Pixie Plummer, MD, still smells freshly cut grass every time she’s reminded of her hometown friend, Lloyd. He lived alone, mowed lawns for a living, and was adored by everyone in the small southwest Iowa town, including Plummer’s family.

The family quickly befriended him and Lloyd was always welcome at family holidays. He was “just someone we loved,” Plummer says.

Lloyd was born with intellectual disability (ID), and in medical school Plummer noticed that some medical providers seemed quite uncomfortable when interacting with patients with challenges similar to Lloyd’s.  

“There was some dread,” she says. “People with ID sometimes present very challenging and unique clinical pictures that can be intimidating to a provider and cause just a little more unease. Some of that may come from a good place.” 

But Plummer felt comfortable interacting with these patients, partially due to the years she spent with Lloyd.

Some individuals with ID may also have associated medical conditions, but are not able to communicate these complexities. In addition to experiencing various common medical issues, individuals with ID are at higher risk of  having seizures, gastrointestinal problems, bowel and bladder problems, she says.

Unfortunately, it was one of these undiagnosed and treatable conditions that led to Lloyd’s death.

Plummer also noticed that once patients with ID reached adulthood, the care they received would change or drop off completely. At age 18, some become their own legal guardian. At 22, public school support ends. Their pediatricians have to be replaced with a new care team, and families have to start quickly planning to accommodate these changes.

Plummer knew her career would be devoted to providing quality care for patients like Lloyd regardless of age and across the lifespan. 

“I have to be as observant as possible. Every movement, every blink of an eye, every change of a facial expression,” Plummer says. “I have to partner with the people who care about the person most in the world. It might be family, it might be support staff from a group home, but then I have to really listen to their observations and include their instincts.”

After completing medical school at the University of Iowa Carver College of Medicine, Plummer matched with an internal medicine-pediatrics residency program in Springfield, Mass. and completed a neurodevelopmental disabilities fellowship at Boston Children’s Hospital.

Boston was filled with providers covering many specialties but just one hour outside the city, neurodevelopmental specialists were harder to come by, she says.

“Even having to travel just one or two hours makes it hard for patients to access care. You can only imagine what it’s like in a rural state like Iowa,” she says.

Plummer was back working in Springfield to help fill a need for specialty care, when a call came from Jodi Tate, MD, UI vice chair for clinical services of psychiatry. She was interested in recruiting Plummer to join the Intellectual Disability-Mental Illness Program (ID-MI) at University of Iowa Hospitals & Clinics.

The ID-MI team sees patients with autism, intellectual disability, and severe challenging behavior. These patients typically have the longest stays on psychiatric inpatient units, more frequent emergency room visits, and tend to bounce from one group home to another due to their challenging behavior. It’s one of the only programs in the nation that provides continuity of care for adults with co-morbid mental illness and intellectual disability.

“To be contacted by a team of committed providers who are using all available resources and training from multiple disciplines to help provide solutions—that was a really unique opportunity,” Plummer says. “To have the opportunity to join a team like this in the US is very rare.”

Plummer now holds a unique role as an internist in the Department of Psychiatry. On top of consultations, Plummer completes full assessments of each patient she meets—working to find out if any medical conditions may be contributing to psychiatric or behavioral issues.  A big component of her job has also been to collaborate with primary care providers.

“We have an opportunity to support primary care in new and more effective ways. I think our patients are some of the more complex and challenging to primary care providers who don’t have enough time in each visit to cover everything,” she says. “I am seeing a lot of opportunities for collaboration between medicine and psychiatry.”

Plummer has also been a valuable addition to the Department of Psychiatry and the ID-MI team, according to her colleagues.

“Her clinical prowess is second only to her ability to completely disarm patients, families, and their caregivers with her genuine kindness and her pitch-perfect sense of humor,” says Marc Hines, ID-MI program manager. “She has a penchant for silliness that lands perfectly with our patients and a dogged work ethic that endears her to colleagues. As if that weren’t enough, she’s a disability rights advocate. Our team is lucky to have her and this hospital is a better place every day she walks through the doors.”