Spotlight on Dr. Skaggs
I chose to work in Orthopaedics at Children's Hospital Los Angeles because...
I announced to my parents that I wanted to become an orthopaedic surgeon when I was five years old. During my internship, I realized that every time I had a child in my lap, I was happy. I knew then that I wanted to work with children every day for the rest of my life. I came to Childrens Hospital to obtain specialized training because I felt Childrens Hospital had the best pediatric spine program in the world. Today, as Director of the Scoliosis & Spinal Deformity Program and Director of the Childrens Orthopeadic Center, I feel I absolutely made the right choice!
My greatest satisfaction comes from...
… changing the life of a child, and knowing that child can often go on to live the rest of their lives essentially normal. It is deeply gratifying to watch a child’s self-image and confidence dramatically increase after treatment. A child will come in for an evaluation wearing dark clothing, self-conscious and avoiding eye contact. After treatment, that same child will return standing taller, smiling, brimming with confidence. More than one mother has joked after I perform scoliosis surgery for their teen, “What did you do to my child - she behaves like a normal teenager now and doesn’t listen to me?”
I feel my greatest contribution is...
…..taking care of one child and one family at a time. In addition, training other surgeons is quite rewarding. I’ve written or edited three major textbooks, published over 80 papers, and given over 500 lectures. In the hospital, I’m able to change the life of one child at a time. But when I teach other surgeons, I can help improve the lives of thousands of children. I tell doctors I train “we are allowed a privileged entrance into a family’s world." Very few professions allow this kind of connection with a family. And because we are granted this unique opportunity, we have the responsibility to do everything we can for the family and child. This isn’t a job – this is a calling.
My Role at Children's
What my day is like...
I wake up early each day and try to meditate and get to work as early as possible. Some days, I get to the gym in the early morning, on others I wait to work out with one of my three children. From 6 to 8 a.m., I work on papers or textbooks and then begin doing surgery at 8 a.m. After lunch I take a nap (NBC News actually did a special on me taking naps). I finish up work in time to get home for dinner with my family.
What surgery is like for me...
Surgery is fun for me. It is an opportunity to be creative and fix things. In a way, it is a meditative activity – a time when I am allowed to put my entire attention in one place, without anyone else requesting anything of me. If I’m on a week-long lecture tour, I find myself itching to get back to do surgery.
What my job means...
My job is to make sure that visits are as fun as possible for our patients, that families get their questions answered, and that we mimize the hassles inherent in the medical system.
Staff look to me for...
In addition to providing guidance for difficult cases, my responsibility is to make this a fun place to go to work. I want everyone on the staff to know how that they are directly helping sick or injured children, and share the rewards of making children and families happy.
My approach to care...
Being asked to perform surgery on a child is being given a sacred gift. Parents are entrusting the most precious thing in their world to your hands and your judgment. Having 3 children of my own, my promise to each family is that I will only recommend for their child what I would want for my own children. I feel like I am working for the child. Unless a child is very young or unable to communicate, I am very hesitant to perform a surgery until the child has told me they are ready for it. It is my responsibility to educate the child about what is going on and let the child make an informed decision. It often takes a lot of time, emails, phone calls, and multiple visits with the whole team including physicians assistants and nurses, but it is worth it. When a child makes a decision to have surgery, he or she takes the responsibility and deals with it instead of blaming parents. One patient with scoliosis cancelled surgery twice. She finally went through with it and told me at the next visit “This is the best decision I ever made in my life . . . thanks for your patience with me.”
One young woman was training to be an Olympic gymnast until she began experiencing career-ending back pain. She visited many doctors, and underwent MRI’s, injections, and even experimental treatments, all to no avail. After diagnosing a rare type of fracture in her spine, I performed minimally invasive surgery, and removed a bone chip that was causing her pain. She went home the same day and returned a week later, proudly demonstrating back-bends in my office, pain-free. This is a child who, prior to the surgery, had lost her life’s goal, and was becoming depressed; now she is pursuing her goal of competing in the Olympics.
Our Center places considerable effort into making visits easy for families. We have received incredible feedback from parents on how easy it is to get appointments for their child and how they feel that they have access to nurses, physicians assistants, and physicians after appointments for further discussion. Personally, for every patient that I provide with a major surgery, their family gets access to my cell phone. Other doctors might feel this is insane. But I have found that parents are incredibly respectful of this privilege.
Changing referral patterns
Parents will think nothing of taking their child out of state for a sports tournament. But those same parents will often have a difficult time driving across town to see a specialist for their child's care. One of my personal missions is to see pediatricians and physicians at local community hospitals change their inter-referral patterns so that a child is sent to the very best doctor at the very best facility for their care, rather than the closest or easiest facility to reach.
One of my goals is to create a fracture clinic for patients who can come here to have a broken bone set the same day. A few years ago, our Center conducted a local research study because of the number of kids who were coming to us with bones healing improperly because they couldn’t get an appointment with a pediatric specialist, or they were treated incorrectly by a general doctor. We called 50 orthopaedic offices in Los Angeles County requesting an appointment for a child with a broken bone. When the child was reported to the orthopaedic office to have private insurance, 50 out of 50 offices offered an appointment that week. When the child was reported as having government insurance, only 1 out of 50 offices offered them an appointment that week. Our goal is to take care of all of these children.
Improving Spinal Implants
In addition to working on minimally-invasive techniques for surgery, we are designing the next generation of spinal implants. Currently, many spinal surgeries result in the fusion of many vertebrae and discs that each have independent motion with metal rods, so that they remain in a straight position. Designs for future spinal implants will allow straightening while still permitting motion between these segments.
BACKGROUND AND TRAINING
Columbia University College Physicians and Surgeons
Columbia Presbyterian Medical Center/New York; Orthopaedic Surgery
Columbia University; Orthopaedic Surgery Research;
Children's Hospital Los Angeles; Pediatric Orthopaedic Surgery
Orthopaedic Surgery; American Board of Orthopaedic Surgery
IN THE MEDIA
Rockwood and Wilkins'
Fractures in Children
Master Techniques in Orthopaedic Surgery: Pediatrics
Staying Out of Trouble in Pediatric Orthopaedics