The Primary Care Physician as a Member of the Educational Team

Elizabeth Bryan, MD Beryl Berg, RN, MS

Spencer K. Thunder, MEd Michael G. Warden. MEd. EdS

ABSTRACT

A combination of direct medical service to a child from community physicians and an “interpretive” medical service within the school provides a pertinent, useful medical component of a child’s school program. An example of this combination is given.

Washington State Law and federal Public Law 94-142 require that all children, regardless of type or degree of handicap, must be provided educational services in the public schools. The value of a medical component in assessment of the child to determine special education eligibility has been acknowledged, but little has been said about procedures for gathering or implementing such information. More is needed than simply securing a report of a child’s “physical examination.”

There has been speculation that to provide adequate medical information, it is necessary to provide direct medical services to children within the school setting. However, an alternative to the direct service model within a school system might be termed an “interpre- tive” medical service within the school with direct medical services being acquired by the family from the child’s primary care physician. A communication procedure set up within the school system enabling the staff to confer with the physician and to integrate medical information into the child’s total school program can be established.

This interpretive service approach aids the school staff in assessing the needs of the child and helps determine the amount of involvement to be expected from a child’s physician when planning a child’s school program. Physicians become familiar with school programs available to their child patients and are also able to judge which information is important and capable of analysis by the school staff and the physician in planning a program adapted to the child’s condition. Improved safety conditons are always an important component in such a program.

Obtaining the necessary medical information about a child through the child’s primary care physician strengthens the child-physician-family relationship, leading to better medical care and supervision as a result of continuity of service. Also by this method, the child’s medical care is provided by a physician who is chosen by the family and familiar to them.

The following case history exemplifies a situation in which the “interpretive” type of medical service was available in the school, and direct medical care to a child was provided by community physicians.

John is a severely, multiple-handicapped child in our pre-school program. He carries a diagnosis from first report obtained from a physician of “severe athetoid ataxic quadriplegia. ”

Before enrolling in our school, the child, with consent of parents, was visited in his previous school setting by representatives from the school staff. Conferences were held with his teachers, therapists, and parents to

OCTOBER 1978 THE JOURNAL OF SCHOOL HEALTH 465

determine the level at which he was functioning in movements, toilet training, and feeding - all necessary to help decide what precautionary and safety measures would need to be incorporated into his program before he was admitted to school. At the same time, again with permission and help from parents, past medical recommendations and the names of physicians currently responsible for medical care were obtained.

After pertinent, direct questions and answers, it was determined that . . .

1. John would need to be in a protected situation as he was totally dependent for care.

2. He could be fed soft and liquid foods without choking, but any solid foods introduced would need to be under careful supervision.

3. Petit rnal seizures were frequent and grand ma1 seizures occasional with a pattern of agitation preceding the grand ma1 seizures.

4. He had nystagmus but could track objects with his eyes.

5 . Arrangements should be made with the local hospital for care in the event of a medical emergency (prolonged seizure, choking episode with interference in breathing).

The child’s physicians provided specific instructions for physical and occupational therapy and for daily administration of medication at school. The physician also gave precautions in management and environment. Observations were to be reported to him, and expectations for John’s futher development consistent with his medical condition were discussed.

A program was planned bearing in mind the information listed above. Staff members who would be dealing with John were alerted and instructed concern- ing his medical condition.

Since John has been enrolled, communications have passed between school staff and the boy’s physicians as needed. In determining his ability to hear, see, and understand, school personnel and physicians con- tributed information. Communications and discussions have been carried on by telephone, letters, and prepared forms.

Even with such a grim prognosis, John is progressing to a degree consistent with his handicap. He is housed in an environment adjusted to his needs with provisions for his health and safety.

Contributions to the medical aspects of his program

-Community physicians providing service to child

-Parents working with school and community

-School staff including:

have come from many persons:

and family.

resources.

- A nurse who knows the school program, the medically significant areas, and the possible contribu- tions of school staff, physicians, and other community medical resources.

- Teachers who observe and are willing to report and discuss observations of medical significance.

- Physical and occupational therapists who work with physicians in their management of the child.

- Communication disorder specialists who analyze and integrate medical information into the total program.

- A psychologist who integrates medical informa- tion into the total program.

- An administrator who supports cooperation and joint evaluation and integration by staff to benefit each child.

- A school physician who helps with general understanding and methods of communication between the worlds of education and medicine.

Our purpose has been to show that, with a child who has severe developmental and medical problems, it is possible to obtain the necessary medical help from community physicians if (1) knowledgable staff are present at school, (2) physicians are alert to and provide information needed at school, (3) each group has respect for the contributions of the other group, (4) time for adequate communication is available, ( 5 ) forms and procedures have been developed to facilitate communi- cation, and (6) the parents of the child are willing to allow interchange of information and are eager to help.

Elizabeth Bryan, MD, is the school physician for the Edmonds School District, 8500 200th Street SW, Edmonds, WA 08020.

466 THE JOURNAL OF SCHOOL HEALTH OCTOBER 1978