What does a physiatrist do all day?

4 p.m. today (May 27, 2024) Most Monday afternoons at this time, Dr. Paul Winston would be doing research embedded in clinical work at the Victoria Peripheral Nerve and Spasticity Clinic, an outpatient clinic he leads in the Victoria General Hospital for patients affected by life-limiting spasticity issues resulting from strokes, cerebral palsy, multiple sclerosis, acquired brain injuries or spinal cord injuries.But from 4 p.m. to 6 p.m. today, the acclaimed physiatrist and former Canadian ballet dancer cum physician will be at the Royal Jubilee Hospital in downtown Victoria for the public premiere of Finding Freedom: Freezing Nerves to Reduce Spasticity and Pain, a documentary that both explores and showcases the innovative technique that Dr. Winston and fellow Canadian physical medicine and rehabilitation specialist Dr. Daniel Vincent have developed using cryoneurolysis to reduce spasticity and improve movement, restore function and reduce pain in patients.The screening, which can also be seen online via Webex, will be followed by a talk with Dr. Winston and patients who have experienced the mini-invasive, nerve-freezing procedure.It’s the fourth such film made with funding from Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC) and B.C.’s Island Health as part an effort by Dr. Winston and his team to promote the procedure in the global medical community.“We made the documentary as patient story telling using the Indigenous informed consent model of Dr. Lisa Boivin, which has been so important to us,” said Dr. Winston. “The patients must tell their own stories, which are intertwined with our journey.”Due to what he calls the “extraordinary” results of the cryoneurolysis treatment, Dr. Winson said the new 35-minute film features worst-case scenarios (i.e. patients with severe problems that have not found relief) rather that best-case patient scenarios. “The filming days were just the patients who showed up that day, so it is transparent and real,” said Dr. Winston. “We wanted to highlight the humanity behind the innovation.”He said the main challenge in his work is having to continually search for funding. “Every member of my team has been funded by our local efforts, not the province,” said Dr. Winston. “We need to change the system and secure funding for everything.”6 p.m. Dr. Winston always tries to make it home to have a healthy-food supper with his partner and their young-adult son Kieran. “I’m not the main cook,” he said. “But I do like to bake.”8 p.m. Dr. Winston likes doing paperwork “on the couch” in the early evening before reading or watching a series or film on Netflix. 10:30 p.m. BedtimeRead: What does a psychiatrist do all day?6 a.m. Dr. Winston is always the first one up and likes to start his day with a fresh-made latte from his coffee machine. Then, depending on the season and the weather, he works out with weights at home or goes for a jog or a swim at a nearby lake.He then takes his emails from Europe, where he regularly runs two-day workshops and training sessions on assessments and treatments for neurologic disorders in general and spasticity—his primary research area—in particular.Chief among those treatments is the cryoneurolysis procedure he pioneered to help reduce spasticity and pain and improve function and motion—and that he hopes to one day see in widespread use around the world.Dr. Winston also runs similar workshops in Victoria for Canadian and foreign doctors and medical specialists. However, reams of paperwork are required to get even day-long observation accreditations for international doctors. “B.C. does not allow any unlicensed B.C. physician to observe clinical work,” said Dr. Winston. He is grateful however for efforts by the College of Physicians and Surgeons of B.C. for temporary licences that allow them to train in direct patient care. “Most patients seem to love seeing so many doctors from around the world joining in their care,” said Dr. Winston.Still, he said many doctors who want to attend his workshops are able to attend only as observers due to the difficulty of English proficiency tests they must pass for the two-day course—something Dr. Winston is hoping to see change.“I’m committed to breaking down barriers to accessing care and making it more equitable,” said Dr. Winston. “Advocating for change is a reflection of my passion for life and for my profession.” 7:30 a.m. After a light breakfast —often a bagel with cream cheese—Dr. Winston is out the door and on his way to spend the day at either a hospital or the clinic.As a fulltime physiatrist, medical director of rehabilitation and transitions at Island Health and a clinical associate professor with UBC’s division of physical medicine and rehabilitation, Dr. Winston does clinical work at both hospitals and a community office in Victoria. However it’s his research work at the clinic—broadcasting tangible treatments like the cryoneurolysis procedure to the world through initiatives like the new film and through groups like CANOSC, which he co-founded – that has been his primary focus for the past 14 years.The team’s research coordinator is Dr. Mahdis Hashemi, an internationally-trained physician and a physical medicine and rehab specialist.Clinical researchers also regularly do six-month clinical blocks at the clinic, such as rehab medicine specialist Dr. Romain David with the CHU de Poitiers in Poitiers, France.Dr. Winston notably finances clinic salaries and expenses through fundraising activities with Island Health as B.C. universities and hospitals do not have an established provincial funding model for its physician lead research.“It’s very unfortunate,” said Dr. Winston. “We need to change the system and secure funding for everything.”The clinic notably designed and developed the cryoneurolysis procedure for spasticity, which involves deep-freezing nerves with nitrogen gas using a tiny probe through the skin to relax muscles and restore function.Dr. Winston said the procedure, which can be done bedside with a portable ultrasound (something donors funded through the Victoria Hospitals Foundation), has immediate beneficial effects on patients.“Pain from stroke can basically condemn some patients to never functioning in society again,” said Dr. Winston. “It might be too painful for them to walk or they may not be able to dress or feed themselves.”He said he regularly sees patients who are immediately transformed by the procedure. “Even if they don’t gain more active movement, the pain may improve and make the movements easier,” said Dr. Winston. “Patients are sleeping through the night, they’re no longer taking opioids or painkillers. “For some people, the results are dramatic,” said Dr. Winston. “Each patient is different, but it’s nice to see the excitement in a therapist’s face when they come back in the morning and they say, ‘What did you do to my patient? They’re a new person!’”Dr. Winston calls the procedure and his team’s ongoing efforts in both research and in communicating its benefits far and wide a “a highly meaningful” project for humanity.“It’s taking suffering that robs people of their independence and mobility and gives them back as much as possible,” he said. “We’re helping to give people back their freedom, their autonomy —and it is very rewarding.”Like the title of Dr. Winston’s Twitter page, where he posts movement-promoting videos of him dancing with staff that have generated 150,000 views, restoring movement is the goal of his professional career.But it sure didn’t start out that way. Raised in downtown Toronto in the 1970s, Dr. Winston trained as a dancer at the National Ballet School and spent six years with the National Ballet of Canada, performing with such illustrious Canadian artists as Karen Kain.His career was briefly halted in the 1990s however when a bicycle accident left him with a dislocated shoulder and complete atrophy in the deltoid muscle from axillary nerve damage. Rehabbing from that injury much faster than doctors expected led him to medicine.After going to an alternative and distance school to get Grade 13 credits and Grade 11 physics and chemistry, he applied to—and was accepted by—the Western’s medical school in his mid-twenties.During his four years of studies, Dr. Winston was drawn to rehabilitation medicine in general—and physiatry in particular—after studying under Dr. Gail Delaney.“I met some patients in a gym with different spinal cord damage trying to regain movement,” said Dr. Winston. “It was a revelation for me. A light came on: This is what I want to do.”After doing a five-year residency in physiatry—a time when he and his partner became parents—Dr. Winston and his young family moved to B.C. where he got a job with an acute-care unit in a Victoria rehab hospital and did both inpatient and outpatient calls.“I fell in love with seeing people at the beginning of admission, at the start of their journey in a new life, especially after serious brain injury,” said Dr. Winston.He remains in the rehab medicine department at Victoria General Hospital, a large hospital with specialties in neurologic trauma, neuro pediatrics and maternity care.“When I showed up there were six physiatrists in Victoria—now we’re 12,” said Dr. Winston.His two areas of focus are complex regional pain syndrome and cryoneurolysis.His ground-breaking work in the latter area has garnered Dr. Winston many awards and accolades in medical circles across Canada and around the world.Dr. Winston said patient efforts and specialised techniques such as cryoneuroloysis are the tools needed to dull pain and restore movement—not reliance on chronic medication use.“Opioids don’t work in back pain,” he said. “My whole career now is trying to reduce painkillers. Restoring and using movement and exercise and interventions to control and improve pain states is a long journey for patients. But it’s the most meaningful trip in their new lives.”

What does a physiatrist do all day?

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