Treating Patients with Disabilities

Treating patients with disabilities can be a little complicated. Treating patients in general isn’t an easy thing to do. A doctor has to know his/her medical knowledge and how to apply it. This excludes utilizing the data collected from the patient’s history, examination, and then investigations. After all of this is done and the diagnosis is confirmed the doctor moves onto the next step: treatment.

In a patient with an intellectual disability this can be a bit more challenging, but definitely more rewarding on a personal level. The difficulty lies in the fact that communicating with an intellectually disabled (ID) person isn’t always very easy. An ID patient may have difficulties with language that may make history taking a more difficult process. Even in the presence of a caretaker certain things can be missed because the patient isn’t capable of fully expressing what he/she feels. Examination may also be tough due to a lack of compliance from the patient.

These are just some of the issues physicians face when it comes to treating ID patients. It is essential however that they get the care they deserve and solutions need to be found in order to overcome these difficulties. As doctors it is our job to help everyone regardless of how tough it can be. It is even more essential to treat those who really need it the most because an ID person will need extra care. Let’s go more in depth and start by defining what an intellectual disability actually is.

Intellectual disability is a term used to define and describe a developmental disorder characterized by intellectual as well as adaptive functioning deficits. Intellectual deficits include cognition and language which are two very essential functions and as a result of these deficits a person will have problems in adapting to society and situations and being a fully functioning member of society. Intellectual disability has replaced the term mental retardation which is a negatively perceived term by citizens as well as doctors.

Some organizations have led the change by altering their names to include the term intellectual disability. This includes organizations such as the President’s Committee for People with Intellectual Disabilities and the American Association on Intellectual and Developmental Disabilities. Changes have been made by the American Medical Association and the Commissions to End Health Care Disparities as well to ensure that intellectually disabled people get the medical care they deserve just like everyone else. The American Medical Association has classified people with ID as a medically underserved population while the Commissions to End Health Care Disparities expanded its scope to include people with ID.

 ID people can under no circumstances get less care than others because they really do need more care. A person with Down’s syndrome is intellectually disabled and has a higher risk of epilepsy, leukemia, Alzheimer’s, and other diseases than the general population. So it would be mad to not give him or her extra medical attention and continuous screening and control of these issues. If the caretaker isn’t taking good care of an ID person seizures may go unnoticed and with the affected individual unable to express himself/herself there’s no way of knowing they suffer from epilepsy. This puts them at a risk of seriously injuring themselves.

If a diagnosis of epilepsy is made another challenge that the doctor, patient, and caregiver will face will be the administration of the necessary medication. Certain drugs like antiepileptics need to be maintained at a certain level in the blood. Missing doses would result in a decrease in that level which will result in epileptic fits. They can also be very dangerous at high levels so taking them in excess can result in toxicity. The caregiver will have to make sure that the patient is compliant and takes the required doses at the correct times. The caregiver must also make sure that the drugs are kept away from the reach of the ID individual as he or she may take them not fully realizing what they are resulting in toxicity.

Getting the patient to tell you their complaint and the story of their illness is often the defining step in coming up with a diagnosis. If a person couldn’t communicate how they feel or what’s bothering them your diagnosis could be very far off. This is another issue physicians face when it comes to ID individuals. A mother may simply come to you complaining that her ID son’s appetite has decreased. There are a million reasons this can happen from depression to GI problems. A patient who can fully communicate might simply say they have pain in their stomach and point to the epigastric region. That’s your diagnosis right there. He has a gastric ulcer which hurts more during food intake so he simply refuses food to decrease the pain. If communication isn’t very clear, however; then you would have to consider many options before reaching your diagnosis.

Examining the patient and performing investigations aren’t easy either because they simply don’t understand what you’re doing. None of us like giving a blood sample or sitting for an MRI, but we do it and put up with it because we understand its value and know it’s a necessary procedure and its limitations. How would you feel if someone came at you with a needle for absolutely no reason or told you to get into this scary box that makes noises? An ID person feels that way in fact they don’t know for instance that you’re only drawing a few centimeters of blood or that the MRI will take a couple of minutes. There are ways to make them more comfortable such as pretending it’s a game or going through the process yourself or have their caregiver do that in order to show them that there’s nothing to be worried about. There’s nothing better than putting a smile on their faces and everyone will feel a lot better if they’re doing it happily and without fear.

Psychiatric problems are another issue ID individuals face. The prevalence of psychiatric issues for them is higher than in the general population. About 40% of ID people have psychiatric problems. Diagnosis of these issues can be very difficult especially in those with severe ID. Psychiatric diagnoses are based on talking to patients and finding out what’s going on inside their heads so doing so with little communication can be very tough.

5-10% of those with mild ID suffer from autism spectrum disorder and up to 30% of those with moderate to severe ID suffer from it. ADHD is also prevalent in those with ID with prevalence rates of 16% compared to just 5% in the general population. Besides these illnesses certain behaviors are 3-5 times more common in ID individuals such as aggression, self injurious behavior, and inappropriate social and sexual behavior.

These are all things that are difficult to diagnose and treat but their correction can really alter the life of an ID patient. These disorders and behaviors can expose the individual to more harm and endanger their lives and well being.

Having an intellectually disabled patient can be very tough especially for an inexperienced physician, but it is certainly very rewarding. Most patients get better on their own anyway and their ability to communicate and undergo physical examinations and investigations makes the entire process easier. It’s also easier for them to follow a treatment plan and even if mistakes occur they’re usually going to be minor ones with no serious consequences. On the other hand treating patients with disabilities is more difficult for the reasons already discussed but these are patients you could really make a difference with. You could change their life from one with disability to an almost normal one. Connecting with and gaining the trust of an ID person will mean the world to you and knowing that their lives are better is one of the most rewarding feelings you can experience.