CHOC Children’s wants its medical staff and patients to get to know its growing team of physicians, including primary and specialty care providers. Today, meet one of our specialists, Dr. Shireen Guide, a pediatric dermatologist.
Q: What is your education and training?
A: I trained at Stanford University Medical Center for both medical school and my internship. Subsequently, I completed my dermatology residency at University of Texas, Southwestern. I then went on to complete a pediatric dermatology fellowship at UC San Diego – Rady Children’s Hospital. I am board certified in both dermatology and pediatric dermatology and have been practicing in Orange County for the last 11 years.
Q: What are your special clinical interests?
A: I have a special interest in birthmarks and genetic conditions that are associated with specific skin manifestations. I also enjoy helping families better control chronic skin conditions such as atopic dermatitis and acne.
Q: What are some new developments within your specialty?
A: Developments in pediatric dermatology developments, such as safer biologics and better lasers for psoriasis, have led to improved treatment outcomes. Using dermatoscopic imaging modalities has provided the ability to better control margins and minimize scaring when we remove abnormal moles.
Q: What would you most like community providers to know about your division at CHOC?
A: Our pediatric dermatology clinic encompasses the evaluation of patient concerns regarding all hair, skin and nail conditions. We perform a variety of minor surgical excisions such as cyst, lipoma and birthmark removals. We also use minimal incision techniques which results in smaller scars while removing larger subcutaneous nodules or lesions.
Q: What inspires you most about the care being delivered at CHOC?
A: Our CHOC clinic allows us to help families with complicated medical conditions, minimal resources and limited access to specialty care.
Q: Why did you decide to get into the medical field?
A: My father immigrated to America with minimal resources, and through his hard work and dedication, this country allowed him the opportunity to become a highly decorated military officer and a successful doctor. The value of education was instilled in me since childhood and I am very proud to have followed in my father’s medical footsteps.
Q: What have you learned from patients and families?
A: I have learned that patients want their doctors to listen to them and know their names, and involve families as active partners in their care team.
Q: What are your hobbies/interests outside of work?
A: I enjoy playing the piano and spending time with my husband and three amazing children. We love to visit local zoos, museums and parks.
An internationally recognized pediatric ophthalmologist with expertise in strabismus, amblyopia, pediatric cataracts and glaucoma has joined CHOC Children’s. Dr. Rahul Bhola is the newest division chief of ophthalmology with CHOC Children’s Specialists.
“The biggest reason I was inspired to join CHOC was the mission of the hospital. I feel that CHOC’s mission to nurture, advance and protect the health and well-being of children is in close alignment with my personal goals as a physician,” Bhola says. “I seek to nurture the health care of children by delivering state-of-the-art ophthalmology care to our community. CHOC has the resources, reputation and experience to provide excellent care.”
Dr. Bhola comes from a family of physicians. His parents practiced internal medicine for more than 40 years in India, and the empathetic and holistic care they provided to their patients inspired him to pursue a career in medicine.
“Very early on in medical school, I developed a special interest in pediatrics, and the surgical finesse of ophthalmology later cemented my passion for pediatric ophthalmology. The gift of vision is the most important sense a child can have,” Dr. Bhola says. “Giving a ray of light to those who struggle with vision is very gratifying to me. Treating children is important to me because they have their entire lives ahead of them, and improving their vision positively impacts their entire family.”
Dr. Bhola attended medical school and completed an internship at University College of Medical Sciences in Delhi, India. He completed two residencies in ophthalmology at Maulana Azad Medical College in New Delhi, India and the University of Louisville, Kentucky. He pursued fellowships in pediatric ophthalmology at the Jules Stein Eye Institute at the University of California Los Angeles and the University of Iowa.
Dr. Bhola has received numerous awards both nationally and internationally and has extensively published in peer-reviewed journals. He has participated as an investigator in many NIH-sponsored trials and has been named to the “Best Doctors in America” and “America’s Top Ophthalmologists” lists consecutively for many years. Dr. Bhola recently started studying the ocular effect of excessive smart device usage in children. His research includes tear film composition in children who are consistently overexposed to smart devices, thereby establishing a link between dry eyes in children and excessive smart device usage.
At CHOC, Dr. Bhola will provide comprehensive eye care, treating patients with a variety of eye diseases and disorders. In addition to treating refractive errors (the need for glasses), Dr. Bhola will provide more specialized care for diseases like amblyopia (lazy eyes), pediatric and adult strabismus (crossing or drifting of eyes), blocked tear duct, diplopia (double vision), pediatric cataracts, pediatric glaucoma, tearing eyes, retinopathy of prematurity, ptosis (droopy eyelids), traumatic eye injuries and uveitis.
Dr. Bhola is among the very few surgeons nationally skilled in treating pediatric glaucoma surgically using the illuminated microcatheter. This highly-specialized, minimally-invasive approach of canaloplasty has been used for treating pediatric glaucoma only within the last few years. Childhood glaucoma, though uncommon, can be a blinding disease causing severe visual impairment if not detected early and treated promptly. The onset of juvenile glaucoma often occurs between the ages of 10 and 20 and can be multifactorial. Glaucoma in pediatric population can also be secondary to trauma occurring from any form of injury including sports injuries.
As a Level II pediatric trauma center, and the only one in Orange County dedicated exclusively for kids, CHOC’s trauma team treats a variety of critically injured children from across the region. This includes children who have sustained sports injuries, during which damage to the structure of the eye can cause glaucoma.
Dr. Bhola is very passionate about educating primary care physicians on the need for regular pediatric vision screenings. For example, children complaining of headaches may be taken to a neurologist. However, eye problems such as refractive errors, convergence insufficiency and strabismus can result in headache from excessive straining of the eyes, which may affect school performance and even social withdrawal in some children. These conditions are likely to be identified at regular vision screenings.
Dr. Bhola’s philosophy of care is to treat his patients as if they were his own children.
“My main philosophy is to deliver patient-centered care with compassion and excellence. I remember their life events and celebrate their achievements with them. It’s important that a patient remembers you in order to start to build trust with them. I love when my patients send me holiday cards and copies of their school photos and let me know how they are doing. They became part of my family. I always treat every patient like they are my own child,” Bhola says.
He also focuses on treating the whole person rather than the disease, and involving patients in their care.
“I don’t treat the disease, I treat the individual. Healing is more than treating the disease. I want to be at their level so I always talk to them directly and not only talk to their parents. I involve their entire group during treatment,” he says.
At CHOC, Dr. Bhola is eager to provide holistic eye care for his patients.
“My practice will offer complete comprehensive vision care to all patients, which includes both medical as well as surgical care. Our patients come to us for glasses, contacts, regular ocular screenings, and we also provide more specialized care like glaucoma, cataract and strabismus surgeries,” Bhola says. “A lot of systemic disorders such as diabetes, sickle cell anemia, juvenile rheumatic disease and lupus, have co-occurring eye issues that may go undetected if children aren’t seen for regular eye screenings. CHOC patients with systemic disorders such as diabetes now have better access to holistic care.”
As division chief for CHOC Children’s Specialists ophthalmology, Dr. Bhola is passionate about providing state-of-the-art care to patients and training the next generation of pediatric ophthalmologists.
“My main goal is to build a leading ophthalmology division, not only delivering excellent patient care but also engaging in cutting-edge research and disseminating education to the next generation of ophthalmologists and referring providers,” Bhola says.
When not treating patients, Dr. Bhola enjoys cooking, practicing yoga and meditation, and spending time with his wife and two daughters.
To contact Dr. Bhola or refer a patient, please call 888-770-2462.
In this CHOC Children’s grand rounds video, Dr. Chantal Boisvert, neuro-ophthalmologist, addresses optic neuritis in pediatric patients. Specifically, she discusses how the presentation and outcome can be different for children ...
CHOC Children’s new vice president and chief information officer, John Henderson, brings decades of information technology (IT) experience in the healthcare setting to his role. Most recently, John served as an assistant vice president at Texas Children’s Hospital, where he was responsible for IT operations, including business and clinical application delivery, business intelligence and analytics, and infrastructure technology. We recently asked him to share a few details of CHOC’s upcoming investments in technology. Here’s what he had to say.
What support will be provided to our population health efforts?
We will continue to expand our population health and pediatric system of care capabilities with new registries, real time information and analytic technologies to improve care coordination, management of patient population, and as well as improve the patient experience.
Will CHOC be investing in telemedicine technology?
We are undergoing a strategic review of telemedicine to position CHOC for broader reach, helping improve across the continuum of care and enhance the patient experience.
What are a few other IT projects you think our physicians should know about?
We are continuing with the roll out of Cerner’s PowerChart Touch for the iPad to bring more mobility and efficiency to our physician community. We will also place a heavy emphasis on expanding our Enterprise Data Warehouse platform to increase access to clinical, administrative and operational information via web-based dashboards, key performance indicators and scorecards. I am particularly interested in communications platforms for clinicians and shared services departments that improve efficiencies and eliminate the number of devices, so we will be exploring solutions in support of this. We are also looking to enable a content and collaboration platform that allows for secure document sharing using Microsoft’s OneDrive and leverages Skype for Business, including instant messaging and web conferencing.
CHOC wants its referring physicians to get to know its specialists. Today, meet Dr. Alyssa Saiz, a postdoctoral fellow in pediatric psychology and neuropsychology.
Q: What is your education and training?
A: I attended Pepperdine University to complete my doctorate in clinical psychology. My clinical internship was at the University of Health Science Center San Antonio. I am currently near the completion of my two-year postdoctoral fellowship in pediatric psychology and neuropsychology.
Q: What are your special clinical interests?
A: My clinical interests are working with children and teens with depression and self-harming behaviors, as well as somatic symptom and related disorders. I am also developing my specialty in pediatric neuropsychology. I love being able to help people during the most confused and vulnerable time in their life, and hope to give them a future they can thrive in.
Q: How long have you been on staff at CHOC?
A: Three years.
Q: What are some new programs or developments within your specialty?
A: CHOC is in the process of building both an intensive outpatient program and Mental Health Inpatient Center for children and teenagers through the Mental Health Initiative. This is very exciting because the services provided by both of these programs are greatly needed in our community and will help us provide even better comprehensive and intensive mental health care.
Q: What are your most common diagnoses?
A: Somatic symptom disorders, depression and anxiety.
Q: What would you most like community/referring providers to know about you or your division at CHOC?
A: As a department, we are growing and evolving with the community, working on research developments and supporting CHOC’s mental health initiative – all for the happiness of the population here. We are here to serve them, and working hard with them in mind each day. For me personally, I would love for people know how much of a passion this is for me – I’m here doing this work because I truly love it, and admire the courage of my patients and coworkers.
Q: What inspires you most about the care being delivered here at CHOC?
A: The aspiration to always give more and provide better services to the children and families we work with, as well as the commitment to training the future generations of medical and mental health professionals.
Q: Why did you decide to become a doctor?
A: I am insatiably curious and always wondering how to improve a situation. I also love to connect emotionally with people and understand their journey. So naturally, I was always drawn to psychology as an area of study and found myself looking for opportunities to work with children and teenagers who were experiencing hardship or mental health concerns.
Q: If you weren’t a physician, what would you be and why? A: I would be a florist or have a ranch for rescued animals. Both very different paths, but in the end they’re creating beauty to enhance someone else’s life and provide joy.
Q: What are your hobbies/interests outside of work?
A: I love to cook (usually anything pasta or cheese-filled) and be outside (hiking, walking my family’s dog, and being in the sun). I am also currently learning Spanish, which I am very excited about!
Q: What is the funniest thing a patient has ever told you?
A: When I told a young patient I was going to get her mom from the waiting room, she replied, “Well, she’s probably getting coffee. She can’t live without coffee!” I can relate. Kids hear and take in everything!
We spoke to Brianne Ortiz, child life clinical educator, who shared the following ways in which physicians can better connect with their patients:
Greet the patient first and let them know they are important to you. It’s natural to address the caregiver first, but ultimately you need the patient’s buy-in for compliance and a valued relationship with the family. After introductions, explain your job in a way that your patient understands. If you are going to listen to your patient’s lungs, show her your stethoscope first. Let the child touch it and have her practice taking big deep breaths. Listen to the caregiver’s lungs first and then tell the child it is time to listen to her lungs. Always tell a child what you are going to do before you approach the patient. Language and delivery is powerful and giving basic and honest information in a non-threatening manner goes a long way.
Do your homework. Patients will be more cooperative and trusting if you find something in common with them. Ask non-medical questions to find out what makes them happy. Be in touch with what various age groups enjoy right now (Mickey Mouse Clubhouse, Minecraft, the Lego Batman movie, Snapchat, Spotify, Taylor Swift and Shawn Mendes, for example). If your patient is more reserved, remember that communication is multifaceted; patients may warm up to you based on your facial expressions, tone of voice, if you’re eye level with them, if you’re friendly and keep them in involved in the exam or check-up. You may not even speak the same language as your patient, but all children understand the language of play. At the end of your appointment, take notes about what your patient enjoys, so when you see them again you have something to talk about and they’ll feel special because you remembered what is unique to them!
Offer choices and utilize positioning for comfort. Even young children have preferences and like to feel included. When you are checking a patient’s tympanic temperature, ask the patient which ear she prefers. The power to choose provides feelings of control and autonomy and allows the child to anticipate what is ahead. Positioning for comfort helps children feel more secure and less vulnerable. Sitting in an upright position is always more desirable than lying down. If a child needs help holding still, ask the caregiver to assist the child during an invasive procedure. If a patient can sit on her mother’s lap during an IV start, the child will have positive support from a person she trusts rather than a negative restraint from a stranger. A sense of dignity and respect is earned when patients feel more comfortable and less helpless.
Let your professional guard down. Take off your doctor cap for a few minutes and tell a silly joke, help build a Lego car, make pizza out of Play-Doh or have a lunchtime dance party. This will foster a safe place for families and make you more approachable. Your clinical expertise will be apparent by the medical treatment you provide; however, being relatable and understanding will convey a human connection.
Less is more. Unfamiliar faces can be intimidating, so only allow for medical personnel who are absolutely necessary in the patient’s room during an exam. If an invasive procedure is scheduled, designate one person who has a calm tone of voice to speak to the patient. Several people speaking and giving directions at the same time may feel chaotic and can cause more anxiety for the child. Having age appropriate distraction items available can also help decrease anxiety. If you have a toddler who is afraid of the blood pressure cuff, ask her caregiver to blow bubbles while staff obtains her blood pressure. Nursery rhymes, counting and interactive toys with sounds and lights, work well for distracting young children. I Spy books, cell phone apps, belly breathing and conversation are better ways to engage older children during stressful situations.