Saturday, November 19, 2016

Surgery Ecosystem

There are many factors for families to consider as they choose a surgeon and a hospital.  There is no perfect path to making these choices but some factors that I believe are important include:

1) Surgeon.  I have previously blogged about choosing-your-childs-surgeon  and this is a key factor for consideration.   I believe that the surgeon must be committed to the care of kids' upper extremities, be involved in the community of doctors who care for these types of patients, and be committed to advancing the field.  I believe surgeons who only occasionally treat kids are not ideally suited to take care of your child with a birth difference of the upper extremity.

2) Hospital.  Utilizing a children's hospital that takes care of kids 100% of the time is an important criteria, as everything the hospital offers is specifically for children.  The anesthesia is more routine, the nurses more familiar, the whole process easier.  This does not mean that you can't get good care in a hospital that treats all aged patients, it just means that if you have a choice, pick a hospital that has specific expertise in pediatric and adolescent patients.

3) Therapy.  We tend to focus on surgery as the most important step in treatment.  And it often is critical, but in many conditions, therapy can be effective instead of surgery and therapy is almost always utilized after surgery.  Therapy matters and therapist experience matters.  You want a team taking care of your child that has experience in your child's specific condition. Splints, exercises, and wound/scar care all effect outcome.

4) Communication.  I strongly believe that when a physician takes care of kids, they should provide increased access for families.  While this can mean the opportunity for thorough office visits, it also means availability to communicate via phone or email.  I understand that decisions about surgery can be challenging for families, and having all questions answered and feeling comfortable help to make the decision easier.  While not every doctor will share his/ her email or cell phone, many will.  Consider this in your decision.

5) Research.  While taking care of the patient is and should be the primary 'job' of any doctor or surgeon, research is another consideration.  Some doctors focus on patient care, but others take care of patients AND teach and conduct research.  Research has the potential to change our understanding of birth differences, change our treatments, and improve outcomes.  Research is ultimately the way we can positively affect all kids born with upper extremity differences.  I feel this is a critically important goal.  It is important for families to understand that research can be done in a way that does affect their child's care in any way as most research is simply observational (we watch and understand how certain treatments affect outcome).  Participating in research offers the hope of a future with increased knowledge of best practices for kids with birth differences of the upper extremity.

There are many factors for families to consider as they pick a team to care for their child.  I hope my brief discussion of a few of these factors is helpful.

Charles A. Goldfarb, MD
My Bio at Washington University
congenitalhand@wudosis.wustl.edu





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