R/UOP at the Rainier School: A perspective from a R/UOP student

By John Geyer, UW Medical School Student

Most residents at the Rainier School are elderly with a wide range of communication capabilities and mobility skill. Many patients are unable to communicate their experience of pain or discomfort. To make sure these residents are not suffering and simply unable to verbalize their distress, it is up to the medical team to carefully observe patients for any symptoms of physical illness. Here the “medical home” model seems very beneficial to patients. Every resident has a dedicated, on-campus, primary care physician and clinic nurse. Many of the providers have a decades-long relationship with their Rainier School patients. The medical team used their relationship and knowledge of the patient to identify any irregular behaviors, often considered signs of distress among this population. This information, coupled with diagnostic criteria generated by physical exams, helped to identify medical concerns on several occasions. For example, one resident became increasingly aggressive as noted by his care providers; a physical exam and diagnostic procedure revealed an impacted bowel.

This method of identifying medical concerns via aberrant behaviors struck me as an interesting addendum to what we learn in first year lectures about patients with chronic pain; we are taught to evaluate the psychosocial context of these patients in addition to any physical aliments. With intellectually disabled adults, we can instead use the behavioral context of patients to gain insight into potential physical illness concerns.

While many residents at the Rainier School were non-verbal, one physician who had worked with intellectually disabled adults for many years noted the need to talk to patients about pending procedures, regardless of their apparent ability to understand the conversation. Initially, it was challenging to appreciate the impact of this technique with some of the more impaired patients. Yet, upon observation of physicians completing medical procedures, it quickly became apparent that talking to patients helped to both calm them and aid practitioners in centering attention on the patient. It was interesting to see how important the foundation of the doctor-patient relationship, and communication between provider and patient can be, regardless of the perceived cognitive ability of the person being treated.

It was a privilege to watch and learn from skilled practitioners, many who have spent their entire career working with the unique population at the Rainier School. In addition, I learned of the specialized care and medical team skill that intellectually disabled adults require. It is up to the community to ensure the needs of this special population are addressed. All too often the care of these individuals is not part of the public discourse.