Developmental Services - Case Management Manual

Dealing with Physicians

The medical profession has historically played an important role in the early diagnosis of mental retardation and related developmental disabilities. In recent years, research has greatly expanded our knowledge as to the myriad causes of mental retardation. Advances in the field of genetics have allowed the medical profession to extend its diagnostic capabilities into the prenatal period.

In most cases, the physician is the first professional consulted by a family when developmental problems are suspected during childhood. As regular postnatal care becomes more routine in our society, we can expect that developmental problems will increasingly by identified during the early stages of growth. In many cases, physicians will be in the position of confirming problems already suspected by parents. In other instances, the physician may detect developmental problems before the child's parents have become aware of them.

Our society ascribes high status and great authority to the physician. As such, the content of the physician's informing interview with the parents of a child with a developmental delay can affect treatment of the child for years to come. Many parents have sought institutional placement for their children with disabilities based on their physician's advice. Others have delayed seeking assistance because they were told that their child would "grow out of it".

It is very important that the Case Manager develop a positive, collaborative relationship with the consumer's physician. The Case Manager should keep the physician informed of his/her activities surrounding the consumer and attempt to involve the physician in the developmental assessment.

The Physician's knowledge and perception of the individual are important components in a comprehensive assessment and every effort to include the physician as an active team member should be made. This is particularly true in the case of consumers with severe and multiple handicaps. Seizure control, orthopedic needs, and medical stabilization rest squarely with the physician. Often, active treatment and programming cannot begin until these needs are met.

The medical profession has professional boundaries which are clearly defined and closely guarded. The Case Manager must be sensitive to this dynamic in order to foster a productive working relationship. In consulting with a consumer's physician, the Case Manager should avoid diagnosing the consumer or recommending specific modes of treatment. In essence, problem identification is best done in descriptive rather than analytical terms.

Case management with medically needy, developmentally delayed consumers will be easier and more productive with the active and informed cooperation of the physician. As such, advocacy in the area of medical care should be balanced by an awareness of, and sensitivity to, the unique nature of the physician's relationship to the consumer. The Case Manager should seek to share with the physician the total picture of the consumer's assets and needs that is gained from the case management perspective. In doing so, the Case Manager can assist the physician to coordinate his or her activities with the overall treatment plan for the consumer.