called OT)-- When many people hear the word "occupation", they think that means "getting a job." Although occupational therapists can help with returning to work, they tend to deal with activities you do every day. In the hospital, they call this "ADL's" (activities of daily living). For example, we all brush our teeth, comb our hair, get dressed, and generally use our hands in a coordinated and smooth manor. With the head-injured patient, the occupational therapist also works on high-level thinking skills necessary to return home and work successfully.
Ophthalmologist (also, Neuro-ophthalmologist)-- This is an eye doctor. Following an accident, some people will have a change in their vision. Vision can become blurry, doubled (seeing two of everything), or have missing areas. The neuro-ophthalmologist has more advanced training in vision problems caused by a brain injury. If your vision has changed, you may go to an optometrist (the person that gives you eyeglasses). A blow to the head can produce changes in your vision. Following a head injury, some people go through 2 or 3 pairs of glasses in one year. Right after the accident, their vision is very bad, then improves with time, and improves again.
Physical Therapist (also called PT)-- Walking and movement means freedom. The physical therapist is a key person in returning physical ability. This is often very painful work. Re-learning movement, or getting your arm or leg to fully extend (called "range of movement"), is often very difficult and can take long periods of time. When people are in the early stages of an injury, they tend to focus on walking. For most of my head-injured patients, the ability to walk and move seems fine. The physical therapist may be called in for common problems like neck or back pain.
Plastic Surgeon-- This doctor will work on removing scars. If you are lucky, a plastic surgeon may be in the ER when you come into the hospital. They may sew up your face or other areas on your skin. For most of my head-injured patients, doctors like to wait for 6 to 9 months before they send you to a plastic surgeon to remove scars that may have developed. Plastic surgeons can do some remarkably good work at removing scars. For example, some scars may be red or slightly raised or bumpy. The surgeon can go in and lighten or diminish the scar so that it's nearly invisible. I have seen some really amazing work by these specialists.
Psychiatrist-- A psychiatrist is a physician who works with people who have emotional or behavioral problems. They often give medications to help assist people in dealing with intense emotions or behavior. In the early phases of hospitalization, the head-injured person can be very confused and agitated. If someone is confused to point of hitting the nurses or being threatening, medications may be prescribed to help calm the patient down. Later in the recovery process, people can become depressed and a psychiatrist may also use medications to help cope with depression.
Psychologist-- A psychologist is not a physician; so does not prescribe medications. A psychologist works with behavior and coping. In the hospital environment, the psychologist has several roles. One role is testing. Psychologists have developed standardized tests to measure things like intelligence. The psychologist may also be called in to help the head-injured person cope with emotions or control behavior, or to help the family deal with different aspects of the recovery process.
Radiologist-- This is a physician who specializes in looking at X-rays, CT Scans or MRI's. He or she is involved with diagnosing problems using X-ray or other imaging equipment. They look at the X-ray or CT Scan and then send a report to your physician.
Recreation Therapist-- A recreational therapist looks at a lot of the important things we do in life--recreation and fun. In the hospital, you may be involved with a recreational therapist who may ask you about your interests and hobbies. I've known some people who are in a wheelchair but loved bowling before the injury. With the aid of a recreational therapist, there are ways that you can continue to bowl, even in a wheelchair. A recreational therapist often helps people to reclaim the enjoyable parts of their life.
Rehabilitation Medicine Physician (also knows as a physiatrist)-- This is a physician who treats individuals who have multiple medical problems. If you are in a car accident, you may have a number of injures, including broken bones, bruises, infections, and so on. Your recovery may take a long time and involve multiple doctors. The rehab medicine doctor commonly takes the role of the primary physician. The medical system has realized that we need one doctor to coordinate treatment when multiple doctors are involved. This responsibility is typically given to the rehab medicine physician.
Social Worker-- In a hospital, you're likely to be involved with a social worker. For some individuals, a social worker helps provide discharge plans for leaving the hospital. In other hospitals, social workers also help the patient and family members to cope with their medical problems.
Speech/Language Pathologist (Speech Therapist)-- Helping people improve their speech is just one area the speech pathologist works with. They also help people with all sorts of language and cognitive problems. With a head-injured individual, the speech therapist may work on attention, memory, organization, planning, and sequencing, as well as things like reading comprehension and writing skills. They also specialize in teaching memory strategies (one of the classic problems in head injury).
Vocational Rehabilitation Counselor--This is a counselor who will assist you with a successful return to work, school, or volunteering. They will help support you by setting up job coaching, job strategies, and school strategies. The counselor will locate jobs, school programs, and volunteer sites that best match your individual needs.
By Dr. Glen Johnson, Clinical Neuropsychologist
5123 North Royal Drive || Traverse City, MI 49684
Phone: 231-929-7358 || Email: firstname.lastname@example.org
Copyright ©2010 Dr. Glen Johnson. All Rights Reserved.