Complex Medical Care

Hosted by Erica Jolene with special guest Dr. Aline Tanios | Transcription HERE



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I am excited and honored to be able to share this new episode with all of you. In this episode, I had the privilege to talk with Dr. Tanios from Cardinal Glennon Children's hospital.


Dr. Tanios helped to established the Complex Care Medical Program at Cardinal Glennon Children's Hospital in St. Louis, MO, where she now serves as the Medical Director for inpatient services. Dr. Tanios provides a glimpse into her life as she shares with us what led her to becoming a physician, her passion for working with children who have complex medical conditions, her approach to establishing trusting relationships with patients/families, and her hopes for how our society can work together to improve the lives of those faced with complex conditions. Dr. Tanios delivers a well-rounded and rarely shared perspective as physician, a mother, and a friend.


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Links related to this episode:

Dr. Aline Tanios

Cardinal Glennon Children's Hospital

ComplexChild.org


Episode Transcription


Erica Jolene

Hello, and welcome back to Atypical Truth. I am your host, Erica Jolene. It is an understatement to say that I am thrilled to share this next guest with the world. She is one of my absolute favorite people and I'm confident that you will feel the same after hearing from her.


Dr. Tanios is a Medical Director at SSM Health Cardinal Glennon Children's Hospital. She is also the Associate Program Director of the St. Louis University Pediatric Residency program. Dr. Tanios is the mother of four beautiful children, and she absolutely lights up when she talks about them.


We met Dr. Tanios when Margot was about six months old. At this point, Margot had been life-flighted to the children's hospital several times due to having status seizures. We had only recently transitioned to a new hospital from the original hospital where Margot spent her days in the NICU. I had already felt a great sense of comfort within those walls of this new hospital. However, I was still very guarded and slightly on the defense. In hindsight, it's easy to see now that I was struggling with PTSD.


The first year of Margot's life was definitely a roller coaster of emotions. It was truly a trying time for all of us. From the moment Dr. Tanios walked into our room, our lives were forever changed. It was like we had met our guardian angel in the flesh. Her personality, her attentiveness, her compassion...it immediately disarmed me. I was finally able to let my guard down. And WOW, what a relief it was to just release that burden of distrust. I have never once ventured to think about what our lives would be like without Dr. Tanios because she's become such an integral part of our care team.


I wish for every family navigating a complex medical journey to have someone like her advocating for them. So, with that said, I am so excited to introduce to you Dr. Aline Tanios.


Erica Jolene

Thank you so much for being willing to do this with me.


Dr. Aline Tanios

It's my honor. Really a true honor.


Erica Jolene

I'm just curious to know...on a day off (which is rare, I know), what is your favorite thing to nerd out on?


Dr. Aline Tanios

Oh, maybe so there are a few, but my favorite one is building a puzzle. As you can see behind me. Yeah, you know, these table puzzles with drawers on the side? I have that! I have tons of puzzles that have been framed. Like once I sit, it goes like three, four hours. Unfortunately, I haven't been able to do this lately, but this is very therapeutic for me.


Erica Jolene

What is your favorite song currently to turn the volume up for?


Dr. Aline Tanios

Okay, there are several and in different languages. I love "Roar” for Katy Perry and I love "What Doesn't Kill You Makes You Stronger" for Kelly Clarkson. These are like...I think the whole neighborhood can hear, hahaha...can hear me driving by if they are on. It just gives me lots of positive energy and confidence. And yeah, these two I like. Like I said I do have others that are in Lebanese that I just feel like I'm dancing when I'm driving. (Laughter) I'm driving, and my kids look at me like, "What's wrong with her?" But they got used to that.


Erica Jolene

There's something about both of those songs that can make me go from sitting to just standing up and going, "I've got this. I've got this. I've got this."


Dr. Aline Tanios

Yes, yes. Absolutely. Like it's just so amazing. I think one time I was leaving work not too long ago, and I had a long, exhausting mentally draining day, and this song popped up and I'm like, "That's it. This is a sign that's it!"


Erica Jolene

This was a random one...if you could go anywhere, would you rather sit next to the ocean, a lake, mountains, desert, or forest?


Dr. Aline Tanios

I would say, ocean.


Erica Jolene

I can see that.


Dr. Aline Tanios

Yeah. Yup.


Erica Jolene

Your favorite meal? I'm dying to know this and I know it's gonna make me hungry. I know it's going to make me so hungry, but... (laugher from both parties)


Dr. Aline Tanios

Okay, my favorite meal is the Lebanese cuisine. I'm gonna list some, but there is Tabouli. There is, similar to the kababs, something called Kafta. Yeah. There's a long, long list.


Erica Jolene

You know, I find things to look forward to if we're going to be hospitalized, and one of them is that I can order from PostMates Lebanese food from St. Louis restaurants. You know, I live in a rural area, and we just don't have that. That's right. Yeah. That's something that I look forward to.


Dr. Aline Tanios

Yes, yes, yes. Yeah. Next time I see you, hopefully, not anytime soon (laughter), I'll make sure to bring you something that I made.


Erica Jolene

Well, no pun intended, but you don't need to add anything else on your plate.


Dr. Aline Tanios

Well, yeah. Yeah. No... (laughter from both parties)


Erica Jolene 06:38

Can you tell us a little bit more about yourself and what led you to the world of Pediatrics? What led you to be a physician?


Dr. Aline Tanios

So, you know, this Erica, I grew up in Lebanon. I'm one of six kids. My parent's main goal growing up was to empower us with the best education they could afford. They literally went above and beyond. Back then I did actually I earned both the Lebanese and the French baccalaureate.


Erica Jolene

Wow!


Dr. Aline Tanios

My mom used to say that your education is really your treasure, no one can take it away from you, this is how you're going to stand tall no matter what. Which is absolutely right. So initially, I thought, okay, I'll...I was interested more in journalism. Until a very dear family friend, we were chatting. I used to work at, during summertime at their bookstore. He was showing me my strengthens and he said, "Aline, why don't you think about medicine?". I said, "I've thought about medicine, but..." and then all of a sudden, it was like (snaps fingers) this moment! So, once I focused on this goal of being a physician, I knew I wanted to be a pediatrician. Part of it is, I just love being around kids. I was also like a Girl Scout member then a leader, so I was working with kids most of the time. So, pediatrics was my dream.


Then I met my husband in med school, we came to the states came straight to Little Rock, Arkansas. Back then there wasn't any open pediatric positions. So, there was a pediatric neurology position that was open for me, actually, after I did like some observer-ship. It was difficult. There were a lot of bumps. After one year, I went and reached out to the program director back then Dr. Gordon Schultze, who I owe him, really, my not just the beginning of my career, he is really my lifelong mentor. I talked to him sincerely, I said, "I like I like pediatric neurology, but I feel like I want to do general pediatrics and then decide what next...". So, he made it really easy. Well, it looked easy, actually, it wasn't easy, but he made it look easy for me and I switched to pediatrics, did two years there, and then moved in the middle of my residency because by then my husband was doing his fellowship. I had two little kids, which is not a great idea to have two little kids during residency, and we have no family support. So so that's how I ended up being a general pediatrician.


Erica Jolene

Wow. You recently shifted into a role as Medical Director at Cardinal Glennon.


Dr. Aline Tanios

Correct.


Erica Jolene

...and Associate Professor and Assistant Program Director for the St. Louis University Pediatric Residency Program.


Dr. Aline Tanios

That is correct.


Erica Jolene

Prior to all of that, you worked for many years developing and establishing the Complex Medical Care Program at Cardinal Glennon. And that's how we met.


Dr. Aline Tanios

That is correct.


Erica Jolene

For our listeners who may not be familiar with what a Complex Care Medical Program is, can you explain to me a little bit about that?


Dr. Aline Tanios

Yes. So, this is a program that has different names at different institutions, but the goal is similar is to be the liaison, caring for children with special needs and medical complexity, as well as their families and the rest of the world - whether it's different specialists, the community, the school, the therapist. So, the program is made up of a physician, nurse practitioner, social worker, dietician, respiratory therapist, speech therapist; who care for every child, every aspect, reach out to all the other specialties to provide streamlined care for these patients so the family can leave that clinic, hopefully, with a very well packaged action plan to follow. Without loading the family from some of the headaches of reaching out to so many others and addressing the needs.


The work is, there's tons of work done behind the scene. What may be a visit for, let's say, 60 or 90 minutes; is the product of work that has been prepared weeks, or even months, and emails flying back and forth, a lot of people brought to the table, conference calls, care conferences, and relying on the family to reach out to this program, with any questions with any concerns. Some are easy to fix. Some require a little bit more thinking and effort. But the goal is really to care for every child by the very fine, smart, loving, and caring team - like each patient is their own.


Erica Jolene

You know, I really do feel like that is felt in Complex Care. It was a different approach for us when it came to the well-being of the child than what we get from sub-specialties.


Dr. Aline Tanios

Yeah.


Erica Jolene

Complex Care for us looks at the whole child.


Dr. Aline Tanios

Yes, yes!


Erica Jolene

...and pushes that further to also looking at the whole family in finding ways to support them in caring for the child.


Dr. Aline Tanios

Yes.


Erica Jolene

...and sometimes that might just be as simple as making the phone calls. So, it's three less phone calls for that parent.


Dr. Aline Tanios

Absolutely. Absolutely. You know, the only thing I wish, and there have been some talks, is to have like a psychologist, also. Someone to address the mental health aspect of the medical conditions in a household affecting the child, affecting the siblings, affecting the parents affecting, the grandparents... you name it.


Erica Jolene

Absolutely. I think that would definitely complete that circle.


Dr. Aline Tanios

Yes, yes. We'll add it to the dream list.


Erica Jolene

Exactly. Yes. Can you tell me a little bit more about that experience? What inspired you to work with and focus on this population?


Dr. Aline Tanios

So, after I finished my residency at Wash U (Washington University), we went back to Little Rock. Part of my job was to be part of their Medical Home Program, which is similar to the Complex Care Program, half-day a week. I'll tell you honestly, at the beginning, I was so overwhelmed because it was new to me. I'm dealing with children with medical complexities and a lot of medical problems, it was so intimidating, I felt I'm not even qualified. A lot of people gave me this advice: start first, and then if you can't do it, you can change your mind later or something like that.


Well, I started taking care of my patients in the clinic, but also when they are admitted to the inpatient service, they were admitted to our team, like a dedicated team. And I felt so comfortable. Maybe because I knew the system. We proved that we decreased, let's say the length of stay of these kids, the parents were happier. So, it became like, caring for children with special needs became my mission.


Then moving back to SLU (St. Louis University) and when I met with my chairman back then, I said I would like to build a program. Barely a year after we had a team and got very strong support from the hospital administration and that was with the help of colleagues who felt that this is the right thing to do. I've seen it on the inpatient side, how it's so overwhelming and confusing. In general, residents are not trained to care in a systematic way, you know what I'm saying?


Erica Jolene

Yeah.


Dr. Aline Tanios

It became more like, my baby. I just felt like this is something that I keep learning, and we keep moving forward, and we keep growing. I feel like at this point, the program is in a very good place.


Erica Jolene

Your role as a complex care physician, I'm sure maybe changed, or at least, inspired your approach to the way you practice medicine. Now, how does that translate into your role as a medical director?


Dr. Aline Tanios

You know, the new role of a medical director is, yes, an administrative role, but it's different than being the medical co-director of the complex care program. In a way that it was more of a brand-new program, it needed a lot of my investment, a lot of my thoughts a lot of my energy. Right now, I feel like as a medical director it's hard for me not to bring the medically complex care population to the table every now and then, to see how we can serve on the inpatient side. That's actually one of my goals when I stepped down from my other role. This current, I mean I hate to say, but this current medical directorship, for the two inpatient units, is not as energizing for me.


Obviously, I'm doing it and I'm trying to do my best and building/bridging gaps between the patient's health care professionals, different types of disciplines. Absolutely. But the other one was a different kind of role, same like my role as a residency program associate director is also different, it takes different energy from me.


Erica Jolene

Absolutely. In one, you were forging a role you were establishing something new and in this other one, you're stepping into it...


Dr. Aline Tanios

Yeah...


Erica Jolene

....something where maybe policies and traditions have already been established for a long period of time.




Dr. Aline Tanios

Yes, yes. yes. I mean, I can bring something new to the table, yes. I have my own, let's say vision and agenda, but it's not something that I'm building myself from scratch.


Erica Jolene

Yeah. Going back to complex care, and looking back, are there any things that you would like to see change for medically complex patients in their healthcare experience?


Dr. Aline Tanios

Yes. So I feel like at the current state, in our state, or hospital, as well as in our nation; there's a lot of programs that have done tremendous work pushing for noble care for children who are more challenging than the rest of the population. Maybe the percentage is smaller, yeah, absolutely; but these programs have taken it to a different level, which is so humbling and so empowering.


But I think we still have a long way to go at a healthcare level, but also at a legislative level. And the list goes on...at the school level, at the community level. I'm hoping that we can, at least at our institution, driven by the mission of being present and you know, doing everything we can in an excellent way, to build a continuity of care that starts from home, outpatient toward inpatient, back to home, like it's a closed circle. Sometimes we do an excellent job, but sometimes I feel like the job is fragmented and that chain is broken, at some point. Maybe at the level of the pharmacy, or at the level of the inpatient service, or the hospitalization stays, or when kids are discharged home with a lack of appropriate or adequate follow up, whether in person or even, like right now in this era, you can use the different platform we can do it remotely. So I feel like we started somewhere, I'm very pleased where we are right now, but I think it's time to branch out and now spread our wings a little bit wider, so we can cover each kid's map.


Erica Jolene

I love that! That is so reassuring to hear. I can definitely say as a parent of two with medical complexities, you do feel that fragmentation. I really feel like we have to get everyone motivated to focus on the continuity to help eliminate that fragmentation.


Dr. Aline Tanios

Yes.


Erica Jolene

You can work tediously to educate and promote this idea, but unless we have everyone involved on that same page, and just as motivated to do that, it won't work. It takes everyone.


Dr. Aline Tanios

Absolutely, absolutely, yes. And the parents are actually and must be, the center of any changes that are affecting their own kids. I mean, you probably heard me multiple times saying that nobody cares about your kid like you do as a parent, but my role as a physician is to be the kid's advocate when I feel like things are not going the right path. Everybody should be at the table discussing this because you see the world through your own lenses, I see it from my own, we should all have a 360 degree view and address it objectively, with empathy.


Erica Jolene

I agree. That's so, like I said, so reassuring to hear. You've worked with a number of patients and families during your time with complex care, but also just being an inpatient hospitalist as well. Having been one of those families...I'm very honored to be one of those families...


Dr. Aline Tanios

You are on the VIP list! (Laughter from both parties)


Erica Jolene

That's very kind of you, but you're on our VIP list!


Dr. Aline Tanios

That's an honor then!