What happens at the Friday outpatient clinic?

What is a general clinic visit like?
It really varies on what the person has. The patient comes in and a nurse practitioner sees them and then determines what their problems are and who needs to see them. So they may see one person (e.g. one from plastics), or they may see two people (e.g. one surgeon and an interventional radiologist). It just depends on what their problem is… I take a history and then a physical examination. Since we’re all different types of physicians, we all focus on different things, we notice different things, so we do a full skin examination and then we figure out what needs to be done. We talk about what we think the diagnoses are and what the possible treatments are.

Marilyn G. Liang, MD


Patients are initially scheduled for evaluation by the multidisciplinary VAC clinic on Friday morning; we have 3-4 clinics a month. There are up to 20 patients per clinic and each patient is assigned to the subspecialties involved based on the type and organs involved. For example, venous malformation of the knee is typically seen by an orthopedic surgeon and an interventional radiologist. Infantile hemangioma of the face is seen by a plastic surgeon and a dermatologist, and so on.

Families and patients come to the clinic with the understanding that they will meet different specialists and teams. For many challenging cases, involved teams confer after evaluating the patient and reviewing relevant diagnostic and imaging exams to discuss the findings and come up with a plan for treatment and follow-up. This is actually a true interdisciplinary work.

Ahmad Alomari, MD, MSc, FSIR


What is the schedule like for a typical patient visit like if they come to the Friday clinic?
MBS: They should generally expect to see either Erin or myself as the first person to introduce ourselves, obtain a history, and perform a physical exam. We often do a lot of teaching even before the physicians come in the room, answering questions from patients and families that are posed during the history and physical. They may ask what the diagnosis might be and how it would be treated. We start the ball rolling, so patients and families should count on seeing us followed by the physicians… Sometimes the patient and family will see the physicians as a group, sometimes each specialist goes in separately and sees the patient and then sometimes they talk together afterwards. We have a lot of visitors to the Center, including many health professionals who are trying to learn about vascular anomalies as well as residents and fellows who work with our specialists. We also have visitors from all over the world who come to see our clinic, so families should certainly expect to see a number of physicians and others. We make sure that the patient or family leaves with a written plan of any treatment that will be planned, medications that have been prescribed, and any necessary follow-up. If they need imaging or need to go to the lab or see a different specialist in a separate appointment, that’s all set up at the same time. Our clinic process takes time because of the number of specialists involved and the amount of teaching that must take place. We tell people to be willing to spend a couple of hours with us so that they can see everybody they need to while they’re here and ask their questions and learn more about the diagnosis and what it means.

ES: We also ask the patients to let us take photographs of their lesion(s)  and explain why these are helpful, in terms of following the progression of lesions or to document pre-operative appearance. Of course patients and families can always refuse the photographs if they are uncomfortable, but we really try to encourage them to allow us to have them so that we have a baseline visualization of the areas of concern.

Erin Spera, MS, CPNP and Mary Beth Sylvia, MS, FNP-BC


What will happen if you go in to see someone in clinic?
I obtain as much information as I can from the chart. If we’ve seen the patient before or reviewed the patient in absentia on Wednesday night, I know a lot about the patient. I knock on the door, go in the room, introduce myself and say, “Who am I seeing today?” Often you can’t tell who is the patient, there are sometimes three or four kids. With an adult, I get a good history and do a physical examination. Often, there’s more than one specialist in the room at the same time, often there are fellows and residents, a coterie of young people. Often we’ll need the help of the radiologist. We have to wait until the radiologist reviews the images before we can go back, see the patient again, and can say, “The films confirm what we think you’ve got” and come up with a plan.

John Mulliken, MD