I'm Aware That I'm Rare: Mark S. Sklansky, MD


Dr. Mark S. Sklansky leads the UCLA Division of Pediatric Cardiology in providing comprehensive, collaborative, state-of-the-art and compassionate evaluation and management of fetal and pediatric patients with a wide range of congenital and acquired forms of heart disease. The UCLA Division of Pediatric Cardiology offers a full spectrum of clinical and academic programs, including fetal cardiology, general pediatric cardiology, state-of-the-art cardiovascular imaging/echocardiography, interventional catheterization and electrophysiology, cholesterol/lipid management, heart failure, state-of-the-art congenital cardiac surgery and pediatric cardiac transplant programs, and a formal transitional cardiology program for adolescents transitioning into UCLA’s world-class Adult Congenital Heart Disease program. In this episode, Dr. Sklansky discusses ways UCLA’s Children’s Heart Center offers the best possible outcomes and how it does so in a compassionate way.

Transcript:

My name is Mark Sklansky. I’m a Professor of Pediatrics at David Geffen School of Medicine at UCLA. I’m the Chief of Pediatric Cardiology and the Medical Director of the UCLA Children’s Heart Center.

During medical school, during rotations on the adult wards it became very clear to me that something was missing. So I knew I wanted to work with children and I’ve always been interested in cardiovascular fitness and intellectual I’ve been interested in how the heart works. And so it’s sort of intuitive to me understanding cardiac anatomy, or physiology, makes sense to me in ways other organ systems don’t. So it’s just merging together my love of children and my interest, and fascination, for the heart and cardiovascular physiology and fitness.

Before I came here to UCLA there was no Children’s Heart Center. Previously children with heart disease were all seen with all the other children in the department, but fortunately we were able to identify this space. It’s now a veritable full purpose outpatient Children’s Heart Center. We see babies before birth here with known, or suspected, heart disease. We make diagnosis as early as the first trimester and we can then arrange for delivery here at UCLA. Particularly for those children whom we identified major heart disease prenatally where we know these are children who are going to need something right away.

And then we follow these patients as outpatients here in the Heart Center and we can offer everything with all the types of general pediatric cardiology services that you may want in terms of cardiologists who are very experienced in listening to murmurs. Is it a normal murmur, is it not? “Why is my child passing out?” We have people with expertise and everything from newborns with heart disease, or fetus’s with heart disease, to children who have arrhythmias, or who need pacemakers. Or who have high pressure in the lungs, pulmonary hypertension. Or who, some children have heart failure, and need transplantation. We have tremendous expertise in all of these areas and more. So it’s really a full service general as well as highly specialized areas of pediatric cardiology full service outpatient facility that works in conjunction with our inpatient facility at Ronald Regan.

I’m particularly happy, and proud, of the center not only because we can provide what I consider state of the art care and diagnostics for children with congenital heart disease, or suspected heart disease, as well as children with pulmonary hypertension or even babies before birth, but also it’s the people who are here really. I mean, just wonderful clinicians. Wonderful staff in the front office at the front desk, the technicians who evaluate functions of pacemakers, and the nurses, and of course the faculty, the physicians. They’re just wonderful human beings so it’s a really compassionate place.

We know it’s not fun for children to have to come see the doctor. It’s certainly not fun for a parent to have to bring their own child to see a doctor. Especially a cardiologist. We try to do what we can to make the visit more pleasant and less scary. And so one of the things we’ve done is we have Chuck Jones artwork on the walls. They see Bugs Bunny, and Daffy Duck, and all these other characters on the wall that are just fun to look at. And so children walk through the halls and usually you walk through a hallway and you don’t get anything out of it but here children walk through and they actually stop and they look and they actually smile. So, I mean, if you can make a child smile when they’re coming to see the cardiologist just walking through the halls I think that’s a good thing.

Many of us are parents ourselves. So we have children and we know how emotional it can be when you’re dealing with the health of your child. And we have a lot of experience, so we know that most things that come up with children, even major forms of heart disease, the management has evolved so dramatically that most children who have even major forms of heart disease can do very well.

So it’s often the unknown that makes things so much worse I think for parents. They just don’t know. It’s their child’s heart. It’s hard to hear anything else. For instance, I do a lot of prenatal diagnosis and so when I’m sitting with a pregnant woman and her partner and tell them for the first time about their baby’s heart defect. Which I know it’s hard for people to hear much more. Once I say that it’s hard to hear all the details, so I try to do it in a way that they’ll understand. So I really tailor what I’m saying, how much I’m saying to the feedback I’m getting. Verbal and nonverbal feedback I’m getting. Then it’s a matter of multiple visits, meeting with our social workers, and other people on the team. And it’s a gradual process but that’s the way we all approach giving a diagnosis, or talking about something, the need say for another surgery or another medication. It has to be done in a compassionate way.

Actually a lot of the children that we deal with, or see, some of them don’t do as well as we like. Some of them don’t survive, or just don’t do well. Then how do you deal with that as a physician or as a parent? But as a physician, it’s also very difficult, but the way we look at it is we can’t control everything in terms of medical outcomes. We can help a lot and a lot of times we make things much better but we could always control how we give news and how compassionate we are with parents. I think parents, including myself, we remember for better or for worse how a physician gave bad news or good news. But particularly bad news. You remember that. So I think that’s an important element of what we do here too. It’s offering the best possible outcomes but also doing it in a compassionate way so that families remember that interchange with the physician in a positive light. Regardless of what happens.

I’ve been doing pediatric cardiology long enough now that I have patients that I saw prenatally who are now in their mid to late 20s. And some of whom I’m in touch with, or I see them on Facebook, or this, or that. It’s very gratifying. One of the great things we have going on here in our Heart Center is that we have a very strong transitional program. Just across the courtyard, is the building where we have our world famous adult congenial heart disease program with colleagues who we interact multiple times a day. We meet regularly once, or twice, a week to discuss our patients. We have people who are taking care of the fetus and we have people taking care of the older adult all with congenital heart disease. It’s the best way to achieve optimal outcomes when you have the perspective, say, of an adult congenital heart disease specialist when we’re taking care of the child.

We have children who get in to teenage years, then we have the transitional team, the adult congenital cardiologist come over here. Meet with the families the same day that we, the pediatric cardiologists, are seeing the family and it’s a gradual thing. Listen, as cardiologists we’ve been taking care of these patients for years. We’re reluctant to let go, but it’s the right thing. Children who are now young adults, they develop adult type disease and there’s perspectives, and experience, and insights that the adult congenital specialist had that we cannot have.

And so it’s really the best of both worlds. It’s a team approach and by being in such close proximity with the adult team from our Children’s Heart Center, it makes it easier for them to come over here. And for the patient, even on the same day, they come to our Children’s Heart Center and then they can walk across the patio and see the Adult Congenital Unit in the next building over. It really makes this transition, which is a tough transition, if you’ve been seeing the same cardiologist and been in the Heart Center for so many years. But it makes it that much easier, I think, for everyone. Doctors, as well as patients, and their families.

This is Mark Sklansky and I’m aware that I’m rare.

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