On a mid-September afternoon, pediatric hematologist/oncologist Shirley Reddoch begins her grand rounds talk on “Sickle Cell – Seeing Beyond Fever and Pain.” The presentation would not be unlike any she’d give at Hopkins Children’s, where she has been on faculty for the past four years, but this day she is at a different venue – the medical pavilion adjacent to the Howard County General Hospital campus in Columbia, Md. – in front of a different audience – community pediatricians rather than pediatric residents. She’s also here in a different role – a private practitioner – having seen a growing need for specialists like her in the community.

“Families of children with concerns for blood disorders, or who have a history of cancer treatment,” says Reddoch, “are looking for community-based specialists focusing only on their specific needs.”

Large urban medical centers have been at the heart of advances in the diagnosis and treatment of blood disorders and cancer, dramatically improving survival, Reddoch explains. But with better survival has come a greater need to integrate long-term care needs in the total healthcare plan and daily life setting of the patient. “Unless the patient and family recognize an emergent problem,” Reddoch says, “they may not seek the specialty care that can mitigate such crises if school, work, transportation or other life and economic pressures are too great.”

With that reasoning, Reddoch established an outpatient community-based hematology/oncology practice in Columbia, Md. Patients who can more easily accomplish disease/health surveillance and periodic follow up, Reddoch stresses, will reap the benefits of age-specific counseling and education, self management guidelines, and being better prepared when acute or higher-level care is needed.

“Through regular education of the signs and symptoms of a disease complication and how to address it – the onset of a pain crisis in sickle cell, for example – patients may avoid a hospital admission or transfer to a more distant medical center,” says Reddoch.

Diagnostic evaluations in non-emergent situations can be accomplished in outpatient settings, Reddoch stresses, for a range of conditions, from anemias and bleeding disorders to heritable clotting disorders. Patients still need to be grounded in primary care, and have a ready link to medical center care when necessary, Reddoch recommends. Also, a community based specialist should be an effective partner with the primary care provider to ensure patients stay current on their individual specialty care needs into their adult lives.

“I feel strongly about this,” she says. “To provide this specialty service, whenever practical, in a convenient community setting for the optimal health and life benefit of our young patients.”

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