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Dr. Brian Alverson is a healthcare clinician, educator, innovator, and patent-holder who currently serves as the Nemours Pediatric Residency Program director. We met up with Brian at the Pediatric Academic Societies Annual Meeting to talk about his vision for the residency program, his recently granted patent for children undergoing spinal taps, and his leadership in working with the American Academy of Pediatrics to create evidence-based guidelines to diagnose and streamline the care of children with urinary tract infections.
Carol Vassar, producer
Guest: Brian Alverson, MD
Pediatric Residency Program Director and Vice Chair, Department of Pediatrics
Nemours Children’s Hospital, Delaware
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Nemours Children’s Health, Well Beyond Medicine Episode 24, Transcript
Carol Vassar, podcast host/producer (00:00):
Welcome to Well Beyond Medicine, the Nemours Children’s Health podcast.
Each week, we’ll explore anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar, and now that you are here, let’s go.
Well Beyond Medicine!
Dr. Brian Alverson, Nemours Children’s Health (00:27):
I go by Brian. I don’t go by Dr. Alverson. I’m not just a doctor. I play the violin, sometimes bluegrass fiddle, I play the viola. I like art. I like to draw sometimes when I’m in a really calm mood. So the things I like to do are a part of who I am. We are all in this together as a family, and I want them to know that I’m going to be approachable, I’m going to be thoughtful about what’s going on, they’re going to know me, they’re going to know each other like brothers and sisters, it’s going to be a great family. And it’s going to be a great time.
Carol Vassar, podcast host/producer (01:02):
That is Dr. Brian Kenneth Alverson in an introductory YouTube video about his approach to the Nemours Pediatric Residency Program, of which he has been the Director since September 2022. Brian, as he prefers, came to Nemours from Brown with a fascinating background. A former high school teacher, he spent part of his childhood in Botswana. He is a healthcare clinician, educator, innovator, and patent holder, whose approachable manner is winning HIM fans across the enterprise and further raising the already favorable profile of the Nemours Pediatric Residency Program. We met up with Brian at the Pediatric Academic Society’s meeting in Washington D.C. to talk about his vision for the Residency Program, his recently granted patent for children undergoing spinal taps, and his leadership in working with the American Academy of Pediatrics to create evidence-based guidelines to diagnose and streamline the care of children with urinary tract infections. With so much to offer and so many talents, what prompted Brian Alverson to focus on becoming a pediatrician? Here’s what he had to say.
Dr. Brian Alverson, Nemours Children’s Health (02:24):
I was a medical student at the University of Pennsylvania and was convinced when I first matriculated to the medical school that I wanted to be a neurologist. And it was during my third year, when I was figuring things out, that I realized, “Actually, I really like working with these kids.” I’d always enjoyed working with older kids, being a counselor at a music camp, things like that, but there was something about pediatric illness that was fascinating to me, and being able to help kids who were in distress. And I really enjoyed the process of helping families understand what their child’s illness was and how we were going to work towards getting it better. And I thoroughly enjoyed that interaction. So I started getting interested in pediatrics, and it was a gradual realization over my medical school years, and then I went on to train in pediatrics.
Carol Vassar, podcast host/producer(03:11):
So you have no family members who are doctors, MDs, nurses?
Dr. Brian Alverson, Nemours Children’s Health (03:17):
None. My dad was an anthropologist. As a kid, I lived in a mud hut in Botswana for two years and herded goats. So my family is not medically inclined in any way. And my mom begged me not to be a doctor, but I did it anyway.
Carol Vassar, podcast host/producer (03:33):
Why would she beg you not to be a doctor?
Dr. Brian Alverson, Nemours Children’s Health (03:35):
I think she was afraid I would catch some strange communicable illness, so that’s what it was. But I was the first in the family to foray into this field, and I’m loving it.
Carol Vassar, podcast host/producer (03:46):
You spent two years as a child in Botswana. Tell me more about that.
Dr. Brian Alverson, Nemours Children’s Health (03:49):
So my dad was studying the language and culture of the Tswana people, and I was there as a kid tagging along for a year when I was three and for a year when I was nine. And I think it helped formulate who I was and my approach towards understanding and being accepting of a wide variety of different backgrounds and I ideological ideas and working with different people. And I’ve always loved exploring cultural differences, and I think that was an early experience that drove me towards that.
Carol Vassar, podcast host/producer (04:19):
And now you are with Nemours. You oversee the Residency Program at Nemours Children’s Health, Delaware. What’s your day-to-day role there, and what’s your strategy for that program?
Dr. Brian Alverson, Nemours Children’s Health (04:31):
We’re in a period that is a remarkable change. I was very fortunate to come down here and step into the very formidable shows of Dr. Steven Selbst, who held this position for about 22 years. And the job opened, and I saw it. I had been here before as a visiting professor to do some teaching and to give grand rounds, and I loved the hospital, and I loved the environment. I loved that beautiful gem of a children’s hospital in the middle of this beautiful park. And so I knew it was a great place with great people. And so when the job opened, I emailed my former medical student, Dr. Carly Levy, who is now a colossal figure in the area of palliative care and children and works at Nemours. And she said, “Oh my god, Brian, you have to come.” So I came, and I interviewed for the job, and everything was amazing. And I said, “Yeah, I’m going to mix it up. After 17 years at Brown University, I’m going to move down to Nemours.” And it’s been fabulous.
Carol Vassar, podcast host/producer (05:27):
And what is the Residency Program status right now? Look at the residents around you. What kind of quality are we attracting?
Dr. Brian Alverson, Nemours Children’s Health (05:36):
So every year, we bring in a new group of residents to start for their three-year voyage through the amazing experience that is Nemours’ training program. This year, we attracted, I think, a fantastic group of residents. They’re remarkably intelligent, they have incredibly impeccable performance in their medical schools, and I think they’re going to continue the, I think, upward trend of our program. Every year, we seem to get better and better residents, and I feel like we’re really going in the right direction. We’re training residents to be real leaders in the field. We’re training residents to practice empathetic, and passionate, and accurate, intelligent care for very, very sick children. Nemours is a great place to train because we have the sickest of the sick patients, and you see it all, and you learn it all. And I think everyone, even people who aren’t in medicine, can recognize that you learn really well by doing, and by being there and being surrounded by experts in the field. And it’s just an exquisite and exemplary place to train.
So I stepped into a program that was already working incredibly well. We’ve made a lot of changes this year. We’re working towards improving some of the curricular decisions. We’re going to build some new tracks in the program. I’m building a global health program where we’ll be getting our residents to be traveling abroad and experience what it’s like to practice in resource-poor areas. We’re also building a new track in health equity and primary care. We’re working on that right now, that’s hopefully going to start next year, using our extraordinary clinic at Jessup Street. And we’re trying to expand our outreach to a variety of clinics in the area. So there’s a lot of exciting changes, and we’re really excited about them.
Carol Vassar, podcast host/producer (07:29):
The health equity track, that’s very interesting because health equity is a big part of what medicine and healthcare is moving toward these days. What’s the importance of the health equity track for your residents?
Dr. Brian Alverson, Nemours Children’s Health (07:43):
I think it takes a very special kind of pediatrician to wrestle with all the issues around providing health to people who have inadequate or unequal resources in our community. And this not only is appealing to people who are interested in exploring further opportunities as underrepresented minorities in medicine but also it’s for all trainees who are interested in exploring how we can use resources in the community to better the health of our children.
The health equities track is something I’m working very closely with Hal Byck in the Jessup Street Clinic, and what we’re trying to do is build an opportunity for residents to have more close continuity with their patients in that very resource-poor area so they can experience what it’s like not only to help with immediate health issues, a sore throat, a more serious illness but also marshal the resources of the community psychologists, experts in the field, who are able to bring what resources we have in Delaware to improve the health outcomes of these kids. Health equity is incredibly important. I am not aware of another residency program on the East Coast that has a specific health equity track, and that’s what we really want to build to really put Nemours on the map as a leader in the field.
Carol Vassar, podcast host/producer (09:07):
In terms of health equity, social determinants of health, how has the approach of healthcare changed through the course of your career in that area?
Dr. Brian Alverson, Nemours Children’s Health (09:17):
It’s interesting in so many different ways, and it’s an interplay both of unequal access to healthcare, both from people of a variety of backgrounds and races, but also poverty. And I think what’s happening in the United States right now is that, regardless of what your political beliefs are, the poor are getting poorer in the United States, and resources are getting fewer, and healthcare is becoming more expensive. And we have to dovetail the fact that poor families are having less access to incredibly important aspects of their children’s health, and society is not lowering the cost of healthcare. And so this is requiring people who are deftly trained in how we can marshal limited resources towards the people who need it the most. And we want to create a cohort of residents who have that ability to really reach out to these poor people, and help them, and improve the lives of their children, both through reducing toxic stress, improving diet and nutrition, helping them with better vaccination rates, a variety of things.
Carol Vassar, podcast host/producer (10:28):
Let’s talk about what else you do in the world, and you’re doing two really cool projects that you talked to me about in the pre-interview. Let’s talk a little bit about each of those. One of them is the spinal tap chair. You have created this spinal tap chair. For anyone who’s ever had an infant or a child have a spinal tap, it is a grueling, painful experience, and a child will wiggle. Talk about the purpose of the chair.
Dr. Brian Alverson, Nemours Children’s Health (10:54):
So the company that I founded and I’m no longer working for, but I’m very proud of it, is called Smoltap, and over the last four to five years, I’ve been developing a… It looks like a little baby massage chair. And it’s very comfortable. The babies tend to fall asleep. The idea though, is that you can hold the baby in a secure, safe, upright position for a spinal tap. Classically, we do spinal taps in babies in a lateral position, and it means that there is a higher failure rate, and the taps can be bloody, requiring multiple attempts, which is very painful for the baby. I think a lot of listeners might be saying, “Why would you do a spinal tap in a baby? And really, is it that common?” Turns out it’s an incredibly common procedure. We do hundreds and hundreds of them every year in our own ER.
Every baby who has a fever under four weeks of age has a very distinct risk of bacterial meningitis. Undiagnosed bacterial meningitis will result in death, severe brain damage, or deafness. And so, rapid diagnosis of the condition is critical to making sure these babies have a good outcome. And so you have to tap really all these babies with fever. So what happens is, classically and historically, we’ve had someone with big hands, it sounds horrible, but almost manhandle the baby into a position, and then the proceduralist will do the spinal tap. And what’s challenging about it is these babies, especially the ones with meningitis, are profoundly irritable, and they don’t want to hold still. I don’t blame them. And so what’s frustrating about that is, you try once, the baby wiggles, you end up getting blood, you have to try again, you try again. And we have to try again because missing the diagnosis could result in very severe problems for the baby.
So our ER doctors are awesome, but it’s routine to have to try four or five times. And I had just come out of doing this with a baby on my own as a practicing pediatric hospitalist, and it occurred to me, “Man if only I had a way to hold a baby upright.” Now, the reason is because when babies are upright, the spinal column is a lot wider, and you’re much more likely to get it on the first try. So I started working with Ravi D’Cruz, who’s now a neonatologist in Seattle, but at that point, we were both in Rhode Island. We started building this device and designing it, put a lot of work in it, raised some money, founded a company, got it all together.
And what’s really cool is, a couple weeks ago, the patent came out. It’s my first patent, I think it’ll be my last as well. And then the product just hit the market, so the hospitals can now buy it. And it’s a really exciting time to see these babies come out and have less pain associated with this, be more comfortable. You can feed them sugar water during the procedure, which is the same effect of morphine in little babies, not in adults, unfortunately, or life would be much simpler. But I think sugar water’s nice now and then. But generally speaking, it’s a really effective device, and it’s really exciting, and I’m really proud to have been a part of that process.
Carol Vassar, podcast host/producer(14:00):
Clinical results to that, have you studied how effective it is?
Dr. Brian Alverson, Nemours Children’s Health (14:04):
Yeah, so there’s going to be a prospective randomized controlled trial, multicenter. Because I’m the inventor, it would be inappropriate for me to be the lead author on the paper. I’ve done lots of research, but I don’t want to do that one because I want it to be real. And so a wonderful woman up at Toronto Children’s is going to be running the study, it’s going to be multicenter, and they’re going to look at babies who do it in the device, and then also the standard way, and looking at a number of outcomes. So that’s ongoing. The device just came out, so it’ll probably take a while to go, but hospitals are already buying it. I think about 100 hospitals have started the purchasing of this, so it’s pretty much taking off, and that’s very exciting.
Carol Vassar, podcast host/producer (14:41):
You are a researcher, you are an author, and you have been tapped by the AAP to be the lead author on AAP Guidelines on Urinary Tract Infections in Children. You’re starting to write that now. Tell us about it.
Dr. Brian Alverson, Nemours Children’s Health (14:54):
Yeah, this is really, I think, probably going to be my epitaph if I have one. There was a UTI guideline that came out in 2011 that created quite a bit of controversy. I think there were a lot of doctors that really liked it, and there were some doctors that didn’t like it, but it was a real good attempt at trying to find a way to take care of infants and children with urinary tract infections in a cost-effective and health-effective manner. Since that publication, there’s been a lot more research that’s been done, and it’s really time for an update. So the American Academy of Pediatrics granted me, and I’m very grateful to them, the opportunity to lead a team of about 20 physicians around the country who are all world experts in urinary tract infections, and we’re getting together and having monthly meetings to try and hone down this guideline and figure out the best way to manage these children.
It’s really tricky, and it sounds silly, but even making the diagnosis of urinary tract infection in a baby who can’t say, “It hurts when I pee,” is deceptively challenging. And then, knowing which babies you have to worry about underlying abnormalities of the kidney and bladder tract is important. And so we’re trying to come up with an evidence-based guideline that’ll help streamline the care of these children, and improve their long-term outcomes in terms of their renal function.
Carol Vassar, podcast host/producer (16:18):
You have some work ahead of you.
Dr. Brian Alverson, Nemours Children’s Health (16:19):
Yeah, it’s a huge project. And it’s really interesting. There’s a lot of controversy in a lot of things, and what I love about it, it’s a real opportunity to just start from scratch, get everyone on the same page, and unify people. Because everyone has the right spirit in mind, we all want to help these kids, and I think we can get there, and I’m really excited about the progress we’ve made. But we’ve got probably another year and a half or two years before this paper finally comes out. It’s a real process. And the AAP, I’m very grateful to them, is investing a huge amount of money in getting us switched over to a new guideline, evidence-based schemata called the grade system. And that’s what most other large adult guidelines are based off of, and we’re the flagship guideline for this new system of evidence-based medicine. And so I think it’s going to be a great guideline, I think it’s going to make a huge difference for children all over the world.
Carol Vassar, podcast host/producer (17:11):
When I say, “Well Beyond Medicine,” what does that mean to you?
Dr. Brian Alverson, Nemours Children’s Health (17:16):
I think that wellness is something we all really have to focus on, and I think that coming out of these years of Covid, there was a real article that was put forth by the Surgeon General, I just read it today. It was about loneliness and how people are lonely right now. And I think we have to start bridging gaps, and reaching out to each other, and forming a community going forward. And wellness requires a community, too, I think. We don’t live in isolation, and we feel sometimes like we’re isolated, and it’s through connections with other people that we get better.
So for me, Wellness Beyond Medicine is about treating more than just, “Here’s your medical illness, here’s the medicine you need to take, and then you’ll get better.” It’s about building relationships. It’s about building longstanding relationships, it’s about building a community so that kids with health problems have people to reach out for, and know that they’re supported, and know that they’re loved, and so families who are in distress have people they know who love them and support them. And at Nemours, we’re building that community, and I think it’s a wonderful thing.
Carol Vassar, podcast host/producer (18:25):
Dr. Brian Alverson from Nemours Children’s Health, Delaware, thank you for being with us.
Dr. Brian Alverson, Nemours Children’s Health (18:30):
It’s been a pleasure. Thank you for having me
Well Beyond Medicine!
Carol Vassar, podcast host/producer(18:34):
Thanks for listening to our conversation with Dr. Brian Alverson, Director of the Nemours Pediatric Residency Program. Have a comment about today’s podcast, perhaps an idea for an upcoming episode? Let us know by leaving a voicemail at nemourswellbeyond.org. That’s nemourswellbeyond.org. While you’re there, check out our other episodes, subscribe to the podcast, and leave a review.
Thanks to Che Parker, Cheryl Munn, and Susan Masucci for their help with producing today’s podcast. Join us next time as we learn to avoid medical misinformation on social media and new neonatal cell therapies being developed Down Under — in Australia. Until then, remember, together, we can change children’s health for good … well beyond medicine.