Treating without a diagnosis
Perhaps I'm still stuck on the medical model, but am I the only one who finds it jarring to treat a client without full knowledge of what causes them to need treatment? I'm finding that in the school system, the occupational therapist isn't always provided with a full history of the child they are treating. I know that this is part of an effort to move away from allowing people to be defined by their disabilities. I agree with this 100%. Aside from the obvious fact that labels create stigma and a set of expectations that may be unrealistic, they travel with a person for the rest of their life. Every medical condition or disability presents a little bit differently in each person, so it is better to operate from a viewpoint of what they can do versus what a diagnostic category says they cannot.
Via our clinical judgment we can often figure out what the general issue is, anyhow. A child with ADHD is easy to identify, as is a child with motor planning problems. However, when diving into the nuances of cognitive differences or the autistic spectrum, things become fuzzier.
Seeing this play out in the school system has reminded me of one of the students I worked with in my previous job. All I was told was that she had a learning disability. She and her family didn't wish to discuss it beyond that and there was no information in her file. I respected and understood that, but then found myself in the position of trying to find a job for a person whose capabilities I didn't fully know. I had a hard time finding the right job because of this. Over time I got to know her and came to suspect that it was some kind of auditory processing disorder. Once I was able to piece that together on my own, I could shift the focus of my search and we did eventually find something. However, I wonder how much more quickly I could have accomplished that if I had known her diagnosis up front.
I foresee the same problem here. Without a diagnosis, how am I supposed to plan treatment for children I have only known for a short while and might see for a half hour a week? Therapists don't really have the time to feel out a person's cognitive abilities (unless it is an initial evaluation) - we can't bill for that, yet it is essential for the tailoring of our treatment.
So often, therapists are inheriting clients from other therapists who may have known them better. Without the pass-down of information like diagnoses and test results, how can a new set of eyes know how to best treat the client? I would rather have the very general guideline of a diagnosis to let me know what I might expect. Any good health professional knows that a diagnosis is just for the sake of eligibility and billing. How that diagnosis presents is variable. But is there really any harm in having some idea of what one might see?
With this I have to acknowledge that diagnoses are often wrong, outdated, or misrepresentative of a person's ability to function in their world. Again, any good health professional would know this and be careful not to assume that just because someone is diagnosed with something, they will present that way. It is proven time and time again that people grow and change and sometimes leave their diagnoses behind altogether.
The medical model dominated for many years in spite of its faults, but perhaps we are being a little too quick to reject it. We still use it to define eligibility for services yet we want to shy away from it. There is a paradox inherent in this attitude. As an OT I want to look at the whole person. A disability is a part of that person, so does it behoove me to operate in ignorance of what that is?
I hope that this has come out logically. I have graciously been given the first of many colds I will surely receive while working with children (Flintstones vitamins, you have failed me!) and I have taken a fair amount of decongestants to combat that. While decongestants clear the nose they sometimes cloud the mind. If that's the case, my apologies - I shall reduce the amount of methamphetamine precursors I consume before writing the next blog.