Monthly Archives: March 2010

Introductions: Gigi Chawla, MD

When I was growing up, my perfect role model, the person I most wanted to be in the entire world, was Dear Abby. That woman could solve any problem honestly and succinctly, and she could say what really needed to be said to shake people out of their own personal fog.

It would be so easy if that Dear Abby model could just be applied to caring for pediatric patients and parenting, but most often, the question and the answer are unique for every child and unique for every situation.  I try to guide families to find the right strategies for themselves, keep them focused on the big picture, and not let the little details become too overwhelming.

Families ask questions on a variety of topics that, honestly, Grandma would be the best person to answer: How do I communicate with my kids? How much sleep is enough? When should I let them have a cell phone?  Hopefully, this blog will open up a conversation, so that we can come to those answers together.  I can give you some ideas of what has worked for other families and what has worked for my own family, too.

I am the current Chief of Staff at Children’s Hospitals and Clinics of Minnesota.  I divide my time between inpatient and outpatient medicine.  I am a pediatric hospitalist (a pediatrician who specializes in the care of hospitalized children), and although my area of expertise is in the care of complex/special needs patients, I also am a clinic pediatrician who sees all kids … those with highly advanced needs and those without any needs except a school physical form.

So, let me know what you’ve been interested in talking about. I can give you my motherly/pediatricianly/Dear Abby-like perspective and maybe something will fit just right for your child….


Introductions: Boris Kalanj

Did you know that more than 50% of patients who seek care at Children’s are nonwhite; 20% speak a language other than English in the home; and greater than 40% are from low-income families, insured through Medicaid?

In this blog, I will write about these and other groups who are often referred to as “underserved” – lacking either in access to health care, its quality, or both.

I will explore some of the social issues that help define Children’s in our community.  You can expect me to write about health care disparities – differences in quality and outcomes of health care due to personal characteristics such as ethnicity, primary language, location, and socioeconomic status.  I will also write about cultural competence and attention to diversity in health care organizations as some of the key methods for reducing disparities.  There are many topics that can be discussed in this context, and I look forward to hearing about issues that particularly resonate with you.

I started at Children’s nine years ago as manager of its then-nascent program of interpreter services.  Over the years, my role has evolved into responsibilities for broader organizational cultural competence.  Currently, as Director of Health Care Equity and Cultural Competence, I collaborate with others to identify, understand and eliminate health care disparities, particularly within care provided at Children’s. Continue reading

Introductions: Scott Leitz

As an unapologetic policy wonk and lover of health policy, I am honored and pleased to be blogging here.  I joined Children’s in December 2009 as our director of child health policy and advocacy.  Prior to joining Children’s, I spent over 15 years working on state health policy issues, most recently as Assistant Commissioner of Health in Minnesota, with responsibility for health reform.

In my years working in health policy, I’ve come to believe that regardless of the perspective you start with—physician, hospital, nurse, health plan, government official — there’s value in advocating your perspective and letting your views be known.  Not everyone is going to agree all the time, but unless we have ideas on the marketplace, we’ll never get good public policy.

I will be blogging about health policy and health reform issues.   The challenges facing our health care system are enormous:

• we still have too many Americans who lack health insurance
• health care costs that are too high and make insurance coverage unaffordable for many families
• quality of care is uneven and we don’t get the best value we could be for our health care dollars
• the way we pay for health care is fundamentally flawed, with little emphasis on prevention
• there are unacceptable disparities in health outcomes across racial and ethnic groups

Those challenges are what make this a daunting and incredible opportunity.

From the perspective of children, we’re fortunate in Minnesota to be starting from a place that most states would envy.  We have few uninsured kids than most states, our general population health is pretty good, and we get good health outcomes at relatively low cost.

That said, the opportunities for improvement are remarkable — there are tremendous and unacceptable disparities in health outcomes between children in different racial and ethnic groups, we’ve seen a steady increase in uninsured kids, our rates of teen pregnancy and STIs remain too high, and childhood obesity continues to increase.  We need to do better and Children’s can and should play a key role in this.

I look forward to sharing my thoughts with you, and I hope you will share yours back — just leave a comment below.  As in good public policy making, an open back and forth makes the best blogging.

Introductions: Dr. Susan Sencer

My teenage children are mortified that I am participating in a “blog”, which to them marks me as a middle-aged techno-wannabe.  My hope, however, is that this will enable me to engage in conversations about  healthcare with people outside of my usual sphere of influence.  I am a pediatric oncologist, or children’s cancer specialist.  I care for children with many kinds of cancer, and have a particular interest as well in complementary and alternative therapies, also called integrative medicine (IM).  Individuals who have cancer or other life threatening disorders are more likely than other individuals to explore the world of IM, and parents of children who have cancer feel that they should leave no stone unturned in looking for treatments which might help their kids.

The Internet is a great tool for disseminating information about all sorts of health issues, but a lot of the information, especially about cancer treatments, is not very reliable.  I consider my role to be trying to help people sort through all that information, learn how to navigate the various websites and get credible information that they can use to make good decisions for their children.

Pediatric hematology/oncology is considered a “sub-specialty.”  Those of us who are hematologist/oncologists go through medical school, then do a pediatric residency and then do a three year fellowship in pediatric hematology/oncology.  Because children’s cancers and adult cancers are very different, the training for adult and pediatric oncologists is very different as well. Continue reading

Defining Complementary and Alternative Medicine

Some of the most fascinating trends regarding consumer preferences for medical care for themselves and their kids, have to do with the increasing tendency of our patients and families — that means you — to choose more natural, non-drug, so-called Complementary and Alternative Medicine (CAM) approaches.

CAM refers to techniques such as massage, meditation, acupuncture, herbals, and energetic therapies like Reiki and Healing Touch. A recent national survey showed that 38% of adults nationwide state that they use CAM and 12% of kids report CAM use. Other studies have suggested that 50-85% of kids/teens with chronic illness Cancer, cystic fibrosis, developmental challenges) use some form of alternative medicine.

At the Integrative Medicine Program here at Children’s Hospitals and Clinics of Minnesota (the largest and longest-running pediatric CAM clinic in North America) we have had 10 years of experience talking to many of you — parents, kids and teens — about why you want alternatives to conventional prescription medication & invasive high-tech procedures. Our experience suggests that people seek out CAM for a few common reasons:

  • some individuals just don’t do well with conventional medical approaches (for example, kids with certain kinds of chronic pain) and are looking for more effective options
  • patients are interested in learning self-care techniques that allow them to be more active participants in their own treatment
  • people appreciate more natural, less invasive options that support the body’s natural healing capacities
  • families value a holistic approach that considers mind, body and spirit in the assessment and treatment process

Continue reading

Frustrations with healthcare reform

From my perspective, it has been a frustrating few weeks.

The number one reason for my frustration is the country’s lack of courage in doing anything about healthcare reform. Now, I’ll point out to you that I’m a bleeding heart liberal. At the same time one of my hobbies, my main hobby in fact, is studying American presidential history. Knowing it as I do, I don’t get as upset when there is partisanship and infighting in Congress. Having the perspective that when the country is ready for things, it does take action.  Unfortunately, it’s usually crises that make us take action, whether it was the Civil War, Pearl Harbor, Kennedy being assassinated leading to Lyndon Johnson being able to create a lot of reform, Katrina, and of course 9/11.

I don’t know what it will take to get the country to realize what a catastrophe we have right now without healthcare reform.

For 17% of the gross domestic product it continues to rise by a quarter percent per year.  It will make our country absolutely noncompetitive in the world market. What’s frustrating is, one party tries to do one thing and the other just opposes it regardless or one party declares “let’s start from scratch,” when we all know that the lobbyists for the insurance companies and those who benefit by keeping the status quo do everything in their power to keep it as-is.  This is done regardless of the fact that we all know how much waste there is in healthcare and how our total outcomes compared to other developed countries is only average. Continue reading