FIRST CLASS quality healthcare. Barriers such as attitudinal, physical, communication, and financial exist and have been highlighted by the World Health Organization.1 One of the main barriers is lack of training on how to care for this population.2
A Journey of
LEARNING
By Vincent Siasoco, MD, MBA INITIAL TRAINING After attempting to call a few places, I tried another clinic to set up a clinical rotation for my elective. I made the call and introduced myself, “Good morning. I’m a third-year family medicine resident and wanted to ask if I could do a clinical rotation at your clinic for patients with intellectual and developmental disabilities (IDD)?” Five to 10 seconds of initial silence passed by, at which point I was transferred to three different staff, and then finally asked for my name and contact number and told that someone would call me back. The following afternoon, I received a call from a kindly, albeit slightly surprised, medical director. A week later, the first elective of its kind in my program started. Following years of schooling and countless sleepless nights in residency and searching for any type of experience with this underserved population, so began my first training for a two-week period…just a few weeks away from graduating from my residency program. BARRIERS TO CARE For a family member or caregiver caring for a loved one with IDD, the challenges are well known in accessing 12 | HELEN • helenjournal.org
ONGOING TRAINING My two-week elective training flew by, as did graduation. After residency, I landed a job at a non-profit disability agency, working in their outpatient clinics in New York City. My education and training with this population had only just begun. I recall the first few days looking out into the waiting room, a mix of different faces, bodies, and sounds. As time went on, I became more comfortable being their physician. I got to know the patients and how to communicate with each. I began to understand where they lived and what their needs were. I met countless direct support professionals (“DSP”) and learned the importance of their roles. The intersection of primary, oral, and behavioral healthcare was highlighted as was the importance of avoiding diagnostic overshadowing. It took time and some of which was a trial by fire especially when it came to learning about state regulations, forms, and community support services (or lack thereof). Fortunately, I was able to find my way and learn how to care for this population with some of the best teachers being my own patients. DATA Reports reveal two-thirds of adults with IDD have two or more co-morbidities including obesity and chronic mental health needs. More than 40% have been diagnosed with four or more chronic conditions in addition to IDD.3 Although individuals with IDD are living longer lives, over all, the average lifespan of those with IDD remains substantially lower than those in the general population.4 TRAINING OTHERS Though my path was unique, I was cognizant about others who may not have had the opportunity, not sure where to turn, or worse, not want to be bothered to make the effort to learn about this population. As my career
