{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/gx44q7rz4n/manifest","type":"Manifest","label":{"en":["Dr. Baharak Tabarsi"]},"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":["Date"]},"value":{"en":["2020-11-06 (created)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Subject"]},"value":{"en":["Covid-19 (topical term)"]}},{"label":{"en":["Keyword"]},"value":{"en":["LatinX","Hispanic","Maricopa County","asylum seeker"]}}],"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/000/198/945/small/BaharakTabarsi%2811-6-2020%29.mp4_1689791504.jpg?1689791506","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100606/file/198945","type":"Canvas","label":{"en":["Media File 1 of 1 - Baharak_Tabarsi_(11-6-2020).mp4"]},"duration":1629.96,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/198/945/small/BaharakTabarsi%2811-6-2020%29.mp4_1689791504.jpg?1689791506","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100606/file/198945/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100606/file/198945/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/198/945/original/Baharak_Tabarsi_%2811-6-2020%29.mp4?1689791504","type":"Video","format":"video/mp4","duration":1629.96,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100606/file/198945","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100606/file/198945/transcript/46426","type":"AnnotationPage","label":{"en":["Transcript of Dr. Baharak Tabarsi interview [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100606/file/198945/transcript/46426/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Crystal Bauer: Good morning, Dr.Tabarsi. Today is November 6th, 2020. Please confirm for the record that you were aware that this is being recorded and that you are giving your permission to do this interview.\n\nDr. BaharakTabarsi: I am.\n\nCrystal Bauer: Would you please give your name in full?\n\nDr. BaharakTabarsi: My name is BaharakTabarsi.\n\nCrystal Bauer: And what is your present title or titles?\n\nDr. BaharakTabarsi: Yes, I wear several hats. So I'm a family physician as well as currently, I am the medical director of quality for our family health centers, as well as the clerkship director for our students and faculty in our residency program.\n\nCrystal Bauer: And where did you go to medical school?\n\nDr. BaharakTabarsi: So I'm actually Canadian trained. I went to medical school in at Memorial University in St. John's, Canada. And I did my residency at McGill University in Montreal.\n\nCrystal Bauer: And what is the name of the current medical residency program you are associated with?\n\nDr. BaharakTabarsi: I am a attending physician at Valleywise Health, which is the safety net hospital system here in Maricopa County, Arizona. As well, the hospital has an academic alliance with Creighton University School of Medicine.\n\nCrystal Bauer: And could you speak a little bit about your current position, what do you do on a daily basis?\n\nDr. BaharakTabarsi: This is the beautiful part of my job as a family physician is that I get to wear several hats so it keeps my day very interesting. Of course, I have days where I'm in clinic seeing my own panel of patients and there's other days that I attend meeting with hospital leadership regarding workflows and quality issues. As well as there are days where I am precepting the residents' clinics and lecturing to the medical students so quite variable.\n\nCrystal Bauer: Yeah. It sounds like you said, you were quite a few hats in your positions. Could you tell us a little bit about the types of patients you treat in your hospital, who they are and where they come from?\n\nDr. BaharakTabarsi: Yes. As I mentioned, Valleywise Health is the only safety net hospital system for Maricopa County. We have a high number of Latinx patients, Hispanic patients who are either uninsured or under-insured as well as other patients who are refugees have who have come to our clinics. And then we have other patients who are self-pay or uninsured as well. So a wide variety, but definitely we are the safety net hospital system.\n\nCrystal Bauer: What unique challenges do you face with COVID-19? What are the barriers, obstacles that you've come across?\n\nDr. BaharakTabarsi: So I don't know if there is a healthcare provider clinician that has not faced any challenges. I think we have all had our challenges from the beginning and the issues with PPE because COVID-19 is of course a novel virus, very little is known about it.\n\nDr. BaharakTabarsi: There's very little guidance initially that we had even from the CDC or our local health departments, because as I said, it is a new virus. And the challenges from being able to protect myself, my family, my patients, my staff. As well as, once patients are diagnosed, how are they getting contact traced?\n\nDr. BaharakTabarsi: Are we able to offer our patients testing in an efficient manner? Are they getting results in an efficient matter? There was a time where it was taking, our health department was quite behind and it was taking days if not sometimes a week for patients to receive results. So the challenges have been many from PPE to patient care.\n\nCrystal Bauer: And do you think those challenges have evolved over time? I mean, you talk about PPE shortages. Has that gotten worse or better? Are there different challenges now versus four months ago?\n\nDr. BaharakTabarsi: Absolutely. So I think the PPE situation did improve somewhat.We're not 100% as to what perhaps we were before the pandemic but has definitely improved. However, the concern is of course now again, as of today we are seeing a surge of cases in the country as well as in Arizona. Yesterday, we had our first day of over 2,000 cases after months of being below those numbers.\n\nDr. BaharakTabarsi: As the cases are going up, it of course raises the concern again, are we going to have enough PEE, enough tests, enough resources to do contact tracing? And the challenges have evolved, which is what we call pandemic fatigue. And I understand that both for, myself, my family, my patients, my colleagues, people do get tired and they want to carry on with some sort of normalcy.\n\nDr. BaharakTabarsi: But unfortunately, we see now again that we're seeing these cases, and some of it may be due to small groups of people even gathering and spreading cases. So the challenges definitely continued to evolve. And this concept of pandemic fatigue I think has a big role to play as to the cases that we're seeing now.\n\nCrystal Bauer: Absolutely. Could you describe how COVID-19 has impacted your current work?\n\nDr. BaharakTabarsi: Absolutely. At the beginning of COVID-19 our practice, our outpatient health centers moved very quickly. In fact, it was a tremendous effort by everyone. It was a fantastic efficient transformation of in-person visits to telemedicine for those patients that were candidates for a telemedicine visit. We quickly transformed some of our clinics into respiratory clinics.\n\nDr. BaharakTabarsi: Other clinics we would still see patients perhaps here and there in person. So the advent of telemedicine in our practice is probably one of the biggest changes. And then of course, everything else from trying to observe some sort of social distancing in the clinics as well as when it comes to my role of being with learners, residents and students.\n\nDr. BaharakTabarsi: Especially students, what is the best way for them to learn? Do they stay home or come to the office and be at a desk and do learning modules and only see a very finite number of patients? Or do we give them enough PPE and have them see patients? So these are all the challenges that we have had to face and our practice has changed in so many ways.\n\nCrystal Bauer: What skills do family doctors need to fight this pandemic? And how do you think medical residency programs are adapting to help their students and residents meet these demands?\n\nDr. BaharakTabarsi: I think the needs are wide ranging. We need, for those that are in private practice as well as those that are in big academic centers everything from adequate PPE, to clear guidance from leadership, to workflows, to what we do with the patients who we are seeing as outpatients, and how quickly can we get those tests?\n\nDr. BaharakTabarsi: How quickly can we deliver a results? What kind of follow-up do patients get? So these are the challenges for that. And then for students and residents and how they've adapted, again, students especially had initially, they were pulled out of their rotation and the work that was involved in reintegrating back in. \n\nDr. BaharakTabarsi: ACGME very quickly acted to pull students out of clinical rotation and the challenge has been to reintegrate them back into the clinical setting, but do it in a way that's conducive to their learning yet keep in mind, of course, first and foremost their safety. And so this has been a fine balance making sure that they're safe, that the patients are safe, as well as though that they're learning.\n\nCrystal Bauer: What have you learned through this pandemic?\n\nDr. BaharakTabarsi: I have learned so much. One of the first things that shocked me was, I'll never forget the day that the CDC said, \"Wear bandanas if you have to.\" So it really taught me, I think at that moment, it's like you kind of go through residency and training and you think about these big organizations like the Centers for Disease Control or the ACGME and you think, gosh, there's these... I don't know, there's just the vision of them that I had very quickly become, you know, that they're going to just struggle with this as much as anybody.\n\nDr. BaharakTabarsi:  I came to America as a refugee asylum seeker. The environment that I grew up in had many challenges and difficulties. And so I've always had in my mind as I work for a safety net county hospital system, is that because my heart is drawn to this patient population. But really, it was through this pandemic that it really reinforced for me. It is this patient population that is being disproportionately affected.  \n\nDr. BaharakTabarsi: And now it's much more in the forefront of my mind as to the health care disparities that we face in America. And what is our role as physicians? And most importantly as family physicians. My patients think of me as their doctor. They'll go see their cardiologist or their pulmonologist but I'm “their” doctor. They often come back to me and say,\"And the cardiologist said this but I wanted to check with you before I do what they say.\"\n\nDr. BaharakTabarsi: So as their primary care physician what is our role in advocating for patients? And how do we resolve the structural racism that exists in medicine? And I think COVID-19 has really exposed in a very bad way, of course, but exposed these disparities in healthcare. But perhaps it's an opportunity for us to, now that we know better, to do better. What is that saying by Maya Angelou? \"When you know better do better.\" I think.\n\nCrystal Bauer: Yes, absolutely. Well, you spoke earlier about how quickly your system adapted to utilizing telemedicine. And I wonder if that specifically kind of exposed disparity in your lower income populations with not having access to necessarily the internet and if you really experienced that issue during this time?\n\nDr. BaharakTabarsi: Yeah. To some extent, yes. Although I think I actually found that patients' kind of were if they didn't have access they did go somewhere where there was access to the internet. But telemedicine, the beauty of telemedicine was that for the first time I could see patients in their environment, in their home. And that for me was as well. It did something for me. It's different when you can see them in their environment. And so yes, absolutely, that in itself but these are challenges.\n\nDr. BaharakTabarsi: Again, these are challenges that we faced all the time as a county hospital system. How much will it cost? Can the patient afford this ultrasound or this CT scan? This wasn't new but it was really that COVID-19 exposed other disparities that we might not always think about. For example, my patient who lives in a home with six other people, how could they isolate? Where are they going to go? Or here's my patient who has to take the bus to work or who is an essential worker because... I mean, so they don't have the luxury of working from an office at home.\n\nDr. BaharakTabarsi: And so these are the things that I have to think about my patients that I didn't have to worry about that aspect before that, oh my gosh, they have to now get on a bus to go to work or that they're working in a situation where maybe they can't do physical distancing as well. And so it really hit home with all of that.\n\nCrystal Bauer: Absolutely. Absolutely. Well, shifting the focus to your students, what do you think your students have learned through this pandemic?\n\nDr. BaharakTabarsi: I think what I said about the healthcare disparity, but even more so for students. I think their age and their energy and their youthful spirits, I've seen some of them just, it's like they've woken up. And now that they're awake there's no stopping them. Some of them have been involved with the local Black Lives Matter movement and really thinking about, can we start a club to address this or address that?\n\nDr. BaharakTabarsi: I think they are fortunate that they are witness to... They are going through this pandemic at a time where they're actually in medicine as learners and they're witnessing all this unfold in front of their eyes. And I can't wait to see once they're out in the world how this will impact their practice.\n\nCrystal Bauer: That's great. If you could start this year over again and do things differently regarding COVID-19 care, what would you change?\n\nDr. BaharakTabarsi: I'm not sure how much is in my power to change. If I had to go back personally, is that perhaps I could have been even more vocal about the healthcare disparities. \n\nDr. BaharakTabarsi: But I wish that not just myself, but as physicians, we have more power and could find the power in ourselves to advocate for some of these healthcare disparities that we're seeing. And I'm not sure if these changes is what I could've done through COVID, but it almost throughout the years I feel there's so much work to do to face the structural racism, the healthcare disparities and why have we not been doing more of it.\n\nCrystal Bauer: Right. During the pandemic, what do you feel you've done right and why?\n\nDr. BaharakTabarsi: I am really proud. I don't know what other healthcare systems are doing, but I'm really proud of my role and the community that I work with, the hospital system I work with. Not only with the telemedicine movement but also thinking about workflows to develop very quickly on how to manage patients who can potentially be managed at home. So in my role as the medical director of quality working with a team of people, we were very quickly able to come out with workflows of, okay, now are patients diagnosed now what?\n\nDr. BaharakTabarsi: So through daily calls, involving care coordinators, involving our nursing staff, prescribing them that pulse oximeter, setting the alarm to the pulse oximeter, making sure that they are monitored at home, that they can quarantine at home. And at what point, the instructions that we give them as to when they will need to seek hospital care. I think that's been something that really makes me proud. And to this day, just yesterday I was on a call with a patient who did end up admit being admitted to the hospital but now post-hospital we're managing her on her oxygen at home.\n\nDr. BaharakTabarsi: And it's my job to kind of slowly think about when is she ready to slowly wean off the oxygen? And you stay on the phone with that patient for five minutes as they lowered their oxygen by one liter and walk around their house and then you ask them about their symptoms. So this outpatient management of patients has been, I think as family doctors this is a critical role, and with COVID specific patients that we have to play. That is our duty to see how we can best manage them at home.\n\nCrystal Bauer: Absolutely. 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. BaharakTabarsi: Some are both actually. So the group of physicians who came out with the various workflows for inpatient, outpatient triage system those were some new relationships. And I'm so privileged to have been representing sort of outpatient primary care family medicine in this team to be able to guide our other colleagues and clinicians.\n\nDr. BaharakTabarsi: The nursing staff, really I've been impressed by our care coordinating team and our nursing team. So those established relationships, but working together to come up with the best way to manage our patients was really beautiful to see. And then some of the newer relationships is with finding out what are the ACGME guidelines for medical students...\n\nDr. BaharakTabarsi: How do we keep them learning? And obviously, I've never had to do that personally where all of a sudden the students get pulled. How do we continue to teach them? And then how do we reinvigorate them safely? And those are some of the new challenges for me but exciting to go through it.\n\nCrystal Bauer: It sounds very exciting. That's wonderful. Looking forward, what is your sense of where family medicine is going in the future?\n\nDr. Baharak Tabarsi: So, I think family medicine has a bright future. I think as I mentioned early on in this interview, I'm Canadian trained. I did do a year of residency and additional year in Vermont but most of my training was in Canada. And so, in Canada, really, family medicine is the foundation. I mean, everybody's got their family doctor. You really don't make a move without your family doctor kind of being in the know about it.\n\nDr. BaharakTabarsi: Doing the referral for you. So family medicine, it's in the fabric of that culture. It's the basis for their healthcare system. And so I think that in America that we still need to move forward toward that vision of putting primary care and family medicine first. Making sure everyone has access to a primary care physician because ultimately that's where you're going to see prevention of disease, management of chronic disease.\n\nDr. BaharakTabarsi: But going back to these issues of healthcare disparities, the heart of a family doctor I think is most connected with their patients. And it's that relationship that is going to plug or pull at that part to become an advocate for the patient. So that's how we can change, I think we have such a crucial role in changing this healthcare disparities that we're seeing and the structural racism in America.\n\nDr. BaharakTabarsi: And that's where the social determinants of health for our patients need to be addressed, is with their family physician. So the future is very bright. But of course, we have challenges in the amount of reimbursement or how family doctors are getting reimbursed. And so I'm happy that our new CEO Shawn Martin at the American Academy of Family Physicians are really in the forefront addressing some of these issues with the government or at the government level.\n\nCrystal Bauer: Absolutely. The other-\n\nDr. BaharakTabarsi: I'm sorry. If I can mention one more thing in relation to just this last point. And I'll just make this as kind of my last point. I'm a firm believer in team-based care and I believe it's this phrase but perhaps it's becoming more common in our lingo now. But I believe that it “takes a village,” you know how we used to say it takes a village to take care of a child? I shifted that to, \"It takes a village to take care of a patient.\" It really does.\n\nDr. BaharakTabarsi: And I'm a big proponent of team-based care. However, I do want to mention that at the same time as family physicians we need to be aware of the role of other clinicians, including nurse practitioners and physician assistants who are providing care to our patients, and what our relationship with them needs to look like and how that transparency of who our patients are seeing, what their level of training is. How do we address that as a community of family physicians?\n\nDr. BaharakTabarsi: How does the American Academy of family physicians address that? And how do we move forward to work with our colleagues? But what does physician led care look like? And I think this is an area that I would love for students to be aware of as well and the same for residents to be aware of. Because if you don't know what's happening then you don't know, how do I address it? You just don't have that awareness. And I think again, this is where I really do appreciate Shawn Martin and his voice in this.\n\nDr. BaharakTabarsi: Because I think as family physicians, again, we are about team-based care. And we valued the role of our nurses, our medical assistants, our pharmacists. As well as the other clinicians and nurse practitioners and physician assistants. They have a role to play but what that looks like and how we educate the community, how do we educate legislators and how we educate our patients about who has what type of training and what does appropriate supervision look like.\n\nCrystal Bauer: Wonderful. I know you said that was your last thing that you wanted to say but just wanted to make sure there were no other thoughts you'd like to add to this interview before we conclude that's okay.\n\nDr. BaharakTabarsi: No, I think that's [inaudible]. I really appreciate this opportunity that you've given me to express my views and my voice. I appreciate it.\n\nCrystal Bauer: Well, thank you so much. This will conclude our interview, and I'd like to thank you for taking the time out of your very busy schedule to conduct this interview.\n\nDr. BaharakTabarsi: My pleasure.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/100606/file/198945#t=0.0,1629.96"}]}]}]}