{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/0k26971z33/manifest","type":"Manifest","label":{"en":["Dr. Mark Nadeau"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eIn this oral history, Dr. Mark Nadeau, residency director for the University of Texas Health Science Center at San Antonio Family Medicine Residency Program, reflects on leading residents and caring for an underserved patient population during the COVID-19 pandemic. He describes the rapid shift to telemedicine, the expansion of inpatient services, and the creation of additional care teams to meet increasing hospital demands. \u003c/p\u003e\r\n\u003cp\u003eDr. Nadeau discusses the challenges of maintaining care for patients with chronic illnesses, particularly those facing barriers related to limited resources and health literacy. He reflects on the impact of the pandemic on medical education, patient care, and family life, while emphasizing the teamwork, adaptability, and sense of duty demonstrated by healthcare workers throughout the crisis.  \u003c/p\u003e (summary)"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2025-06-18 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["interview"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Alexis Ramos (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Keyword"]},"value":{"en":["San Antonio","Texas","Texas","Covid-19","pandemic","family physician","family medicine"]}},{"label":{"en":["Subject"]},"value":{"en":["Mark Nadeau (personal name)"]}}],"summary":{"en":["\u003cp\u003eIn this oral history, Dr. Mark Nadeau, residency director for the University of Texas Health Science Center at San Antonio Family Medicine Residency Program, reflects on leading residents and caring for an underserved patient population during the COVID-19 pandemic. He describes the rapid shift to telemedicine, the expansion of inpatient services, and the creation of additional care teams to meet increasing hospital demands.\u0026nbsp;\u003c/p\u003e\r\n\u003cp\u003eDr. Nadeau discusses the challenges of maintaining care for patients with chronic illnesses, particularly those facing barriers related to limited resources and health literacy. He reflects on the impact of the pandemic on medical education, patient care, and family life, while emphasizing the teamwork, adaptability, and sense of duty demonstrated by healthcare workers throughout the crisis.\u0026nbsp;\u0026nbsp;\u003c/p\u003e"]},"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/313/420/small/Nadeau%281%29.mp4_1782845869.jpg?1782845877","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420","type":"Canvas","label":{"en":["Media File 1 of 1 - Nadeau_(1).mp4"]},"duration":2207.35515,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/313/420/small/Nadeau%281%29.mp4_1782845869.jpg?1782845877","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/313/420/original/Nadeau_%281%29.mp4?1782845832","type":"Video","format":"video/mp4","duration":2207.35515,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049","type":"AnnotationPage","label":{"en":["Interview with Dr. Mark Nadeau [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Transcribed by Avery Roman on 09/08/2025\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=0.0,0.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I'm Alexis Ramos. And you're Dr. Mark Nadeau.\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=0.0,3.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yes, I am.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=3.0,4.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/4","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And today is June 18th, 2025. And we're going to go ahead and get started if that's okay?\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=4.0,9.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/5","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah, that's fine.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=9.0,10.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/6","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Perfect. Please describe your current title.\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=10.0,13.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/7","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I am the residency director for the Family Medicine residency at the University of Texas Health Science Center of San Antonio.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=13.0,19.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/8","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Perfect. Okay, and can you describe a typical day in the clinic for you prior to 2020?\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=19.0,25.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/9","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): So it's not that much different from now, I mean my job is a combination of patient care and teaching. So I lead the residency. So I teach residents and medical students here in the clinic and in the inpatient setting I do some other teaching with medical students and some leadership and some administrative stuff that has to go- has to do with running the program.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=25.0,51.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/10","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And can you describe the population that you serve at the Robert B. Green?\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=51.0,56.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/11","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah, so this is the lowest income zip code in San Antonio as I understand it. And so we’ve got a large underserved population here- I think this- you know- would be considered a “safety net” clinic. Got a lot of patients that got no insurance, are underinsured and then- you know- some patients with insurance but its typically underserved population of patients with you know- a mixed ethnicity. Which I think actually is pretty close to nearest what the city is like. The San Antonio demographic.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=56.0,88.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/12","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Okay. And can you describe what your- No title or role changed during the 2020 COVID pandemic, right?\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=88.0,97.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/13","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): So I did not- no I was in the same role at the time as I am now and I was before the pandemic. So there was no change.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=97.0,103.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/14","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Got you. Okay. And so during the pandemic, what setting did you spend most of your time in? That could be inpatient, outpatient, telemed.\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=103.0,112.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/15","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): So things changed a lot. I mean immediately after that- right after the pandemic started they really closed the clinics down a lot. They really brought very few patients into the clinic very low volume for that. We spent some time initially trying to transition the outpatient part of the practice as much as possible to telemedicine. Try to do as much for the patients as possible over the telemedicine, telephone, mostly at the start for us. Some videos, we moved into it. And then there was just a lot more inpatient. So, what I saw the institution change is they tried to maximize the number of beds in the hospital. They took the rehab patients- as an example- moved them to a different location, tried to use those for acute beds, they used space that was used for lots of surgery for acute beds, they opened some other areas that had not been acute beds and, you know, anyplace they could find to stick extra patients. There was extra patients in the hall and the emergency room and they turned some of the ORs that were used for elective cases into ICU-type beds. So there was significant changes in that regard at the institution and there was just a lot more inpatients. Lot more requirement for people to do inpatient work and that was at all, really, for all disciplines. So, you know, the more nursing, the medical technicians, the physicians. And, you know, the patients got more administrative things to get done. So really everything ramped up on the inpatient side to quite an extent. And so the institution spent some time and effort trying to organize some extra teams under the Internal Medicine Department and so that was organized. Our faculty and leadership in this department, we decided that we already had admitting privileges and so rather than join that effort what we did is just increase our inpatient team. So, we actually decided to have two teams and so we had the one team that was our regular team that had all of our patients on it and then we took some additional patients and additional people to take care of those patients. So we had Team A and now Team B. So extra faculty over there, extra residents over there. When you have more patients in the hospital you need more, a little more space for meetings with residents and meetings with team members and so the institution- the University Hospital- was able to get us an extra small room that we used as well. And so that was appreciated. Anyway, I think I- we just started changing what we did, quite a bit. Um, I’m very grateful to the people on our team- really everybody- but right now I’m speaking about our team members. We really- the extra- the changes were met with, what I think, were pretty good cheer. From the faculty standpoint, you know, people that had admitting privileges which is most of the core faculty just did more inpatient. Really, twice as much time on inpatient. As far as the residents went- the curriculum- we still used our previous training curriculum. We still had an inpatient curriculum, right, and that's what we were training against. Of course, they weren’t in the outpatient setting so that was- we’re just doing more inpatient. And so that was how we reorganized what the residents were doing and what the faculty were doing to respond to the situation.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=112.0,355.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/16","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Amazing. I think that was a really great summary about the inpatient changes. Okay. What do you remember about those first few weeks in clinic when you started to hear those words?\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=355.0,363.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/17","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Well, I remember the volume was lower, really low, so I remember you spent a lot of the day making phone calls. So we spent some time trying to get that organized, trying to do it better. And I found it sometimes a little frustrating that we were having trouble seeing patients who I think really needed to be seen. Some patients are fine if you do a televisit, you can deal with whatever the issue is on the phone, but there's a lot of patients you can't. And the physical exam and the in-person interaction I think was lacking and I really felt that, especially in our patient population, it was more challenging for our patients to really get the kind of care they needed. It was more challenging for us as physicians to really give them the care that they needed and deserved because they weren't here. I mean, that was done because if you need to follow up for your blood pressure, your CHF, maybe that's not an emergency. Maybe that can wait until things are better organized and safer. But still, I think there was a lot of people with chronic illness that didn't get what they needed during, especially during the initial part. But I think that went on for several months. I really think there was a lot of people and not just our patients. I think nationwide there was a chronic care gap, people not getting the care they needed just for some of their routine, chronic outpatient illnesses, blood pressure, cholesterol, diabetes, congestive heart failure, chronic kidney disease, and on and on for not to just single out those diseases. But I think for all chronic disease there was a gap in general. And I think I really felt that here. And I think we did our best and it was all well-intentioned. I don't think we controlled some of these things as well given the tools that we had available to us as we did before the pandemic.\n\n(","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=363.0,501.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/18","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And then since I think we've caught up on that gap, but I don't think the remote work matched the quality of care, the depth of care we were able to give give during the pandemic. I mean, we were able to give before the pandemic and after the pandemic. I don't think we were able to match that during the pandemic. And I think just objectively, as for the American Board of Family Medicine, you need to do a QI project from periodically to as part of your maintenance of certification activities. So one of the things I did, what I did is I did a review on how we were doing here on blood pressures. So I went through and looked at a group of patients that had on their chart a diagnosis of blood pressure and they were on medication and that they had called for medication. They'd called for a medication refill because they couldn't get in for a visit or they'd had a televisit. And then I went through the charts and I tried to compare that to, well, what do we actually have recorded as controlled blood pressures? I mean, even if the patient said, oh, I checked it at home and it was this, but there wasn't much of that, but looking back at previous visits or visits, maybe they'd take it to an acute care or any blood pressure I could find there was a high percentage of the blood pressures that were not controlled. So the people were calling in for refills of all the standard med- Lisinopril and hyrdochlorothiazide and Amlodipine and all the others. They're calling in for a refill on this and we talked to 'em on the phone, maybe refill the medicine, give 'em follow-up, try to get 'em in person visit if possible, which we're in short supply, and then compare that to a lot of those people did not have a recorded blood pressure that was in the control range.\n\n(","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=501.0,637.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/19","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): There's a lot that were not in the control range, and we really didn't have the tools to, I think address those in a timely fashion given that it was all outpatient. So try to do something to improve it, and I think we got a little better over time. So that was part of the QI, that project, as you're aware how those work. And we improved it some, but it wasn't great performance. It wasn't as good as I think we're doing now and we're doing before the pandemic. And I think there's a lot of reasons for that, but I think the whole system changed a lot and it's very difficult to do the right thing for non-urgent patients who still needed care.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=637.0,680.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/20","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Absolutely. That's very interesting. I didn't know you did that work with the blood pressure, so that's very interesting.\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=680.0,685.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/21","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=685.0,685.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/22","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Nice. That also kind of leads into my second question about if our patients experienced the pandemic differently than others. You touched on that. What about any health disparities, if any, did you witness being exacerbated by the pandemic?\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=685.0,701.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/23","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah so let me take that last question and then this new one- sort it together. I mean how did it affect our patients and did healthcare disparities have any effect? So I think it affected our patients because of what I said that I think they weren’t as well controlled but I think that was true other places. I don’t have data on this but I do think it was harder for our patients than for some groups of patients. I think patients with low healthcare literacy or low literacy it was much more difficult in that era. I think even if you’re not a medical person but people with some formal education they have an easier time. You give ‘em five or six things to do on a zoom call and they’re supposed to take some notes and follow some directions and that sort of thing. I think that was harder for our group of patients who, not all, but a number of them have low literacy and/or low healthcare literacy. I think it was harder for that group. I think about people that I know personally and some of them like it: “I don’t really have to go to the doctor- I take all my notes and I write some stuff down and tell them and they tell me to go check this stuff and I get it checked and then I call back.” Much better organized. I think everybody deserves the same but I think it was harder to deliver on that sort of concept for a lot of patients that aren’t used to taking notes and taking detailed directions and following stuff. I think we seem to have, at least, with our current processes and skillsets I really felt like we connect a lot better when we meet here in the clinic. And our performance, in terms of the patients actually understand what we tell ‘em and if they actually go do it and we follow up on it was better when it was in-person visits. And I think there was a healthcare disparities issue that for the people with lower access and lower education levels- I think a lot of them didn’t get- we weren't able to provide as good of care, as good of control, especially on a lot of these chronic conditions.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=701.0,851.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/24","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Absolutely. I one hundred percent agree with you. Okay. And so you mentioned a few strategies that our clinic implemented to handle the health disparities exacerbated by the pandemic such as telemedicine, deploying team B. Any other innovative strategies that we're employed to help manage the limited resources?\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=851.0,875.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/25","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Innovative strategies? Since we’re talking about resources, I guess what I wanna do is give a shout out to the folks that were on sort of the supply chain side of things. Many healthcare organizations had difficulty getting enough protective equipment and our organization here at UHS and UT worked very hard to make sure we had what we needed. I think that was super important to basically keep the morale of the workforce, for the care of the patients, for the safety of both the workers and the patients. So really a big shout out to that. They probably did some innovative things supply chain wise to do that. Certainly, they did some things that this isn’t a new thing. I think most everybody figured out ways to sterilize PPE that was particularly before that was one use type of thing. I mean you use for mask for five days- I can’t remember what the numbers were. But things that were typically disposed of, we figured out ways to use them for longer to make it last longer. I think that was innovative. I’m not sure if that’s innovation. But that's the innovation that a lot of people used in a lot of places. But, it certainly was an innovation. And I really thought that really helped us make sure we had what we needed to do that. I think we did a pretty good job here to get people trained up. To protect them as best we could. I thought that was really important. As long as we’re talking about PPE, if you don’t mind, one of the things, the changes that they made to make the protective equipment go further is tried to optimize the number of people that actually wore PPE. I think that and effective education. And I think most of the folks on patient care at this point. So for the faculty members, I mean we’re trained, board certified, so I don’t think that had taken effect on us. Oh we’re doing more inpatient this week and the next few months and then we’ll transition back to outpatient another time. I think for the residents it affected their education some because there was more inpatient. We’re largely outpatient in terms of what our residents, when they graduate, what they go do. But guess what, we’re doing more inpatient today. That was a need and I 100% support all that but I think it did change their education. I think it affected to some extent what we were able to offer in terms of depth of outpatient training because the volume was different. But, they were training full-time and they were on the curriculum although they were on more of the inpatient than they’d been in the past and less on outpatient than they’d been in the past. I think clinical training, I think the group that was probably most affected was medical students. Clearly residents were necessary personnel, they just get the work done, right? Medical students, less so, right? They’re training but we’re gonna get the patient’s here seen and that's true in the inpatient setting too whether the medical students show up or not, right? They got a training day for something else. It's still true. If they got a didactics and they got to go to that, that’s fine. We’ll get the work done. But during the pandemic it was sort of systematically less available in terms of clinical experience. And so I think in terms of educational impact, that was the group that I deal with, that I think was the most impacted. We’ve had to work at the residency level to catch some people up. Which I thought was a huge disruption. And while it was true for the clinical part, which I think is what we concentrated on here- I teach a little bit on, as you know, on the second year level we do the small group synthesis cases. And I think for even lecture type didactics they’re all phoning it in. They’re home watching their medical education on zoom or whatever system their using. And I think the participation had to be affected. I certainly felt it in the small group sessions we were doing. You know, you’re trying to do a small group interactive session. It’s me and like 16 students and I’m looking at 16 black tiles, right. That’s not really that interactive. So I think that was just one significant example. But I think it probably beld over into other didactics as well, other sessions. It just wasn’t as personable. I think that would have made it hard for some of the students to stay motivated and be thorough, and ask follow up questions, and etcetera. Without having measured anything, but in terms of my experiences I really thought medical student education was affected here in terms of what I observed. And I think in terms of the outcomes, residents, people who are graduated from medical school come here as residents, and I think some of them came less prepared for clinical experiences because they hadn’t had those as students.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=875.0,1247.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/26","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): No, absolutely. That makes perfect sense. I agree. It is tough to give a presentation to just black screens.\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1247.0,1253.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/27","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah, it's hard to be personal. I think education wise, I really think students, a lot of the learning happens within the context of relationships. And it's just not the same when you're sort of doing it on the screen in my opinion.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1253.0,1271.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/28","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I agree. Okay. And so any changes from that period that have stayed in place?\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1271.0,1334.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/29","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"):  So we haven’t gone completely back to the old way. I think we’re still doing some telemedicine visits. I think we’re trying it right, such that I think there is a group of patients that I was trying to describe who can benefit from telemedicine. It’s more convenient, right? They maybe don’t need to come in. You can talk to them on they phone, you can observe over the screen or they can tell ya stuff online and can make equally good decisions. So we’ve tried to emphasize that. It is more convenient for some patients. So there is certain things that I’ve seen here and talking to colleagues from other places, there’s more of that and I think some of that’s been used to good effect patient-care wise. I think some of the meetings- So, it used to be you have in-person meetings. Then zoom comes along and it took over and teams, I guess. Not to be favoring one brand over the other. A lot of meetings happen that way. A lot of that has stayed. I think some of that for the worse and some of that for the better. I think can think of a meeting- for example like the graduate education meeting- it’s better attended because it’s on zoom, right? Because a lot of people they don’t have to travel to get there and its easier if you only have to log on at the time of the meeting and be there for the hour and fifteen that the meeting actually goes on, so they get better participation. I see that as it’s some decision making but a lot of it is the institution's opportunity to, the dean's opportunity to, disperse information and to give context to those decisions. I think that meeting is an example of a meeting that is significantly better. But I think a lot of meetings are not better. I mean I think people participate better in certain meetings when they’re in-person. I think the team building part of online, that I’ve seen, when you get natural working groups and that sorta thing, sometimes that doesn’t work as well on the zoom. I really feel like in the early days, when we went all zoom early on in the pandemic, a lot of the teams were pretty effective because I think a lot of the team building stuff had been done before we switched to all online. So I think teams were better if they’ve got some relationships, at least certain kinds of teams- working groups especially. Now four years in, some teams are- I think it’s just harder to build a team over the zoom, not that it can’t be done but it’s harder. I’m not sure we’ve got the hour optimally back to in-person meetings. I think a lot of people wouldn’t like to go back because there’s more traveling and it’s easier to sit at home and just have just your shirt and tie and just shorts on, on a zoom call rather than go in for a meeting and that sort of stuff. I’m not sure we’ve optimized meetings yet. So I talked about the education part, the meeting part… What was the original question again?\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1334.0,1487.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/30","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Changes from that period that have stayed in place.\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1487.0,1490.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/31","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): So I think a lot of the meetings, I guess, and then the telemedicine, and then we've gone back I think to more inpatient, the more in-person outpatient visits. I think our inpatient volume is much more like it was before the pandemic. And so I think things on a lot of those levels are back to the old way. And I think inpatient is organized the way it is because not to say it's perfect, but it works. And so it's organized. And so I think we're back to that old organization, back to where it is better. It was before the pandemic.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1490.0,1531.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/32","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I would agree with that. Moving forward, can you describe a moment or a time that felt especially overwhelming or powerful during that time for you?\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1531.0,1550.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/33","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Well, I guess in terms of motivation one thing I found very motivating was that the people here. But not just our people but all over the institution. People were having pulled together. People were organizing this other team to where we had two maybe PM\u0026R doctors who are working under another internal medicine doctor to make another inpatient team to see more patients. I think people are pulling together on that. People overcome their own personal reluctance because it was a scary time. They put on the PPE and they went and did their work. I found that inspiring. I think there was a lot of um- It was a sad time. And I think you know watching some of the suffering with patients of course I think watching people that are air hungry is particularly distressing. There was that. The palliative care folks certainly got a workout during the pandemic and they did more work, they enlarged their teams. I mentioned that was challenging work at that time. I certainly admire what they did. I found that motivating. And umm… sad, I guess. I thought there was lots of stories. Like we had patients, as an example, on our inpatient service and her brother had died, so she’s in with us in the inpatient. And so she didn’t go to the funeral and all these people are sick and dying and the family reactions were all disjointed because of the change in the pandemic, right? You can’t leave your COVID isolation room to go to somebody’s funeral no matter how close they are to you. Kinda how it shook out in that particular case. There’s a lot of examples like that. The question’s about my profession but on a personal level my mom was in an assistive care facility at the time but she was a prisoner with the facility. So she’s like in her 90s and she can’t go anywhere and the family, they can’t even go visit. You go visit through the window. That’s just one example, my personal family example. I’m not sure that was best for her. The isolation in that particular instance I thought was particularly cruel, actually. I mean I’m not blaming anybody but its particularly hard for my mom and for really all the people she was living with at the time. It was hard for the families, right? The looking through the window at this person that’s isolated and lonely and hurting and they can’t do anything. I think there’s lots of individual stories like that. That would be my personal example and there’s a lot of professional examples like that. It really changed a lot. You did see a lot of suffering. I thought that was striking. If I might be allowed to give one more story, just one more insight I guess was during the events you hear periodically people talking about the nurses and the doctors and the people doing extraordinary things and that was indeed true. But I thought some of the ancillary folks had it even worse. I thought in particular to be respiratory therapy must have been just grueling and painful. They weren’t really saying “Oh the RTs are doing…” they talked about the doctors, nurses, and ER personnel and all that and first responders and all that was true but I don’t think anybody had it worse than respiratory therapy people.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1550.0,1841.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/34","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I 100% agree. And I did get a chance to interview Dr. Aniemeke and she did also talk about the isolation that she saw in the nursing homes.\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1841.0,1851.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/35","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah it’s particularly harder on the older patients, right?\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1851.0,1854.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/36","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Absolutely.\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1854.0,1854.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/37","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1854.0,1855.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/38","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And that was my next question. How did the pandemic affect you personally? But you already answered that.\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1855.0,1859.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/39","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah I think that was it. Well, I will say, I’ve given you some of the negative. Now, I’ve got two adult sons. They were both living in town. So we actually spent a lot of time together. I almost feel guilty saying that, right? From a family point of view it was that positive. Every Sunday, for sure maybe one or two other times during the week the boys would be home for dinner. And that was our little bubble so it was good. So it wasn’t all bad. Yeah.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1859.0,1905.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/40","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And that's the theme I'm getting from a lot of other people as well. Okay. Did this experience shape the way you practice medicine now?\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1905.0,1915.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/41","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Well, I've been at this a while, so I can't say. I could see how it really changed my style a lot. I mean, I certainly learned how to do telemedicine visits better and sharpened my inpatient skills a little bit more during the pandemic. But I don't think it changed my philosophy approach too much. I mean, except for the immediate effects that we talked about. I wouldn't say it really had huge changes. I think I learned a lot about education. I think I learned some of these other, there were some lessons in there in terms of interaction and had some thoughts about chronic care, which I've already shared how I have some thoughts about patient communications. I really think for a lot of our patients, the in-person touches is really, for a lot of them, essential to getting good care. I don't think that the telemedicine approach is for everybody. I don't think it's just by this diagnosis is fine for telemedicine and that diagnosis is not. I think there's a lot of personal aspects of that.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1915.0,1984.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/42","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Do you think the system is better prepared now that we went through this?\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1984.0,1988.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/43","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah, if we had another pandemic just like COVID, I think we'd be ready for it. I've been through two major pandemics during my career, and you're a younger physician than I am, so this probably is not your last pandemic, but when I was a resident, the AIDS pandemic was hitting, and so that was totally different. So we learned a lot of lessons there and maybe some of that helped us with COVID, but it was just so different than how that pandemic rolled out and all the issues related to that. So the next pandemic, I dunno what it's going to be, and I don't know how it's going to roll out. And so I think at some extent it helps you. I mean, I think some of the things that happened with previous events that weren't considered pandemic, but were epidemic like the Zika and the SARS, things that we had that went on before COVID helped prepare us to some extent for that. So yeah, I think it's going to help some just in terms of some of the infrastructure, but we're well positioned I think, to fight another COVID type epidemic, but the next one's going to be something totally different. So I think you really need to have some flexibility in whatever the response is going to be, because the next one likely will be different.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=1988.0,2084.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/44","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Absolutely. Okay. And finally, this interview is being recorded to preserve and document provider's experiences during this unprecedented time. Is there anything else that you'd like to share?\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=2084.0,2101.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/45","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I guess nothing specific. I’ve already said this but I do really want to go back to I’m really grateful to be a part of a team that I think really pulled together for that. Grateful for the effort, really across the board, not just the providers, the people with direct patient care responsibilities, but the people that were trying to procure and the people that were trying to organize the facility. I think here it was a really good team effort and I was really grateful to be a part of that. And I don’t think you can just find that observation here where I work. I think nationwide we saw a lot of that. Just talking to other friends in other cities and such I think they saw a lot of that as well. There’s always some stories of this happened and that person didn’t do the right thing but mostly I think people did the right thing. And I’m very grateful to be a part of that. And I saw a lot of people, they were, you know, it was a little bit frightening, daunting, you’re worried about your own personal safety, etcetera but I think people for the most part said well I’m gonna do my duty, right? I heard it on a newscast or something, somebody said, “well, I didn’t sign up for this,” and well, you kinda did. When you went to medical school you did sign up for that, I think. When you went into healthcare, nursing school, you did sign up to serve. I think most people looked at it that way- like I’ve got a duty to do these things and I’m gonna do that. So, I saw a lot of the good in people and this organization. So that would be the last reflection that I have.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=2101.0,2203.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/46","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Thank you so much, Dr. Nadeau. I appreciate it.\n\nNadeau (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=2203.0,2205.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420/transcript/95049/annotation/47","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/173983/file/313420#t=2205.0,2207.35515"}]}]}]}