Tap Pediatricians in Your Community as Health Resource

by Howard L. Taras

Links between schools and physicians save school districts time and money. Moreover, students benefit. Here are two examples:

Sonia, a third-grade student with mild learning disabilities, barely attended her special day class. Her parents, recent immigrants, did not appreciate the purpose of a formal education for their delayed child. In fact they kept her at home to protect their only child from the flu and frequent colds.

Later, Sonia’s physician signed a statement claiming that her predisposition to respiratory infections qualified her for the district’s "home-hospital" educational program. This was an abuse of an expensive special education program and jeopardized Sonia’s ability to become employable and independent.

The district called its medical consultant who talked with Sonia’s doctor and invalidated the medical authorization. The consultant also reviewed records of other home-hospital program enrollees. He modified the authorization procedure and forms so that all future medical referrals to this program would be appropriate.

A second student, Bryan, was bright and attentive until entering middle school. Then staff started spending inordinate class time dealing with his frequent mood swings, skipping class with older students, and failure to turn in homework. His cooperative parents had begun to work with school staff on behavior modification when Bryan was suspended for gesturing obscenely to a principal and then participated in an auto theft. He was sent first to Juvenile Hall and later to an in-patient psychiatry unit. He now attends an alternative middle school.

Bryan’s own physician learned of the situation when Bryan was hospitalized. He lamented that the school had not included him on the team early on. Bryan’s depression and oppositional behavior could have been diagnosed and treated before he incurred a criminal record and before the district’s counseling, educational, and administrative resources were unnecessarily expended.

Affecting Academics

Many students’ cases are typical. Unless parents are sophisticated enough to bridge the educational and health systems, schools are not informed of student health problems that affect school performance. Schools and physicians communicate reliably only when a medical crisis arises or a physician’s signature is required. Yet health problems in school- age children often appear first to teachers as academic and behavioral problems.

Societal changes and laws (such as Section 504 and the Individuals with Disabilities Education Act) have brought health issues to unprecedented prominence in schools. To tap the resources of local physicians, consider the following:

* What to expect: Doctors can play two roles. As a student’s personal physician, a doctor should communicate directly with the school staff to help develop behavioral and medical management plans, attain parent cooperation and endorsement, and expedite medical, social, and mental health referrals. School officials should identify one contact person for physicians, preferably someone who can be reached during the day by telephone.

A second major physician role is as a consultant to a school or district. Expect a consulting physician to develop, interpret, and revise health policies and protect the district’s interests on health matters. Consultants can run in-service programs, assist with health curricula, serve on committees, supervise the quality of health services on school campuses, and represent the district in discussions with students’ own doctors. Some help districts bill Medicaid and health insurance plans.

Consultants cannot assume the role of a student’s own physician. They should not diagnose (or treat) any one student’s medical, attention, or behavioral problems.

Cost Implications

* Identifying a medical consultant: A school nurse in your district may already have a good relationship with a physician in the community who is particularly interested and attuned to school health issues.

Alternatively, you may call the local or national office of the American Academy of Pediatrics. The national office maintains lists of physicians with an expressed interest in school health. The academy also offers technical support, including written material, on school health issues.

* Expected costs. When acting in the role of a student’s own physician, the school sustains no charge (although some physicians may bill students’ health insurance plans). The time doctors spends collaborating with school officials is part of their patient management plan. Physicians and school staff with experience in collaboration find the team approach to be effective and ultimately a time-saver.

Many physicians, serving as consultants, will volunteer some time to sit on advisory committees or give occasional in-service presentations. Since regular office hours are at a premium, organizers should schedule events during early mornings, evenings, or on physicians’ scheduled days off. Letters of gratitude from school administrators are helpful to physicians employed by large medical groups, health management organizations, hospitals, or universities. These agencies may sanction physician time away from patients when it promotes good public relations for themselves.

For school districts that require consultative services more routinely, districts should offer remuneration. A letter of agreement or contract should outline the expectations, duties, any secretarial support, and rate of remuneration. Large urban districts often contract with school physicians on a full-time basis. Other districts contract by the hour.

Sample contracts, defined roles for school physicians, and related information are available through publications and personnel of the American Academy of Pediatrics (call 800-433-9016).

Dr. Howard Taras is a physician consultant to the San Diego City School District. He serves on the American Academy of Pediatrics’ school health committee. Howard Taras is associate professor of Pediatrics, University of California, San Diego, Calif.