CAFP proudly recognizes Erika Roshanravan as the September 2019 Member of the Month. Dr. Roshanravan, along with Dr. Warren Brandle and others, has led the merger of the Sacramento-El Dorado and Yolo Chapters to become the Sacramento Valley Chapter. She is a current member of the Ready to Lead fellowship and an active participant in advocacy efforts. Recently, Dr. Roshanravan represented CAFP along with Dr. Brea Bondi-Boyd at the California Legislative Women's Caucus Equality Day.
We sent Dr. Roshanravan some questions to get to know her better and share her perspective on Family Medicine in California.
Why did you choose family medicine? What is your favorite aspect?
I used to want to become a pediatrician. Towards the end of medical school, however, I realized that I felt really passionate about preventing disease, not just treating it after the fact. I thus decided to go into primary care. Family medicine offered me the prospect of seeing and building relationships with people of all ages with a very wide variety of concerns, including psychiatry, obstetrics and a wide range of procedures. That challenge was the most exciting for me. Besides, the family physicians I met were just the coolest bunch of them all. I never regretted my change of path.
What inspired you to pursue family medicine?
When I was a pediatrics sub-intern at Seattle Children’s Hospital, there were three interns on my team: two family medicine interns, Amy Wilkerson and Matt Logalbo, and one pediatrics intern. While the peds intern was very diligent and correct, it was the two family medicine interns that truly inspired me. They were so hands-on practical, and so compassionate with their patients. They did not fear being creative and think outside the box. They always paid attention to all aspects of our patients’ well-being. They were up to procedures anytime when necessary no matter how much pus there was, or pulled strings to ease social stress. Like I said before, these family physicians were truly the coolest bunch of them all, and it was easily evident to me that I wanted to be like them. Along the way, I had the great fortune to be inspired by a large number of family medicine physicians who all contributed to shaping the family physician I am today.
What is your most interesting or memorable experience dealing with a patient?
This is a really tough question as truly memorable experiences happen all the time when seeing patients -- some happy, some sad, all of them special through our shared humanity. One of the interactions that stands out is a woman in her late 40s who had completely uncontrolled hypertension and diabetes for years. She started to seek care due to severe pain in her legs, loss of sensation in her feet and decline in vision. She avoided all diabetes meds as she had an eating disorder and had noticed that she gains some weight if she takes her meds. She avoided her antihypertensives because it made her feel dizzy. Her A1c was 14% and her blood pressures around 200/120 regularly. It took many visits and a few months of relationship building before she trusted me enough to start taking small doses of medications and slowly titrate up. It took much longer before her A1c was well controlled and the blood pressure significantly lower. One day, she came in for a brief visit stating “I just wanted to come say hi before going on a trip tonight, our first vacation in years”. It seemed unusual, and she seemed reserved, and I figured out eventually that she was there because she did, in fact, have chest pressure since earlier that morning, something she had never experienced before. She was adamant that she would not go to the ER. Her EKG was normal, but I was still so concerned I made clear that she may not be alive by the time her plane landed in the Caribbean. I advised her that I would continue with my clinic and keep coming back in between patients to check on her so she could think about it, and after a few hours, she agreed to go to the ER, extremely upset to miss her trip. She got a cardiac cath that night and a quadruple bypass the very next morning, and when I called her in the ICU postop, she thanked me for saving her life by not giving up on her.
What is one word or phrase to characterize your style of family medicine?
Why do you belong to CAFP/AAFP?
It is important to me to be a member of CAFP/AAFP because they provide me with the tools, the venues and the support to help effect change for family physicians, for our patients, and for primary care and the healthcare system at large.
What would you say is your best experience as a CAFP member?
Last year, while still living in Washington State, I was an International Medical Graduate delegate for Washington State to NCCL, and later in the year, just after moving to California, a delegate for NCCL at the national AAFP Congress of Delegates. I was introduced to the California delegations both at NCCL and at COD and was truly thrilled to meet and be welcomed into such an enthusiastic, dedicated and bright group of people. This was an extremely lucky lineup of events for me as we made the big move down the coast, and one that I will forever be grateful for.
What is an important CAFP resource?
The most important resources CAFP offers me are the Legislative Updates, the information about how and when it would be helpful to speak up, and the truly extraordinary support I have received as a chapter leader.
How do you make a difference in family medicine and in your community?
Working in a FQHC embodies my firm belief that everyone deserves access to high quality healthcare regardless of immigration status or ability to pay, and the availability of these services is vital for our communities. I am proud and grateful to work in a place where the entire team is dedicated to the mission of delivering quality healthcare to all, and each member of the team has a vital role in making a difference. On a larger level, the engagement with the CAFP gives me a setting to be engaged in improving health care access, delivery, quality and sustainability for all.
Tell us about a project you are involved in and why it is important to you.
For the last few months, I have been contributing to building an active Sacramento Valley Chapter of the CAFP. We merged our Yolo and Sacramento-El Dorado chapters, wrote bylaws, and are currently in the process of electing a newly formed seven-member board. We will be serving over 1,000 CAFP members and represent two medical schools and soon-to-be four family medicine residencies on the footsteps of our state’s Capitol. If I have learned anything in the last few years of soul-searching as to how I can best make a difference in the world at large beyond the confines of my FQHC, my family and my friends, it is that my voice is most powerful if I speak from my experience of being a family physician. I realized that the privilege of deep insights into my patients’ lives grants me perspectives that are truly unique and shared by very few. Sharing them is a powerful way to speak up and help effect change on behalf of my colleagues, my patients and the healthcare system at large. Don’t get me wrong, besides my three children and my part-time work at a FQHC, I usually have rather limited time or energy to invest beyond these, and that is where the AAFP and CAFP and now our local chapter come in. The AAFP and particularly the CAFP are giving me a structure, venues and resources to make the most of my limited spare time. From the provision of sample bylaws to administrative support to legislative updates to opportunities for CME or to speak up, to the Ready To Lead fellowship I am privileged to participate in, to mentors to a simply amazing group of people, the CAFP has become an outstanding source of support and inspiration for me. I am hoping that with our newly merged Sacramento Valley Chapter, we can reach more and more family physicians with these resources, support our residents and inspire medical students to choose family medicine as a career.
What are some good qualities a family physician should have?
Listening. That really is it. You can be super smart and have all the top-notch medical knowledge in the world, if you are unable to hear what the patients are telling you between the lines and what your staff’s needs are, you will struggle as a family physician. I agree with Burr’s “Talk less, smile more” in Hamilton, but only half-way. It should say “Talk less, listen more” (though one cannot argue with smiling more, either, it improves our well-being).
Give us one sentence of advice for medical students interested in FM.
Family medicine physicians are the solution to the healthcare crisis in America. So, if you would like to be part of the solution, come join us for the #FMRevolution and bring your friends! Join your local AAFP chapter, your Family Medicine Interest Group, and get connected with a mentor, and you will be on your way to the most challenging, most interesting, and most gratifying career in medicine.
What do you do in your free time?
My other job, and really my everything, are my three children Kian (7), Yasmin (almost 6), and Darian (2). I love camping, hiking, anything outdoors, traveling, singing and music overall. Another big part that helps me keep my sanity is working out with the amazing mommas at Fit4Mom Davis in the wee hours of the early morning a few times a week. And I could do none of this without the dedicated support and task sharing by my husband Baback, who is a nephrology professor at UC Davis.
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