Q&A: William Middlesworth, MD

William Middlesworth, MD

William Middlesworth, MD, is Director of the Regional Pediatric Trauma Program at Morgan Stanley Children's Hospital of New York (MSCHONY). An Assistant Professor of Surgery and Pediatric Surgery at Columbia University, Dr. Middlesworth graduated from the Robert Wood Johnson School of Medicine in New Jersey. He is an attending surgeon at MSCHONY and operates as one of the Program's pediatric surgeons. In addition to his appointments at MSCHONY and Columbia University Medical Center, he is Chief of the Divisions of Pediatric Surgery for Bronx-Lebanon Hospital Center and St Barnabas Hospital in the Bronx.

Q. What is the Regional Pediatric Trauma Program at MSCHONY?

A. The Program operates one of New York State's three designated regional pediatric trauma centers, putting the resources of Morgan Stanley Children's Hospital of New York—its pediatric intensive care unit (PICU), operating facilities, and emergency department; its nurses, anesthesiologists and specialized house staff—at the service of severely injured children in the five New York boroughs and Westchester. In addition to our work running the program, Jeanne Rubsam, RN, MS, CPNP, the Program's Coordinator, and I also hold seminars for paramedics and EMTs, conduct ongoing systems analysis to monitor and improve the Program's performance, and undertake injury prevention outreach in the Northern Manhattan community through the Injury-Free Coalition for Kids.

Q. You did some of your training before medical school. What was the focus?

A. I had a research grant from the Muscular Dystrophy Association. With that grant, I worked in a molecular biology lab at Harvard University's Children's Hospital in Boston. There, we cloned a gene involved in Duchenne muscular dystrophy. That was during a time when I was deciding whether to be a scientist or a doctor. It was a really nice way to make that decision because it was science in a clinical environment.

Q. How did you decide to become a pediatric surgeon?

A. Working at Children's Hospital oriented me toward pediatrics. Caring for children really appealed to me—it's different from adult medicine. Also, during medical school I was very inspired by one of my teachers, like a lot of surgeons are, and that's what made me decide to pursue pediatric surgery.

During my residency at the University of Maryland and the Maryland Institute for Emergency Medical Services, I had a significant exposure to trauma surgery. The Institute pioneered pre-hospital trauma care and is a state of the art trauma facility. That exposure showed me the importance of dedicated trauma care and the difference it can make to the lives of the injured.

Q. What are the differences between pediatric and adult medicine—why do we need separate medicine for kids?

A. There's an old cliché that "children are not just little adults." It's really a totally different set of diseases and disorders.

Communication skills are especially important in pediatric medicine. In adult medicine the physician patient relationship is often a one-to-one interaction; a patient sees a doctor, who counsels that individual. When parents bring their children to me I need to gear the discussion to both the parents and the child.

So in my work at MSCHONY there's a significant element of care for the family, in addition to care for the medical problems the trauma has caused. Issues around school performance and development for traumatized children need to be addressed. Children who have been severely injured may have diminished school performance for a period after their injury.

Q. What do you think are the most important qualities for a director of pediatric trauma?

A. An ability to interact with people, definitely. A child's point of entry might be the emergency room or the PICU—or the child might be brought in from another hospital altogether. So I need to be able to effectively interface with intensive care team and ER staff.

Q. What do you appreciate most about your work at MSCHONY?

A. I like the integration into the other areas of the hospital and disciplines other than my own. Also, I like that our focus is very much on prevention, through the Injury Free Coalition for Kids of New York and pre-hospital work, where Jeanne has been involved in developing safe play areas for children in our local area so they're not playing on fire escapes and rooftops. I like that our work extends beyond the walls of the hospital into the community. That brings another dimension to what you do.

Another thing I enjoy is the challenge of looking at things at a systems level. An important part of what I do is facilitating—enabling people to practice medicine in a way that's safe and effective. For example we're working right now developing a protocol for evaluating possible cervical spine injuries. So that involves collaboration with the Emergency Department, neurosurgery, and the PICU to achieve consensus around the details of care: what kinds of x-rays we are going to get, what we need to look for on physical exam, and who will ultimately make the determination that it is safe to remove the cervical collar.