{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/pc2t43m76d/manifest","type":"Manifest","label":{"en":["Dr. Fozi Ali"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eThis is an oral history interview with Dr. Fozia Ali, a professor of family medicine at UT Health San Antonio, reflecting on how the COVID-19 pandemic transformed clinical care for underserved patients in San Antonio. She describes the fear, uncertainty, and health disparities that intensified during the pandemic, while also highlighting how telemedicine, medication delivery, food access screening, and stronger outreach helped her clinic maintain care and support vulnerable communities. Dr. Ali also shares a powerful inpatient story that shaped her perspective, emphasizing the lasting importance of trust, listening to patients’ social contexts, and adapting care to meet people where they are.\u003c/p\u003e"]}},{"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":["Type"]},"value":{"en":["interview"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Alexis Ramos (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["video file"]}},{"label":{"en":["Keyword"]},"value":{"en":["Covid-19","family physician","family medicine","San Antonio","Texas"]}},{"label":{"en":["Subject"]},"value":{"en":["Ali, Fozi (personal name)"]}}],"summary":{"en":["\u003cp\u003eThis is an oral history interview with Dr. Fozia Ali, a professor of family medicine at UT Health San Antonio, reflecting on how the COVID-19 pandemic transformed clinical care for underserved patients in San Antonio. She describes the fear, uncertainty, and health disparities that intensified during the pandemic, while also highlighting how telemedicine, medication delivery, food access screening, and stronger outreach helped her clinic maintain care and support vulnerable communities. Dr. Ali also shares a powerful inpatient story that shaped her perspective, emphasizing the lasting importance of trust, listening to patients\u0026rsquo; social contexts, and adapting care to meet people where they are.\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/000/309/130/small/Ali.mp4_1779128790.jpg?1779128792","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130","type":"Canvas","label":{"en":["Media File 1 of 1 - Ali.mp4"]},"duration":1551.4,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/309/130/small/Ali.mp4_1779128790.jpg?1779128792","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/309/130/original/Ali.mp4?1779128772","type":"Video","format":"video/mp4","duration":1551.4,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842","type":"AnnotationPage","label":{"en":["Fozi Ali transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Ramos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=0.0,0.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I'm Alexis Ramos, you're Fozia Ali. Today is August 21st to 2025. I'm at home. I think you're at home as well. So let's go ahead and get started. Go ahead and tell me your current title.\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=0.0,19.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): My current title is Professor of Family Medicine and Department of Family and Community Medicine with UT Health San Antonio.\n\n(","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=19.0,30.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/4","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Excellent.\n\n(","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=30.0,30.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/5","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): In the residency program.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=30.0,32.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/6","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Okay. And go ahead and describe a typical day in the clinic for you prior to 2020, before COVID.\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=32.0,48.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/7","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I will say it was a normal routine. Everything was normal. We would just go to work, see what we have, and see everything and not worried about just a normal routine. And we thought we can handle everything and see everything. Just taking care of acute conditions, chronic conditions, meeting everyone, greeting, at the same time, shaking hands and socializing. And also the same thing with our patients. When they would come, we'd just go in the room and just meet with them and spend a lot of time. So yeah, this was just what we have done. I've done most of my careers, but that's how it was in 2020.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=48.0,103.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/8","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Excellent. And can you describe the population that you serve at the Robert B. Green?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=103.0,108.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/9","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Mostly underserved population. Most of the patients, they have a Bexar County payment plan, which is called CareLink. So it's not health insurance, but it's a payment plan. So most of our patients are underserved, which means they can't pay a lot. And then we also have patients with Medicare, Medicaid, and some with commercial private insurance, the Affordable Healthcare Act. We see age groups from newborns until geriatrics, and so the age group and the same thing, diverse ethnicity from different cultural and religious backgrounds.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=108.0,146.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/10","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Excellent, okay. And you had the same title back in 2020 as well, correct?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=146.0,155.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/11","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yes.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=155.0,156.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/12","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Okay. And what setting did you spend most of your time in during the pandemic? The inpatient, outpatient, virtual?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=156.0,166.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/13","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): This is now we're talking about during pandemic, right? In 2020 when it started. So most of the time I think it was the big transition for me. I like to spend time with my patients a lot of time, especially in the clinic. So most of my time was spent in clinic, but at the same time I had done a lot of inpatient service because of the COVID deployment. The need for covering the hospitalized patients with COVID was high. And then we had to also provide inpatient coverage during that time. So that year was a good amount of inpatient in addition to outpatient. In terms of outpatient, we did really good in terms of providing virtual care through telemedicine. We would either go to our office and do telemedicine visit and then later on transition to home doing telemedicine visits.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=166.0,224.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/14","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Excellent. And what do you remember about those first few weeks in clinic?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=224.0,231.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/15","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Oh, that's scary. Uncertain. I still remember, I still had hope because growing up in Pakistan, a country which was still underdeveloped at the time, seeing a lot of epidemics over there. So when I heard about COVID it's like, okay, it seems like the same as we had growing up over there, but a lot of uncertainty, what's going to happen and a lot of things that we did not know. So I think there was a fear and there was the mix of fear, anxiety, uncertainty, a lot of emotions. But at the same time, the hardest part was for me, if I go back like knowing I can handle this and I don't know how to handle this, it's not just I can, but also I don't know how to handle this. I don't know what I'm going to tell my patients. So that kind of the uncertainty was very bothersome. But if the patients ask this question and I don't have the answer and then plus there's no evidence and there's no research and I can't even find the answer. So that was very, very hard throughout the year, I would say it was a question about not just about the illness, but also about how it spreads, how it can be prevented, what's going to happen if I have this, a lot of questions that I had no answers.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=231.0,316.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/16","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Absolutely. Okay. And do you feel that patients in this area experienced the pandemic differently than other areas?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=316.0,329.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/17","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I'm not sure, but I think as knowing the San Antonio population, which is a whole tapestry of diversity, I think our community is very used to be social. So that loss of social connection and loss of connection with senior providers that our patient is very, very, they're very used to see us in person. So I feel like of course they were affected more because the way that we provide care is very unique. And also at the same time we do take care of patient and families together. So they couldn't come as a family. We couldn't see them all in one room if someone has COVID, have to separate them. For us also being gearing up with whole entire head to toe, not just us, everything covered. And then also our patients couldn't see us, we couldn't. That was just very uncomfortable. So I feel like they went through a lot.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=329.0,386.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/18","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Absolutely. I agree. What health disparities, if any, did you witness being exacerbated by the pandemic?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=386.0,397.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/19","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I mean besides access to care. Access to care was a big thing because our patients were used to sometimes walking and not just having an appointment-- just coming and showing up in the clinic and getting things done while they're there. They lost that connection because of course now they have to either do through telemedicine, they had to be careful if they're having symptoms, they need to be screened before they directly go to their doctor. So that was a big thing. And also then we also noticed some of my continuity patients. I mean they were nervous to tell about their COVID symptoms because they wanted to see me and then they were saying if they would be screened, but if they say they have fever, they had travel, recent travel or any of the symptoms. And even if it was not COVID related, they were worried given about that, but there was a lot of worrying.\n\n(","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=397.0,449.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/20","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): The biggest thing is also that I think the transportation was a big barrier because now traveling through most of our patients, they come through public transportation. So that was a big barrier for them just to take public transportation. And then how are we going to go and do that and see our doctors doing the groceries was a big challenge. So there was a lot of food insecurity. Actually we did questionnaire with patients, how many patients would access the food bank. That study has been published, and many of our community members reported that there was a lack of access to food and especially not just not able to go to grocery stores at the same time are patients who have no transportation, how they will have the food coming to their home. Medications compliance was also a big thing that I noticed. Getting the refills on time. At the same time, there was, I mean, they were worried if they run out of the medication, will they still see the doctor to get the refill?\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=449.0,511.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/21","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah, absolutely. So how did our clinic handle the health disparities? Any innovative strategies–you touched on it a little bit– that were employed to try and mitigate those disparities?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=511.0,527.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/22","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I think that we realized, our clinic immediately realized that we have to connect with our patient no matter what. The COVID should not be a barrier, it should be an opportunity. So I would say our clinic management took COVID Pandemic as an opportunity to connect with our patients at their homes where they'll feel comfortable. They don't have to worry about taking a bus, they don't have to worry about going to the pharmacy and pick up the medications. So what we did a lot of different ways that the biggest thing was the transportation. So we did change to telemedicine visits and having our patient also access to from their home, they can see their doctor, they can access to care and the pharmacy, the university health system, they started delivering medications to patients' homes. So that was another big step that our clinic actually acted on. No one can be without any refills or without any medications. We also have food insecurity questions implemented from all this. We've been doing in our clinic now as well to identify if anyone has food insecurity. We also had our Behavioral Health Services always with us, and then they also were available remotely for our patients, so that was another resource for our patients. I think the staff was trained really well, reaching out to patients and reaching out to provider and really communicating using electronic medical record in a very innovative way. Teaching our patients how to use MyChart as well. The pandemic actually brought us even more closer. Of course, it was initially separating us, but we overcome the barrier.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=527.0,636.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/23","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Excellent, okay. And what changes from that period have stayed in place?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=636.0,643.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/24","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Most of these changes actually we still doing it. We have patients who can come and especially during emergencies we do provide telemedicine. We learned actually this whole skill of telemedicine with our residents. Also the same thing with our food insecurity. We found the resources. We are connecting our patients with the resources, with the food bank, giving them different food vouchers and pharmacies still delivering medications. And so that's still happening. What else? I'm trying to think. The BHC was a resource. I know we have other pharmacology clinic was also, they did the telemedicine visits. Our psychotropic clinic, the patients with different psychiatric issues, they were still able to get their medications, especially during pandemic. Their anxiety, depression were uncontrolled and added on. So we still provided all those other cures.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=643.0,702.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/25","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Okay. And so was there a moment that felt especially overwhelming or powerful during that time that you feel comfortable sharing?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=702.0,713.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/26","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I do. Maybe many, but one actually really I can never forget. So this is more inpatient related. I don't know if it's okay to share. I was on COVID deployment. We had this gentleman who was hospitalized and this was a time when we knew a little bit more about pandemic. We knew that it wast real. We were telling our patients that COVID it's infection. It can of course have a lot of complications and then you need to be hospitalized, you need to be separated being in isolation. And then also certain medications we were trying at the same time I remember we're also giving someone steroids sometimes putting them on oxygen. It was not a complete treatment in place, but still we were trying to apply some optimal measures to prevent the complications. So this patient was hospitalized and then he was on oxygen. He was still requiring oxygen I believe was on at least one week.\n\n(","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=713.0,773.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/27","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): So when I was thinking every day we would hear from the staff that he was very agitated, He wanted to go home. Also, he was on steroids during that time. I think he got steroids for five days. We're watching his covid labs, including the labs to check if there's any risk of clotting, if there's any liver failure risks. We're checking his daily labs, and he was declining his daily labs in the morning. One day, he actually told us– initially he was very upset with the staff, that's why they were coming to his room getting his vitals, and then he got upset with everyone. We're like thinking maybe he has some underlying anxiety or any other condition. We had psychiatry coming in and then they also evaluated for his capacity, and then they said he has capacity. Then he does also probably have a small covid related stress that he's going through, but there is no concern of any other psychiatric illness.\n\n(","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=773.0,836.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/28","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): It was the afternoon and we're almost wrapping up...Going to do our handoff for the next team, coming overnight and then we get a call from the nurse that patient removed his oxygen and wants to leave right now. In this case, the good thing, we had ethics also involved because the patient was actually threatening staff that he's gonna leave, and then it was a risk to public as well. So Ethics was involved. And then I remember going there, spending an hour and, you know, gowning up and with the patient not even thinking and remembered taking that paperwork for when they do the…when they don't agree with the medical what is it? AMA paperwork. Right? So imagine, like, with the gowning up, and I had one of our other faculty that was a resident…great resident with me, and then we both went together, spent an hour going over complications, going over, like, he might die if I go he'd go home,\n\n(","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=836.0,948.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/29","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): and he was like, no. I'm gonna go. I don't think this is a real virus. I remember his words, “You're all make making me stay in hospital longer so I can die in hospital, and I'm not gonna die. And if I go home, I'll get better because whenever you're giving me through all this, you know, it's not real. I'm gonna go home. I spoke with my mom. She has arranged a room for me. And if I die, then you win, and I'm not gonna let you all win”. It was witnessed by the staff as well. We had ethics and legal and everyone involved, and then he left. And then of course, know, he left, but also we were still worried about him. This was a time Infectious Disease started this clinic, hospital discharge follow ups, and the patients who were leaving the hospital. So, we reach out to infectious disease just to make sure this patient left AMA.\n\n(","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=948.0,948.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/30","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): He was in regular floor, but he was on oxygen, two or three liters, and then he pulled up oxygen and he left. Remember, speaking with Infectious Disease, and then they said, okay. They will also follow-up on his case and fall and see how he's doing. So they kept calling him. He did not answer his phone call for two days in a row. Day three, I get a call from Infectious Disease. The patient answered the phone, and he said he's coming back because when he went home, his family member wouldn't allow him to stay. Then he had to find another friend's place at a hotel room and when he went there, so after like third….this was day three, he was feeling he couldn't breathe, so he wanted to come back. ID told him to call EMS and come back through emergency medical services. He came, he was brought back by ambulance. When he came back, his O2 sat was seventy percent already, and then at the end, he actually was intubated, and then he couldn't make it.\n\n(","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=948.0,1012.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/31","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): And that stays in my mind because I just feel like what was missed? How we could have prevented this. But again, at the same time there was a lot of uncertainty and he had capacity to make his decision. But it was so sad and then he wanted to come back and when he came back he told infectious disease that he should have listened to the doctors and stayed.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1012.0,1035.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/32","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): That is very powerful and yeah, I can't imagine going through that. So during this really overwhelming time, what kept you going?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1035.0,1052.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/33","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I think the one thing he is coming back, I felt that was very powerful also because we were calling him, documenting and calling him, making sure that, so I think the one thing I learned that we never give up as a physician so matter what patients have perception, but it doesn't mean we're going to give up the care for that day and for the moment. So since then actually I spoke with my patients even longer, did not care. I was gowning up, staying in the room even 30 minutes, an hour. I think the most important thing for me is to just capture that moment and have my patient ask questions. So I think I had another patient who declined COVID vaccine and then I asked why. So I think that asking why that was something that I learned that skill, there is a story behind that. No, there's a story behind that. So I think if we really ask them why you think this, that it really helps them to also rethink and reconsider the care that they should receive.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1052.0,1117.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/34","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Absolutely. And so you touched a little bit on this, but do you think this experience shaped the way you practice medicine now?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1117.0,1125.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/35","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): It did. I mean, COVID taught me so much and as I mentioned, I see patients and families together in one room. And of course it couldn't happen during telemedicine visits, but at the same time I was able to see patients at their home through the video call and I was able to see, they would show me this is the place they spend most of their time in recliners, some of my patients. I also was a little sad to see some of my patients, they were not comfortable even having their video on. And then we respected their wishes and still continued care. I think that, so this really helped me also just to adapt according to our patient's needs at the same time, not just their medical needs for their social needs and their cultural needs. Because I remember one of my patients during telemedicine visit had a lot of things going on at the home and she didn't want to cancel her visit. And then once we had the camera on the patient's like, I'm so sorry doctor, can I just turn off my camera? I don't feel like, so just that kind of the respect because when they come to the clinic it's a different, but when they're the home that's kind of, I mean I feel like I learned so much about my patients more than I knew before. And it changes, of course there was improvement the way that I do practice medicine now. We can provide care anywhere no matter what and where they are.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1125.0,1217.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/36","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Excellent. Did the pandemic affect you personally at all?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1217.0,1225.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/37","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): It did. I mean, of course I'm a mother of two, so coming home and thinking we'll bring to our kids, our family. And the other thing is we don't know the next day what's going to happen. And as I said, also not knowing a lot of things and just still going, that was something that we don't do in medicine. We always like if we don't know the answer, we look up and there was no way to look up and there was no way to find the answer until we found few things. And other thing is just going, I used to go to a lot of community health fairs and community events. So during this time I felt like a lost connection with the community. But then we started with help of Dr. Shi we started a community education series virtual and that's how we found the way just to connect with our community. But yes, it did. I mean I think that the social isolation and not able to. A lot of us, we learned through connections and meeting others and seeing others. So that loss of that connection was a little bothersome. But I think there was an opportunity for me to just write about it and at the same time give my patient empowerment at the same time with my family also trying to see how they were doing.\n\n(","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1225.0,1324.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/38","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): The good thing is we worked more home and interestingly, a lot of times we were not mentally at home before pandemic. The life was very busy. So I would say, we'll come home, have dinner, sleep. But COVID actually brought us back to our homes where we could feel all corners at home. So really spending time at home was also something very... an eyeopener. Because a lot of times really knowing where you are being present, being mindful.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1324.0,1357.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/39","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yes, absolutely. It's sometimes tough to do that. Okay. Do you think that the system is better prepared now to handle a situation like this?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1357.0,1371.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/40","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): It's much, much better. It's never happened before. So when this happened, we learned a lot of things. Our clinic is fully equipped to do transition to telemedicine, doing all these medication deliveries to the home. And at the same time, we can arrange things better now as we did before. And a lot of things can happen remotely now. The patients are connected through online portal, so we don't have to bring our patients to the clinic to provide care. I think we are better prepared. At the same time, communication got better because we had also interpreters we can use if our patients have any language barriers because we're not using them a lot in clinic, you have in person, but now with this three way phone call. So we found a lot of different opportunities.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1371.0,1425.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/41","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Excellent. If you could tell the public one thing about what it was like to work through the pandemic here, what would it be?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1425.0,1434.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/42","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I'm sorry.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1434.0,1435.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/43","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Yeah. If you could tell the public one thing about what it was like to work through the pandemic, what would it be?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1435.0,1445.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/44","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): A milestone that we achieved. I feel more well equipped. More prepared, more confident. More confident of saying that I don't know. That's the one thing and I'm not sure what's going to happen, but how we can we talk about this, talk about a lot of things that we don't know. And I think it just gave us more power. I feel like we were unaware about the resources before that we had we could use. And then now I feel more prepared to utilize services even in an emergency situation.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1445.0,1489.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/45","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Excellent. And finally, this interview is being recorded to preserve and document providers experiences during that unprecedented time, is there anything else you would like to share?\n\nAli (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1489.0,1504.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/46","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): I'll tell a next generation just not to give up and at the end of the day in medicine, think history is our best friend. We always focus on history, HPI, but I would say also with HPI, history of present illness, please focus on social history as our patients are unique. When you connect with them through the social history, you connect them with them for a long time and you develop that trust, that goes long way, not just prescribing medication. Our goal is to really develop that trust and connection that goes long way and then brings your patient back with that to you or your healthcare team.\n\nRamos (","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1504.0,1548.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130/transcript/93842/annotation/47","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"): Excellent. Well thank you so much Dr. Ali for doing this.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3695/collection_resources/170281/file/309130#t=1548.0,1551.4"}]}]}]}