Table 1.
The clinical members of the MDT and their roles in providing care to the patient and the parents
| Role | |
|---|---|
| Neonatologist or General Paediatrician | Initial explanation |
| Management of the unwell child | |
| Initiation of first‐line investigations | |
| Seek advice from paediatric subspecialist (endocrine or surgical) with an interest in DSD | |
| Paediatric Endocrinologista | Detailed explanation over multiple visits |
| Management of the unwell child | |
| Interpreting first‐line investigations and planning second‐line investigations | |
| Organize timely and appropriate involvement of other members of MDT | |
| Act as the link between the parents and MDT | |
| Initiate and monitor long‐term medical therapy such as steroid or sex steroid therapy | |
| Paediatric Radiologist | Interpret and often perform ultrasound scans in the newborn |
| Judge the reliability of ultrasound scans in the newborn esp. when the results may influence sex assignment | |
| Paediatric Urologista | Assessment of external anatomy |
| Explanation of the anatomy and results of imaging | |
| Explanation of pros and cons of reconstructive surgery | |
| Develop a plan for complex imaging (other than pelvic ultrasound) and further assessment of the anatomy | |
| Perform procedures such as laparoscopy, biopsy, reconstructive surgery and gonadectomy | |
| Organize timely and appropriate involvement of other members of MDT | |
| Paediatric Specialist Nursea | Provide general support to the patient and parents in addition to that provided by other members of the MDT |
| Arrange specialist investigations | |
| Liaise with the rest of the DSD team, including the clinical psychologist | |
| Clinical Psychologista | Provide specialist support to parents soon after birth |
| Provide support to the growing up child and the parents | |
| Develop an individualized plan for each family | |
| Guide the MDT on timing and tempo of explanation of the condition to the older child and adolescent | |
| Clinical Endocrine Biochemista | Facilitate timely analysis of samples |
| Provide specialist support and interpretation of results | |
| Guide subsequent biochemical tests | |
| Facilitate storage of samples for analysis at a later stage | |
| Clinical Geneticista | Facilitate timely analysis of karyotype |
| Closer involvement in the child with dysmorphic features | |
| Oversee the process of genetic analysis | |
| Facilitate storage of samples for analysis at a later stage | |
| Genetic counselling | |
| Gynaecologista | Availability at an early stage to discuss future outcome and map long‐term care pathway in the affected girl |
| Discuss issues related to sexual function, reproductive function and surgery | |
| Assess the understanding and review the diagnosis | |
| Assess the need for psychology support in the adolescent girl | |
| Initiate and monitor long‐term sex steroid therapy | |
| Perform examination, investigative and therapeutic procedures in the adolescent girl | |
| Oversee vaginal dilator training with specialist nurse | |
| Adult Endocrinologist | Investigate and manage the adolescent presenting for the first time after the age of 16 years |
| Liaise with other members of the MDT | |
| Act as the link between the patient and MDT | |
| Initiate and monitor long‐term medical therapy such as steroid or sex steroid therapy | |
| Act as the transition link for adolescents under paediatric care |
a
Professionals that are core members of the MDT who should meet regularly to discuss cases in a clinic setting.