Reply to Forum 10: Neither the Monster Nor the Maker

The Frankenstein metaphor is compellingly used to describe the conundrum we face today. The image of a barely stitched-together creation, probably misunderstood and extremely untethered, etches in the mind of the reader. The creature wreaking havoc in the absence of a guiding hand resonates eerily well with the state of rehabilitation in many places. However, unlike Shelley’s novel, the problem here is not that we created something dangerous but that we abandoned our role in shaping what we created. Let us step back from the metaphor and examine the quieter reality behind the scenes. We did not vanish out of guilt or grief like Victor Frankenstein. Instead, we simply became invisible through inertia, in systems that no longer demanded our presence. Frank H. Krusen and Howard A. Rusk laid the foundations of physiatry not to create technicians or referral bots, but to build a specialty that looked beyond organs and pathology, toward function and human ability. Yet in many teaching hospitals, our presence is now seen as optional, especially with the National Medical Commission removing Physical Medicine and Rehabilitation from the list of mandatory subjects in undergraduate medical education. It is in this vacuum that narrative is being rewritten. One where therapists are positioned as the face of rehabilitation and the physiatrist is reduced to a mere pawn on the board, if acknowledged at all. We work with some of the most skilled, dedicated professionals in therapy. We share patients, goals, credit and often frustrations. However, the system we are all part of has eroded the natural checks and balances that should have existed. Instead of collaborative, supervised practice, we now see unregulated autonomy. Instead of interdisciplinary planning, we see silos. And the worst part? Much of this has been normalised. Much of this has set precedent for the upcoming medical post-graduates, deterring them from opting the branch at times. And now, we are paying the price. An array of treatments without real evidence is sold under vague banners of ‘functional recovery’, ‘comprehensive rehabilitation’, ‘non-surgical cure’ and ‘holistic care’. The irony is that these offerings appeal to patients more than our language of function, impairment and outcome measures ever could. The solution lies not in lamenting what is lost, but in reclaiming what is ours. Physiatrists are physicians first. We diagnose, prognosticate, plan and lead. We design comprehensive rehabilitation protocols. We look at function through the lens of evidence-based medicine. We understand the disease processes and the potential impairment and disabilities they can cause. We stay through the long, often unseen path of reintegration. If we want our discipline to command respect, we must start by respecting its full scope ourselves first. Taking ownership of interdisciplinary planning Reforming teaching curricula – ensuring MBBS and post-graduate students understand the physiatrist’s role in function-oriented medicine Demanding our rightful place in institutional structures Engaging with policymakers, research and public health. We must definitely be present where the story begins – in the minds of medical students, the conference halls of other specialties and the bureaucratic rooms where services are budgeted and sanctioned. Because if we are not present in these spaces, someone else will speak on our behalf. If we do not conquer the uncharted territories that lie within our boundaries, someone else will build cities there. Victor Frankenstein was undone not by his ambition, but by his abandonment. His creature did not seek violence or destruction – it sought purpose. It sought meaning. And when that purpose was denied, destruction followed. Let us step back into the story, as authors to the new tale. As clinicians, coordinators and most importantly, as leaders of a specialty that has so much to offer. A specialty that looks for meaning in medicine.