Because of the opioid crisis in the United States, the rate of hepatitis C virus infection among pregnant women increased 60 percent between 2006 and 2014. Sadly, only 30 percent of infants exposed to the virus were screened for infection.

Hepatitis C can be passed from affected mom to their babies. If left untreated over many years, hepatitis C causes cirrhosis of the liver, liver cancer and even death.

The recent study published in the latest edition of Pediatrics says the recent increase in the disease is most likely due to the opioid epidemic in the United States.

The researchers looked at a database of 87,924 pregnant women who delivered at Pittsburgh University Medical Center. The doctors who performed the study recommended universal hepatitis C screening during pregnancy, especially in high prevalence areas.

“This study is important because it shows the importance of proper screening, prior to pregnancy,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “Without proper screening, children run the risk of going undiagnosed with hepatitis C until they show symptoms. Hepatitis C doesn’t cause symptoms at first, but can lead to irreversible liver disease if not treated.”

Because of the serious nature of the disease, Cook Children’s has been involved in the research of new drugs that could change the lives of teenagers with hepatitis C.

The Food and Drug Administration (FDA) has approved the use of Harvoni and Sovaldi in the treatment of young people between the ages of 12 and 17. The drugs have proven to be more than 95 percent effective in the treatment of hepatitis C for those who have used the drugs.

Dr. Whitworth calls her research into the effectiveness of these drugs the “most rewarding thing I’ve done in the last 20 years. Hands down.”

Click to learn more about her work.

Cheryl Petersen has had an amazing career in the nursing field. She came to Cook Children’s with the plan to help start the Pediatric Intensive Care service. She has held many nursing leadership positions at Cook Children’s and currently serves as the Chief Nursing Officer.

Ways to listen:

• Listen on Soundcloud
• Subscribe for series on iTunes
• Download/Listen to MP3
• Google Play

Maria Perez, M.D., is a pediatric rheumatologist with Cook Children’s in Fort Worth, Texas. She has practiced pediatric rheumatology for 23 years and continues to find joy in her career despite the unique challenges of caring for children with chronic illness. Her clinic has been a winner of the Practicing the Promise award eight of the last nine quarters. The award is based on elements of patient satisfaction and depends upon a the impression that the staff has made upon patients and families.

Ways to listen:

• Listen on Soundcloud
• Subscribe for series on iTunes
• Download/Listen to MP3

Today’s guest is Dr. Artee Gandhi. She is a pediatric anesthesiologist and pain management specialist. She has trained across the country including residency at the University of Missouri and fellowship at Stanford Univeristy.

Ways to listen:

• Listen on Soundcloud
• Subscribe for series on iTunes
• Download/Listen to MP3

I’d be hard pressed to compare waiting for a doctor’s appointment including an appointment with me to the anticipation of waiting in line for any Disney ride or show.

It happens that the question about Disney and healthcare actually crossed my mind in March. While checking in on Twitter, I came across an intriguing book mentioned by one of the folks whom I follow: @JohnNosta.

The skeptic in me wondered how the entertainment industry could have any relevance to health care. Fortunately, the curious skeptic in me decided to buy the book and learn more.

The author approaches healthcare from a business, non-physician perspective focused on serving patients and those who care for patients. I found some fresh perspectives that I think will help me going forward.

Here are three pearls that I got out of the book.

Pearl 1: A focus on loyalty and not satisfaction

Loyalty and trust are different from satisfaction. Loyalty is built on a consistent caring and engaged compassion. Loyalty is built in large part by creating a memorable event in a patient care experience.

Pearl 2: Courtesy is more important than efficiency

A commitment to courtesy both improves experience and can lead to opportunities for efficiency improvement.

A focus on the satisfaction and service for others in your institutional may improve responsiveness and lead to better sharing of resources.

Pearl 3: Create a climate of dissatisfaction

Dissatisfaction with the status quo combined with the dream for what can be are key ingredients in growth and improvement. Even when all measures are near the top, there will always be room for improvement.Final Thoughts

I don’t believe it’s completely valid to compare the work done by me and others at Cook Children’s to work done in other service fields. Stakes and expectations are much higher - solving a problem, managing chronic illness, fixing a hurt - than getting a Starbucks order right or the thrill of a roller coaster ride.

Still we are all compared to real life experiences. Waiting in line is seldom fun. And the ride is sometimes not a ride the child or family would choose. We can still strive to make the experience as pleasant as possible.

About the author

Joel Steelman, M.D., is an endocrinologist at the Cook Children's Endocrine and Diabetes program, which treats infants, children and teens with conditions that are caused by or affect the hormonal balance of the body. We understand the importance of working together and that's how we approach the care of our children.

There is no single criteria that makes a person eligible to lead. Education, job title and seniority can all be a start to establishing a role as a leader. But sometimes, the best leaders aren’t the highest ranking of any of the three. Today we are going to talk about leading when you are starting your career and how an early-career physician can develop leadership skills when they are not the most senior physician on their team.

Today’s guest is Matthew Carroll, M.D. He is a pediatric hospitalist at Cook Children’s and serves on Quality Improvement/Practice Management. Prior to coming to Cook Children’s, he served as the chief resident at Cincinnati Children’s Medical Center.

Questions to work through on the topic:

• What do you think are some personality characteristics that allow you and other young physicians to find roles within leadership?
• How big of a factor is the institutional culture toward the ability to develop young leaders?
• How do you see medicine changing now and as we go into the future?

Ways to listen:

• Listen on Soundcloud
• Subscribe for series on iTunes
• Download/Listen to MP3

With the rates of burnout and suicide in physicians at shocking levels, it’s important that we continue to talk about the satisfaction and mental health of physicians. There are systemic issues at hand that lead to the situation that we are in. In her article “Physician burnout is physician abuse” for kevinmd.com, Dr. Pamela Wible has said that, “Burnout is physical and mental collapse caused by overwork. So why are we blaming the victims? The fact is medical students and physicians are collapsing because they are suffering from acute on chronic abuse.”

There are systemic issues that lend itself to the state that we are in. Many physicians are over-worked and over-stressed. And, it’s not just the grisly 30-year career doctor who is tired that feels burnout, medical students report high levels of emotional exhaustion as well.

There are various numbers in studies but the most recent available studies show symptoms of burnout in 40-50 percent of respondents. It’s a shockingly high number, especially those on the outside looking in. Doctors often appear to have it all together and they can make a great living.

So what’s there to be dissatisfied about? It’s not that simple. Demands to see more patients, giving up less control of our lives and other factors can make what should be a rewarding profession very frustrating.

All this is true and we need to continue to talk about it and continue to search for systematic changes that can lessen the burden on physicians

But, I love my job.

I love going to work every day.

I love the deep relationships I have with my patients and their families.

I love the relationships I have with my staff.

I love the other roles I have carved out within my health care system - Cook Children’s in Fort Worth.

Are there difficulties and frustrations?

Sure. Nothing is perfect but currently, for me, the good far outweighs the bad. Because of this, I walk into and out of work feeling energized and excited about the challenges rather than exhausted.

I certainly don’t think it’s because of anything inherent in me that has allowed me to continue to love my job. Is it just the confluence of good circumstances? Good luck? A great system to work for? Yes, but I’ve also fought to change the system in ways that make life better for myself and others. Maybe I’m just too young and burn out is just around the corner? (Although studies show that people with much less experience than me are already burned out.)

Any of those are probably partially true. But, just like the difficulty in pinpointing the reason for burnout is tricky, pinpointing the reasons for physician satisfaction would be difficult as well.

This post floated through my head for months. I hesitated to put it to paper. How would it be received? Is it trite? Would it be slammed for minimizing the problems?

It’s possible it could be all of those things. I hope not. I hope instead that it is seen as encouragement for those out there that love their job and for medical students and trainees who hear the burnout statistics and wonder if they’ve chosen the right field.

Those of us who aren’t burned out need to listen to those who are.

Together we could take their concerns and our energy and make medicine a fulfilling career for compassionate and empathic people again.

I have been having conversations with some very energetic pediatric leaders and recording them for a new podcast. I hope that you’ll find some piece of their story encouraging: https://soundcloud.com/pediatricleadership

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, TX. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnesroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the Fall of 2016.

Navigating Transitions in Leadership

Frank McGehee, M.D., is a pediatrician in the Cook Children’s Magnolia clinic. He practices in an office that has roots in an 80-year tradition of providing excellent patient care to the children of Fort Worth. He has seen many changes in medicine, but still believes that the heart of pediatrics lies in his connection with families.

There are probably a bunch but what are a few of the big changes you have seen in pediatrics over your career?

How have you seen your role in leadership change over your career?

What do you see coming for you in leadership in the next few years?

Ways to listen:

Listen on Soundcloud

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How do we break down silos for innovative design?

Ways to listen:

Listen on Soundcloud

Subscribe for series on iTunes

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Innovative ideas often require a team approach. It’s difficult to make changes that truly move the needle when you consider a problem from just one perspective. Broadening the team allows physicians to consider other ideas. These new ideas might just open up possibilities that they may have never thought of.

Dr. Marks is a pediatric neurologist with Cook Children’s in Fort Worth, Texas. He has a particular interest in movement disorders and has been involved in Cook Children’s effort to advance the use of deep brain stimulation in the pediatric population. His latest project has been the design and implementation of an innovative pediatric motion lab, which uses a multidisciplinary approach, and advanced technology to assess and develop plans for children, teens and young adults with movement disorders.

Questions to work through on today's topic:

• How are things going with the new lab?
• Going back to when it started. Walk us through some of the different professionals who had input on the design of the lab. How did each member of the team contribute to the big picture?
• What were some of the challenges associated with having a big/diverse team?
• What’s next on the horizon for the lab?
• What part of your work are you most proud of?
• What is the most important quality for a leader in pediatrics?

Quotes:

In order to develop a lab like this, it takes a lot of people who have a great deal of understanding about all the components.

The most important people are the physical therapists who run the lab every day.

The technology itself is just to tool but it does allow for better procedures and better outcomes.

I enjoy team building. I have done that throughout my career…This team was unique because there are constant moving pieces.

There is a huge need to study how childhood obesity affects movement…it should allow us to intervene and better understand what we are doing.

All the things that I have done have required teams.

Neurologists, orthopedists and neurosurgeons desperately need each other.

At the end of the day, we are all in this to help the patient and to make their life better.

I think it is important to surround yourself with good people…and allow them to be creative.

Re: Good ideas-This is not about ownership, it’s about outcome.

Before we see a kid from far away, we do a lot of pre-screening via video and questionnaires.

Links:

• Cook Children’s Motion Lab
• Cook Children’s Neurosciences
• Dr. Warren Marks
• Referring a patient

Why develop a center for clinical excellence for a rare disease?

Getting help for patients with rare diseases can often be a large struggle for families. Finding someone who understands and has the experience to properly diagnose and treat can lead to frustration for families. Often there is no place to go. For long standing issues, this can lead to bouncing to multiple doctors without resolution of symptoms.

For more acute issues, not having an expert available can cause significant morbidity, even mortality. Today on Pediatric Leadership: The New Medicine, we talk to one of our pediatric endocrinologists who set up a center for treating a rare disease, hyperinsulinism.

Dr. Thornton is a pediatric endocrinologist at Cook Children’s and is the founder of the Cook Children’s Hyperinsulinism Center which is one of only two centers in the country focused on hyperinsulinism. The website for the team lists endocrinologists, pediatric surgeons and many other medical specialities as well as coordination between education, social work and even Ralph Lauren, one of Cook Children’s play therapy dogs.

Questions to work through on the topic:

What is hyperinsulinism and when should a clinician expect it?

What motivated you to begin building a center for treating such a rare condition?

How did you get the institution on board? Who did you have to convince?

What were some of those first steps that got the ball rolling?

What has been the hardest step?

How can someone find out more about the center or refer a patient?

What part of your work are you most proud of?

What is the most important quality for a leader in pediatrics?

To listen:

Download on Soundcloud 

Subscribe for series on iTunes

Download/Listen to MP3

For more information:

• Cook Children’s Hyperinsulinism Center
• Dr. Paul Thornton
• Cook Children's Referral Page

What does servant leadership mean to you?

How has your thinking changed since you transitioned into this leadership role?

How do the principles of servant leadership serve you well as a leader in pediatric medicine?

How does an organization stick to their roots and culture when things are changing?

Quote:

“Sometimes we have a crucial conversation about something that needs to be changed in order to make you better at what you do, about the way you think about things. “- Dr. Britt Nelson

“Always with a heart of: I want something better for you and for the patient you are taking care of.” – Dr. Britt Nelson

“Picture the child in front of you who needs what you are talking about. Will you go to war for that?” – Dr. Britt Nelson

Ways to listen:

Listen on Soundcloud

Subscribe for series on iTunes

Download/Listen to MP3

Listen to episode 2 of Cook Children's podcast - Pediatric Leadership: The New Medicine.

Questions addressed:

1. Have you noticed differences in leading in or advancing pediatric issues?
2. What are some particular challenges in pediatric leadership?
3. Moving forward, what are some particular issues in pediatrics where we need strong leaders to step in and lead?

Important links:

Texas Pediatric Society

Texas Medical Association

“Future pediatric leaders are waiting to step forward and it’s a matter of responding to the tap on the shoulder, the encouragement of a colleague to get involved.” – Jason Terk, M.D.

Jason Terk, MD-Cook Children’s Keller

Read Dr. Terk’s article about low HPV vaccination rates-Epic fail

Subscribe for series on iTunes

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Listen to episode 1 here. 

Our guest Mary Uhl-Bien is the BNSF Endowed Professor of Leadership at the Texas Christian University Neeley School of Business. She teaches in the Advancing Healthcare Leadership class which is a combined initiative between Cook Children’s and TCU. Participating in the class are about 30 physicians from throughout the Cook Children’s system including both specialists and primary care physicians. The goal is to establish a culture of strong leaders throughout the system so that we can work together to better serve our patients. Listen to episode 1 of Cook Children's new podcast - Pediatric Leadership:The New Medicine.

Listen on iTunes

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