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A Fellowship Where You Learn to Treat the ‘Whole Patient’

During her education and residency Melissa Robinson, DO, became passionate about treating each patient as a whole person, not just as their disease. As she searched for programs that aligned with her commitment, she was thrilled to learn about the Pediatric Day Program at National Jewish Health.

Dr. Robinson graduated with her Doctor of Osteopathic Medicine from the Chicago College of Osteopathic Medicine of Midwestern University and moved on to her pediatric residency at Nationwide Children’s Hospital at The Ohio State University. During her residency, she developed a new spacer, on which a patent is currently pending.

“Children with asthma hate their spacers. So I developed a spacer that lights up and has a few fun games to it. It makes the whole process a little more fun for our pediatric patients,” said Dr. Robinson.

Shortly after she completed her residency, she accepted the Hal Nelson Fellowship at National Jewish Health, where she currently works in pediatrics.

The Pediatric Day Program is a unique, multidisciplinary program in which patients and their families participate in appointments, disease management and therapeutic activities over the course of an average of 10 days. It combines the intensity of an inpatient hospital stay with the cost savings of outpatient treatment.

“In a more typical model, doctors will meet with patients for a short period of time, and give them a standard diagnosis. After all, there is only so much you can do in 15 minutes. But in the 10 days, you really get to know the patients,” Dr. Robinson says.

The child’s treatment team consists of an attending physician, a nurse, and an allergy fellow or physician assistant. Since chronic illness often affects the emotional and social well-being of children and their families, a psychosocial clinician is also included. Other providers may be consulted, including speech therapists, rehabilitation therapists, dietitians, immunologists and pulmonologists. Very often these patients have visited numerous doctors to no avail, but this program enables staff to observe and monitor the patient throughout the day, which in turn helps ensure accurate diagnosis and individualized treatment.

As a first year fellow, Dr. Robinson’s focus is primarily clinical in order to spend a lot of one-on-one time with patients before moving to the research side. This approach puts faces to the patients who may be affected by research outcomes.

This also gives fellows more time to learn about the wide variety of research happening on campus, and decide which project most closely aligns with their interests and skills. Dr. Robinson’s current focus is tree nut allergies and early prevention of atopic dermatitis.

“There are so many research opportunities, it’s hard to pick one! Of course, that’s the best problem one can have as a fellow,” said Dr. Robinson.

She is already making herself known nationally for her research into food allergy, anaphylaxis and the under usage of epinephrine autoinjectors. A study she began as a resident was published in July 2017 in the Annals of Allergy, Asthma & Immunology, and featured on CBS News and in U.S. News & World Report and The New York Times. The study found that only 36 percent of pediatric patients experiencing anaphylaxis received epinephrine autoinjections before arriving at the emergency department. The research focuses on the need to educate parents, teachers, emergency responders and other caregivers to look for signs of anaphylaxis.

“If you’re not sure to the point where you’re thinking about it, I tell parents it’s better to give it than to wait,” Dr. Robinson told The New York Times.

Dr. Robinson has enjoyed another special aspect of the culture at National Jewish Health – the ability to be creative with patient care.

“If you propose a new method of treatment, something that might be out of the box but incredibly effective, and you back it up with data and evidence, the doctors and clinicians here are very receptive. That openness to innovation is what really sets our care apart,” says Dr. Robinson.

This care model gives doctors the opportunity to cast a critical eye on previous diagnoses. For example, Dr. Robinson describes one patient who came from a family who loved to travel. However, travel was incredibly difficult for their daughter, who they believed to be allergic to tree nuts, peanuts, milk, seafood, shellfish, soy, gluten and wheat.

But over the course of the 10-day program, Dr. Robinson slowly introduced her to each of these foods and found no negative reactions whatsoever. So, after years of having to refuse family travel and live on an extremely limited diet, she’s now free to travel (and eat!) with her family across the globe.

“We just really take the time to get to know our patients. And it makes a huge difference,” she says. “Our model and level of treatment is something I’ve haven’t seen anywhere else.”