Tuesday, November 18, 2008

Doctors' orders

Hi Robin!

One of the barriers we continue to face with implementing evidenced-based practices is physician "orders" and information to families that their child needs a specific frequency of a specific therapy - with more being "required" the more significant the delay, disability or diagnosis. As we have worked in XXXXXXXX to teach practitioners about effective intervention, we are finding that while some or most understand, they are having trouble articulating the rationale and sticking with recommendations in the face of expectations and sometimes "demands" from families to provide what the physician has recommended or ordered. Can you point me to some articles, reports, research, etc. that we could used in our public awareness efforts with physicians and that providers could use with families to explain why we are recommending something different. It would be nice if we could come from strength - provide information that is compelling in and of itself - so providers don't feel that they have to "sell" their recommendations. Also, it is challenging to recommend something different in a way that doesn't put down the physician.

I don’t know of any materials that would directly help. As you might imagine, I deal with this all the time and here are the main messages I give:

  1. It is “illegal” for physicians to dictate services, let alone intensity of services, upon diagnosing a child; according to IDEA, this is the responsibility of the team. Doctors respond to “illegal”!

  2. We explain to parents that doctors base their recommendations on the diagnosis, as though all children with the same diagnosis had the same needs. “And of course your child is doing well, has awesome parents, and now has a team of early interventionists helping, so we’re not in a worst case scenario.”

  3. What the doctor means is that your child needs at least this much INTERVENTION, but doctors don’t understand the difference between intervention and service. And actually your child deserves even more intervention than the doctor prescribed. Let’s do the math and add up all the intervention your child will get from you and his other primary caregivers. The job of the SERVICES is to help you make those interventions work.