Arizona Physician

Arizona Physician

The world of the heart: thoughts on cardiology and caring for Arizona’s veterans with David Biglari, MD

By Dominique Perkins

Dr. David Biglari dwells in the world of the heart – both literally and figuratively. As a cardiologist for the Phoenix Veterans Affairs Health Care System (PVAHCS), he spends his time caring for Arizona’s service men and women returned from active duty, giving back for their acts of selfless service.

Admiring the sophisticated machines

When David Biglari was only 11 years old, his family experienced a scare when his mother was diagnosed with an inoperable coronary artery disease. Later, it was decided she did not actually have the disease, but it was this experience that Biglari said planted the earliest seeds of his interest in medicine. His interest continued throughout his early school years, with human physiology particularly capturing his attention in high school biology classes.

“I was always most fascinated by the human machinery and how each part worked in concert with others,” he said. “And as long as each part did its job well, things rolled smoothly as a whole, just like any other sophisticated machines.”

He completed his undergraduate and graduate studies at the University of California Los Angeles, graduating with a Master of Science, and PhD in neuroscience. He attended medical school at Midwestern University, in Arizona. After graduating, he moved to Henry Ford, Michigan, where he began a residency in neurological surgery. However, one year into the program, Biglari decided to switch his specialty focus to cardiology, and he returned to Arizona to complete his internship and residency at the University College of Medicine-Phoenix. He also completed several fellowship training programs in Phoenix – in Cardiovascular medicine, and interventional cardiology.

VA from the start

Aside from the year spent in Michigan in neurosurgery, Biglari settled immediately into practice in Arizona. Currently, he is a complex cardiac interventionalist and co-director of the cardiac rehab center at the PVAHCS.

“My skillset involves performing minimally invasive, percutaneous cardiac, peripheral and structural heart procedures,” he said.

He and his team have helped develop the cardiac interventional program, which is set to go live later this year. Aside from his clinical and administrative duties, he is also involved in teaching and training medical students, interns, residents, and fellows in the field of cardiology.

Biglari was drawn to a career with the VA after getting acquainted with the patient population during his training and is honored to feel such genuine care for those he works with and cares for.

“I did 50% of my training at VA medical centers,” he said. “It is a privilege to serve those who served us.  Joining the military is a selfless act and those who answer this calling, truly put themselves and their families in harm’s way.”

By serving them, Biglari feels as though he is “giving back” to a group who have given so much. When he first joined the PVAHCS cardiology program there was a particular need for his specialty – percutaneous cardiac complex procedures. And he has had a home ever since.

The best care

With much public and political debate over the options available to veterans when it comes to medical care, several topics are at the forefront. One being whether veterans should have access to care at institutions other than VA hospitals and clinics, while still maintaining their VA coverage and services.

Biglari believes that veterans deserve the best medical care money can buy, and feels that those fighting on both sides of the argument share that view – it’s just a difference of opinion in how to carry it out.

“In my opinion and experience from both VA and the private sector, our Veterans get the best care through the VA network,” Biglari said.

The coherent and comprehensive care network of the VA is not matched in any other system, he believes. And, while certainly most any doctor has the wellbeing and best interest of their patient in mind, Biglari asserts that those who work at VA medical centers have a deep-rooted belief in their mission, and are truly devoted to serving those veterans in need.

Frequently veterans have occasion to access healthcare on both sides – necessitating coordination between the VA and non-VA providers.

“I think the VA does everything in their power to have coordinated care with the private health care sector in times when Veterans are referred for care,” Biglari said. “I cannot say with certainty this is reciprocated by the private sector.”

In his own experience working across systems, Biglari noticed there are often delays in communication – transferring medical records and health summaries. While certainly no system is perfect – all have issues and shortcomings – in the end everyone needs to do what they can to contribute to quality veteran care.

“What matters is how we as a society come together to improve health care delivery for all Americans,” he said.

Of course the best care for veterans is not limited to treating physical ailments. With the prevalence post-traumatic stress disorder (PTSD) present in those returning from activity, it is more important than ever for veteran care facilities and systems to have robust and effective mental health branches. Fortunately, increased research as well as recent world-wide awareness campaigns have pushed for a more open and accepting discourse concerning mental health.

Biglari is confident in the VA’s dedication to the prevention, identification, and treatment of mental diseases.

While the field of care does not fall within his specialty – which he described as “the world of the heart” – Biglari has seen this emphasis evident since the early days of his training.

“In the last 2-3 years, I have seen a tremendous surge of efforts in this arena,” he said. “Numerous psychiatrists have come on board, the overhaul to the hotline call system, and the rapid acute care within the Emergency Department and outreach programs for Veterans with mental health needs.”

These changes signify one of many positive approaches the VA system takes to ensure top quality veteran care. Biglari describes continuous efforts to improve and expand in all areas, even including parking.

“State of the art technologies are made available for the providers to enable them to provide the latest proven diagnostics and therapies,” he said.

“The direct example of this is the program we have been building to create one of the most advanced cardiac intervention laboratories in the VA system, and Arizona.”

Another way the VA is working to expand care is by utilizing technology to provide more home-based, and telemedicine approaches. In fact, Biglari says these are cornerstones for some major conditions that we treat.

“My heart failure patients certainly benefit from these services and often request for extending them out,” he said.

The VA has long been a pioneer in expanding care outside the walls of a clinic or hospital. In Phoenix, the VA has a mobile medical unit (MMU) fully outfitted with state-of the-art equipment and mobile exam rooms, ensuring that distance will not interfere with care. In addition to more standard mobile medical equipment, the MMU is also stocked with multiple tablet computers, so that veterans seeking care in the mobile unit can connect for sessions and evaluations with providers based in the VA in Phoenix at any time.

Challenges

Certainly every healthcare system, large or small, faces challenges. The VA has challenges unique to their calling, and does not face some of the same barriers as other institutions.

For one thing, the VA does not have quotas to meet, or other financial obligations or incentives.

“Our main goal is only to provide the best of care for individual patients based on their needs through the latest evidence based medical science,” Biglari said.

Because of this relived pressure, Biglari is blessed to spend more time with each of his patients, listening to their stories, and ensuring they are well taken care of. This is fortunate, since he lists the biggest challenge for veteran care as sorting through the fragmented care path the veterans have followed in and out of VA, private, and community service systems – systems that don’t always do the best job communicating with one another.

Healthcare throughout America has been crippled by interoperability issued between health records systems. Differences in systems across fields makes record sharing, transfer, and tracking a constant struggle.

While Biglari has experienced the frustration of waiting for records, he says this is not really an issue of care. Caring for veterans, wherever they receive their care (whether VA or Department of Defense or the private sector) is still a priority. He describes the differing electronic record struggles as society’s issue to solve.

Another issue society is grappling with is homelessness, especially among veterans.

“Caring for the homeless in any system is always more challenging, as it is more rewarding,” Biglari said. The main challenge for healthcare with those experiencing homelessness is a lack of routine follow-ups, and a compliance with medications and other therapies.

The challenge of caring for homeless vets is no different, although Biglari says the VA in fact has solid support structures in place to help with compliance and follow-ups for vets experiencing homelessness, essentially ensuring they get the care they need.

 

 

 

 

 

 

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