“If you’re really listening, we actually learn from each other. I learn from my patients every day, says Keith W.L. Rafal, MD, MPH director of Healing Choices, P.C., a specialty medical practice in Medway. A medical doctor and specialist with a master’s in Public Health from Tufts University, Dr. Rafal serves as Chief of Rehabilitation and Restorative Care at Memorial Hospital of Rhode Island and was the former Director of the Fibromyalgia Program at the Rehabilitation Hospital of Rhode Island. He is an assistant clinical professor at Brown University and clinical faculty at Tufts. Dr. Rafal says one of the first questions he asks patients, many of whom suffer from chronic pain, is “What do YOU think is going on?”
“It’s a very important question,” says Dr. Rafal. “Some people have a very definite answer, or they don’t know. It would never have come out in a standard interview if I didn’t give them the space and listen and observe their body language. They’re telling their story. I’m the physician, I have 30 years of experience, and I am going to bring that to bear, but I’m also aware of the limitations of that exclusive approach.” Putting away preconceptions and listening, says Rafal, is something a good doctor should always incorporate.
A physiatrist, Dr. Rafal specializes in physical medicine and rehabilitation. Physiatrists diagnose, treat and rehab a wide variety of pain related diagnosis as well as non-surgical treatment for the neurologic and musculoskeletal system.
His patients are often referred by another practitioner or another physician, and he helps them “to be in a better place and really live their life as fully as possible,” he says.
There is no cookie cutter approach to managing chronic pain. Anyone who claims to have a cure-all, says Dr. Keith Rafal, should be regarded with skepticism. Dr. Rafal works with patients who suffer from a variety of conditions. In addition to musculoskeletal problems, Fibromyalgia and chronic pain, he routinely treats patients living with a stroke, brain injury, spinal cord injury and other new disabilities, that require rehabilitation.
While he doesn’t believe in miracle cure-alls, Dr. Rafal does incorporate open-mindedness toward alternative approaches. His job is to help patients arrive at a tailored, interdisciplinary, holistic approach for chronic pain management, by offering a balance of treatments that works best for them.
The first step, he says, is ensuring a proper diagnosis.
“We want to make sure as much as we can that we understand the etiology of the pain, that a correct diagnosis and proper evaluation has been done,” says the doctor, who then helps patients determine the most appropriate combination of treatments to manage their pain, collaborating with a variety of healthcare and wellness providers.
“I’m open to working with any (healthcare or wellness provider). It’s important to me to have this interdisciplinary support system.” Dr. Rafal has worked with acupuncturists, massage therapists, physical therapists, chiropractors, psychologists, primary care physicians, medical specialist and others. In fact, he co-leads a group of practitioners from different disciplines, focused on chronic pain at Milford Hospital.
“It’s a way of educating ourselves and helping our patients,” he says.
In medical environments, he says, “When it comes to chronic pain, research shows that alternative approaches if properly chosen have intrinsic efficacy. They can be even more powerful when a coordinated approach of western and alternative care is provided. As a rehab physician, and as an integrated medicine physician, I’m familiar enough with all these disciplines to have a sense of what may be best suited for each patient.” Dr. Rafal can identify what specialists would help.
“Knowing how to support patients on their journey is a really important role,” says Dr. Rafal.
Because of his background, Dr. Rafal can be a resource for his patients and their specialists seeking advice on pain medication options. “I can evaluate how pain medication has impacted each individual and what some of the alternatives may be. If patients are still having pain, are we addressing it—looking at it from an interdisciplinary perspective?”
Dr. Rafal takes the mind-body approach so seriously, he has even spearheaded an international patient stories project supported by the nonprofit Our Heart Speaks.
“We do not routinely acknowledge what it means on a very fundamental level to be faced with the challenge of living with a new disability. This international patient stories project speaks to the power of the human spirit by giving voice to those who have been successful in finding meaning and purpose in their lives by sharing their heartfelt stories,” says Dr. Rafal, of Our Heart Speaks (www.ourheartspeaks.org), which is intended to serve as inspiration for the disability community, patients, caregivers, healthcare providers and thought leaders in health care.
Rafal hopes to inspire “a culture of possibility,” a paradigm shift. He was inspired to create the site by the questions that arose from patients he treated at rehab facilities who faced the unknown with newly acquired disabilities.
“Initially, when patients are in the hospital, once they are past concerns over survival and questions over lost function like, ‘Am I going to walk?’ and ‘Am I going to talk,” that are very important, there is also a deep searching of ‘Who am I now?’” says Dr. Rafal.
With compassion and a more holistic approach, we look at the whole person and all evidence based treatments that can make a difference. With this perspective, Dr. Rafal works with his patients. being open to what might be effective and makes sense for that individual. For example, he says, a person may find acupuncture or physical therapy to be helpful for healing and pain management, but may still need a knee replacement. It is not necessarily an either/or.
Ultimately, says Dr. Rafal, “What I really want to find for the patients I treat is, what will work for them and to help provide that guidance.”
Healing Choices is located at 89 Main Street, Medway, Ste. 112., or you can find the practice online at http://www.healing-choices.net/.
Dr. Rafal can be reached at
(508) 533-1110.
Issue Date:
October, 2017
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