Meet Dr. Beth Gottlieb!
Beth Gottlieb has had an interest in outcomes since the start of her medical career. As a fellow, she was interested in the impact of family support. She looked at how social support networks were linked to outcomes for children with active arthritis. When she looked at similar disease patterns with different social support, she found very varied outcomes. In particular, moms without support have a difficult time managing and children have more difficult outcomes.
Then in 2008, she and Esi Morgan, among others, were invited by the American Academy of Pediatrics (AAP) to talk about forming learning networks. It made sense to attendees to form a network around JA and by 2010, PR-COIN was launched.
Dr. Gottlieb has been practicing at Cohen Children's Medical Center for over 29 years where she is now director of the Division of Pediatric Rheumatology. For her, then and now, working with families to improve quality of life is key.
“It impacts outcomes,” she says. “A provider might be focused on the number of joints impacted, but the parents just want their child to have less pain. We would not be focusing on the most important factor. And we should never lose sight of the family’s input.”
Recently one of her fellows did the barriers assessment with a patient who had been on a medication for a long time. They kept saying they were fine but when the fellow gave the assessment, the child indicated difficulty with all items impacting taking medication.
“She never talked about it but there were things we could have addressed. Many times, people feel more at ease writing down difficulties rather than saying them out loud. I also didn’t know things about my patients before I used the barriers assessment, what an eye opener that was for me.”
Another thing she appreciates about being a PR-COIN site is that they do pre-visit planning and a morning huddle. When they noticed better outcomes, it completely coincided with the start of pre-visit planning.
“We have got to get rid of clinical inertia, searching through the chart to find info, knowing you are behind while seeing patients and just letting a treatment change wait for the next visit when the patient could get by for a little longer on the same medication. When we do pre-visit planning, we are prepared with answers. When we see an exam isn’t perfect, we don’t just say ‘we’ll just see how you are next time’. That’s not bad medicine, but PR-COIN allows us to practice better medicine.”
She had some hesitation about the Shared Decision-Making Cards. She thought they would have to talk through every card, but that’s not how it’s worked. Instead, it provides a great visual and makes things clearer. And she credits that to families helping to develop them.
Dr. Gottlieb originally intended to go into hematology and oncology. But when the rotation she was supposed to do was full, she took a spot in rheumatology at the Hospital for Sick Children and had an amazing experience.
She says it’s very special to be able to get to know families and be with patients for a long time. On tough days, she looks at her wall of pictures of patients – her “happy wall”.
Visit our Get Involved page to learn more about how you and your center can get involved in PR-COIN.