Five questions for Marion Sills

Marion Sills, M.D., is an associate professor of pediatrics at the University of Colorado School of Medicine, and an attending physician in the emergency department at Children's Hospital Colorado. She received her medical degree from the Johns Hopkins University School of Medicine in 1993 and completed her residency in pediatrics there in 1996. She is board-certified in pediatrics emergency medicine and in pediatrics, and is a member of the Academic Pediatric Association and the American Academy of Pediatrics.

While completing her undergraduate and graduate medical degrees on the East Coast, she visited the mountain West during vacation and several elective rotations. She later moved to Colorado so she could enjoy the mountains year-round.

At the university, she mentors residents and fellows. Her research focuses on emergency department crowding, quality measures and health information technology.

— Cynthia Pasquale

1. When and how did you decide to become a doctor? Why did you choose pediatrics?
After college, I followed my interest in policy by working for a nonprofit environmental group in Washington, D.C. Although this was a great experience, it coincided with what I did not then know would be the last of three consecutive terms of Republican presidencies. Given that political milieu, I felt that if I couldn't make headway as a budding environmentalist, I thought I would at least try to make a difference for individual patients, so I applied to medical school.

I chose pediatrics because it was the most fun, especially in the otherwise rather formal environs at Hopkins. Early in my medical school pediatrics rotation, a young patient delightedly grabbed one of the rounding physicians by his requisite necktie and announced he had a new pet on a leash. I found it refreshing that children seemed to cut through any pretense on the part of their providers, and reminded us to be humble.

2. Describe a shift as an attending physician in the emergency department at Children's Colorado.
One of the mixed blessings of emergency medicine practice is there is no such thing as a typical shift, but rather a continually changing milieu of acutely ill and injured children. The clinical workload varies, but is usually intense, as emergency department volume is not limited by scheduled appointments, bed spaces or nursing capacity, as are many outpatient and inpatient settings. Emergency providers are federally mandated to stabilize all patients, whenever they arrive, for whatever reason they present, including adult patients. The clinical hours also are quite varied, with the majority of our shifts including the busiest nighttime and weekend hours.

I enjoy the challenge of the diagnostic dilemmas, as well as the variety of clinical presentations, ranging from major trauma resuscitations requiring life-saving procedures to basic safety-net services, such as providing reassurance to the young mother of an infant with a diaper rash. For the emergently ill, one of the challenges is providing care without the luxury of a prior patient-provider relationship and its accompanying trust. For some patients, the primary challenge is managing expectations. Many arrive with expectations difficult for any emergency department to meet, whether they be clinical (that we have a secret stash of cure-for-the-common-cold not yet available over-the-counter), or more global (that we can help their child stop acting out in school). A family once brought in a child asking for a CT scan to find out what she was seeing when awakened by nightmares.

Every emergency department shift includes stories that reveal broader, societal ailments. Some stories are access-related, such as the patients who come to the emergency department because they have nowhere else to go for a medication refill or cannot take time away from work during typical clinic hours. Some tell us about challenges faced by our primary care system, such as patients sent to the emergency department by primary care providers who lack the time or other resources to coordinate complex outpatient care. Other daily stories – involving obesity, tobacco exposure, illicit drug use, vaccine-preventable-illness and injuries – remind us that public health battles are far from over.

3. One of your research interests has been emergency department crowding. What has the research found and what do you hope to accomplish?
Some of my research has looked at hospital crowding (both emergency department and inpatient) and its impact on children's health care quality and health care resources. One set of studies, set at Children's Hospital Colorado, modeled the relationship between emergency department crowding and the quality of care delivered for acute asthma and fractures in children. Consistent with studies in adults, we found a similar inverse association between crowding and quality for children seen in the emergency department.

Another set of studies looked at the impact of crowding during the 2009 H1N1 influenza pandemic on a few dozen children's hospitals across the country – both in terms of emergency departments and inpatient resources. A third set of studies in the same group of children's hospitals has highlighted the lack of hospital response to high occupancy despite opportunities to alleviate a lot of crowding through smoothing (redistributing) elective admissions more evenly across a seven-day week.

Currently, I'm helping to lead a comparative effectiveness research (CER) project within a federated research network of safety net providers across three states. Performing CER in minority, underserved and rural populations is especially valuable because historically they have limited representation in clinical research and well-documented health care disparities. And there are differences between documented clinical trial efficacy and real world effectiveness in these populations. These are also the patients most likely to visit emergency departments for ambulatory care sensitive conditions – conditions that potentially are preventable – and emergency department use is one of the many outcomes we are studying.

4. What is your favorite part of the job and why?
There are many favorites, but here are two: The simplest favorite is the satisfaction of fixing something – whether it's a simple laceration or life-threatening shock. A more complex favorite is the window the job gives me on the inspiring love within families.

5. How do you deal with being in a high-stress environment like the emergency department?
My friends, family and religious community help me keep things in perspective. A colleague once gave me a list of time-management techniques and I try, with varying diligence, to stick to it. I also use sports – mostly biking, running and swimming – as an outlet.

Want to suggest a faculty or staff member for Five Questions? Please e-mail Jay.Dedrick@cu.edu