{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/5717m05863/manifest","type":"Manifest","label":{"en":["Dr. Sudha Subramanyam"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"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":["Language"]},"value":{"en":["English (primary)"]}},{"label":{"en":["Format"]},"value":{"en":["English"]}},{"label":{"en":["Subject"]},"value":{"en":["Covid-19 (topical term)"]}},{"label":{"en":["Keyword"]},"value":{"en":["India","Idaho","Latino","PPE shortage","telemedicine","internet access","pandemic","family medicine"]}}],"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/000/205/884/small/SudhaSubramanyam%2811-18-2020%29.mp4_1692201392.jpg?1692201393","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/105307/file/205884","type":"Canvas","label":{"en":["Media File 1 of 1 - Sudha_Subramanyam_(11-18-2020).mp4"]},"duration":1989.84,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/205/884/small/SudhaSubramanyam%2811-18-2020%29.mp4_1692201392.jpg?1692201393","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/105307/file/205884/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/105307/file/205884/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/205/884/original/Sudha_Subramanyam_%2811-18-2020%29.mp4?1692201391","type":"Video","format":"video/mp4","duration":1989.84,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/105307/file/205884","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/105307/file/205884/transcript/48868","type":"AnnotationPage","label":{"en":["Transcript of Dr. Sudha Subramanyam [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/105307/file/205884/transcript/48868/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Crystal Bauer: Good morning, Sudha. Today is November 18, 2020. Please confirm for the record that you are aware that this is being recorded and that you are giving your permission to do the interview.\n\nDr. Sudha Subramanyam: Hi, Crystal. Yes ,I have given permission to record this as a video interview and I am aware that it is being recorded. \n\nCrystal Bauer: Okay. Would you please give your name in full?\n\nDr. Sudha Subramanyam: My name is Sudha Subramanyam.\n\nCrystal Bauer: And, what is your present title?\n\nDr. Sudha Subramanyam: I'm a resident physician at the Family Medicine Residency of Idaho. I'm a second year chief resident.\n\nCrystal Bauer: And where did you go to medical school?\n\nDr. Sudha Subramanyam: I went to medical school near Bangalore, India. I went to Rajiv Gandhi University of Health Sciences, and the medical school was Adichunchanagiri Institute of Medical Sciences.\n\nCrystal Bauer: And you're currently a resident. Where are you completing your residency?\n\nDr. Sudha Subramanyam: At the Family Medicine Residency of Idaho, Nampa program.\n\nCrystal Bauer: Got you. Can you speak about your current position and what you do on a daily basis?\n\nDr. Sudha Subramanyam: I am a second year resident and my daily work kind of varies every 2-4 weeks. Some weeks I work in the in-patient setting, where I admit and manage patients in the medicine floor, in ICU, in med-surg and telemetry floors. I also do OB where I deliver babies and take care of postpartum moms. \n\nI spent about 50% of my time doing clinic. I have my own panel of patients and sometimes see walk-in patients. I also do respiratory clinics.  Some weeks I go out and work in specialty clinics with other specialists in the Treasure Valley, and also engage in community work such as covid testing in Homeless shelters. I have an ongoing community project with the Health Department as well and I am working on setting up a school-based nurse clinic at an underserved school district. \n\nAside from the above, I have some administrative responsibilities as a Chief Resident. \n\nCrystal Bauer: You sound quite busy.\n\nDr. Sudha Subramanyam: Yes, it is pretty busy. Overall, we spend about 70-80 hours at work every week. It is satisfying. \n\nCrystal Bauer: Could you tell me a little bit about the types of patients you treat in your programs? Who they are, and kind of what their backgrounds are?\n\nDr. Sudha Subramanyam: Yes. Our program is very uniquely located in a spot where there is a significant shortage of primary care providers. Our patients are diverse and they come from rural, frontier and suburban counties. Several of our patients are from an agricultural background. We also have patients that work at other local mining industries and tech companies. About 25% of our patients are from a Latino heritage. Our residency is a Federally Qualified Health Center and we are able to provide healthcare at a very low cost to the insured through a sliding fee. This has been a huge strength of our residency as we are able to help patients from different socio-economic backgrounds. \n\nCrystal Bauer: So what unique challenges do you and your program face with COVID-19? And what are the barriers and obstacles that you've come across?\n\nDr. Sudha Subramanyam: The rigors of our residency shifts, especially in the inpatient setting have significantly grown. \n\nDonning and doffing PPE and constantly being aware of keeping our hands sanitized has been taking up a lot of time and causing a delay in the overall flow of the day. \n\nCOVID patients in the hospital have significant morbidity and mortality and the rapid progression of the disease has a huge bearing on our own mental health. We want to do everything to save our patients’ lives but sometimes the virus shows it’s aggression. There is a sense of helplessness.\n\nIn the clinic, we are trying to do Telehealth visits for some of our patients with multiple co-morbid conditions to limit their exposure to COVID. While it has its benefits, we are missing that in-person connection with our patients. Also, our clinic volumes have been down as there is a lot of fear and anxiety in the community about the pandemic. \n\nInitially, we had a shortage of PPEs but now we are in a better spot. \n\nOn the personal front, I miss socializing with my co-residents. We haven’t had any social events or get togethers ever since the start of the pandemic. \n\nI also fear bringing the virus to my family and that has been somewhat of a constant anxiety for all of us. \n\nCrystal Bauer: How do you see COVID-19 impacting the learning of students and residents in family medicine, and what changes do you think will be permanent?\n\nDr. Sudha Subramanyam: For the educational component of residency training, our weekly didactics have been moved to online learning. It has become harder to get procedural training with the online learning. A lot of outpatient providers prefer not to take medical students at this point, to limit the exposure. The impact of the pandemic is more on medical student training. Many medical schools had to suspend clinical rotations due to the pandemic. \n\nI  believe that online learning would almost become permanent but some parts of it seem to  working well from a residency standpoint. \n\nCrystal Bauer: With your specific population, has telemedicine kind of created some of its own challenges with lower income populations? Have they had issues with being able to connect via telemedicine that you've seen?\n\nDr. Sudha Subramanyam: Yes, that has certainly been a challenge because a sizeable portion of our population is from a lower socioeconomic background, and they do not have access to internet, or smartphone or laptop. To help these patients we have been doing telephone visits without video, but sometimes it is challenging as we are unable to see them. \n\nCrystal Bauer: What skills do you think family doctors need to fight the pandemic? And how do you think residency and medical programs are adapting to help their students and residents meet these demands?\n\nDr. Sudha Subramanyam: Family doctors play a critical role in diagnosis, containment and treatment of patients during the pandemic. We are the source of information to our patients. Testing and treatment strategies have been constantly evolving as this virus is significantly more virulent that most other respiratory viruses. Following credible sources of information about the pandemic and providing the correct resources to our patients is very important. As family doctors, I think we have a huge responsibility of spreading awareness about the benefits of masks, social distancing and infection control measures, not only with our patients but also in our community, including family and friends. We also need to continue to remain kind and compassionate towards our patients during these difficult times. \n\nOur residency has taken steps to make sure that we get weekly updates about the virus and its spread in our community. We have taken measures to triage patients and see patients with respiratory symptoms at the respiratory clinic and the other patients at our regular clinic so there is no cross contamination. We also have handouts from credible sources to give to our patients. We have a reasonable supply of PPE. All providers in our residency have been fit-tested.\n\nCrystal Bauer: What have you learned through this pandemic?\n\nDr. Sudha Subramanyam: I have been constantly inspired by the nurses and doctors at the hospital. Everyone has been resilient and extremely kind despite several setbacks during this pandemic. I have learnt to adapt to Telemedicine. The pandemic has taught to manage my patients’ chronic conditions better, to help them have a faster recovery if they are sick from COVID. I have been increasingly conscious of preventing ER visits for my patients. My interest to seek credible sources of information has gone up. I have become more vigilant of using PPEs and handwashing.  I have learnt that I need to constantly update myself if I want to provide the best care to my patients. I have learnt to adapt to changes in residency structure. \n\nCrystal Bauer: If you could start this year over again and do things differently regarding COVID-19 care, what would you change?\n\nDr. Sudha Subramanyam: I would increase our preparedness and response. I would have appropriate PPEs for all healthcare workers. Social media and news channels could have handled this better, by providing more accurate information. There were a lot of “unknowns” about the virus that resulted in a lot of misinformation. Masks could have been mandated right at the start of the pandemic. Social distancing could have been appropriately practiced to flatten the curve. Overall, as a country, our response was slow. I did a study on COVID with data from the population that we serve, and the results proved that the Latino population were disproportionately affected by COVID. I think increasing awareness about the virus and infection control measures could have been initiated at all levels and at every industry. \n\nCrystal Bauer: During the pandemic, what do you feel you have done right, and why?\n\nI have tried to stay calm and not get anxious about the unknown. I think my patients are in more vulnerable position and I have been trying to be more patient and compassionate. I have tried to help in places like homeless shelters as homeless people have been hit hard by the pandemic. I have learnt to adapt to change. I have used PPE appropriately as I want to stay healthy and keep my family healthy. I have been consciously trying to not think about work when I am at home and this is for my own wellness. I have been very grateful for my co-workers for being my source of strength. \n\nCrystal Bauer: What do you feel went wrong and why?\n\nDr. Sudha Subramanyam: It was an aggressive virus to begin with. There was a lack of understanding of the nature of the virus. There was a lack of awareness on preventative strategies. Social distancing was not practiced appropriately. Family gatherings and mass gatherings without mask use, resulted in a significant increase in the number of cases. Places like Nursing homes and prisons saw a surge in cases because of similar reasons. Protocols kept changing but that was anticipated. Businesses were closed, yet masks were not mandated in most states. Our overall response was slow, although the virus had already ravaged many countries before it hit the United States. There was a shortage of PPEs for healthcare providers that resulted in more healthcare providers falling sick. Hospitals were overwhelmed. Small town hospitals were unable to handle the complications of covid due to lack of ventilators and infrastructure. There continues to be a shortage of ventilators. We took a longer time to understand the aggressiveness of the virus. \n\nDr. Sudha Subramanyam: Crystal Bauer: Who are the people you have worked with most closely during this pandemic? Who has impressed you during this time and why? And were these established professional relationships or new relationships?\n\nDr. Sudha Subramanyam: I have worked with nurses, medical assistants, receptionists, fellow physicians, intensivists, anesthesiologists, CNAs, housekeeping staff, case managers, social workers, Community health workers, hospital staff, staff at the health department and security personel on regular basis. I have immense respect and gratitude for each one of them. Some of them are established relationships but some are new. They have all been very kind to each other and to me. Everyone brings unique skills and make life so much better. They always greet us in the hospital. The receptionists welcome us and our patients with a smile on their face. They are the true frontline heroes. \n\nCrystal Bauer: What is your sense of where family medicine is going in the future?\n\nDr. Sudha Subramanyam: There is going to be growing emphasis on quality-based care. Family Medicine is fundamental to the long-term health of the country. The country needs more Primary Care providers to provider quality care across all ages. Family Medicine training is going to continue to expand to provide more comprehensive care. As Family doctors we have the unique opportunity to provide care to babies, pregnant ladies and the elderly. Family doctors would continue to learn to independently manage all medical conditions across all ages. Shared medical appointments with other subspecialities such as Behavioral Health and Dieticians and social work is something that might happen more consistently in future. \n\nCrystal Bauer: Any views on important in the specialty related to COVID-19 that we have not addressed here that you would like to share with us?\n\nDr. Sudha Subramanyam: The pandemic has resulted in a lot of elective procedures being suspended. Tumor removal surgeries have been delayed, cancer screenings and colonoscopies have been postponed. Medical appointments have been canceled. Elective surgeries like valve replacements and joint replacements have been deferred. This has resulted in increased morbidity and mortality related to non-COVID reasons and also puts these patients with multiple co-morbid conditions at higher risk for complications due to COVID. Mental health issues have gone up significantly. These are all ongoing issues that are going to have an impact on the long-term health of the nation collectively. Some COVID patients have significant long-term consequences from the lung damage. Some are at increased risk of strokes. Managing our patients after they have recovered from COVID is also going to be crucial. \n\nCrystal Bauer: Are there any other last thoughts you would like to add?\n\nDr. Sudha Subramanyam: Those of us that are caring for both COVID patients, either directly or indirectly, need to start thinking about how we can minimize the catastrophic impact of this virus. We need to start thinking about how we could do this better. We need to continue to encourage our patients, families and friends to wear masks, wash their hands and socially distance themselves as much as possible. I think these are some of the things at minimum that we can all do as a society to minimize the catastrophic consequences of this pandemic. \n\nDr. Sudha Subramanyam: And as we continue to reopen the society and open up schools, we should be in a good position to provide for better access for PPE, to not just people in the hospital or staff in the hospital, but also for others that work in close quarters and in service-based industries. There should be better screening measures at every work environment. \n\nDr. Sudha Subramanyam: Also, physicians need to have better access to PPEs, testing kits and telemedicine. I think COVID is on track to catalyze a total overhaul of how we provide and pay for healthcare. Advocating for improved access to healthcare for minority communities including Latino, African American, Asian and refugee population should also be one of our biggest goals. \n\nAnd if our country comes together to embrace change, we may be able to improve access in the long term. Whatever happens, we should not wait for too long, and we must continue to advocate for our patients’ needs, both in sickness and in health. \n\nCrystal Bauer: Well, thank you so much. If you have nothing else to add, this will conclude our interview, and I'd like to thank you for taking the time to do this interview.\n\nDr. Sudha Subramanyam: Thank you. I appreciate the opportunity to participate in this research.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/105307/file/205884#t=0.0,1989.84"}]}]}]}