Physical examination and investigations

It is essential to develop rapport and trust before attempting physical examination of a person with developmental disability. If possible, avoid examination during a first consultation. See also Trauma related to medical care of people with developmental disability.

A person with developmental disability may find physical examination and investigations (eg blood tests, X-rays) frightening. Reasons for this may include:

  • unfamiliarity with the doctor or the surroundings
  • difficulty understand what is happening
  • memory of past medical procedures that were painful or invasive
  • previous or current abuse and trauma; see trauma-informed care.

Useful strategies to prepare the person for a physical examination or procedure include:

Uncomfortable examinations (eg genital examinations) should be deferred if possible, until the person is:

  • familiar with the doctor and the surroundings
  • comfortable with general examination
  • accompanied by a trusted support person.

If the person is distressed by an investigation or procedure in the consulting rooms, consider whether it might be more achievable with a home visit (ie in familiar surroundings).

Occasionally, a person with developmental disability may require sedation or anaesthesia in hospital to enable a diagnostic investigation or procedure. It is important that these investigations are performed with appropriate consent and minimal waiting time. The general practitioner (GP) may need to liaise assertively with hospital staff to achieve this. Consider other examinations and procedures that could be done at the same time to optimise care; see Opportunistic examinations and procedures.

Note: The GP may need to liaise assertively with hospital staff to facilitate investigations for people with developmental disability.

If a person refuses examination or investigations, their right to refuse must be respected. However, consider the harms and benefits of performing the investigation with sedation versus no further investigation if:

  • the person does not have capacity to make independent decisions about health care
  • refusal presents a significant health risk.

For other strategies to overcome common barriers to health care experienced by people with developmental disability, see reasonable adjustments.

1 For advice on formal desensitisation programs from the Queensland Centre for Intellectual and Developmental Disability, see here.Return