When a Child Truly Needs the Best
No, getting the right care at the right place isn't easy. Yes, you can make it happen
A talk with an elite specialist might send an unexpected message: Stay home. "Part of my job is to reassure people that they're getting good care where they are," says Robin Cotton, director of otolaryngology, head and neck surgery at Cincinnati Children's Hospital Medical Center and a pre-eminent expert in disorders and in complex pediatric airway reconstructions—like the one he did on Malcolm Turner with the help of a piece of the little boy's rib. If parents want to see Cotton but their child is being treated by someone he knows and trusts—in particular, the 60 or so pediatric otolaryngologists he has trained—he will vouch for their doctor.
Besides, good specialists are in constant contact. Scans and lab results fly across the country and oceans via E-mail, making it possible for top practitioners to be consulted on tough cases. Cotton, Caniano, and Baldassano field multiple inquiries every week.
Referral. If a face-to-face is necessary, the best way to land a coveted appointment with a top-flight doctor is by working the system through your child's current doctor. Parents are welcome to call in themselves, says Baldassano, but their kids are best served when a referral comes through another doctor who sends medical records—or at least a summary letter—and makes the case for urgency.
Thorough research is vital for families that must rely on a nearby community hospital. It isn't that good pediatric medicine is not regularly practiced in such places, says Caniano. "The issue is, if your child has a problem with anesthesia or interoperatively, you have no specialists." In a center like Columbus Children's, everyone, from the pediatric nurses in the intensive care unit to the pharmacists, psychologists, and board-certified pediatric surgeons and anesthesiologists, focuses solely on children. As any pediatric expert will tell you, says Caniano, "children are not little adults." The dose of medicine for a 50-pound child is not a third of the dose for a 150-pound adult. Treatment protocols can be drastically different. Caniano even argues that hospitalwide pediatric expertise is just as important in routine procedures like tonsils removal, hernia repair, and insertion of ear tubes because all require general anesthesia. If a complication arises, she says, odds are that it will be recognized immediately, and specialists are on hand.
That's a little extreme even for some at the upper rungs. "Pediatricians tend to refer to pediatric hospitals, and family doctors tend to refer to adult hospitals," says Cotton, and for routine procedures that's fine with him. He believes most ear tube insertions and basic sinus, adenoid, and tonsil surgeries are appropriately performed by adult otolaryngologists if the child is otherwise healthy and the surgeon and anesthesiologist have treated a good number of children.
And even in the best children's hospitals, when parents do all the right research, ask all the right questions, and advocate exhaustively on their children's behalf, things can and do go very wrong. "We lost faith in the system," says Ann Herzog of Wakefield, Mass. She and her husband prepared for the arrival from Russia of their adopted daughter, Yana, now 3, by seeking out the best place to repair her bladder exstrophy, a condition in which the bladder develops outside the body. Such infants are usually operated on right after birth, but that wasn't an option where Yana was born. For such a complex case, and because she was 2 years old, the Herzogs sought the best. They selected an East Coast hospital that by all measures of data, research, and reputation was one of a handful of top exstrophy centers.
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