Pediatric Surgeons Aligned to Lead Specialty Areas in 2018

A Q&A with David Magnuson, MD

Fueled by the addition of a new Cleveland Clinic fetal center, David Magnuson, MD, Section Head of Pediatric General and Thoracic Surgery, and his team are currently organizing more of the surgical care in their section along programmatic lines. Dr. Magnuson answers our questions about the shape of things to come.

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Q: Darrell Cass, MD, just joined your team last fall as Director of Fetal Surgery. What does this addition mean to the services you provide?

A: We’re thrilled to have Dr. Cass join us. He is a highly respected pioneer in his field and previously developed one of the country’s premier fetal surgery programs, at Texas Children’s Hospital. His mission of building a world-class program at Cleveland Clinic not only fulfills a longtime aspiration we have held, but is also a large component of our department’s strategy to organize along more programmatic lines and provide the best subspecialized care to patients.

Q: What do you mean by “programmatic lines”?

A: Historically, pediatric surgeons have been generalists who treat a broad spectrum of conditions in children. While variety is something that attracted all of us to this specialty, as surgical care advances, it’s important to its important to develop disease-specific expertise and programs in areas where rapid progress requires more focused effort. Today, within our section we have a Center for Excellence for Pectus Excavatum (one of only a handful in the U.S.), run by John DiFiore, MD, and Tony DeRoss, MD. Dr. DeRoss also co-manages an adolescent colorectal clinic with Jeremy Lipman, MD, an adult colorectal surgeon. The surgical oncology program falls mostly under my direction. And Dr. Cass, of course, is developing the fetal intervention program.

None of us wants to restrict our practice to a few conditions, but each of us is working toward providing leading-edge surgical care in areas of particular interest to us. We counsel each other about management strategies and options and help each other in the OR where appropriate. This helps us find the right balance between “variety” and “expertise.”

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Q: Besides the credentials of the individual surgeons, what do you feel will drive the continued strength of Cleveland Clinic’s pediatric surgery services?

A: All of us who are involved in the care of children at Cleveland Clinic are colleagues within a unique, comprehensive group practice model. We are familiar with each other, which helps foster a spirit of trust. There are shared values and expectations and our personal relationships make a big difference in outcomes. I also like having access to our adult surgical colleagues for guidance when we encounter a problem that is rare in children but common in adults.

Another key factor is that we take family-centered care very seriously, and work within a larger system that values and supports this.

Q: What are the benefits and challenges of practicing this family-centered philosophy?

A: Family-centered care is critically important for children. The outcome of many operations depends on the patient and parents clearly understanding the purpose and goals of surgery, the post-op activity restrictions and rehab, nutrition, pain control, wound care and outpatient follow-up. We have an incredible nursing staff in our department and they are absolutely invaluable when it comes to communicating these in a consistent and timely way to our families.

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Electronic medical records (EMR) are a huge part of making family-centered care possible. We use it not only to document but also coordinate the efforts and activities of the many professionals who are involved in the care of an individual patient. Fortunately, Cleveland Clinic devotes considerable resources to continually refining this tool. Everyone who knows me would have their jaw hanging open to hear me say this since I was not an “early adopter,” but our EMR system is an important part of our practice and is really well-done.

A lot of things factor in to providing great care ― experience, expertise, empathy ― but there’s nothing more important than communication ― with patients, families, external physicians and other caregivers. We’re not perfect, but we understand its importance and we work constantly to make communication better ― clearer, more timely and more consistent. The unique environment we work in makes this possible.