New Member at Large

I am a First-Year Fellow in the Boston University Primary Care General Internal Medicine/Family Medicine Academic Fellowship. My concentration is: Developmental Disabilities. What does all that mean? Well, in a nutshell, "academic" means research and medical education...and lots of it, with a little bit of clinical work thrown in.

Kind of a funny situation, since clinical work is what I love! I would like to consider myself a "Developmental Internist." I must confess, if there were a Clinical, rather than AcademicFellowship in that field, I would be in that program, on my way toward an outpatient primary care provider with a patient panel of adults with DD. There isn't such a clinical fellowship (that I know of), however. The experts in the field, many of whom are on this mini-fellowship panel, have gained their substantive knowledge through other individual and varied means. I am thrilled to be involved in this MAHEC mini-fellowship initiative to formalize what is currently self-directed or self-procured education and make it more accessible in the training of physicians.

While I've basically just confessed that I am a reluctant academe, I must make it clear I have now come to embrace that role whole-heartedly and see enhancing medical education and improving health systems issues as ways of improving the lives of patients and, hopefully, improving the world in general in some way.

Why I am so dedicated to the health care of people with developmental disabilities has a lot to do with my childhood and my brother Ian, whom my family adopted when he was 4. I was 7 at the time, and met a young boy so "severely mentally retarded" that it was questioned whether he would be able to walk properly, become toilet trained, communicate, or even feel love or recognize family. Growing with him and seeing him develop into the man he is today, a witty, charming and an important contributor to the world - it's been inspiring.

I did take a circuitous route to get to where I am today, however. As an undergraduate at Emory University, my mind was more set on learning about things I didn't have experience with. I chose International Studies as a major, and travelled and lived around the world for many years, including a good deal of time in Paris and Jerusalem. When I started to focus on exactly what I wanted to achieve with my life and who I wanted to do that with, I returned to the US and became a special education teacher in Tampa, Florida. After a few years of teaching I felt inspired to study the scientific basis of developmental disabilities, and I took post-bac premed classes at Harvard Extension School. I fell in love with medicine, and attended medical school at Brown Medical School, through the Brown-Dartmouth Program. From there, I completed an Internal Medicine residency at Cambridge Hospital, in Cambridge, Massachusetts, staying on an extra year afterward as Chief Resident.

Now, as a Fellow at Boston University, I am involved in a myriad of projects, and I wear about 5 different hats (figuratively, not literally). The GIM and FM departments of BU have been incredibly supportive of this focus on Developmental Disabilities, and have been flexible and creative in helping me construct an Academic Fellowship that incorporates the clinical learning and practice I seek. I am also very much enjoying learning and working in the domains of medical education, research, and public health care systems. Here is a brief description of what I am involved with:

Clinics:

 - I see patients at the general primary care practice at Boston Medical Center, and I'm excited to be a resource to physicians there with patients with DD, I'm always looking to further awareness of DD in "mainstream" medicine.

 - I see patients at Boston Community Medical Group, an innovative Medicare-based HMO for people with major chronic health care needs. "Team approach" (MD's, NP's, PA's, OT, PT, etc.) and "Medical Home" are concepts endorsed by this group.

Health Systems Projects:

 -I am getting my Masters of Science in Health Services at the BU School of Public Health, learning about health systems, always thinking of how they affect the DD population. Improving health care systems failures has become a passion of mine, partially because of the flaws in systems I witnessed in my brother's life and partly as I became for "systems savvy" as chief resident.  I will be choosing a research project for my Masters Thesis. Here are some research themes that I am considering exploring in this vein. I am looking at medical, legal, financial, social and ethical aspects of:

 *Transitioning between primary care systems throughout the course of life, i.e. peds, adolescent care, adult care, geriatric care.

 *Transitioning between subspecialty care systems throughout the course of life, for example, building communication between pediatric cardiologists and adult cardiologists.

 *Adapting the current hospital system to better accommodate those transitions.

 *Transitioning from a residential institution to the community. 

Medical Education:

 -The MAHEC Mini-Fellowship! This could provide the blueprint for future clinical fellowships in care for adults with DD. Perhaps even an official subspecialty...

 -I teach physical diagnosis to second year medical students currently. I enjoy thinking of ways to teach the student who is not going to specialize in DD how to feel competent in serving that portion of their patient panel that may be small in number, but large in challenge - and reward.

 -I am hoping to introduce DD education in the training of GIM residents, and find the GIM Primary Care Residency Program leadership to be very receptive. Ideas include incorporating DD-oriented projects in the Activism Elective and incorporating more experience with people with DD.

 -I am proposing a workshop for the Annual National meeting of the Society of General Internal Medicine to reach current practioners.

Epidemiologic Research Projects:

 -Increasing the awareness of possible health care disparities within the DD population, between socioeconomic status, geographical location or race.

 -Researching the prevalence and health outcomes of some of the alternative approaches that are often necessary in the DD community, such as treating osteomyelitis with po antibiotics because nursing union issues prevent a residential institution from adminstering IV antibiotics, routine PSA testing of patients with ID and/or communication difficulties, Pap smear practices and cervical cancer outcomes, routine screening practices in general.

Thank you for reading my long introduction! If there is anything you read that you are already or want to be involved with and you wish to contact me with ideas, or questions, or simply to tell me "Wendy, that's already been done, I'm doing it" ...Please don't hesitate to let me know! I am just starting out in my "specialty" but do feel my research and medical education efforts are well supported by BU. I am reaching the point where I have the time to gain IRB approval, gain access to databases, etc. for research projects, so would welcome your ideas. I find Massachusetts a particularly good place to investigate the health care needs of people with DD who are moving from an institutional setting to the community, so I have signed up for that initiative within the MAHEC mini-fellowship.

I also like to simply have fun and relax with my friends with and without DD and I'm part of a group that runs some great camps, in Nantucket, Vermont, California, Mississippi and Guatemala. Feel free to ask me about that...

And feel free to contact me just to chat, too, if you wish. Part of what I adore about working in the field of DD is meeting people like you.