OHSU Doernbecher physician-in-chief champions ‘care by pit crew!’

H. Stacy Nicholson, M.D., examining a patient in the Pediatric Neuro-Oncology Clinic at OHSU Doernbecher.

As chairman of pediatrics and physician-in-chief at OHSU Doernbecher Children’s Hospital, I spend most of my days in meetings. They didn’t teach you how to run or attend meetings in medical school, but such is the life of an administrator – making the world a better place, one meeting at a time. (Full disclosure: I borrowed this phrase from one of our administrative interns.)

On Wednesdays, I still get to be a doctor in exactly the way most people understand. As a pediatric neuro-oncologist (brain tumor specialist), I walk into an exam room to see one of my patients who had an MRI scan that morning. The first thing I do is explain to the child and her parents what the MRI showed – I know they won’t be able to relax until they know the results. I then go through the usual history gathering, perform an examination, order labs and treatments and make plans for the next few weeks or months.

I also get to be a doctor in the way most doctors will be working in the future. In the past, doctors practiced as “John Wayne” — a rugged individual. In the future, care will increasingly be done in teams that more closely resemble a NASCAR® pit crew.

Wednesday is Pediatric Neuro-Oncology Clinic day at OHSU Doernbecher’s Kenneth W. Ford Children’s Cancer Center. Brain tumors in kids are complicated, and each member of the program brings a unique viewpoint and special expertise. The oncologists, Dr. Kellie Nazemi and I, are joined by a pediatric nurse practitioner, several great nurses, a social worker and a teacher. We also arrange for other medical specialties to be present, including Neurology, Neurosurgery, Radiation Medicine and Endocrinology.

Before clinic, we huddle and determine what each patient needs that day, and we review the MRI scans with a neuro-radiologist. The Pediatric Neuro-Oncology Clinic even has a “traffic cop” to direct patient flow, and it has a dedicated scheduler. Each child gets “face” time with her doctor — the length of time depends on what is going on that day — and the other members of the pit crew are just as critical to great care.

Someday (soon I hope!) the pit crew model will be how most, if not all, of medicine is practiced. The doctor will perform the duties that only she can do and others, who can spend more time with the patients and families, will perform other aspects of their care. Reimbursement models need to be adjusted, and we need to educate our patients and society about the benefits of care by pit crew!

H. Stacy Nicholson, M.D., M.P.H.
Chairman and Credit Unions for Kids Professor of Pediatrics
OHSU Doernbecher Children’s Hospital