The Top Doctors in the Twin Cities, 2021 - Mpls.St.Paul Magazine
As medicine evolves with lightning speed, our medical community, built on a tradition of excellence, is taking a leading role in delivering transformative care. Local doctors are constantly shaping innovations that go on to become common practice and exploring new ideas about where care should be heading. The results—improved lives and outcomes, cutting-edge targeted treatments, and patient-centric care strategies—benefit us all.
This year, as we celebrate the 25th edition of our Top Doctors list, we talked with professionals who have been on this list for decades and others newer to the ranks about the changes they've seen and what's coming next in their fields. Read on to discover more than 800 local top doctors from 46 specialties who have been selected through a process involving extensive research and peer review.
See the complete list of doctors selected to this year's Top Doctors.
Fighting Brain Cancer
There's much that is sobering about brain cancer: Glioblastoma (the most common type of brain tumor in adults) remains one of the deadliest cancers, and one of the most challenging to treat. Even with the most advanced care, it is a devastating disease. But patients today benefit from some major advancements of the past 15 years: Before 2005, there was no common standard for treating glioblastoma. Now, the protocol of surgery, radiation, and chemotherapy has extended life expectancy—and much more is on the horizon. "I'm optimistic that before the end of my lifetime, we are going to see major changes for glioblastoma patients and achieve meaningful benefits," says Dr. Clark Chen. We asked him for his thoughts on the milestones in his field and what's giving him hope.
"Surgically implanted radioactive seeds have the potential to improve life expectancy and quality of life for brain tumor patients."
—Dr. Clark Chen
Why is brain cancer one of the most challenging/deadly cancers? The brain is a very different organ than the rest of the body. Our brain is so precious to us that our body has evolved barriers to protect it. For example, if you get food poisoning, your brain is protected from those toxins. And many chemotherapies are like toxins, so they can't get into the brain. Surgeons also have a very challenging task in figuring out how much of a tumor to remove, since one millimeter of difference could be the difference between the patient talking and understanding and not.
What improvements have been made in treatments over the past few decades? Surgically removing as much of a tumor as possible dictates how a patient will do. We have a number of tools to help with that, including MRI. But an MRI machine weighs tons—it's not like you could easily bring it into the operating room. In the 1970s, the University of Minnesota started using one of the first intraoperative MRIs in the world, so we could do a surgery and bring in this state-of-the-art MRI and look in and know how much was removed during the surgery. It gives you real-time feedback. So surgeons could see when they could remove more and save a second surgery. That was a major, major milestone. We just installed the newest generation in 2019.
Another milestone allowing us to remove more of a tumor is a drug called 5-ALA. It's a drug that the patient drinks before surgery so that if you shine a blue light on the tumor, it will become fluorescent red. We were the first in the state, at the University of Minnesota, to have it during surgery—we started using it the moment the FDA approved it in 2017. Sometimes it's very difficult to tell where the tumor ends, and this dye gives us that tool.
"I'm optimistic that before the end of my lifetime, we are going to see major changes for glioblastoma patients and achieve meaningful benefits."
—Dr. Clark Chen
Also, surgically implanted radioactive seeds have the potential to improve life expectancy and quality of life for brain tumor patients. Picture cancer cells as unruly students, and the seeds as teachers. Having one teacher for 10,000 students is not going to work. But after a surgeon removes the majority of the cancer cells, the seed can be used to destroy the microscopic cells that are invisible to the naked eye. Because of its short range, which is five to eight millimeters, the radiation is concentrated in the region of the tumor and does not affect the rest of the brain. In the old days, the patient would have had to go back to the operating room if the tumor grew back after surgery.
When will immunotherapy be able to be used in brain cancer? Injection of a genetically engineered virus into glioblastomas will solicit immune responses—responses that can be further enhanced with the immunotherapy that was awarded the 2018 Nobel Prize. Tumors that tend to benefit from immunotherapy are known as "hot" tumors. They are tumors with a lot of immune cells in there already; that's why they're called hot. "Cold" tumors are ones that don't have a lot of immune cells. So a really exciting thing that we are doing is to surgically inject this virus into a "cold" glioblastoma that is devoid of immune cells and does not respond to immunotherapy and convert the tumor into a "hot" glioblastoma that responds to immunotherapy. In this way, we can engage the patient's innate immune system to fight off the tumor cells. People have survived beyond expectation, but it doesn't work for everybody. We're trying to figure out why it works for some and not others. We are beginning to see extraordinary responses, and with each extraordinary response, we are one step closer to a cure for every patient. —S.M.E.
Gaining Control
Dr. Brian Swiglo, an endocrinologist with Allina Health, specializes in the treatment of conditions related to hormones and their effects on the body's organs. Two-thirds of his practice is devoted to the treatment of people with diabetes.
It's been standard procedure for many people with type 1 diabetes to check their glucose levels with a finger stick about four times a day. However, modern technology is changing all of that. Dr. Brian Swiglo says that continuous glucose monitors are replacing finger sticks—and they're doing a much better job. Abbott, Dexcom, and Medtronic make small wearable devices (FreeStyle Libre, Dexcom G6, and Guardian Connect) that adhere to your arm or stomach and automatically read your blood sugar levels every 5 to 10 minutes. Then the information is sent to your phone or device. For people taking insulin, this is a huge boon. "You really need that information in order to choose the right dose," Swiglo says. "They can just look at their phone and know, 'Oh, I'm 220. Well, now I need an extra three units on top of what I take for my food.' It helps them dose their insulin a lot more accurately."
This knowledge is powerful, both for the patient, who gets a better understanding of how their glucose levels are affected by certain foods, activity, and insulin, and for the endocrinologist, who gets a better understanding of their patient's meal and exercise habits. "When we're in clinic with them, we can download that information, look at it, and make more accurate adjustments in their insulin regimen," Swiglo says.
Insulin pumps have been around for about 30 years and are now being replaced with closed-loop insulin pumps, which "talk" to continuous glucose monitors. "It's a huge step toward an artificial pancreas," Swiglo says. And it's giving people greater freedom—especially at night. "The biggest advantage is when someone goes to bed, they can fall asleep and sleep through the night while still having good control." That's because the pump and the monitor are in constant communication and making any needed adjustments.
The newest medicines for type 2 diabetes can do more than lower a person's blood sugar. They're helping with weight loss and lowering the risk of cardiovascular disease. "Most people with type 2 diabetes struggle with their weight," Swiglo says. "So anything we can do to help them with weight loss is a benefit." —J.J.
Reducing Heart Disease
A cardiologist since the 1990s, Dr. Pamela Paulsen has worked at all three Level 1 trauma centers in the Twin Cities. After starting her career at Hennepin Healthcare, she moved to North Memorial Health Hospital for 17 years, and she's now with Regions Hospital. She also started the first women's heart clinic in Minnesota, which she ran for 10 years. Paulsen has cared for patients in acute emergency situations. Today, she practices all areas of general cardiology.
Dr. Pamela Paulsen completed her fellowship training in interventional cardiology at the University of Minnesota more than 25 years ago. "We had reasonable treatment in 1994, but it's unbelievably different now for patients," Paulsen says. "It's our advancements in prevention—but also in heart attack care—that really revolutionized during the time I have been a cardiologist."
A combination of technological advancements and medications are helping to reduce heart disease and death from heart disease. Paulsen lists the three biggest game changers, the first of which is the use of stents. "The ability to treat heart attack and chronic coronary artery disease with revascularization—or restoring blood flow predominantly through stents—replaced a more invasive approach and had excellent outcomes," she says. Bonus: Today's stents come in all sizes and are drug-coated so that they are less likely to narrow as time goes on.
The second is the less invasive method now used to replace aortic heart valves. Transcatheter aortic valve replacement (TAVR) is performed by creating a small incision in the chest or using a blood vessel in the leg rather than through open-heart surgery. Advanced imaging guides a catheter to the aortic valve, where a new valve is positioned with the help of an inflated balloon. "It's the preferred strategy for replacing aortic valves when they're narrowed," Paulsen says.
Lastly, statins followed by injectable cholesterol drugs have significantly helped lower the risk of heart disease altogether. Since the 1970s, the risk of death from heart disease is down an average of 60 percent in the United States.
Paulsen is hopeful that the wave of the future will include incorporating personalized medicine in heart care that would pinpoint the best drugs and diet for an individual. She also is encouraged by the future potential of wearable technology for monitoring blood pressure, heart rhythms, and sleeping patterns and helping doctors care for patients. —J.J.
Enhancing Care for Children
In the 20 years that Dr. Gigi Chawla has been practicing as a pediatrician, advancements have fundamentally altered children's health care experiences. If you still call a "well-child visit" a "yearly checkup," here's a glimpse into the way today's parents and children experience the doctor's office. First, new routine childhood immunizations for rotavirus, approved in 2006 and 2008, mean parents have one less thing to fret about. Hospitalizations from severe gastroenteritis, caused by rotavirus, have almost been eliminated. "Kids would have serious morbidity, and some would die with the rotavirus," says Dr. Chawla, recalling the days when wards of kids would be hospitalized with the disease every winter.
"With every scientific breakthrough, we have to think about how we apply those breakthroughs. This piece has got to be elevated."
—Dr. Gigi Chawla
And COVID-19 vaccines may have a similar impact, she predicts. Even though most children don't experience serious illness from COVID-19, the technology used to create the Pfizer and Moderna vaccines could be applied to vaccine development for other illnesses, such as respiratory syncytial virus (RSV), a common respiratory virus that can hit infants hard, she says. "That will also change the face of how pediatric illness is experienced," she says, explaining that RSV is the number one cause of childhood hospitalizations in winter.
But the COVID vaccines also revealed a negative side, highlighting disparities in health care—and further accentuating them, Chawla says. "It's not going to do us much good to have these breakthroughs if all it does is divide the haves and have-nots," she says.
Chawla has devoted the past three years to better understanding disparities in immunization rates between patients of color and white patients. "With every scientific breakthrough, we have to think about how we apply those breakthroughs," she says. "This piece has got to be elevated."
It's something Chawla thinks about constantly, she says, working to help health care overcome generations of institutional racism. Looking at vaccine disparity, for example, reveals a gap of 40 percent between Black and white patients in completion rates of the entire routine vaccination series before age 2, she found. "For me, the first step is really understanding that vaccine disparity, which has likely been present during my entire career and we've just never been brave enough to look at it or willing as clinicians to understand what our role is in mitigating it," she says. To close the gap, Children's Minnesota has implemented drive-up vaccination and mobile vaccination clinics and recognized other access hurdles, including the ability to make an appointment during clinic hours and to speak a language understood by front desk staff and providers, as well as the ability of clinicians to earn a patient's trust.
Another important shift that's happened over Chawla's career, she says, is a recognition of just how important early childhood development is, as well as understanding the science behind it. "Understanding how critical that bonding is with a trusted adult/caregiver/parent, and really engaging infants, toddlers, and young children in experiencing and exploring the world—including facilitating early language development," she says. "There are 700 neural connections being made every second. It's immense." The time and energy we can all put into things like early language development pay off in multiple ways, including decreasing educational or opportunity gaps, which has inspired her to serve as Reach Out and Read Minnesota's Medical Director.
Children's Minnesota and others have also integrated behavioral health into routine pediatric exams. Therapists, psychologists, and social workers are available during well-child and primary care visits should families need them. And given the high impact social determinants beyond the clinic have on kids' health—where they live, learn, and play—primary care appointments at Children's Minnesota now include screening for food insecurity, educational needs, housing concerns, and legal issues. After witnessing the value of this more comprehensive approach to caring for children, Chawla notes, "Hopefully, every health care organization is working toward families' experiences." —S.M.E.
Improving Odds
Dr. Mohamed Hassan has spent his nearly 32-year career specializing in gastroenterology and hepatology (diseases of the liver). In the last 17 years, he has also been practicing transplant hepatology. Today, he practices at M Health Fairview Clinics and Surgery Center in Minneapolis and M Health Fairview Clinics and Specialty Center in Edina.
More than 30 years ago, Drs. Harvey Alter, Michael Houghton, and Charles Rice identified the hepatitis C virus. In 2020, they received the Nobel Prize for their discovery. "That was a big deal because hepatitis C went from not being known before 1989 to a disease that can easily be treated more than 93 percent of the time with direct-acting antiviral agents (DAAs)," says Dr. Mohamed Hassan.
The field of liver transplantation has also made great strides since the first successful procedure in 1967. These days, a liver donor doesn't need to have a perfect bill of health. Patients in need of a liver transplant can even receive a good-functioning liver from a donor who has the hepatitis C virus. "There are people who are very sick and cannot wait for a negative hep C liver or donor," Hassan says. After the transplantation is complete, the latest DAAs—such as sofosbuvir—treat the hep C–positive liver. "That is really remarkable and probably one of the best things that's happened." Hassan hopes in the near future there will be medications that can eliminate hepatitis B, a disease more likely to affect people born in Southeast Asian and African countries. "It is now being tested," he says.
Hassan enjoys helping others, and his influence reaches beyond the clinic with the work he does in the local Somali community. Recently, to help build trust around the COVID-19 vaccine, Hassan was in a video with an imam at a mosque getting the vaccine. "A lot of people gave me feedback and told me it did work," he says. Even family and friends back in Somalia saw the video in their community. —J.J.
Targeting Disease
Back in 1990, Dr. John Wagner conducted the first-ever cord blood transplant for a leukemia patient. Now, he looks back on those early days of transplant medicine and exploration of the potential of cell therapies as a preamble to a future with endless possibilities for treating all types of diseases: manipulating cells to do what doctors and scientists want them to do. Whether you call it immunotherapy or precision or personalized medicine, Wagner's work is on the fast track to curing some types of cancer.
What has been the biggest game changer in your specialty in the last few decades? Engineered cells, "living drugs" that can last in the body for days or a whole lifetime. One example is the use of genetically modified immune cells that specifically target a cancer. I became involved in the mid-'80s during my training at Johns Hopkins School of Medicine, when we first started working with bone marrow for transplantation, but we've learned how to engineer cells more precisely since then.
"Today, we can take cells from a sample of blood or skin biopsy and generate cells called induced pluripotent stem cells—replacing the need for embryonic stem cells."
—Dr. John Wagner
Has your work ever yielded any unintended results with a positive impact? A decade and a half ago, we thought that the embryonic stem cell was the only way you could make the various tissues of the body. Today, we can take cells from a sample of blood or skin biopsy and generate cells called induced pluripotent stem cells (IPSC)—replacing the need for embryonic stem cells—cells which can be used to test drugs and other treatments as well as repair damaged tissues. For example, our lab is working on using IPSC to make a nearly endless supply of blood-forming stem cells from a small sample of blood. You won't need any other donors, potentially.
What advancements are on deck? Even though the current approach is very effective, I can't tell when a patient with leukemia is going to come in the door and then everything stops to make it happen. Say you had leukemia. First, we'd have to give chemotherapy to beat down the number of leukemia cells so that sufficient numbers of normal T cells can be collected for genetic engineering. It takes a month for manufacturing and testing the cell therapy before it is shipped back to the hospital where they give it to you. There are a couple of problems with that. One, you have to have chemo. Two, it's an individual product for every single patient. That makes it logistically challenging and much more expensive—and you might not have a month. Many people are lost while waiting for the manufacturer. My guess is we may, for the first time, be able to cure cancer without using chemotherapy, radiation, or surgery. That's the path we're pursuing. So when you're diagnosed with leukemia, we will be able to forget about the traditional way of treating it and use cell therapy as the only treatment. That's what we hope to move forward in the next one to two years. And we could move it into other fields . . . cardiology or multiple sclerosis or brain injury. All are in development with the same concept of taking a cell and modifying it to do what we want. This is going to be the game changer, and it's sitting on the shoulders of the work of the prior 30 years.
How do these advancements impact previously overlooked or underserved communities? In the past, getting patients to take advantage of new advancements was more of a passive process. If you had a specific disease and you figured out how to get to the University of Minnesota and to me, I would check to see if you met the eligibility requirements and treat you. Today, we go to much greater lengths to find patients and make sure they know what is available, potentially, to them. We want to make sure the patients being enrolled into clinical trials appropriately reflect the makeup of our larger community—that is, we want to ensure that we have people of all races and ethnicities.
One example: We want to develop off-the-shelf, cryopreserved products. You'd make them all in advance, and they'd be immediately available. Otherwise, some treatments, like immunotherapy, when manufactured as individual products, may never be available for the majority because of logistics and expense. But if I could take one sample of starting material and make 1,000 or more products and verify their potency in advance, we could send them anywhere in the world and people could get it the day they're diagnosed. —S.M.E.
Focusing Care
Dr. Siobhan Flanagan is an interventional radiologist at University of Minnesota Health (M Physicians) who does minimally invasive procedures under imaging guidance. She treats liver cancer, vascular malformations, aortic aneurysms, peripheral arterial disease, and more.
University of Minnesota physician Kurt Amplatz helped invent interventional radiology more than three decades ago when he created a small plug-shaped medical device that could be passed through a catheter from the leg to the heart, thus repairing an atrial septal defect (hole in the heart) and avoiding open-heart surgery. Today, Dr. Siobhan Flanagan continues to move the field forward by providing targeted treatments to patients with serious medical problems, including liver cancer. "If we can treat patients' liver cancers effectively, we can then bridge them to transplant," Flanagan says.
With the help of a catheter and x-ray guidance, the treatment is injected directly into the artery that leads to the liver. As opposed to chemotherapy that circulates all throughout the body, "we're targeting the treatment just where it needs to go: the local blood supply to the tumor," Flanagan says. And that's especially great news for people with a liver tumor that's less than three centimeters. "We can cure tumors less than three centimeters with some specific treatments and control tumors larger than three centimeters with a local therapy."
Compared to cancer, an abscess that develops in the abdomen after surgery might seem like an easy fix. But it's not for a surgeon who has to navigate an area that was recently operated on and has a lot of inflammation. Thankfully, an interventional radiologist can come to the rescue. "We can place an abscess drain under CT or ultrasound guidance to help drain the infected fluid so the patient doesn't have to have another operation," Flanagan says.
Vascular malformations, abnormal groupings and developments of blood vessels throughout the body, can also be treated with this technology. A lesion can be biopsied to test its genetics and determine which medication will help shrink it.
Flanagan is excited to see what's on the horizon in terms of personalized medicine, especially with tumor-specific therapy, determined by tissue receptors and genetics. "There's this continued opportunity for us to be involved with these treatments by delivering them directly to a tumor," she says. —J.J.
Expanding Awareness
Dr. Charles E. Crutchfield III practices dermatology at his clinic in Eagan, where he sees patients for the treatment of a variety of medical and cosmetic conditions. He also teaches dermatology to medical students, residents, and other clinical physicians at the University of Minnesota, Carleton College, and around the world.
Crutchfield has made it his mission to share the knowledge he has with others, including those in the medical field. "Skin conditions in skin of color can look a lot different than what we're trained on. So I coauthored a textbook of dermatology and made sure to include over 3,000 photographs, half of them in skin of color." He also covers the topic in lectures at the University of Minnesota and around the country. And he writes a weekly health column for the Minnesota Spokesman Recorder, the oldest Black newspaper in the state of Minnesota. "We're doing our part to educate and further the knowledge in treating skin of color," he says.
Crutchfield is excited about the advances he sees in the treatment of various skin conditions. "We're seeing treatments now for psoriasis, atopic eczema, and vitiligo that are extraordinarily effective for treating skin and inflammatory conditions in the human body," he says. "They are changing the lives of our patients," he says.
And the advancements in aesthetic dermatology are also big game changers. Hyaluronic acid fillers and Botox injections rejuvenate the skin with natural-looking results. Crutchfield estimates he does 5 to 10 aesthetic treatments a day. And many of his patients will express to him that they wish they would have done the treatment years ago. "I tell them, 'Well, we couldn't have done it years ago because we didn't have it, but we have it now. And we'll use it moving forward.'"
As everyone learned in 2020, COVID-19 created a paradigm shift in the delivery of care. And physicians had to pivot their practices to meet the needs of patients in a safe manner. These days, telehealth visits make up 30 to 40 percent of Crutchfield's appointments. "A year and a half ago, I had not done one telehealth visit," he says. "And now I've done 10,000-plus." It's surprising how much can be covered in a visit with a dermatologist via a webcam. Platforms such as Zoom, FaceTime, and Google Duo have great clarity of picture for medical evaluations and discussions. Crutchfield uses them for triage purposes, follow-up visits, and prescription refills. "This will be part of our practice moving forward," he says. "Patients love it, and I like it too."
After more than two decades of being the doctor, Crutchfield is now the patient. In early 2021, he was diagnosed with non-Hodgkin's lymphoma, for which he is currently receiving treatments at the Mayo Clinic in Rochester. And the cancer treatment he has received has a medical legacy that ties back to early efforts by friends in the medical community. "I have colleagues that were on the development team at Genentech 30 years ago that helped develop the [monoclonal antibody treatment] that's being used to treat me right now," Crutchfield says. "My friends are so delighted that the medicine they helped develop is actually helping their friend." —J.J.
Tackling Sports Injuries
Back when Dr. Elizabeth Arendt was playing sports in her first few years of college, the training room was only for male athletes. When Arendt or a female teammate got injured, they went to student health services, where ankle sprains were sometimes mistakenly treated with a hot-water bath.
Arendt, who played "everything" growing up, from Ping-Pong to horseshoes, competed in varsity volleyball and basketball in college in the early days of Title IX, the federal civil rights law aimed at preventing discrimination based on sex in education. As a premed student studying biology and anatomy, she was encouraged by administrators to fill a gap in the training room by treating female athletes. By her senior year, she was a student athletic trainer, challenging inequities in the newly coed training room. This experience not only motivated her to work to change the culture of athletics at the University of Rochester in New York; it also inspired her to pursue orthopedics and sports medicine instead of pathology, she says.
"Research suggests that simple warm-up exercises can drastically lower the risk of ACL injuries."
—Dr. Elizabeth Arendt
The world of orthopedic surgery is heavily male-dominated. In a 2015 survey, according to the Association for American Medical Colleges, 95 percent of orthopedic surgeons were male. The field is also lagging in diversity as a subspecialty field, but that is improving, Arendt says. But since graduating from medical school in 1979, she's seen some shift in the way athletic injuries are viewed in the field, placing less emphasis on gender.
When it was first discovered that females tear their anterior cruciate ligaments (ACL) more than males, some doctors theorized this was related to the hormonal environment due to menstrual cycles. While that hasn't been ruled out conclusively, there's much more evidence linking the risk to anatomic risk factors present in both sexes and body movement patterns, Arendt says. "I think the focus has been less on the sex of the patient and more on what it is that characterizes knee injuries," says Arendt, who conducts research in the area.
This has led to a better understanding of acute injuries to the ACL and the patellofemoral joint, including an increased recognition of risk factors such as body movement patterns and anatomy in other musculoskeletal injuries. And that's helpful because smart training and coaching can reduce the risk of injury. Research suggests that simple warm-up exercises can drastically lower the risk of ACL injuries, for example.
The biggest change across knee surgeries, however, is probably the push toward outpatient surgeries. Ultimately, Arendt says, the shift comes with pros and cons, but to optimize the experience, patients should understand their insurance plans more than most do. For example, even patients who stay in the hospital overnight may be counted as outpatient surgeries, she says, meaning they don't qualify for a skilled nursing facility and would be expected to complete physical therapy with in-home physical therapy or on an outpatient basis.
And, love it or hate it, the biggest change in medicine in the past 30 years is the advancement of electronic medical records (EMR), she says, recalling the days of taking charts home to work on at night. From the patient's perspective, there are clear benefits.
"As much as it burdens us, there's no doubt the ability to document a patient's pertinent information electronically and share it across medical systems is a huge improvement," she says. "And it's greatly improved our ability to deliver service at all hours." —S.M.E.
Advancing Solutions
Dr. BJ Harris specializes in gynecology and urogynecology at Women's Health Consultants and the Pelvic Floor Center.
In her 21-year career, Dr. BJ Harris has witnessed many gynecological and medical game changers. One of the big ones is the reduction in the number of hysterectomies, which used to be much more common and not always a medical necessity. Today, she says, minimally invasive hysteroscopies allow doctors to manage many issues in the uterus, such as abnormal bleeding and the removal of polyps and some fibroids. Also, some types of IUDs—typically used for contraception—have been FDA-approved to help mitigate heavy bleeding. And tranexamic acid, originally prescribed to women to help make their periods less heavy, is now being used to help reduce blood loss from C-sections or other big surgeries, she says.
Other discoveries, such as the fact that some of the more aggressive types of ovarian cancers can begin in the fimbriae (fingers) of the fallopian tubes, help women make decisions about how to manage their long-term health. So, if one of Harris's patients is having a procedure, like removing an ovarian cyst, and this person is not planning on having (more) children, Harris also recommends removing the patient's fallopian tubes at the same time. "The fallopian tubes have never provided any hormone in the past, and they never will in the future," she says. "All they provide is a cancer risk once women are done childbearing."
The majority of her practice focuses on patients with pelvic floor issues, such as vaginal prolapse or urinary incontinence. She helps them assess treatment options. For those with incontinence, she says, "I do quality-of-life surgeries. One woman's quality of life versus another woman's is very different. I have some people that leak urine like a sieve, and they don't want surgery. And I have other people that say, 'I leaked twice at my aerobics class last week and I want surgery yesterday.'" She helps these individuals weigh risks and find healthy solutions and alternatives if they don't want surgery. —J.J.
Sharing Power
Dr. Mumtaz Kazim grew up watching her parents take care of patients in their 17-bed hospital on the island of Trinidad. She went to college in Canada and med school in India. She's seen plenty of changes in health care in her career as a physician in the field of family medicine and as president of Edina Family Physicians.
What has been the biggest game changer in your specialty in the last 20 to 25 years? You said game changer, but maybe you'll allow me three! The first everyone will agree with: EMR. It's increased access and ability to share information with specialists, allowing for better communication for multidisciplinary care. Also, the concept of what has happened with outpatient clinics. Edina Family Physicians used to be an independent family practice; most of these are now being purchased by larger systems—Edina Family Physicians is now affiliated with Allina. It's a big change. Then there's the concept of virtual visits. With COVID, our clinic was closed for a while, except for emergency care and phone calls, and you can't imagine the expressions of patients who were so lonely. When you see each other face-to-face, there is such delight to talk to somebody. And you can call back to check up on them. It was very helpful. It shouldn't be used for all medical care, but when they cannot come in, seeing them face-to-face in their own home gives you a whole different perspective.
"I believe the increased number of women and minorities in all medical fields has had a positive impact on patient care."
—Dr. Mumtaz Kazim
What's the most exciting advancement just around the corner in family medicine? Personalized medicine, including genomic sequencing to target drugs for certain diseases, immunologic approaches to treat cancer, and CRISPR, which is a technology that adds or deletes genes to improve and cure medical conditions. It will help to improve the medical health of the community from sickle cell disease to diabetes and various cancers. Think about it, how great it would be if we could cure diabetes.
How has the diversity of our medical community changed things, and how have advances impacted previously overlooked or underserved communities? I believe the increased number of women and minorities in all medical fields has had a positive impact on patient care. Providers are so much more sensitive to disparities in the medical services available now—so much more than 30 years ago. I think that will eventually have a positive effect on delivery of care to underserved communities. And with the continuity of care now with EMR, we can provide better tracking of patients. Even though EMR is far, far from perfect (this is not an ad for it!), it provides us a tool to have continuity of care. And access to previous medical records is a tremendous help. For example, take the case of a patient who has mental health issues, in addition to some dementia, and no family in the Twin Cities. He's gone to different emergency rooms and been seen by different providers across all of the systems. We have the EMR, and we can then get access to some of those records, which will then educate me on what has been happening.
Patients don't always offer a detailed medical history, and many patients, especially with cardiac disease, get shipped from one hospital to the next. So we may have patients with records from Abbott and then Southdale, and by the time they come back to me, I can check all of it. That's very important because doctors shuffle around medications and dosages all the time, and cardiac patients are often on 6 to 10 medications. —S.M.E.
Helping Youth Tackle Anxiety
Dr. Marjorie Hogan is a pediatrician at Hennepin Healthcare who's been caring for the needs of infants, children, adolescents, and young adults for 41 years.
When Dr. Marjorie Hogan started her practice in 1980, office visits typically involved the usual litany of questions regarding nutrition, sleep, and vaccines. "Since then, pediatric care—and the world—has become much more complicated. We used to think brain development stopped sort of abruptly in childhood," but that's not the case, she notes. "The brain continues evolving and maturing and arborizing and getting more complex and wonderful in many kids up to their 20s."
One of the dramatic shifts she has seen recently is in the number of school-aged children and teens expressing feelings about anxiety, fear, and stress, Hogan says. Thankfully, during these unprecedented times, providers like Hogan can put patients and their families in touch with a team of resources—including nurses, social workers, educators, community health workers, and more—that will support the whole health of the child. However, she says, "We need more mental health providers for children and teens. It's a crisis. It impacts every part of their lives. I am seeing more teens—both male and female—grapple with eating disorders, with the risk of self-harm, [and] with substance abuse."
One of the complicating factors in the struggle: media. Back in the '80s, Hogan authored some of the first American Academy of Pediatrics (AAP) media statements that recommended parents limit children's TV watching to less than 2 hours a day. Today, young people have access to more media than ever. "In this past year, there's not one family I've seen that has not had concerns about their children's screen time and media use." Hogan recommends that parents be good media role models and develop a family plan. That means no electronic devices at the dinner table and certain shows and games should be off-limits. "Be aware of what your children are watching or using as much as you can."
In recent years, the medical community has become more aware of the role that social determinants and inequities play in a child's overall health. Hogan is pleased that today's medical students and residents take courses on the topic so they can be better prepared to help children in a changing world. —J.J.
Meet the 2021 Top Doctors
See the complete list of doctors selected to this year's Top Doctors.
The 25th edition of our Top Doctors list includes 816 doctors in 46 specialties. Here's how we put it together. When compiling a list that's as relied upon as our annual Top Doctors list, research is essential. We asked physicians to nominate one or more doctors (excluding themselves) to whom they would go if they or a loved one were seeking medical care. From there, candidates were grouped into 46 specialties and evaluated on myriad factors, including (but not limited to) peer recognition, professional achievement, extensive research, and disciplinary history. Doctors who had the highest scores from each grouping were invited to serve on a blue-ribbon panel that evaluated the other candidates. It should be noted that doctors cannot pay to be included on this list, nor are they paid to provide input. Only doctors who acquired the highest total points from the surveys, the research, and the expert physician review panel were selected to this list. Of course, no list is perfect. Many qualified doctors providing excellent care are not included on this year's list. However, if you're looking for exceptional physicians who have earned the confidence and high regard of their peers, you can start your search here. In addition, this year's crop of Top Doctors will join a prestigious group of doctors from more than 20 cities around the country who have been selected to Super Doctors, the full list of which you can find at superdoctors.com.
Editor's Note: Many of our Top Doctors have specialty certification recognized by the American Board of Medical Specialties. This board certification requires substantial additional training in a doctor's area of practice. We encourage you to discuss this board certification with your doctor to determine its relevance to your medical needs. More information about board certification is available at abms.org.
© 2021 MSP Communications. All rights reserved. Super Doctors® is a registered trademark of MSP Communications. Disclaimer: The information presented is not medical advice, nor is Super Doctors a physician referral service. We strive to maintain a high degree of accuracy in the information provided. We make no claim, promise, or guarantee about the accuracy, completeness, or adequacy of the information contained in the directory. Selecting a physician is an important decision that should not be based solely on advertising. Super Doctors is the name of a publication, not a title or moniker conferred upon individual physicians. No representation is made that the quality of services provided by the physicians listed will be greater than that of other licensed physicians, and past results do not guarantee future success. Super Doctors is an independent publisher that has developed its own selection methodology; it is not affiliated with any federal, state, or regulatory body. Self-designated practice specialties listed in Super Doctors do not imply "recognition" or "endorsement" of any field of medical practice, nor do they imply certification by a Member Medical Specialty Board of the American Board of Medical Specialties (ABMS) or that the physician has competence to practice the specialty. List research concluded April 19, 2021.
Sign up for our Be Well newsletter to get the latest health and wellness coverage.
Comments
Post a Comment