How to hold your rehab plan together after a serious crash
Insight from a rehabilitation physician and a nurse care coordinator on building one plan that works
A bad crash can leave you with a broken bone, neck pain, headaches, poor sleep and a pile of referrals. Each specialist sees one piece. You still have one body and one day to get through. Rehab works to bring back the abilities you need. It often involves several kinds of clinicians. Early on, the most important question is who will tie the whole plan together. [1, 2]
To a rehabilitation physician, a good plan links treatment to the activities you need. To a care coordinator, it names who is in charge of each referral, medicine change and follow up visit. You shouldn’t have to guess which office will answer your question. [1, 2]
Find out who your main contact is
Ask your primary care doctor, rehab physician or discharge team who will coordinate your care. The answer may depend on where you’re treated. Write down the office number and the best way to send a question. Ask who fills in when that person is away. [2, 3]
If several offices are involved, ask for one clinician to review your full medicine list. That same person should look over all your activity limits together. [2, 3]
A lead contact doesn’t replace your specialists. Their job is to connect the advice you get. Suppose the orthopedic team limits how much weight you can bear. Then the physical therapist hands you a new walking task. Ask them to sort out the two instructions before you try it. When two plans seem to clash, quote the exact instructions and ask for one shared answer. [2]
Build a one page map of your care
Keep a single page that a helper or a new clinician could grasp in a minute. List each injury or symptom, the office treating it and the current instructions. Add the next appointment and any question still open. Include a current medicine list with doses. Bring your discharge papers and test results when you have them. Don’t assume every office has the same records. [2, 3]
- Who is treating each problem, and what’s the next decision they’ll make?
- What limits apply today to walking, lifting, driving, work or exercise?
- What happens if an appointment or referral can’t be scheduled quickly?
Keep the map short. Use it to communicate with your team. It doesn’t need to be a second medical chart. Date every change. If pain, tiredness or trouble focusing makes paperwork hard, ask someone you trust to help keep it current. [2, 3]
Set goals tied to your everyday life
Rehab may include physical therapy, occupational therapy, cognitive rehab for thinking skills, pain care or counseling. Each one meets a different need. Tell your team what you want to be able to do again. That might be climbing the stairs at home, making a meal, reading for 20 minutes or picking up a child. [1]
A good goal names both the activity and what’s in the way. “I cannot get into the shower safely” guides care better than “I need to be normal.” [1]
Ask how your progress will be measured and when the plan will be reviewed. A target may shift as swelling, pain or thinking gets better. Needing a different approach gives your team new information. It is no sign that you failed at rehab. [1]
Close the gaps between visits
Before you leave each appointment, repeat the next step in your own words. Ask who will send the referral and whether it needs approval first. Find out when to expect a call and who to contact if no one calls. Get written instructions. Handoffs between care settings often cause confusion, especially when several clinicians are involved. [2, 3]
Tell the team about anything that makes the plan impossible. Maybe you have no ride, stairs at home, a job that requires lifting or a copay you can’t afford. A social worker or a patient navigator may help find rides and financial resources. The best medical plan is the one you are able to follow. [1, 2]
Signs your plan needs a fast review
Call the office treating you when symptoms get worse or a new one shows up. Do the same if an activity keeps causing a big setback. After a possible head injury, get emergency care for a worsening headache, repeated vomiting, weakness or seizures. Growing confusion or trouble waking up also needs emergency care. For other injuries, follow the warning signs on your own discharge papers. [4]
A question for your next appointment
Ask two things at your next visit. “Who is coordinating my overall recovery?” “What is the one goal we are working toward before the next review?” Write down the answer. Note the date you’ll come back to it.
Sources and further reading
- 1MedlinePlus: Rehabilitation
- 2AHRQ: What is care coordination
- 3AHRQ: Discharge planning and transitions
- 4CDC: Concussion danger signs
General U.S. information drawn from rehabilitation medicine and care coordination. Your own treatment team has to set your limits and decide what comes first in your care.
Keep learning
Safe Driving Resource Center
Guides, self-checks and articles for drivers, parents of new drivers, and families recovering after a crash.
