ADAM LITVIN
Dr. Todd Wichman, the physical medicine and rehabilitation medical director at Encompass Rehabilitation Hospital of Richmond, came to Richmond from Womack Army Medical Center at Fort Bragg, North Carolina, where he served as the chief of physical medicine and rehabilitation and battalion surgeon for the 1-508 Parachute Infantry Division 82nd Airborne, with active service in Afghanistan.
Wichman earned his undergraduate degree from the University of Oregon and medical degree from the Uniformed Services University of the Health Sciences, with postdoctoral training at Walter Reed Medical Center in Washington, D.C.
In addition to his duties as medical director, Wichman competes in national CrossFit and mud racing competitions, is an active aviator with a commercial pilot's license, and is cultivating a hop farm in Craig County.
Interviewed last week, Wichman shares the questions that patients who have experienced a life-changing illness or injury, and their families, should ask before choosing a rehabilitation partner.
Who has been one of your mentors and why?
Dr. Todd Wichman: My residency director pointed out a truism we don’t always see, which is that communication is the most difficult thing we do. Oftentimes, it’s a one-shot deal, and if you think you are communicating well enough, you are not. And then the person who influenced me the most was Dr. Simon Auster, who just passed away in January. He taught a course called Human Context in Health Care. Dr. Auster always stressed the human component of health care, encouraging us to become involved and engaged with our patients and their families. He helped to set the standard for how a lot of us practice medicine today.
What do you share with patients so that they can make their stay the most successful it can be?
Wichman: In my initial interview with them, I like to explain what their first few days will be like, and I share that we will feed them well — we have an amazing small kitchen here — and that we will treat them very well, and if they are here long enough, we will make them part of the family. For me, the important thing is to put them in a situation where all they have to worry about is about themselves and getting better. We make sure the staff is very engaged and very personable. I then tend to leave people with a bad, dad-level joke, and then I end with my favorite saying, "Every day, a little bit stronger," as a reminder to them that while they are here, they will gain a little bit of strength every day, and importantly when they go they home, they need to continue to work every day to gain strength, to gain function to get back to their life.
How do you integrate families into care?
Wichman: We will meet with the families as a group. One of the important concepts of rehabilitation medicine is the team concept. The center of the team is the patient, and on the team is the patient’s family, and we incorporate them. We hold meetings with therapists, case managers and nurses with the family. And we provide family training — for example, safe and proper ways to transfer someone to and from the car to avoid any injury to the patient themselves and injury to the family members. We also will do home visits with the patient along with therapists and case managers. It allows us to go through the home, suggest ways to make it easier to navigate and figure out any final tasks or skills that the patient still needs to work on.
In addition to three hours or more of rehab every day five days a week, what are some of other unique approaches that Encompass takes to ensure that patients are better equipped for life back at home and in the community?
Wichman: One of the nice things about being a small, stand-alone hospital with consistent staff is that we are very interactive, and we communicate all day long, both with patients and with fellow staff members. Beyond that, all the programs are patient centered. For example, we bring all patients together to the dining room and bring them together during therapy. Sometimes the strongest role model is a peer. If you just had a stroke, maybe you are scared and uncertain, but to meet and talk to someone who is a couple of weeks ahead of you is very motivational. And after a life-changing event, some patients get a little depressed, so we provide a comprehensive approach. The doctors are trained in basic psychology or psychiatry. And the therapists and nurses spend a lot of time reminding patients that we will get them back to their life.
We also host several support groups that meet here. We encourage patients to start attending while they are here and [let them know] that they can keep coming after they do go home. Again, working with your peers can be a very powerful way of improving people’s lives.
If you had a loved one seeking a rehab program after a life-changing event, what would you recommend they look for?
Wichman: To me, the most important is what the environment is like and feels like — what kind of approaches does everyone take, how approachable is everyone, how well does the staff communicate amongst themselves? Are people approaching you with a smile? Listen to how they speak with patients. Take a tour. You will be led around, be introduced to staff, be shown what’s going on, so they get a good feel. I’d also look at safety and medical outcomes. What are readmission rates to acute-care hospitals from the facility? Medicare keeps tabs on that, and that information can be looked up online.
The last thing is what are outcomes: How many people return to home and how well are they doing? And what kind of follow-up care is offered? We have programs where our case managers call after discharge, following up on medications, making sure patients are following up with primary care and other specialists.
This interview has been edited for length and clarity. Because of the COVID-19 pandemic, restrictions have been put into place at Encompass to protect patients, staff and their families.
