The following text formed the body of my email to several individuals – both in and out of medicine & rehabilitation; and in and out of the country. Their replies were invaluable; interestingly, nearly all consented with the views presented in the email.

Dear friends,

I am the keynote speaker for a national level workshop on "Rehabilitation Nursing" here at St. John's Medical College Hospital, Bangalore, on the 19th of this month. I would like to make the best of this opportunity to further rehabilitation both here & elsewhere.

The main thrust of my talk will be that traditional “Organ-specific Medical Practice” as practiced across the world is being buffeted by winds of change, and is not doing too well itself. “Organ-specific medical practice” was ideal a couple of decades ago, and is still ideal for anybody who has one or two specific problem.

However in today’s world where the average patient’s problem list ranges from 4 to 10, this system is itself having trouble coping. And even when there are 6 or 7 problems identified by the treating specialty, there are often many more which have not been identified, or worse, simply ignored as not relevant for that specialty. These often may be relevant for the patient. Referrals to multiple other departments only has limited and often delayed results.

The demographics of patients being admitted all over the world are changing. Some of the reasons for this are:

1. People are growing older
2. People are growing sicker
3. People are getting richer
4. People are growing wiser (more exposed to treatment abroad) and
5. People are growing more demanding.

These are the tectonic plates that are shifting in the medical world. They may not be appreciated or even recognized. However the ramifications of these seismic social changes will change the medical world forever.

The average in-patient admitted in St John’s has medical illnesses that straddle 3 different specialties.

Fragmented care, conflicting opinions, escalating costs are all a serious cause of concern - both to patients, and to health management teams.

Rehabilitation – with its central focus – on function is most patient-oriented. And with its central focus on function, rehabilitation cuts across traditional organ- specific medical disciplines. Most rehabilitation doctors have knowledge that exceeds theoretical knowledge; they have actual hands-on practice managing a variety of both medical and surgical problems.

Such an approach gives cohesive, comprehensive, cost-effective care to the patient - and to hospitals.

With global economic pressures, other more costly approaches are themselves going to feel the pressure. Health economies are around the world are already starting to re-look existing medical strategies, and to look for alternatives. In the US and in UK, hospitals are increasing run by managers. In UK doctors are given incentive to take up General Practice which is very similar to Rehabilitation Medicine.

I believe the alternative is already existing but un-recognized. Over the next 20-30 years the solutions that are inherent in Rehabilitation Medicine are going to become more and more palatable to an insurance-dominated, economic-centred and money-strapped hospital administrations.

I believe that the general specialties - General Medicine, General Surgery, Obstetrics & Gynaecology, Paediatrics and Community Medicine will experience a resurgence, with Physical Medicine & Rehabilitation being the New Kid on the Block.

It is always better to be in the fore-front, rather than be dragged by the crowd. My appeal to the Administration would be to continue to be a national leader and develop Rehabilitation Nursing by starting a Post Basic Diploma course in Orthopaedic and Rehabilitation Nursing here at St John’s.

Editor’s note: This speech was written in preparation for the keynote address on the National Conference on Rehabilitation Nursing at St. John’s National Academy of Health Sciences, Bangalore in July 2012

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