Jan. 19, 2021
Diagnostic dilemmas can be a challenge, for physicians as well as for patients and their families. This situation is particularly true when a child or adolescent presents with complicated or undifferentiated symptoms spanning numerous organ systems. In some instances, arranging specialty care, making sense of specialist opinions, and providing a cohesive diagnostic opinion and treatment plan can take months or even years. The process weighs heavily on parents and can take substantial time from a primary care provider's practice.
The Mayo Clinic Children's Center strives to serve as a resource to you and your patients for difficult diagnoses. Amie E. Jones, M.D., medical director of the Pediatric Diagnostic and Referral Clinic, describes the Children's Center as a "pediatric center of excellence for complex care at Mayo Clinic" or a "one-stop shop for coordinated diagnostic services."
When a child presents to the Pediatric Diagnostic and Referral Clinic, a coordinated medical team is mobilized around patient and family. Before the patient arrives, the medical record is reviewed and a condensed appointment itinerary is created. Patients typically begin their visits at Mayo Clinic Children's Center in Rochester, Minnesota, with a seasoned diagnostic pediatrician who takes the hour or more necessary for gathering a comprehensive history and performing the physical exam. The test and consultation schedule is refined and patients begin their journey through the system in an individualized, efficient and coordinated manner. A nurse coordinator serves as a point of contact throughout the process.
Some patients will have only a couple of tests and specialty consultations, whereas others will meet with numerous pediatric medical subspecialists, surgeons, therapists and proceduralists.
In some cases, patients' schedules will include referral to Mayo Clinic's Center for Individualized Medicine, which brings together clinicians, laboratory geneticists, bioinformaticians and genetic counselors to enhance treatment and research of genetic conditions.
Along the way, the diagnostic pediatrician and care coordinating nurses ensure seamless communication within the entire specialty team to facilitate maximum coordination of effort.
Holistic treatment plan development
Patients return at the end of the evaluations to wrap up the episode with the coordinating pediatrician. Patient, family and provider review all the tests and consultations and develop a unified, holistic treatment plan. In most cases, this process takes about a week. Families appreciate starting and finishing with the same provider so that all of the information can be tied together and explained.
Many patients, families and referring providers will request only one or two evaluations at the Mayo Clinic Children's Center to appropriately address a specific and targeted medical concern. However, the Pediatric Diagnostic and Referral Clinic is a good entry point for those patients who have medical issues that cross multiple specialty areas and need a more diagnostic-odyssey approach.
The patients who benefit most from this type of referral include those who have struggled with fragmented care or those seeking multi-subspecialized expertise in identifying the right diagnoses and effective care plans for complex conditions. Some patients and families initially seen through the Pediatric Diagnostic and Referral Clinic will chose to remain connected with Mayo for ongoing coordinated specialty cares for the children's complex conditions.
If this ongoing care relationship requires longitudinal involvement of three or more specialties, then the child can be enrolled in the Mayo Clinic Complex Care Clinic. In this clinic, the child will be followed by one of the complex care pediatric providers and a care coordinating nurse. This clinic does not replace the medical home, but assists in organizing and centralizing the specialty care a child may need.
The Mayo team engages with the local primary care provider by phone with interval updates and is always available to take calls from the local care teams to best support the patients and their local providers. This close partnership ensures seamless care; active collaboration between local care providers and Mayo Clinic pediatric specialists helps ensure that children with medically complex conditions receive high-value care, wherever they may live.
For more information
Mayo Clinic Children's Center. Mayo Clinic.
Center for Individualized Medicine. Mayo Clinic.
General Pediatric and Adolescent Medicine: Complex Care Clinic. Mayo Clinic.