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Author: Jonathan Schindelheim, M.D.

Introduction to the course

Knowledge of normal growth and development is fundamental to good doctoring. Whether working as a generalist or specialist, it is part of every assessment and every work-up of every patient. It is also essential in building a successful doctor-patient relationship, which depends on the doctor's appreciation of the patient as an individual. As we learned last tern in "Interviewing and the Doctor-Patient Relationship," understanding a patient is deepened by the physician's ability to elicit from the patient information about his/her inner experience of illness. If a patient feels the doctor understands his/her experience of being sick, the collection of essential diagnostic data is facilitated, compliance with therapeutic regimens is increased, malpractice claims are diminished, and physician job satisfaction is improved. That understanding of a patient is as central a factor in caring for patients as is eliciting the signs and symptoms of physical disease. Both are essential to the diagnostic and therapeutic functions of the physician. In practice, each is dependent on the other.

The study of Growth and Development serves many purposes. There are diseases, conditions and disabilities that relate directly to the disruption of the development of physical or mental processes. Every physician, regardless of focus, must be knowledgeable about the manifestations of these conditions since it is to their doctor abnormal. A thorough familiarity with the range of normal will be essential in advising your patients at these moments. Determining what needs immediate attention, planning further work-up, deciding what can be "followed" over time, and reassuring patients in the fears that invariably accompany these "simple" questions are all a product of physicianly competence based in an understanding of normal growth and development.

Learning about Growth and Development also provides a framework for understanding in greater depth who a patient is as a person. Knowledge of the normal "landscape" can guide our exploration in clinical encounters. By giving the physician a background knowledge of the hurdles that every person must negotiate in their life, such vulnerabilities of both a physical and emotional nature. It can also help us to understand precipitant to disease and disability. The study of Growth and Development can help us to know a person more thoroughly and thereby be better doctors than when we were to meet our patients without such informational prompting.

As you listen to patients about what they have gone through in their lives, their individuality emerges. Genetic endowment, environment, relationships, life events, etc. all effect different people differently at different times in their lives. "Locating" a patient developmentally will allow you as a physician to approach the gathering of data, performance of procedures or construction or a treatment plan in a way that will be more individualized for your patient. You will therefore have a greater likelihood of success. Knowing of life events or aspects of illness that carry a particular significance for your patient will make it possible for you to anticipate stressors that others who don't know the patient in this way) will miss. Your doctoring will be more personal and therefore more precise, more therapeutic, less costly and more appreciated.

There are many ways to organize the subject matter that we will cover in this course. One way is to follow various developmental "tracks" longitudinally from birth to death. For example, one can follow the various development of motor, language or cognitive capacities and skills from the beginning of life to its end. All of these have as much clinical relevance in assessing a child's development as in assessing and elderly patient's decline. Alternatively, one can study the individual at various cross-sectional stages/ages of life. For example, one can try to get an inclusive picture of an individual during infancy, or adolescence, or mid-life, etc. Clinically, this is useful for knowing and being able to relate to special issues or concerns that an individual might be facing at a particular period in their life cycle. For example, an adolescent with a new diagnosis will have different concerns than an individual with the same new diagnosis in mid-life. We have chosen to combine these two ways of presenting the material of growth and development and to try to relate it to the practical/clinical realm.

As we see people (both patients and patients on videotape) in the lecture hall, we will have the chance to integrate the specific content of the lecture through the life of one particular person. Hopefully, we will be able to identify the patient's story of illness and life story as well as the developmental tracks, stages, issues, etc. being specifically addressed. Knowing more about Growth and Development will aid you in the future by helping you to generate questions when talking to or hearing about a patient, questions that otherwise might not have occurred to you. Keeping a practice that allows the longitudinal tracks and cross-sectional stages to complement one another will make each patient a deeper resource for learning.