Medical Staff Profile: Q&A with Ford Vox, M.D.
Dr. Vox joined the medical staff of Shepherd Center in summer 2012. He treats patients who are recovering from traumatic or non-traumatic brain injuries, as well as people who have had complications from a stroke or tumor.
Q: Why did you decide to become a doctor and then specialize in physical medicine and rehabilitation (PM&R)?
A: My interest in medicine began due to my interest in science. I thought about becoming a physician, but I also wanted to be an English professor. I kind of view myself as more of a humanistic person. I was always interested in arts and letters. As an undergraduate, I took a lot of science classes, but also took philosophy and political science classes. I’ve always had broad interests and maintained that throughout my career.
After college, I went into medical school not knowing what specialty I wanted to pursue. Then I was referred to a PM&R doctor about some back pain I was having, and that was a good experience. I thought about becoming a PM&R physician who treats back pain, but then I got some early experience with inpatient rehabilitation. That patient population was very compelling to me. There is a lot of dire need. It is very rewarding to be able to help patients who need neurologic rehabilitation.
I am drawn toward the brain injury patient population in particular because I grew up with an older sister with a mental disability. I was always protective of her. There were some difficult situations in which people made fun of her in school.
In addition, I am drawn to brain injury rehabilitation because brain science is one of the most interesting areas in medicine today. So much remains to be known, and I hope I can contribute to the field. There is a lot of uncharted territory in the practice of brain injury rehabilitation. A lot of what we do is more experimental in nature in the sense that each patient is treated based on his or her own unique constellation of injuries.
At Shepherd Center, we get a lot of complex brain injuries with effects that are sometimes unpredictable. Typically, there are a handful of diagnoses yet to be made once a patient arrives here. I appreciate the educational aspect of my job in terms of explaining the neuropathology of the injury to the patient and the family, and to provide them with advice for how to cope. I have a body of expertise because I’ve seen so many of these patients, and I enjoy relying on that experience to offer the best available treatments to my patients.
Q: From the patient’s standpoint, what qualities make you an excellent physician?
A: By nature, rehabilitation physicians see their patients for weeks or several months. We care for them during the entire course. It’s a unique field of medicine that makes it possible to treat patients at a high level for such an extended time.
I rely on this time with my patients and their families as my number one advantage. I focus on building therapeutic relationships with patients and families. That is key in rehabilitation. There has to be a sense of trust on both sides, and I work to build that.
Also, I try to stay open-minded in my patients’ treatment plans. As you become an expert in treating a particular condition, it’s easy to start seeing your way as the only right way and neglect other ways. But I remain open to the input of families and therapists. Sometimes, the families are effectively additional nurses for the patient. I appreciate that rather than push back from it.
Q: Shepherd Center is known for some distinctive approaches to the practice of rehabilitation medicine. What aspects are most professionally rewarding to you and effective in producing excellent patient outcomes?
A: Shepherd Center has so many more additional resources than the average rehabilitation hospital, which is trying to make do on insurance payments alone. Those resources include our dynamic therapeutic recreation program and our well-integrated psychological services, which are very important to patients and families. Also, I really appreciate that our nurses are only following four to five patients versus the six or seven that is common elsewhere. This level of nursing attention, which is a big investment for the Center, allows our nurses to know their patients and families better and serve them better.
As an attending physician at Shepherd, I have relationships with a wide array of consulting specialists that allow me to expand the services I can offer to my patients during their rehabilitation course. It allows for more continuity of care and more comprehensive care. For example, at most freestanding rehabilitation hospitals, a patient would have to be transferred back to an acute care hospital for surgery. But here, because of Shepherd Center’s relationship with Piedmont Hospital and other facilities, we can get an expert opinion, determine an intervention and often get a procedure done the same day. Then the patient comes right back to Shepherd Center for post-op care, in our ICU if necessary. Keeping more of our patients admitted here continuously, no matter what has to be done, allows us to capitalize on the limited time we have for inpatient rehabilitation.
Q: How do you offer hope to patients at Shepherd?
A: By now, I’ve seen most every type of injury before. I’ve seen people of different ages and levels of injury severity and they have come through it. I am able to see through what seems like insurmountable challenges at the time. I’ve seen patients in follow-up appointments one or two years after the injury, and they are continuing to make remarkable gains. I’ve seen people who were in a vegetative state for several months, and they have recovered to the point of returning to college. Of course, we cannot guarantee that, but it does offer grounds for giving hope to patients and families.
Q: What should brain injury patients and their families keep in mind as they start their recovery journey?
A: One of the most important factors for success is not seen on a brain scan. It’s really the family structure and the strength of the patient’s relationships with family and friends. Frankly, brain injuries strain people to a breaking point. And just as an injury damages parts of the body, it can damage relationships – if not in the beginning, sometimes months or years later. People need to be prepared as much as possible that this will be the most trying period of their lives in terms of their relationships with their loved ones.
Their loved one’s perception of the world and aspects of their personality may change. Families and friends need to be as forgiving as possible as the patient recovers. Sometimes, it may seem too much to ask, but typically the turbulence calms at some point. Still, families and friends must recognize the storm they’re going through may last for months or years. The people who are most successful in the end are those who have made a commitment to stick by their loved one at all costs.
Q: What have you learned about yourself and others in the process of treating people with brain and/or spinal cord injuries?
A: My work provides a daily reminder of what’s important in life, which is other people. I’ve seen people struck down in the midst of high-powered careers. They were young and healthy. As someone who is dedicated to his career and is relatively young, this experience keeps my head screwed on straight. I view my profession as a calling, but I must still recognize that it’s just one aspect of who I am. The most important thing is the people who love me.
Q: What promise does the future hold for improved treatments for people with brain injuries?
A: While I frequently use neurostimulant medications to help my brain injury patients move forward during the rehabilitation process, as a physical medicine doctor, I am always particularly interested in physical treatments. Those include the range of treatments like, heat, cold, electricity, bracing and prosthetics that rehabilitation medicine began with back in the 1940s.
It’s actually in this rather old-fashioned area of physical medicine where we are seeing the beginning of a new way to rehabilitate the brain – by selectively stimulating its injured and uninjured parts with electric current. We’ve moved a long way from electroconvulsive therapy thanks to advancements in technology.
The most promising treatment, which we are learning more about through waves of studies coming from labs all over the world, is repetitive transcranial magnetic stimulation (TMS). This is an already FDA-approved technology being used now by psychiatrists for treatment-resistant depression. With TMS, we can selectively target fairly discrete areas of cortex. In rehabilitation studies, we are finding that inhibitory frequencies of TMS applied to undamaged brain areas opposite of damaged brain areas allow the damaged brain to function better.
For example, aphasic patients (those who have speech disorders because of brain injury) have been shown to communicate better when the area corresponding to the speech zone on the opposite side of the brain is stimulated with inhibitory frequencies of TMS. I and the other brain injury specialists at Shepherd Center are paying close attention to technologies like this, and as soon as we believe they are safe and effective for our patient populations, I am certain we will be among the first centers employing them clinically.
Q: Describe your interest and involvement in medical journalism.
A: I’ve enjoyed writing really ever since I learned how to type! Given my interest in science, medical journalism is a career path I considered in college, and it occurred to me back then that I might have better access to my subject matter, and better stories to tell, if I was a doctor myself.
I can also recall a speaker at a college career day sharing his frank views about how competitive science writing had become at that time. The idea of writing about medicine from the inside perspective certainly ranked low down there on my overall list of reasons to become a doctor, but I was aware of the advantage I’d probably have in terms of scoring writing gigs and getting published.
All of my early suppositions have proved to be true, so I have to thank the 19- or 20-year-old me, and that career day speaker, for the swell advice to my future self. Today, I have relationships with several national outlets for my science writing, most especially The Atlantic, where I am a correspondent for TheAtlantic.com.
Ford Vox, M.D., Physiatrist, Shepherd Center
Experience:Medical director of brain injury rehabilitation at New England Rehabilitation Hospital in Woburn, Mass., 2011-2012; Clinical assistant professor, Tufts University School of Medicine, Boston, Mass.
Physiatry Residency:Washington University in St. Louis School of Medicine
Fellowship:Boston University School of Medicine
Medical School:University of Alabama
Undergraduate Degree:Rhodes College, Memphis, Tenn.
- Dr. Vox and his wife Lisa have moved 10 times since they graduated from college.
- Though Dr. Vox is from Alabama, he didn’t like barbecue until his wife (who’s from Memphis) showed him “the good stuff.”
- Dr. Vox says he never got around to checking his own cholesterol until he was in his mid-30s – well after his wife got him hooked on barbecue. Doctors really are the worst patients, he adds.
Written by Jane M. Sanders
In the media
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Shepherd Center, located in Atlanta, Georgia, is a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury, brain injury, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions. Founded in 1975, Shepherd Center is ranked by U.S. News & World Report among the top 10 rehabilitation hospitals in the nation. In its more than four decades, Shepherd Center has grown from a six-bed rehabilitation unit to a world-renowned, 152-bed hospital that treats more than 743 inpatients, 277 day program patients and more than 7,161 outpatients each year in more than 46,000 visits.