Miller Children's Hospital Long Beach serves as the leading "medical home" for kids and teens with chronic and complex conditions. At Miller Children's, there are more than 30 unique types of specialty doctors specifically chosen to treat our patients and work with an expert care team. Some kids need as many as 3-5 different specialty doctors, all to combat one condition. Children are not "miniature adults" and need specialized care just for kids that only a children's hospital can provide; by trained pediatric specialists, who are experts at treating multi-system illness in a still developing body.
Divya Joshi, MD, Chief Medical Officer at Miller Children's Hospital Long Beach, speaks on chronic and complex conditions, children's hospital verse adult and how to properly play an active role in your child's care.
Selected Podcast
Miller Children’s Hospital Long Beach the Leading “Medical Home” for Kids and Teens with Chronic and Complex Conditions
Featured Speaker:
Organization: Miller Children's Hospital Long Beach
Dr. Joshi's Bio
Dr. Divya Joshi, MD
Divya Joshi, M.D., Chief Medical Officer, Miller Children's Hospital Long Beach has previous experience in both children and adult hospital and outpatient settings and is board-certified in pediatric hematology/oncology and in pediatric and adolescent medicine. Dr. Joshi strives to continue to create a system of welcoming and supportive care delivered to patients and families in inpatient and outpatient settings.Organization: Miller Children's Hospital Long Beach
Dr. Joshi's Bio
Transcription:
Miller Children’s Hospital Long Beach the Leading “Medical Home” for Kids and Teens with Chronic and Complex Conditions
Deborah Howell (Host): Hello. Good morning. Welcome to the show. You’re listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I’m Deborah Howell. Today’s guest is Dr. Divya Joshi. She is the Chief Medical Officer at Miller Children’s Hospital in Long Beach. Dr. Joshi has previous experience in both children and adult hospital and outpatient settings and is board-certified in Pediatric Hematology-Oncology and in Pediatric and Adolescent Medicine. Dr. Joshi strives to continue to create a system of welcoming and supportive care delivered to patients and families in in-patient and outpatient settings. Welcome, Dr. Joshi. Dr. Divya Joshi (Guest): Thank you very much. Good morning. Deborah: Total pleasure to be with you. Why is it so important to take our children to a children’s hospital rather than a regular adult hospital? Dr. Joshi: Yes. That is a very good question that I think is important to understand the answer. Children are not little adults. What I mean by that is they have very different emotional needs, intellectual needs, and a different physiology. And by physiology, I mean that a child’s organ systems function differently than an adult’s, so they need different medical care and different attention. The best example that is easily understandable is if you use a common medication such as an antibiotic, pretty much every adult can use the same dose. If the same antibiotic is given to a child, the dose has to be based on the child’s weight, which once again just expresses the fact that their bodies function differently. Deborah: Well, just knowing children’s aspirin, the difference between that and a regular adult aspirin, tells you the world of difference. Dr. Joshi: Yes, absolutely. And so, the training that physicians undergo, who want to be pediatricians versus internists—in other words, doctors taking care of adults or grown-ups—is very different. And so, a children’s hospital has several benefits over an adults’ hospital as it pertains to the care of children. Number one, the physicians and the nurses as well who work in a children’s hospital have specific training to take care of children, but the other advantage is the entire environment. As you know, adults in a scary situation can try and reason with themselves. Children really cannot. They’re much more dependent on an environment that is supportive. And so, children’s hospital have chairs that are smaller so that children can sit in them. It starts with little details like that. The staff usually has a psychological training to talk to children appropriately. We have child life therapists who will play with children to decrease and allay their anxieties. Deborah: That’s great. Dr. Joshi: It really is the entire environment, from the way the children are treated, welcomed, and cared for, all the way to the obviously important medical care that they receive. Deborah: I know I feel better when I go in to the children’s portion of my dentist’s office. There’s all these wild colors and butterflies and fun things. You just feel like, “Oh, okay.” Dr. Joshi: As an adult myself, I don’t understand why adult clinics and hospitals can’t be more cheerful. Deborah: Absolutely. I think they’re getting better with the art. The art used to be really dreadful, and at least they’re coming up with the art. But I think you’re right with colors and other forms of expression. We can make hospitals a little bit happier for everybody. Dr. Joshi: Yes. It’s been shown. Scientific studies have shown that certain colors seem to have certain psychological responses in human beings, not just children. Deborah: Absolutely. Dr. Joshi: And then, certain colors like orange make you very engaged and active, and other colors can be more soothing. Well, it’s just the entire approach, I believe, that is different. And more importantly then what I believe as an individual are the scientific studies looking at how children do when they have been taken care of in children’s hospital that, once again, is geared to take care of children versus a regular non-children’s hospital. The outcomes are better if children are taken care of in children’s hospitals. Deborah: Absolutely. Dr. Joshi: And to me, I would say that that is the most important reason that any parent should be aware of that children’s hospitals are geared towards providing the best care for children, and the outcomes are better. Deborah: Now, Miller Children’s is the leading medical home for kids and teens who have chronic and complex conditions. So let’s get into this. What is a chronic condition first, and then later, what is a complex condition? Dr. Joshi: Yeah. That’s an interesting distinction and something to really understand. A chronic condition is a condition that lasts for a longer period of time. So, if somebody were to break their leg, that usually will heal and is not a chronic condition. However, if somebody has diabetes, which unfortunately nowadays is getting more common in children, that is a life-long condition. You have diabetes once, you really have it for the rest of your life. So that is what a chronic condition would be. Deborah: May I stop you there? Dr. Joshi: Yes. Deborah: Because I’ve always wondered this, does chronic mean it will never be cured, or can it only be managed? Dr. Joshi: Well, yeah. That’s a subtle difference, indeed. Let me give you an example. Cancer used to be thought of as an acute condition that can be managed. In many cases in children, it can be cured, and then you’re done with it. And what we are finding—and I’m speaking as a pediatric oncologist here—is that cancer really seems to be more of a chronic disease. So, to answer your question, the disease can be cured and managed in the short term, which is the acute disease aspect of it. But on the other hand, there are consequences from the disease itself and from the treatment, which can be very harsh, that last a lifetime. Deborah: Yes. Okay. Dr. Joshi: So sometimes, chronic can mean different things. Usually what physicians and staff mean when they say chronic is a condition that has longer-lasting consequences. Deborah: Okay. Thank you for that. Now, I will let you get into what a complex condition is. Dr. Joshi: Yes. A complex condition, I’m not aware of a scientific definition, but typically complex means that either several organ systems are affected or several specialists are required to take care of this child. An example for a non-complex condition, again, might be a simple fracture that just requires an orthopedist and a cast. Deborah: Okay. Dr. Joshi: A broken leg could, however, also be more complex if the consequence is that it requires maybe a neurologist’s attention if a nerve has been damaged, that it might require a physical therapist to increase use of that leg. So another maybe clearer example of a complex condition would be, like I said, cancer, would be diabetes, would be cystic fibrosis. Basically, several organ systems are affected and several specialists are required to provide good care. Deborah: Okay. Understandable. That care can be in a hospital. It can also be in a general pediatrician’s outpatient’s clinics, which are considered medical homes for kids with chronic conditions, correct? Dr. Joshi: The term “medical home” is relatively new, and I think the first time I heard it was just a few years ago. Dr. Joshi: The concept is that if a child has a condition that is complex and/or chronic and requires multiple specialists to manage, it can be very difficult—and I am sure many parents know this firsthand—it can be very difficult to coordinate all these visits. So, as an example, if a child has diabetes and needs to see the diabetes doctor, the endocrinologist, might need to see a dietician, might need to see a psychologist, might need to see a cardiologist, that can be daunting for the family to coordinate all those appointments, and then maybe they have to drive to four different offices. Deborah: Sure. Dr. Joshi: So the consequence of those different visits is that sometimes, unfortunately, parents might hear one doctor say one thing and the other doctor say another. And that is very difficult for patients and for families because it is very confusing, and the disease is complex enough as it is. So what a medical home does is it typically ideally is the primary pediatrician’s office. And that primary pediatrician is in touch with all the players, all the specialties taking care of their patient and can communicate in a unified voice what the plan would be, can help to coordinate the care, can help to make appointments, and can just streamline the process for the family. Deborah: Absolutely. Now, where can I learn more about the medical home at Miller Children’s? Dr. Joshi: Well, I think that the web page certainly has a lot of information. Deborah: Maybe you can give that out? Dr. Joshi: Yes. Deborah: If you have it? Dr. Joshi: That’s a good question. I just accessed the Internet as we are speaking. Deborah: Okay. Dr. Joshi: So, maybe Sofia can give the easiest access to that. Deborah: Don’t worry. You can Google Miller Children’s. Just a general search? Dr. Joshi: Yes, absolutely. Deborah: Okay. And we want to thank you so much, Dr. Joshi, for taking the time to talk to us today about so many of the health concerns we all share when it comes to our children. I wish we have another six hours. I mean, we could go on and on. But it’s so good to know that you and your staff are providing wonderful care to so many in Long Beach and beyond. Dr. Joshi: Thank you very much for your time. I appreciate it. Deborah: It’s been a real pleasure to have you, and we learned a lot. I’m Deborah Howell. Please join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Be involved in your children’s care. Have a great day, everybody.
Miller Children’s Hospital Long Beach the Leading “Medical Home” for Kids and Teens with Chronic and Complex Conditions
Deborah Howell (Host): Hello. Good morning. Welcome to the show. You’re listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I’m Deborah Howell. Today’s guest is Dr. Divya Joshi. She is the Chief Medical Officer at Miller Children’s Hospital in Long Beach. Dr. Joshi has previous experience in both children and adult hospital and outpatient settings and is board-certified in Pediatric Hematology-Oncology and in Pediatric and Adolescent Medicine. Dr. Joshi strives to continue to create a system of welcoming and supportive care delivered to patients and families in in-patient and outpatient settings. Welcome, Dr. Joshi. Dr. Divya Joshi (Guest): Thank you very much. Good morning. Deborah: Total pleasure to be with you. Why is it so important to take our children to a children’s hospital rather than a regular adult hospital? Dr. Joshi: Yes. That is a very good question that I think is important to understand the answer. Children are not little adults. What I mean by that is they have very different emotional needs, intellectual needs, and a different physiology. And by physiology, I mean that a child’s organ systems function differently than an adult’s, so they need different medical care and different attention. The best example that is easily understandable is if you use a common medication such as an antibiotic, pretty much every adult can use the same dose. If the same antibiotic is given to a child, the dose has to be based on the child’s weight, which once again just expresses the fact that their bodies function differently. Deborah: Well, just knowing children’s aspirin, the difference between that and a regular adult aspirin, tells you the world of difference. Dr. Joshi: Yes, absolutely. And so, the training that physicians undergo, who want to be pediatricians versus internists—in other words, doctors taking care of adults or grown-ups—is very different. And so, a children’s hospital has several benefits over an adults’ hospital as it pertains to the care of children. Number one, the physicians and the nurses as well who work in a children’s hospital have specific training to take care of children, but the other advantage is the entire environment. As you know, adults in a scary situation can try and reason with themselves. Children really cannot. They’re much more dependent on an environment that is supportive. And so, children’s hospital have chairs that are smaller so that children can sit in them. It starts with little details like that. The staff usually has a psychological training to talk to children appropriately. We have child life therapists who will play with children to decrease and allay their anxieties. Deborah: That’s great. Dr. Joshi: It really is the entire environment, from the way the children are treated, welcomed, and cared for, all the way to the obviously important medical care that they receive. Deborah: I know I feel better when I go in to the children’s portion of my dentist’s office. There’s all these wild colors and butterflies and fun things. You just feel like, “Oh, okay.” Dr. Joshi: As an adult myself, I don’t understand why adult clinics and hospitals can’t be more cheerful. Deborah: Absolutely. I think they’re getting better with the art. The art used to be really dreadful, and at least they’re coming up with the art. But I think you’re right with colors and other forms of expression. We can make hospitals a little bit happier for everybody. Dr. Joshi: Yes. It’s been shown. Scientific studies have shown that certain colors seem to have certain psychological responses in human beings, not just children. Deborah: Absolutely. Dr. Joshi: And then, certain colors like orange make you very engaged and active, and other colors can be more soothing. Well, it’s just the entire approach, I believe, that is different. And more importantly then what I believe as an individual are the scientific studies looking at how children do when they have been taken care of in children’s hospital that, once again, is geared to take care of children versus a regular non-children’s hospital. The outcomes are better if children are taken care of in children’s hospitals. Deborah: Absolutely. Dr. Joshi: And to me, I would say that that is the most important reason that any parent should be aware of that children’s hospitals are geared towards providing the best care for children, and the outcomes are better. Deborah: Now, Miller Children’s is the leading medical home for kids and teens who have chronic and complex conditions. So let’s get into this. What is a chronic condition first, and then later, what is a complex condition? Dr. Joshi: Yeah. That’s an interesting distinction and something to really understand. A chronic condition is a condition that lasts for a longer period of time. So, if somebody were to break their leg, that usually will heal and is not a chronic condition. However, if somebody has diabetes, which unfortunately nowadays is getting more common in children, that is a life-long condition. You have diabetes once, you really have it for the rest of your life. So that is what a chronic condition would be. Deborah: May I stop you there? Dr. Joshi: Yes. Deborah: Because I’ve always wondered this, does chronic mean it will never be cured, or can it only be managed? Dr. Joshi: Well, yeah. That’s a subtle difference, indeed. Let me give you an example. Cancer used to be thought of as an acute condition that can be managed. In many cases in children, it can be cured, and then you’re done with it. And what we are finding—and I’m speaking as a pediatric oncologist here—is that cancer really seems to be more of a chronic disease. So, to answer your question, the disease can be cured and managed in the short term, which is the acute disease aspect of it. But on the other hand, there are consequences from the disease itself and from the treatment, which can be very harsh, that last a lifetime. Deborah: Yes. Okay. Dr. Joshi: So sometimes, chronic can mean different things. Usually what physicians and staff mean when they say chronic is a condition that has longer-lasting consequences. Deborah: Okay. Thank you for that. Now, I will let you get into what a complex condition is. Dr. Joshi: Yes. A complex condition, I’m not aware of a scientific definition, but typically complex means that either several organ systems are affected or several specialists are required to take care of this child. An example for a non-complex condition, again, might be a simple fracture that just requires an orthopedist and a cast. Deborah: Okay. Dr. Joshi: A broken leg could, however, also be more complex if the consequence is that it requires maybe a neurologist’s attention if a nerve has been damaged, that it might require a physical therapist to increase use of that leg. So another maybe clearer example of a complex condition would be, like I said, cancer, would be diabetes, would be cystic fibrosis. Basically, several organ systems are affected and several specialists are required to provide good care. Deborah: Okay. Understandable. That care can be in a hospital. It can also be in a general pediatrician’s outpatient’s clinics, which are considered medical homes for kids with chronic conditions, correct? Dr. Joshi: The term “medical home” is relatively new, and I think the first time I heard it was just a few years ago. Dr. Joshi: The concept is that if a child has a condition that is complex and/or chronic and requires multiple specialists to manage, it can be very difficult—and I am sure many parents know this firsthand—it can be very difficult to coordinate all these visits. So, as an example, if a child has diabetes and needs to see the diabetes doctor, the endocrinologist, might need to see a dietician, might need to see a psychologist, might need to see a cardiologist, that can be daunting for the family to coordinate all those appointments, and then maybe they have to drive to four different offices. Deborah: Sure. Dr. Joshi: So the consequence of those different visits is that sometimes, unfortunately, parents might hear one doctor say one thing and the other doctor say another. And that is very difficult for patients and for families because it is very confusing, and the disease is complex enough as it is. So what a medical home does is it typically ideally is the primary pediatrician’s office. And that primary pediatrician is in touch with all the players, all the specialties taking care of their patient and can communicate in a unified voice what the plan would be, can help to coordinate the care, can help to make appointments, and can just streamline the process for the family. Deborah: Absolutely. Now, where can I learn more about the medical home at Miller Children’s? Dr. Joshi: Well, I think that the web page certainly has a lot of information. Deborah: Maybe you can give that out? Dr. Joshi: Yes. Deborah: If you have it? Dr. Joshi: That’s a good question. I just accessed the Internet as we are speaking. Deborah: Okay. Dr. Joshi: So, maybe Sofia can give the easiest access to that. Deborah: Don’t worry. You can Google Miller Children’s. Just a general search? Dr. Joshi: Yes, absolutely. Deborah: Okay. And we want to thank you so much, Dr. Joshi, for taking the time to talk to us today about so many of the health concerns we all share when it comes to our children. I wish we have another six hours. I mean, we could go on and on. But it’s so good to know that you and your staff are providing wonderful care to so many in Long Beach and beyond. Dr. Joshi: Thank you very much for your time. I appreciate it. Deborah: It’s been a real pleasure to have you, and we learned a lot. I’m Deborah Howell. Please join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Be involved in your children’s care. Have a great day, everybody.