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A unique primary care residency rotation in Brooklyn: the Heartshare Wellness clinic--the site of a primary care clinical rotation for Family Medicine residents from the programs of NYU/Lutheran Hospital and Mt. Sinai/Beth Israel Hospital--is where Family Medicine residents are immersed in the care of patients with disabilities.

Great disparities in healthcare for patients with disabilities unfortunately still exist. Compared to patients without disabilities, those with disabilities face greater challenges in obtaining adequate healthcare which leads to poorer overall health. Studies reveal that they're less likely to receive routine preventative screening tests such as mammograms and pap smears or have an annual dental visit. They're more prone to have high blood pressure and be overweight or obese (1) Though different causes for barriers to quality care can be identified, one of the main reasons is lack of training for healthcare professionals.

In one study, it was revealed that more than 80 percent of U.S. medical school students reported that they are not receiving any clinical training regarding individuals with intellectual disabilities. In the same study, it was noted that more than 50 percent of medical school deans report that their own graduates are not competent to care for a person with a disability. (2) Licensing and accreditation for clinicians or institutions do not require that they have expertise around disability. No established competencies or guidelines for U.S. medical training have been published. (3) In addition, a lack of sensitivity is often perceived by patients with chronic disabilities among physicians during clinical encounters. (4)

The Heartshare Wellness clinic located in Brooklyn, New York, is addressing this issue. A multi-specialty community health clinic established in 2000, the clinic provides care for children and adults with intellectual and developmental disabilities. In addition to primary medical care, the center provides podiatry, optometry, neurology, and psychiatry as well as long-term rehabilitation and behavioral health services by physicians and clinicians experienced with the population of people with disabilities. It is equipped with height-adjustable examination tables, a wheelchair scale, and a spacious waiting room with a separate dining area. Open six days a week with late night clinic hours, the patients' comfort and access to quality care is ensured.

The Heartshare clinic is also the site of a unique primary care clinical rotation for Family Medicine residents from the programs of NYU/Lutheran Hospital and Mt. Sinai/Beth Israel Hospital. In this rotation, Family Medicine residents are immersed in the care of patients with disabilities.

Upon entering the waiting room, the resident gets their first exposure to the population of people with disabilities that they'll be caring for as part of their rotation. They encounter a mix of patients with varying degrees of intellectual and physical disabilities. Some are ambulatory, some in wheelchairs. Some are verbal, some aren't. Before they see their first patient, they're given a brief lecture, not only on the different types of disabilities and associated medical conditions, but also the various barriers to care that these individual's face. They get a clearer understanding of the environment these individuals live in and the different services it takes to provide not only adequate healthcare but to maintain activities of daily living. During the patient encounter, the importance of communication is emphasized. They learn how to obtain information on patients who may not be able to provide it themselves, and ensure their plan is conveyed, not only to the patient but the caregiver at the completion of the visit. They deal with patients who may present with challenges due to uncontrolled behaviors or physical limitations. They gain confidence and comfort in doing physical exams on patients who may be using a wheelchair and realize the importance of height adjustable exam tables and staff that may be needed for assistance during these encounters. They also encounter the intense paperwork that is required by state regulations to be completed by the providers and challenges in obtaining specialized services that may be limited by the patient's insurance.

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In a recent report it has been shown that, "Even residents and the most seasoned generalist physicians could benefit from exposure to the most basic information (knowledge), to positive interactions with persons who have disabilities (attitudes), and to the opportunities to become more proficient in their interactions (skills)." (5) The Heartshare clinical rotation supports this notion. The medical residents already have strong clinical knowledge base but they benefit from this experience by learning and treating the different medical conditions of individuals with intellectual and developmental disabilities.

An even more important aspect that they learn during this clinical rotation is all the different barriers to care that these individuals experience and how a lot of them can be overcome through proper communication and solid care coordination. As the clinical rotation progresses, the nervous touch during an initial physical examination by the residents quickly disappears as each patient's encounter becomes more comfortable, as they get to know the patients as persons. Upon the end of the rotation, the medical residents are able to better empathize with the patients that many had never encountered before in their medical training. The clinical rotation is a small part of the overall training in the busy life of a medical resident. Hopefully though, it is enough to leave a lasting impression so when they graduate and a patient with special needs comes into their own office for an appointment it will be a positive experience. There will be no apprehension, no concerns knowing they have a better level of competence, and rather a comfort level that will come through at the start of the visit by looking at that patient in the eye when they arrive and with a smile saying, "Good morning, I'm Doctor...."

Since opening in May 2000, Heartshare Wellness has provided high quality health care to thousands of individuals with intellectual and developmental disabilities. Located in a beautiful, state-of-the-art facility in Downtown Brooklyn, HeartShare Wellness is a diagnostic and treatment center that offers its patients medical, specialty, rehabilitative, counseling, and evaluation services in one convenient location.

BY VINCENT SIASOCO, MD, MBA

Vincent Siasoco, MD, MBA, a board-certified Family Physician, is the Medical Director of Heartshare Wellness, a community based multi-specialty health clinic in Brooklyn, NY that provides care for children and adults with intellectual and developmental disabilities. He established and supervises the primary care clinical rotation at Heartshare Wellness for Family Medicine residents.

References

(1.) Healthy People 2020. Web site: www.healthypeople.gov. Accessed Oct. 10, 2015.

(2.) Holder, M., Hood, H. Special Olympics. Changing Attitudes Changing the World. Web site: www.spedalolympics.org/.../Research.../policy_paper_Health.pdf. Accessed Oct. 10, 2015

(3.) [WOodward, L., Havercamp, S.M., Zwygart, K.K., & Perkins, E.A. (2012). An innovative clerkship module focused on patients with disabilities. Academic Medicine, 87(4), 537-542.]

(4.) [Sabharwal, S. (2001). Objective assessment and structured teaching of disability etiquette. Academic Medicine, 75(5), 509].

(5.) [Minihan, PM., Robey, K.L., Long-Belil, L.M., Graham, C.L., Hahn, J.E., Woodward, L., & Eddey G.E. (2011). Desired educational outcomes of disability-related training for the generalist physician: knowledge, attitudes, and skills. Academic Medicine, 86(9), 1171-1178.]
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Author:Siasoco, Vincent
Publication:The Exceptional Parent
Geographic Code:1USA
Date:Nov 1, 2015
Words:1138
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