The Benefits of Choosing Surgery at Lurie Children’s with Earl Cheng, MD

It's estimated that nearly 4 million surgeries are performed on children each year in the U.S., but no matter how complex or routine these surgical procedures may seem, none are simple, and the skill of a surgeon is always a key component of its success. On this episode of Precision, Earl Cheng, MD, explains the benefits of seeking out highly trained pediatric surgeons and specialized providers, like those at Ann & Robert H. Lurie Children's Hospital of Chicago.

“All we take care of is children. From the minute that you walk through the door, everything is dedicated towards taking care of that patient population.”

Earl Cheng, MD 
Division Head, Urology
Co-Head, Reconstructive Pediatric Urology 
Founders’ Board Chair in Urology; President, Lurie Children's Surgical Foundation 
Professor of Urology, Northwestern University Feinberg School of Medicine

Show notes 

• Dr. Cheng leads the largest pediatric urology division in the Chicago region. His expertise is in major complex open reconstruction, but the surgeons in his division also performs intricate surgeries with robotic or endoscopic techniques.
• Performing surgery on children is very different from doing the same on adults and Dr. Cheng says beyond their size, children's resilience and unique healing abilities are part of that equation.
• Dr. Cheng understands the anxiety that parents may have when their child undergoes a surgical procedure, and he says leading conversations with empathy is an important part of his job.  
• There are many choices to consider when deciding where your child should receive a surgical procedure, but Cheng emphasizes that seeking out care at an independent children's hospital such as Lurie Children’s, has many benefits. Even during routine surgeries he says situations arise that are more complicated than expected and to have the expertise of pediatric specialties in and outside of his specialty is advantageous. 
• As the father of five children, Dr. Cheng has been in the shoes of many of the parents he meets because all of his children have had surgery at young ages. He says it's very common for parents to ask him what he would do in a situation involving surgery on their child and he always answers truthfully. 
• The quality of surgeons at Lurie Children's is top-tier and Dr. Cheng says that is due to fostering an environment that encourages continuous improvement and innovation.
• Lurie Children’s is an academic partner of Northwestern University. Dr. Cheng says being part of an academic medical center provides surgeons with access to research, tools and ideas that help them make groundbreaking advancements in pediatric surgery.
• Reflecting on Lurie Children’s mission, "All, for your one," Dr. Cheng says the “all” part of the mission is particularly important because it means that everyone in the hospital is dedicated to the care of your child. Making your experience as least stressful as possible is very important to everyone at Lurie Children’s, whether your experience will involve surgery or not.
• Another special aspect of Lurie Children's is it provides care to all patients regardless of their ability to pay. “Once they're in the walls of our building, we treat every single child the same. And that's the core of what we do.“
• Waiting for specialty care and surgery is sometimes a reason why families decide to seek care outside of a pediatric hospital, but Dr. Cheng emphasizes that the expertise provided is worth the wait. He also says in serious situations where it is needed “tomorrow,” Lurie Children’s can make that happen, too.
• His message to parents considering Lurie Children's is to come and see for themselves the special care provided, from the simplest of problems to the most complex. “We try to provide an environment that is going to be unique and beneficial and hopefully special, that's what Lurie Children's is all about.”

Transcript

[00:00:00] Erin Spain, MS: This is Precision, Perspectives on Children's Surgery from the Ann & Robert H. Lurie Children's Hospital of Chicago. I'm your host, Erin Spain. On this podcast, we introduce you to surgeons at one of the country's most renowned children's hospitals to find out how they're transforming pediatric medicine. It's estimated that nearly 4 million surgeries are performed on children each year in the U.S. But no matter how complex or routine these surgical procedures may seem, none are simple, and the skill of a surgeon is always a key component of its success. Today, Dr. Earl Chang joins me to talk about the benefits of seeking out highly trained pediatric surgeons and specialized providers, like those here at Lurie Children's. Dr. Cheng is the division head of urology at Lurie Children's and an expert in complex reconstructive urology. Welcome to the show

[00:01:02] Earl Cheng, MD: Great to be here.

[00:01:03] Erin Spain, MS: You lead the largest pediatric urology department in the Chicago region. Tell us a little bit about you and your background and your specialty.

[00:01:10] Earl Cheng, MD: I'm very blessed to have a large group of pediatric urologists. There are 12 people in our group, along with all the additional staff that works with us, nurses, the advanced nurse practitioners, physicians assistants, we have an entire team that work together that support our group's efforts. We all specialize to a certain degree. So for example, my area of specialty is complex reconstruction where, A child might be born with, aspects of the urinary tract, that have not developed correctly and that will require some element of reconstructive surgery to allow the urine to drain appropriately or to allow them to have continence, Or, situations that may require, minimally invasive surgery, where we then may rely on some of my partners who bring in, to the equation robotic surgery or endoscopic techniques that are different from major complex open reconstruction, which is what I specialize in. So, we're blessed to be together, to lean upon each other, especially in complex cases. And we work with our academic partners at Northwestern, here at Lurie Children's. And, it's a team that I feel very fortunate to be part of.

[00:02:08] Erin Spain, MS: This podcast, Precision, is all about surgery, and surgery on children is different than surgery on adults. Tell me about those differences.

[00:02:17] Earl Cheng, MD: I think we all know that children are not adults for many different reasons, but, the way that they are tolerant of certain situations that maybe adults would not be were actually blessed in that fashion because they're very resilient, both emotionally as well as physically. They also heal differently and the manner in which they heal and are able to sustain certain aspects of surgical recovery, is remarkable. So, many people feel that a surgical field that is concentrating on pediatric patients can be more challenging from the standpoint of, how you handle tissue and some of the complexity and the conditions that they have, and that is true. But we're also blessed with many of the innate aspects of infants and children and how they heal and respond to certain elements of surgery and the recovery that's involved afterwards.

[00:03:05] Erin Spain, MS: Tell me about some of those challenges or things that you really enjoyed about pediatric surgery that brought you to where you are today.

[00:03:14] Earl Cheng, MD: I think if you speak to any pediatric surgical subspecialist, they'll tell you what drew them, is the type of surgery. But along with that goes the interactions that you have with families. Having five children myself, I've experienced certain emotions that are good and bad. We all just want what's best for our children. And in the setting of performing, what we would consider relatively simple bread and butter surgery for a parent, it means everything .How you interact with them, counsel them, both pre and post op, and, address some of the anxiety that they have concerning their child's, condition is something that I... found challenging, but at the same time very gratifying.

[00:03:51] Erin Spain, MS: Some surgeons operate on both children and adults, but there's benefits of going specifically to a pediatric surgeon. Share those benefits with me.

[00:04:00] Earl Cheng, MD: Parents have numerous different options for where to obtain their care. And it's not for me to say what they can achieve on a local level is as good, better, or worse of what we provide. What I can speak to are the things that we can provide that I think are relatively unique. And so, when you take a pediatric subspecialist at Lurie, that's all they take care of is infants and children. And so, that's what they do every single day, as opposed to maybe somebody that is doing something more broad based. But for a simple problem, most of the time it will just be simple. But at times you'll be in the operating room and all of a sudden something becomes a little bit more complicated that you didn't expect. And so I've been doing this for 30 years and I can tell you this happens more often than you would like it to happen. And so when you have a situation as such, When you have a situation in which hopefully you've seen that before, or you can rely on the people around you to help you with that situation. I'm blessed to have numerous people around me, not only my own specialty, but many others in or outside the operating room to assist in taking care of those challenging situations in which it might be something that you didn't expect to see. That is something that is very advantageous. And then here at Lurie Children's, like many other independent children's hospitals, that's all we take care of is children. So from the minute that you walk through the door, everything is dedicated towards taking care of that patient population, as opposed to... being in a situation where maybe there's both adult and children. It's important what happens before the operation, during the operation, and after the operation. And to have that setting where everything is dedicated to the needs of that individual that is specialized for them, can make all the difference in the world. Another benefit of being at Lurie Children's, especially in the field of surgery, is the anesthesia. And as we all know, putting a child to sleep, especially if you're a parent, is one of the most anxiety provoking situations that you have. And to be in a setting where your anesthesiologist is very comfortable putting a newborn baby to sleep, and extreme circumstances would suggest that even for the simplest of situations, they're very comfortable taking care of your child in that setting. For me to have the assurance is that I don't necessarily need to be concerned about how that child is going to be put to sleep or how that child is going to be, woken up. As well as address their pain concerns, is another tremendous added benefit for being where I'm at.

[00:06:18] Erin Spain, MS: You mentioned that you have five children yourself. Tell me about that as a parent, how that impacts the care that your patients receive.

[00:06:27] Earl Cheng, MD: I do believe that most pediatric surgeons bring an element of empathy that is a little bit different, than what you see in the adult world. Not to say that adult surgeons are not empathetic to their patients and their families, but it's just a little bit different when it's a child or a baby. It is certainly advantageous to have experienced some of the things that some of my parents of my patients will go through. For whatever reason, all of my own children have had surgery, at a young age. Having been in that situation, having gone through that, I think it allows me to hopefully better empathize with what other parents are going through and to help them through that process, as well as understanding the fact that every single child is different. Believe me, all five of my children had different experiences in and outside the operating room. I oftentimes, remind myself when I'm challenged with a situation where I'm not quite sure of how to transmit information to a parent or a family member or actually the child himself if they're old enough to be involved in their own decision making for their body , is to try to put myself in their seat and ask myself what would I want to hear from the surgeon? It's very common for parents to ask me what would I do in that situation. I always tell them that my advice is based upon what would I do if that was my own child?  

[00:00:] Erin Spain, MS: Vetting providers can be very difficult for parents who are looking for the safest and the most successful surgery for their child. How does Lurie Children's ensure that its surgeons really are top tier?

[00:07:55] Earl Cheng, MD: To be able to attract the top talent, you need to have an environment that is going to be conducive for them to be able to practice their art of surgery. To me, a top tier surgeon is not one that just doesn't have the technical abilities to take care of a specific problem, but one that is always looking at, how can I do this better? And that's our job. That's our job because all of us at Lurie Children's are also academic surgeons where we are looking for ways to make things better clinically. We're looking at ways to take experiences that we may have in areas of research, whether it be clinical research or basic science research, and put that into practice where what we do now is different from what we did historically. Also being in a multidisciplinary environment, they're being challenged. And so when you look at the top tier talent across the nation, that's the environment that they want. Fortunately, at Lurie Children's, as well as many other top tier children's hospitals, they have an academic affiliation with a major institution like Northwestern, which is where we have our academic affiliation, and, it's an environment where that thought process is a constant of, how can I do this differently to make it better? And how can I think out of the box, as opposed to just conventionally? And that's where discovery is going to be made. So that's always in the background. That's what top tier talent is looking for. They're looking for that environment where they're going to be challenged and stimulated, intellectually, as well as what they do technically in the operating room. And then having the resources to explore novel ideas and ways to make things better. And so our ability to do that, which is not inexpensive, but it's obviously based upon, the dedication of resources that we have to create that environment as well as, the philanthropic efforts of, many that this is something that is near and dear to their heart, allows us, to be able to do that.

[00:09:44] Erin Spain, MS: We're part of an academic medical center. These are academic surgeons who think differently and have access to different tools and ideas? Tell me how that impacts children?

[00:09:54] Earl Cheng, MD: When you talk about doing things differently, there are conditions within my field where individuals are born with either a bladder that doesn't work, or a bladder that needs to be partially removed, or for some reason, it's an inadequate reservoir for them to store urine, not only to prevent infection, but also to provide an element of social continence. And in that situation, we don't have a great answer. We don't have a way to substitute that bladder tissue in a way in which that child can have a more normal aspect of how they store urine. and evacuate urine. So we're looking for opportunities of how we can potentially replace bladder tissue or augment the bladder with tissue that can then be utilized in a normal fashion. And so that's where basic science research comes in in the area of tissue engineering and that's where our laboratory focuses on ways to make new bladder tissue that potentially can be put into the body and address situations in which an individual has inadequate bladder tissue themselves. And so, it's been about 20 to 30 years of research in this area, but we are very close to being able to implement potential clinical ways of doing this, which can be potentially life changing and altering for those individuals, that have those rare conditions, in which they don't have a normal bladder. The environment that is being provided here at Lurie Children's, as well as Northwestern, to be able to do this. perform that type of research in conjunction with brilliant minds in stem cell biology and nanotechnology and to bring those talents together where I can work with them to help make that truly what we would call translational in nature, where you can bring it from the laboratory to the clinical setting, is something that, is very exciting.

[00:11:33] Erin Spain, MS: Tell me about the mission of Lurie Children's and how all of the people, all of your colleagues, really support the mission of the hospital.

[00:11:42] Earl Cheng, MD: I think everyone here is dedicated to our motto of all for your one, and that is to be singularly focused on the child, their condition, and their family. When we say “all for your one,” that can mean numerous different things. And the “all” is, is very important to me, that means everyone in the hospital is dedicated to the care of you, your child, and everything that is involved in making that an experience that is the least stressful as possible, whether it involves surgery or not. And also understanding that all of those resources are available to you. In comparison to maybe other health care facilities that don't have the luxury of having all of those resources. You never know when you're going to need them. And in the situation that you are, whether it's someone that knows how to draw blood on a baby, whether it's someone that is, involved in helping make an environment around the operating room better, as many of our nurses will do, as many of our social workers will do, as many of our child life specialists are trained to do and are passionate about, having all of that at your fingertips, is something that I sometimes take for granted and, and maybe I should not. And then there's the all for your one in the one aspect and that is, concentrating exactly on that individual their specific needs but also recognizing their environment surrounding them and how we can make that better.

[00:13:02] Erin Spain, MS: Also, Lurie Children's turns no patients away, regardless of their ability to pay. Tell me about that. How does that work?

[00:13:10] Earl Cheng, MD: The environment in which we are is one in which we are dedicated to taking care of every child, regardless of their background, their means, what their situation is, There are a lot of different challenges that we have in healthcare today, especially with regards to, a family's ability to have insurance or not and have insurance or what means that they have. Once they're in the walls of our building, we treat every single child the same. And that's the core of what we do.

[00:13:36] Erin Spain, MS: Sometimes when a parent wants to come to Lurie Children's. They could be faced with a waitlist to get into a specialty clinic or into surgery at Lurie Children's. Tell me about these wait lists and what do you want parents to know about how they work and why they should wait?

[00:13:50] Earl Cheng, MD: Well, in a perfect world, no one should have to ever wait. As a parent, anytime you're told that you need to see a specialist, you want the answer tomorrow. But you also want the right answer. And, the expertise that we bring is one that sometimes is in great demand. In a perfect setting, we'd be able to provide that expertise for all families tomorrow, if asked for. And in situations where it's needed tomorrow, we will always make that happen. But in other situations where it can wait a few weeks, is it worth the wait? For many of the reasons that we've talked about already, I do believe it's worth the wait. I oftentimes will liken it to if you have a car and if you have an option to go to a dealer, which you know might take a little bit longer and it's more expensive, versus going to another situation where they might do an equally good job, but at the same time, most people would go to the dealer if it was free. Well, in most instances, if your insurance allows you to come to Lurie, which most insurances will, regardless of the type of insurance that you have, whether it be commercial or state funded, it's a situation where that care is available to you. And if one has to wait a couple more weeks or travel a little bit longer to get that care, I'm biased. I think it's worth it.

[00:15:02] Erin Spain, MS: What would you like to leave us with today as a message to parents listening who are considering coming to Lurie Children's?

[00:15:08] Earl Cheng, MD: I think I would tell parents that we're here for them. We want to take care of their children. From the most simplest of problems to the most complex. That we treat everybody the same. And that, if they have an opportunity to come see us, we'd like to think that we'll make a difference and it's well worth maybe the additional wait that they would have to see one of us as a specialist. That's why we're here. That's what we do, We try to attract the top talent. We try to attract the people that are going to make a difference. We try to provide an environment that is going to be unique and beneficial and hopefully special, that's what Lurie Children's is all about.

[00:15:39] Erin Spain, MS: Well, thank you so much for coming on the show today and talking about what parents may experience when they come here to Lurie Children's. Thank you, Dr. Earl

[00:15:49] Earl Cheng, MD: You're more than welcome. Thank you.

[00:15:50] Erin Spain, MS: For more information, including how to make a referral or an appointment, visit LurieChildrens.org.