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June 25, 1982

The Physician and the Handicapped Child: Dilemmas of Care

JAMA. 1982;247(24):3325-3326. doi:10.1001/jama.1982.03320490023029

WITHIN medicine, problems of care are usually discussed in terms of data gathering, treatment strategies, and outcome evaluation. Scientific advances notwithstanding, medicine remains a profession that is highly social in context and transactional in approach. Care involves attitudes, expectations, and values as much as it does instruments, surgery, and drugs.

In working with children, and especially handicapped children, there are many dilemmas of care that the physician confronts. These are often described as "emotional issues" presented by the handicapped child1 and his family2 (eg, problems of overprotection, denial, rejection, overcompensation, depression, and loss of self-image). These problems generally relate to the family and not to the physician. However, there are also social and transactional issues that affect the physician as well, and these have received less attention. We offer the following as several examples of such dilemmas.

The Toleration of Uncertainty  The physician is trained to do. Medicine attracts