Latest / Becker's Healthcare Behavioral Health / Dr. Thomas Pineo, a medical director at UPMC Community Osteopathic

Transcript

Dr. Thomas Pineo, a medical director at UPMC Community Osteopathic · Becker's Healthcare Behavioral Health

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  - Prepare to dive into the forefront
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  and engage in these important conversations.
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  - This is Laura Dedo with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Dr. Thomas peo,
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  medical director of UPMC community osteopathic in
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  Harrisburg, Pennsylvania.
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  Dr. PEOs, a pleasure to have you on the podcast today.
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  - Oh, thank you so much. It's a pleasure to be here.
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  - Now I'm looking forward to our discussion.
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  Um, and before we dive in though,
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  can you tell me a little bit more
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  about yourself and your background?
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  - Sure. I am a physician.
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  I've been practicing as a physician
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  for about 24 years now.
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  I started out my career as a family practitioner,
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  and about halfway through that time, I, uh,
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  became a hospitalist,
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  and I've been working for the last eight years
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  as the medical director at community osteopathic
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  and worked closely with my hospitalist team
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  and remain engaged in clinical care on a daily basis.
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  - Well, that's great to hear. And Dr.
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  Peno, you're part of the lost generation
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  of autistic US adults.
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  Can you tell us more about your journey to a diagnosis
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  and why so many adults have fallen through the cracks?
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  - Sure. Yeah.
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  So as your question, um, presupposes I was diagnosed
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  with autism and I was diagnosed later in life.
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  I was in my early fifties when I was diagnosed,
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  and my story is very similar to
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  a story told by many other late diagnosed autistic adults.
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  Um, in that I came to my diagnosis through my children,
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  um, when I was young.
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  Uh, the diagnostic criteria were different
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  than they are today.
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  So a person like me would not have qualified
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  for a diagnosis of autism.
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  Um, it wasn't
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  until 2013 when the DSM diagnostic criteria folded,
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  uh, diagnoses like Asperger's and autism
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  and pervasive developmental disorder all into one, uh,
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  broad category that, uh, people from my generation,
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  um, what is referred to in the autism literature
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  as the lost generation, um,
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  had an opportunity to be diagnosed.
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  And I think as we, as a society, uh, talk more about autism,
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  uh, we become more familiar with the traits
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  and the diagnostic criteria.
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  Um, we start to see it, uh, more and more.
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  And I can, I can, I can assure you that
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  that has been the case for me in my clinical life.
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  My diagnosis actually came as my oldest daughter was,
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  um, working her way through her own, um, struggles
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  and was diagnosed with OCD for a number of years.
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  And, uh, she was, uh, very intelligent, um,
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  young woman who, um, at some point began
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  to question her own diagnosis
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  and said to her counselor one day says, look, I
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  I just don't feel like this is me.
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  I don't think it describes me well, and I mentioned that
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  because of the, um, psychiatric
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  diagnoses that people tend to have on their way
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  to an autism diagnosis, OCD is is one
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  of the more common ones.
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  Um, she had been working hard doing everything
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  that the counselor was telling her to do.
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  And, and, and then finally the counselors came back to her
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  and said, gee, I wonder if we're dealing with autism here.
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  And I can tell you that she came home from that meeting
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  and started her own deep dive in the world of autism
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  and our lives,
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  our collective lives have never been the same since.
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  Um, it was just a year later that her sister was diagnosed.
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  And, and then the two of them were armed
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  with all this diagnostic information,
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  and they turned their attention towards me.
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  Um, I think like a lot of adults who have not been
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  around autism
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  and certainly didn't understand it deeply, I, you know,
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  offended them off or, you know, kind
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  of denied, uh, for months.
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  But they persisted. And I finally swallowed my pride
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  and carefully reviewed the diagnostic criteria,
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  and I said, you know, I think they're onto something.
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  I, um, sought, you know, a professional
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  evaluation, and indeed the diagnosis was concern,
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  uh, was confirmed.
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  Um, and it's really been a,
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  a fantastic journey.
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  I've learned so many things, um,
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  and so many ways that not only does this diagnosis, uh,
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  help me to bring clarity to me and to my life,
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  but also to help me be a better doctor and to,
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  and to see autistic traits in my patients and, uh,
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  and colleagues alike.
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  - Well, that's a fascinating, uh,
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  perspective that you have now.
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  And just so interesting to hear, um,
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  the way in which you came to your diagnosis
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  through your children,
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  and as you said, um, I can imagine others have had
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  that same experience as well, or,
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  or really, you know, could be transformative to understand
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  that about themselves.
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  How has your diagnosis changed your understanding
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  of yourself as well as your professional and personal life?
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  - Yeah. One of the things that is
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  unique about autistic people is this concept
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  of a spiky profile.
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  Um, if you think of just very generally speaking,
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  a non-autistic person being like a circle
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  and the profile of an autistic person being spiky,
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  those spikes are the special interests they represent, um,
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  deep and, and,
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  and recurring, uh, uh, topics that, that they,
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  um, Brent that brings joy
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  and, um, motivates them to learn more and to do more.
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  Um, which means that autistic people tend
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  to be exceptionally good at certain things.
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  Um, and then there are other areas where we tend
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  to need some support.
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  And the degree of that, of those, you know,
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  exceptional traits
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  and the degree of those areas of support is so variable.
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  It really is such a vast, uh, world, uh,
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  that autism represents.
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  But fortunately, I have
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  had a support structure in my life that I,
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  I really didn't appreciate until you know, much later.
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  And I think that support structure has been my wife
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  and my family and the people around me.
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  As I've learned more about autism, I've noticed that
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  that part of the reason I didn't realize, uh,
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  didn't appreciate it in myself is
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  because probably many
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  of my family members are also autistic.
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  And I, I just had a sense of normal, um,
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  that was probably more autistic than non-autistic.
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  So yeah, I've been able to be immersed in my profession,
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  you know, very young in life that I developed, you know,
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  passions for math and science and education.
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  And, you know, that led me off to medical school,
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  and I was very fortunate to have a chance
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  to become a physician and care for patients.
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  But seeing that spiky profile in myself has helped me to see
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  that same kind of spiky profile in my patients.
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  So, for example, you know, aren't they able to, uh,
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  pay their bills, um, executive functioning?
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  Can they schedule their own appointments?
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  Is it reasonable
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  or even fair for me to expect my patient to be able to
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  take on the, this level of independence in the future?
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  Just like we counsel patients
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  and their families of all sorts of neurologic issues,
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  autism is one of those areas where we can dig deep,
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  ask questions and find out about
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  what areas they may have support needs, uh, what areas, uh,
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  can they be independent?
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  Um, does this person need a social worker in their life?
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  Is there a family member who can be engaged?
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  And we can have a conversation about autistic traits
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  and how this, how this all works.
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  Um, or is, is this an individual
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  who really can be quite independent,
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  but just needs to have, um, some appreciation of their,
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  you know, enjoyment of, of, you know,
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  having a relatively small social circle and,
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  and, um, you know, managing their own day-to-day life.
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  - Uh, that's really interesting to hear,
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  and certainly such important points to think about
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  as you're caring for patients
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  and really for any doctor
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  to understand is they're looking at their patient's profile
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  and, and trying to create expectations
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  and a plan for the future.
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  I know you recently authored a paper on caring
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  for autistic adults in the inpatient setting.
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  What are some tips that you can share with our listeners?
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  How has your own journey
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  with autism helped shape your awareness of these strategies?
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  - Yeah, thank you. So the first point
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  that is so important for our listeners to appreciate is just
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  how common autism is.
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  Um, as of 2023, the CDC and the Autism
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  and Developmental Disabilities Monitoring Network reported
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  that the incidence is 2.7800000000000002%
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  of the population, or about one in 36 people.
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  There was another study done by Kaiser some years ago
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  where they looked at a sample of 1.6 million adults
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  who were diagnosed with autism,
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  and they found that only 0.095% of
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  that sample had been diagnosed.
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  What that means is
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  that autistic adults are 30 times less likely
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  to have a diagnosis than children, meaning
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  that there are over 7 million undiagnosed adults
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  in the United States who are autistic.
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  These numbers are staggering.
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  And the healthcare community, society at large, we need
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  to get better at recognizing autistic traits,
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  offering diagnostic clarity to autistic people
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  and matching up the support needs
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  that this vulnerable population has.
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  The second point that I would make is that being autistic is
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  a social determinant of health.
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  We know that autistic people have higher
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  rates of unemployment.
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  They're more likely to live with family members
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  or relatives, and they may have very
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  limited social connections.
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  We know that there's higher rates of diabetes, hypertension,
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  heart disease, and just generally speaking,
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  they're less likely to have their health needs met.
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  We know that there are higher rates of hearing loss,
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  autoimmune disease, sleep problems.
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  Sleep problems are, uh, extremely common.
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  Uh, so folks who are complaining of insomnia, could
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  that be an autistic trait.
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  Um, and we also see higher rates of mental illness
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  and substance use.
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  And in the end, the average life expectancy
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  of an autistic person is 16 years shorter than that
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  of the non-autistic population.
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  So we in the healthcare community have to first recognize
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  that this is more common than I think that we've, uh,
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  that we've appreciated in the past
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  that the implications are quite severe,
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  and that there is really a massive population
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  of people out there who have yet to be diagnosed
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  and who are in effect nurturing a disability
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  that they don't know about.
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  - That's such great perspective, you know,
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  and really puts things into a clear picture, especially
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  for people who may not understand, as you were saying,
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  you know, this is their diagnosis
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  or something that they're struggling through in their ways
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  that they can manage that or, or seek extra help,
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  but just haven't, it seems like
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  because, um, they didn't know that it's something that,
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  you know, um, they need to be thinking about or managing.
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  So from your perspective, how important is it
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  for leaders in the healthcare industry to advocate for
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  and accommodate these marginalized groups?
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  And can you share any examples from your role
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  as a medical director?
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  - Yeah, absolutely.
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  Um, I've been so gratified over the past couple of years
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  as I've done my own deep dive on autism
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  to see these autistic traits show up in
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  my patients in the hospital.
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  Um, I've had patients when I questioned them, uh,
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  revealed to me, um, issues around sensory, uh, intolerance.
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  Uh, I, I can remember specific examples of, you know,
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  asking about, you know, how is the sound level in your room?
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  And I remember one patient saying back to me that, you know,
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  I'm so glad you asked.
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  I can hear the nurses talking up
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  and down the hallway all day and all night.
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  Um, this individual had been struggling with a long history
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  of anxiety and sleep problems.
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  And I said, Hey, you know, hang on a second.
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  Lemme go get the sensory kit that we had put together, um,
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  about a year and a half ago as part of, you know,
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  an autism education program
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  that we were doing in our health system.
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  And into the room, I brought, uh, some headphones, just,
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  just some quieting earmuffs.
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  And I said, why don't you put these on? And she said, okay.
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  And the moment that she put them on, she smiled
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  and she looked at me
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  and she says, wow, that really feels nice.
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  And then I said, okay, well, how about the blinds?
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  Do you want me to lower them?
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  Well, we have blinds in all of our rooms,
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  but they don't, they're not blackout blinds.
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  So they let a fair amount of light in,
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  and I said, do you want to try these sunglasses?
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  And she put 'em on and she said, yeah, it's
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  so bright in here all the time.
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  I really appreciate having these.
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  And then I took one more step
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  and I said, how about this weighted blanket?
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  Do you want to try this? And she said, she was kind
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  of apprehensive in the beginning,
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  but then she allowed me to place it on her lap.
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  And, and she, she really just relaxed into these,
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  um, very simple interventions.
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  And what was so gratifying to me was
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  when I returned the following day,
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  she was asleep in her bedside chair with all
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  of the equipment on, and I, I just touched her very gently
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  and I stalled, startled her awake,
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  and she said, I, I slept, I slept
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  for several hours last night,
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  and it's the first time in years, and she was so grateful.
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  And we went back and we talked about, you know,
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  different ways that we can, you know, support and,
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  and certainly I don't want to give your listeners the
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  impression that, you know,
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  these simple interventions can solve all the problems of
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  that autistic people face, but,
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  but there are some very simple interventions
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  that healthcare systems can implement
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  and it can really make a big difference in the sensory
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  overload that is so common, uh,
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  for autistic patients in a healthcare setting.
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  - That's a fantastic example.
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  And, and certainly, you know, can make a big difference,
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  like you were saying for the experience, then ability
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  to get well, um, from, you know,
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  the health side of things too.
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  Dr. Peno, thank you so much
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  for joining us on the podcast today.
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  This has been a fascinating conversation.
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  I really appreciate you opening up
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  and sharing your own journey with us, as well
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  as the advice you, you've been able to provide
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  for other healthcare providers would be so meaningful, um,
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  for them and their patients going forward.
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  I appreciate this conversation
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  and I look forward to connecting with you again soon.
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  - Yeah, it was great talking to you,
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  and I really wish you all the best.