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Dr. Eric Brody puts his heart into cardiovascular care

TUCSON, Ariz. – When you love what you do it shows. Dr. Eric A. Brody, director of clinical services and associate director of the Native American Cardiology Program at the University Medical Center at the University of Arizona is enthusiastic about the state of the art cardiovascular care he is able to offer patients.

The program is a collaborative effort between UMC, IHS and the University of Arizona. UMC has consistently been ranked one of the best hospitals for cardiac care and cardiovascular surgery by U.S. News and World Report.

The team at UMC offers its services to 43 IHS and tribal clinics and hospitals in Arizona and the Southwest, which serve between 500,000 and 550,000 people. “Until the ’80s and ’90s, most of the cardiovascular disease causing problems for American Indians was associated with rheumatic fever,” Brody said. “As American Indians developed more of the cardiac risk factors that we see in the general population – high blood pressure, Type 2 adult onset diabetes and smoking – they developed the type of cardiovascular disease that causes heart attacks. We have seen a real explosion of this sort of problem in the last 20 to 25 years.”

Today, even though the rates of cardiovascular disease have began to decline, Native deaths from heart disease continue to surpass those of the general U.S. population. In an effort to provide cardiac care to more distant and rural IHS sites and tribal clinics, the cardiology program offers teleconsultation with cardiology staff to help fill the need for specialists. Patients in rural health settings can have electrocardiograms and stress ecocardiography at their local clinic while Brody – at UMC in Tucson – communicates directly with the patient and medical staff using the services of the Arizona and IHS Telemedicine programs.

“We are fortunate that here at the University of Arizona there is a first rate, nationally recognized telemedicine program with its foundation built on the desire and need to provide quality care at a distance to rural facilities,” Brody said. “IHS facilities have been able to piggyback onto their services to improve care through the system that already exists. There is some wonderful leadership in telemedicine at the university and also within our program that have recognized telemedicine is a great way to improve the delivery of subspecialty care to sites that wouldn’t otherwise get it.”

In 2005, Brody received an Excellence in Teaching Award – Gold Level – Online Telehealth from the United States Distance Learning Association for his approach to teaching distance learners. He developed and taught a course for the Native American Cardiology Program based on the game show “Jeopardy” – which he called “EKG Jeopardy.”

“Telemedicine in cardiology offers – at its most basic – subspecialty care 24/7 by phone, fax and computer. At its most sophisticated we do some pretty interesting and amazing things. We have a large echo outreach program that allows ultrasound studies of the heart to be done at IHS facilities by certified echo technicians and then have those studies sent to us in a variety of ways. They may be as simple and old fashioned as VHS tapes with an appropriate set of paperwork and a preliminary write-up by the echo tech for us to review a day or two later,” Brody said.

 

 “Along with the language differences there are also cultural differences. We work hard to recognize that when we are prescribing care, treatment and surgeries for our patients.” – Dr. Eric A. Brody, director of clinical services and associate director of the Native American Cardiology Program at the University Medical Center at the University of Arizona

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“Or it may be as sophisticated as an immediate upload of the echo studies through a digital Internet link allowing us to look at the study while the patient is there at their own clinic. I work with the Arizona Telemedicine Program because I believe strongly this is a great way for us to improve our care delivery. They also provide training for people throughout Arizona and internationally who are interested in developing telemedicine programs in their own communities.

“The Arizona Telemedicine Program also works with the radiology program at the university. Many of our patients who get studies of other types, for example CAT scans at a site that is distant to us – are ultimately being read here too. Having all those studies in one place has allowed tremendous continuity of care.”

According to Brody, 40 – 50 percent of the patients he treats speak only their native language. “We have patients who speak Navajo, Hopi, Apache and others. I only take care of American Indians through the cardiology program – I don’t take care of any of the rest of the population – and even if they do speak some English they are clearly more comfortable when we use a translator to speak with them. We feel very strongly about the need for cultural sensitivity, our staff includes translators for our patients who speak native languages.

“A vital part of what we do is explaining and teaching the patients cardiac condition to the patient and their family. That is every bit as vital as the medicines we prescribe and the kinds of procedures we do. That is why having these translation skills as part of our staff is important.

“Along with the language differences there are also cultural differences. We work hard to recognize that when we are prescribing care, treatment and surgeries for our patients.”

Traditional medicine also plays an important role in treatment. “You can’t ignore something that your patient feels is an important aspect of their recovery. We have a traditional healer on our staff that routinely does rounds with us and spends time with patients and families to make sure those needs are being addressed.

“We make sure that patients throughout the region are getting the quality of care they deserve. We think that should be equal to the highest quality of care anybody in the general population would get. The Native American Cardiology Program is a collaborative effort at many levels and is strongly supported by IHS leadership. Without that support the program wouldn’t be here to do all the good things it does.”

Brody, an IHS employee, has been with the Native American Cardiology Program since 1995.