Flora Sadri-Azarbeyejani, DO, MPH, FAAFP, has been practicing family medicine for 7 years, and is currently the medical director of the Community Health Center of Franklin County in Greenfield, Massachusetts. Dr. Sadri-Azarbeyejani said the federally funded community health center opened in 1997 to serve the underserved in rural areas of Massachusetts. The area's population includes migrant farm workers and many living in a depressed economy. The medical center has both a migrant farm worker program an an outreach program and three sites. Dr. Sadri-Azarbeyejani's influence goes beyond her local community, as she prioritizes being an advocate for her patients. She has held multiple positions on the Massachusetts Academy of Family Physicians board of directors, the AAFP Congress of Delegates, and the National Conference of Special Constituencies.
Q: What do you love about your work?
Dr. Sadri-Azarbeyejani: Every day is different. I help educate patients on how to change their lives to become healthy, achieve goals, and make informed decisions, whatever their goals may be — tobacco cessation, weight loss, healthy lifestyle. At the end of the day I feel content, satisfied, and fulfilled. I look back at the complexity of the work I have done, the care and the support I have given, and it feels good and rewarding. Whether the support is to my patients, the support staff, or my colleagues, I feel I have accomplished much. This is not a job. It is a lifestyle choice that challenges your intellect daily and your ability to interact and develop relationships based on mutual trust to promote the health and wellbeing of your patients.
Q: What has been the greatest challenge you have faced as a family physician?
Dr. Sadri-Azarbeyejani: The greatest challenge has been to recognize I have a voice. I can help direct medicine as an advocate for my patients. Seeing patients in a traditional setting is not the entire scope of being a family physician. A family physician needs to be involved in their medical community, attend congress, become involved in special constituencies, and be involved in their (AAFP) state chapter. This provides another avenue to advocate for your patients; to be sure politics do not control health care. If every family physician uses the strength of his or her voice, then many voices together can achieve what is needed for our patients, our patients' families, and for providers. The greatest challenge was recognizing that I am an advocate and needed to learn how to be heard, to control changes, and to find the time needed to be involved.
Q: What would you tell an undecided medical student who is considering family medicine?
Dr. Sadri-Azarbeyejani: As a family physician you are privileged, you get to know and treat the patient's emotional and physical needs. You get to take a patient-centered approach rather than a disease-centered approach, and you get to take care of them from birth to death and watch their lives unfold before them. Nothing could be more rewarding and satisfying.
Q: What is your most vivid memory from medical school?
Dr. Sadri-Azarbeyejani: My most vivid memory is of a patient who was undergoing a work-up for blood in her urine and weight loss. I was assigned to her, and she was afraid of the possible outcome of her diagnosis. I remember when she needed to go down for her cystoscopy, she asked for her medical student. She held my hand during the procedure and bragged to everyone that her medical student took the time to care and listen to her about her fears enabling. This provided her with comfort and helped her to face her cancer diagnosis. This made a large impact on me, and I realized that I need to take the time to provide comfort and care to my patients and respect their feelings.
Q: Describe a typical day for you.
Dr. Sadri-Azarbeyejani: I arrive at the office around 7:30 to start the day, review paperwork, and look at lab results and messages that have arrived overnight. My first patient is scheduled at 7:50 a.m. My practice brings in a variety of insured and uninsured patients. My morning generally starts with about 10 patients: physicals, follow-ups, and acute visits. The eighth patient of the morning is a heartbreaker. My 40-year-old female with severe cardiac and anxiety comorbidities. She has a 15 percent ejection fraction after a massive myocardial infarction (MI), is homeless and has been for about eight months, lost her job due to her illness, experiences much anxiety over her health, and has multiple episodes of chest pain during the week. She comes in for a visit and explains how she has eaten her last meal and will have nothing until her disability check arrives in six days. We discuss her homelessness and how she cannot save enough to rent an apartment. I visit our social worker to determine what services I can provide information on, shelters, food pantries, and free community meals. I also meet with our outreach manager to obtain grocery gift cards from our Project Bread program. I do this while EKGs and labs are being obtained. This allows her time to rest and lie down instead of sleeping upright in her car. I finish seeing my morning patients, over lunch more paperwork, discuss cases with my two nurse practitioners, then the afternoon begins. Another 10 patients in my schedule. My 3:00 patient is an uncontrolled diabetic. He is so depressed he cannot control his diabetes, nor does he care about any treatment. Instead of discussing the diabetes, we discuss what to do about his life and how his family would view his outlook on his decisions for lack of treatment. This is another soul-searching, meaningful interaction with a patient while developing and maintaining the physical patient relationship. I finish seeing patients and then complete the paperwork of the day. I am the medical director, so I complete emails and administrative work and finally leave for home about 6:15. I live close by and on my short drive home, I look back at the day and feel good that I was able to listen and help my patients make educated decisions about their health care. I am able to have dinner with my kids and then I finish up paperwork and try to read a journal article or two. I usually fall asleep while reading an article, and my 12-year-old removes my glasses, tucks me in and then he heads off to sleep.
Q: What surprised you most as a new physician?
Dr. Sadri-Azarbeyejani: Patients come to you with their most personal problems, concerns, and secrets. It is not just the physical ailments they bring to you, but their emotional and spiritual ailments. For some patients, you are their last hope for help. I was worried I would not be supportive enough or able to help. In most cases listening and asknowledging their concerns made a big impact and the initial steps in the health process. I learned to offer support and clinical and mental health options, and allow them autonomy to maintain their dignity to make informed decisions about their lives.
Q: What led you to practice family medicine?
Dr. Sadri-Azarbeyejani: I consider myself privileged to have had the opportunity to pursue my dream of becoming a physician. I don't, however, think there was any particular moment in time when I knew I would be a family physician. I observed patient-doctor relationships over time. I witnessed family member interactions and how they were intertwined as they developed. The family as a whole provided more of a distinct and complete picture of how to provide comprehensive care for the family, and in turn, each individual. I enjoyed a much more satisfying and meaningful relationship treating families as a whole as the individual relationships grew strong and the requisite trust more profound. I have relished and appreciated the benefits of building trusting relationships with each member as they grew stronger, sincere, and more genuine. These long-term relationships provide a healthy environment and approach to practice family medicine and provide care for the entire family. The term "family history" suddenly meant much more than a few lines on a chart for reference; it became a dynamic link that brought the family members full-circle as I treated them, their children, and hope to care for their children's children. I have enjoyed developing the long-term relationships that challenged both the mind and soul as I participate in my patients' health care.
Q: How have things changed since you entered the field?
Dr. Sadri-Azarbeyejani: Medicine is changing quickly, whether it is new treatments, legislation affecting delivery of care, insurance changes, and now the term "population medicine" is coming to the forefront. Terms such as accountable care organizations (ACOs) and the Patient-Centered Medical Home, electronic medical records (EMRs), meaningful use, Healthcare Effectiveness Data and Information Set (HEDIS) measurements are also helping to shape the world of medicine. These new concepts add additional stressors and take up our time, but the patients' needs remain the same.
Q: What community service are you involved in and what motivates you to do this work?
Dr. Sadri-Azarbeyejani: At my town level, I am on the board of health, emergency preparedness committee, and the wellness committee of the regional high school. In the medical community I am involved in the local hospital medical staff and serve on committees such as the community benefits access program. On the state level I served on the board of directors of the Massachusetts Academy of Family Physicians for two terms and then was elected to the position of secretary, which can lead to presidency of the chapter in the future. I have served five years for the National Conference of Special Constituencies (NCSC), and have been a co-conveaner, and I've served as a delegate for the AAFP Congress of Delegates. I have also been on the legislative committee and a delegate for the Mass Medical Society. You need to be involved, you need to have a voice for those who don't or can't represent themselves. You become an advocate for your patients, your medical community, as well as yourself.
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Dr. Flora Sadri-Azarbeyejani