Unique clinic ‘magical’ for patient who sees multiple MDs

4 doctors, 1 monthly visit to treat complex pediatric immunodeficiency cases

Unique clinic ‘magical’ for patient who sees multiple MDs

Gianna Osborn has been to a lot of doctor’s appointments.

The 17-year-old from Minot, North Dakota, has spent the past four years being treated for common variable immunodeficiency (CVID), which makes her susceptible to infections and autoimmune diseases. This includes chronic idiopathic thrombocytopenic purpura (ITP), a disease which affects Osborn’s blood platelets, organs and more.

Because her disease — and the potential complications that could stem from it — straddles so many different medical specialties, she now goes to a unique clinic at Sanford Health in Fargo, where she can meet with four different doctors, in four different specialties, all at the same time.

“At my old appointments, I would have to go over my history and how everything started about five different times and it kind of just got to be a lot,” said Osborn. “So I definitely like coming here and just being able to talk to all of them at once and hearing how they bounce off each other’s ideas and they just make it all work the way I kind of want it to work.”

How the clinic coordinates treatment

The pediatric immunity deficiency clinic within Sanford’s coordinated treatment center is the brainchild of Christopher Failing, M.D., a pediatric rheumatologist in Fargo who saw the benefits of a multidisciplinary clinic during his fellowship at the University of Michigan.

“We had several patients in the state that already had pre-existing immunodeficiencies, some living very far away. So we thought it’d be great to have a clinic where everyone can come see all the specialists that they need to see at one time instead of having to come back and forth for separate appointments,” said Dr. Failing. “That was my dream to start something for the Dakotas.”

The clinic is held once a month, and the group might see four or five new patients along with two or three returning patients each clinic day. It is also unique in the region. In fact, according to Dr. Failing, the nearest equivalent clinic is in Milwaukee, more than 500 miles away.

Clifford Mauriello, M.D., a specialist in pediatric infectious disease, is one of the many colleagues who have joined the clinic. He says the overlapping knowledge of each specialist reassures the patient, and keeps the team on the same page.

“Instead of going to four different clinics and then everyone getting part of the story, we all have all the data together, and we say, ‘This is the plan that we’re all doing.’ There’s no doubt in the patient’s mind that there’s a comprehensive plan of action,” Dr. Mauriello said.

“That kind of shared work, that kind of collaborative thinking is becoming more and more common in medicine for a lot of these kinds of syndromes.”

Collaboration benefits patients and providers

After meeting with the patient, the doctors reconvene to talk about a treatment plan, making sure medications don’t conflict, while also bringing their own unique perspectives to the table.

While all of their knowledge is obviously beneficial to the patient, the doctors themselves get a great deal from these clinic days as well.

“I’m learning things every time I’m in this clinic,” said Sam Milanovich, M.D., a specialist in pediatric oncology and hematology. “Being able to have that conversation, that collaboration, that collegiality in-person, face-to-face, it’s a rewarding experience for us.”

For Gianna Osborn and her parents, the collaboration between these four doctors is something at which they marvel.

“Watching them work together, it’s magical,” said Angie Osborn, Gianna’s mother. “It just gives you goosebumps because you see their minds and how smart they are and working together to figure out what’s going on with her.

“She’s doing a lot better, but it can spiral for sure. You have to stay on top of it, and I think that they’re going to continue working with her a little bit, even through college, which is a really comforting feeling.”

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Posted In Children's, Fargo, Specialty Care