Kathleen Kieran

Kathleen Kieran

Kathleen Kieran, MD is a pediatric urologist serving patients in both Seattle and Tri-Cities.

You’re from Boston originally. What brought you to Seattle Children’s?

Dr. Kathleen Kieran, pediatric urologist, Seattle Children’s: I’ve been slowly working my way across the country from the East Coast. I grew up in the suburbs of Boston, and went to college, graduate school, and medical school there. I attended the University of Michigan for my urology residency, and then the University of Tennessee for pediatric urology fellowship. I worked in Iowa for 5 years before I came to Seattle.

The greatest impetus for my move to the West Coast was that my husband (who grew up in Puyallup and is an adult urologist in Tri-Cities) loves living in the Pacific Northwest and will absolutely not entertain the idea of living anywhere else. So I called Dr. Paul Merguerian [Seattle Children’s division chief of urology], and luckily they were about to post a position.

As a pediatric urologist, what does a typical work week look like for you?

Dr. Kieran: There is a lot of driving and flying involved. When I came to Seattle Children’s, I was interested in improving access to pediatric care in Eastern Washington and I advocated to significantly expand the urology services we have available in our Tri-Cities Clinic. As a result, I now spend a lot of my working hours east of the Cascades. On Mondays, I operate in Eastern Washington, Tuesdays I have an academic day, Wednesdays I teach at the medical school as part of the Colleges Program, Thursdays I operate in Seattle or Bellevue, and Fridays I have clinic in Tri-Cities.

An “academic day” means that I am working on research or quality improvement projects, which often involve collaborations with local or regional organizations.

Tell us a little bit about your local collaborations.

Dr. Kieran: Like all of us, I have limited time. I try to direct my resources toward projects that I believe will have a meaningful and durable effect on patients. For example, right now I am working with the Yakima School District to implement protocols for fluid intake and scheduled bathroom breaks during the school day. This is relevant because about 40% of all referrals to pediatric urology at Seattle Children’s last year were for voiding issues like urinary tract infections and incontinence. Behavioral modification is a crucial component of the initial treatment for these children, but if schools aren’t involved, six or more hours of the day are overlooked. Another project of which I am particularly proud is a study that engaged community members and parents of children with special healthcare needs in Eastern Washington to identify barriers to transition to adult care.

How does working in two very different cities benefit your work?

Dr. Kieran: I do travel a lot between Seattle and Tri-Cities. It gives me a perspective that clinicians at large medical centers often lack: I understand that it can take three or more hours each way to get to Seattle from some parts of the state, because I’ve done that drive myself. It’s critical to keep health care local when we can; this helps preserve tertiary and quaternary care resources for those children who truly need them, but also saves families time and money, which can be substantial at times.

How do you try to keep care local?

Dr. Kieran: Ideally, every child should receive their needed medical care from the right provider at the right time, in the right place. Sometimes that means going to Seattle, but often it doesn’t. I’ve been very impressed by the willingness and interest of local providers to try to manage common pediatric conditions themselves. When I first started at Children’s, I met Dr. Roy Simms, who has been a pediatrician in Yakima for decades and whose practice is a WWAMI training site*. He and his colleagues have really opened my eyes to what can be done at the local level, and how important it is for primary care and specialty providers to be attuned to all aspects of a child’s care. As subspecialists, we also need to be aware of social determinants of health.

Part of the difference with my practice is that I know the kids, I know their parents, and I also know their pediatricians by name and face. That level of integration helps all of us figure out the best care for a given child at any time, and helps parents feel like they are not being sent to Seattle Children’s, but to a particular person. That can make a stressful situation less so, I hope.

My working relationships with local clinicians are important beyond serving individual patients. As an example, by working in partnership with some practices in Eastern Washington, we were able to decrease the number of referrals for voiding issues by about 50%. This is in part because of education, but also because partnering with local providers helps to decrease the number of visits that are generated simply because someone can’t get a urologist on the phone to answer a simple question. Providers, especially those in more rural areas, want to be thoughtful about their threshold to send patients for specialty care, because they know it can be burdensome for families; if families are going to take a day off of work and lose money and time, it should be because the pediatrician has exhausted local resources.

I should also mention that I am the Pediatric Chair for the Washington State Urology Society, the Advocacy Chair for the American Academy of Pediatrics Section on Urology, and a Trustee of the Washington Chapter of the American Academy of Pediatrics. In these capacities, I enjoy being able to advocate for children at the local, regional, and national levels.

One last question: what do you like to do in your spare time?

Dr. Kieran: Sleep? No, really, I like to travel. Last year, I went to Japan, which was amazing. I also enjoy hiking and running. There are a lot of underappreciated but beautiful places in Eastern Washington. My husband and I have nine dogs, but only Blue, my German Shorthaired Pointer, likes to run with me. And, of course, anyone who knows me knows that I am a huge fan of OrangeTheory fitness; it’s the one hour of the day when I don’t have to make any decisions and want someone else to tell me what to do.

*WWAMI is the acronym for the University of Washington School of Medicine’s multi-state medical education program in Washington, Wyoming, Alaska, Montana and Idaho.