Pediatrician trained in England now sees patients in Farmington
By Chris Motola
Q: You’re in the Rochester health system. Where do you practice and are you currently accepting patients?
A: Yes. I work mainly at Farmington Pediatrics. So, Canandaigua Medical Group, part of Thompson Health, has two pediatric offices: one at Farmington and one in Canandaigua. So, I’m mainly at the Farmington office.
Q: What got you interested in pediatrics?
A: So basically, I did a lot of my training in England. So, pediatrics primary care didn’t exist there and I could see that it was really not a great system when you don’t have pediatrics primary care. General practitioners managed everything. But pediatrics itself is a big specialty. I moved to the U.S. when my husband moved here for training, so I had the opportunity to do residency here, even though I had done years of training in England. So, I did my residency here. I happened to work in AC-6, which is a primary pediatric care clinic at Strong Memorial Hospital and I could see how important the work is. So, that triggered my interest because you can follow a child from birth until they’re like 20 and monitor their development closely. You can form a relationship with families. It’s not the same when you work in hospitals, so that’s the reason why I prefer primary care.
Q: Can you talk a bit more about why you feel the U.K.’s approach was not as effective?
A: Yeah. So, in England, we didn’t have a pediatric primary care. I mean, they do a great job, but they have a different model of care. So, general practitioners look after everyone from birth to old age. But sometimes we feel like not having pediatric primary care actually affected screening and early detection of diseases. I can see the difference when I moved here. When you follow the same kid for years, you come to know them very well. So, if you see a change, you can pick up on it. You notice that something’s not the normal pattern of the baby. And you can follow them from there. I think that’s a better model of care.
Q: Does obesity medicine factor into your pediatrics practice?
A: Not really. Obesity medicine is not a big part of the practice, but we do try to promote a healthy lifestyle. And then we have to remember, it’s not a topic that everyone is happy to discuss. So, we just have to be mindful about the barriers and access to care. It’s a bigger picture, really, when it comes to obesity and lifestyle-related diseases in general. It’s just that access to facilities is limited. And we live in an area where we get heavy winters. People always tell me that they don’t really have anywhere safe to go during winter months. So, if you ask them to increase activity, we have to be very mindful. I am more interested in promoting holistic health changes in lifestyle rather than focusing on numbers.
Q: Have you found the University of Rochester medical system to be conducive to holistic medicine?
A: Yes, I mean generally. What I mean by holistic is that I take into account the whole picture. In pediatrics, the patients usually come with parents. They come as a unit, right? They have their belief system, they have their ideas and we try to be respectful. The system doesn’t really force us to do anything that the families don’t want us to do. We do have our policies, but our underlying aim is to work with families as much as we can.
Q: What are some of the challenges you’ve run into in treating the local pediatric population?
A: There are a lot of barriers in accessing care in our community. It’s easy to say “do this, do that” to parents, but sometimes it’s hard. If you don’t have transportation, say to go to a specialist, that’s not going to happen and that’s not the parents’ fault. It’s basically we don’t really have public transport in the region that much. So, when we live in the Finger Lakes area, going to Rochester can be a big trip for many of our families. It can be more than an hour’s drive and that’s not easy. So those are some of the challenges that we see. It’s hard for families to follow everything that we recommend, mainly due to different kinds of access issues. Sometimes we prescribe something and if it’s not covered by insurance — that becomes a problem. So those are kind of the main challenges.
Q: To what extent are you able to address those challenges?
A: Our system really supports us. We do have prior authorization specialists working for us now. Our nurses are very supportive too. So, for example, I might prescribe something not covered by insurance. Usually, they will try and see if there is any alternative and will call the insurance company and guide us in prescribing another one, which is covered by insurance.
Q: How do you manage allergies and things along those lines?
A: We do a lot of allergy management in our practice. For example, we do have amoxicillin challenges in our office now. That’s a recent introduction. So, both our offices, both Farmington and Canandaigua, we do offer an amoxicillin challenge. This was introduced recently. Amoxicillin allergies, if you don’t know, are over-diagnosed. Sometimes people get diagnosed with amoxicillin allergy if they have a rash after taking amoxicillin and it’s not always allergy.
Q: What is an amoxicillin challenge?
A: So, amoxicillin challenges, if you have rash after taking amoxicillin, you normally get the diagnosis of an amoxicillin allergy and that’s not a good thing when it comes to antibiotic surveillance. It’s a commonly prescribed antibiotic. So, what we do in our office is we select patients based on strict criteria. If they had a mild rash and it happened a year ago and if it wasn’t a significant allergic reaction like breathing difficulty or anaphylaxis, we might select that patient. So, they come to our office. We initially give a small dose of amoxicillin in collaboration with the allergy department. And they wait in the office and after about 15 minutes, we go and check in and see everything is fine and we give a larger, a higher dose of amoxicillin. And after the second dose, again, wait around 15 minutes and if you don’t have any reactions, examination and vital signs are normal. Then amoxicillin will be taken off your allergy list. So, this is a very common thing in pediatrics that many kids, especially young children, are diagnosed with amoxicillin allergy. They don’t really have true allergy to amoxicillin and that means they can actually safely take amoxicillin for common medical conditions.
Lifelines
Name: Parvathy Rajagopal, MBBS
Position: Pediatrician with Canandaigua Medical Group Pediatrics, part of Thompson Health
Hometown: Kochi, India
Education: Pediatrics residency, University of Rochester Medical Center, Rochester; membership at Royal College of Paediatrics and Child Health, United Kingdom; Bachelor of Medicine and Bachelor of Surgery (MBBS), Mahatma Gandhi University, Kerala, India. Board-certified in general pediatrics
Affiliations: F.F. Thompson Hospital (University of Rochester Medical system)
Organizations: American Academy of Pediatrics; Royal College of Pediatrics and Child Health
Family: Husband, three children
Hobbies: Enjoys spending her free time immersed in reading, cultivating her garden, and exploring new destinations through travel.