Travis Baumgarten (Host): Welcome to Mile Bluff Unscripted, where we bring you real conversations with the people behind your care. I'm Travis Baumgarten. And today, I'm joined by family nurse practitioner JD Lierman talk about family medicine and primary care. Welcome, JD.

To start off, for someone who doesn't currently have a primary healthcare provider, why is it so important to establish that relationship? So, what are they missing out on by not having a regular primary care provider?

James Lierman, FNP: Well, I think, first off, I mean, even having someone that you name your primary care provider, they know your history, they know your problem list, they know, you know, a lot of medications that you're on. Sometimes even just shooting them like like a quick portal message to see if it's it's something that they need to come in with. They're familiar with that provider. I mean, the most significant thing I would say about having a primary care provider is this, having that healthcare provider at least be familiar with you.

I know sometimes even going to a different provider or even urgent care for things, which is okay too, but that primary provider may know like your history. You say, "Hey, you know, I had this last summer, you know, this is what worked well for me," and it'd be a quick and simple visit.

Host: Yeah, and that leads nicely into understanding what primary care really includes. So, what of conditions do family medicine providers and family nurse practitioners typically manage?

James Lierman, FNP: So typically, with family practice, primary care providers, it's, you know, first foremost, prevention, you know, making sure that we're going through screenings for, you know, your colonoscopies, your mammograms, and different things like CT lung cancer screenings and some other things that maybe people aren't aware of and actually making sure immunizations are up to date.

Some of the conditions would be, you know, like hypertension, high cholesterol, hyperlipidemia, type 2 diabetes, type 1 diabetes, heart disease, just to name some of the few. But there's a wider range of different things that we see. Also, musculoskeletal conditions for people. But mostly, hypertension and some of those lifestyle type diseases too.

Host: Yeah. And for someone who's had a regular primary care provider maybe hasn't been in for a while, what can they expect during typical primary care visit with you?

James Lierman, FNP: So, I'd say typical when if it's someone that hasn't been seen for a while, they're new establishing to myself, it would be obviously going through family personal history for themselves. And then, you know, I like to go over like their screening options, as what pertains to age. The colonoscopy, mammogram, things like that. But also, you know, if they had any questions concerns.

And then, the thing is just to get a baseline level of labs as well, you know, to look and see how if there's anything like anemia or see how the kidneys are functioning, looking at cholesterol things like that. And obviously, then, you know, the physical exam is making sure there's not any abnormalities on that that as well too.

Host: Yeah. And once you've gotten to know a patient, what some of the most health issues you see in primary and how typically manage those?

James Lierman, FNP: think the most common for myself be hypertension, type 2 diabetes, high cholesterol, high triglycerides, different things like that. And how I go about those is, you know, obviously making sure that we're first changing our lifestyle, doing preventative things. And also, if we do need need to get on medication, we get on appropriate medication, make that we monitor those with labs.

And then, you know, based on, you know, how the person is doing, if blood pressure's been doing okay, you know, could be every six months or so until everything goes away, or gets stable on that medication. And then, you know, obviously for diabetes, making sure that A1c is stable enough for three months and then, you know, obviously checking other things for diabetes as well, and also cholesterol throughout the years and everything too.

Host: Yeah. And you mentioned managing health concerns, but primary care is also about preventing problems before they start. Many people only see a provider when they feel sick. So, how do you explain value of regular checkups and preventative visits even when someone feels perfectly healthy?

James Lierman, FNP: Yeah. So, that's like when I have new established care patients and patients that really don't ever had a primary, haven't seen anyone, because the old age, you know, "I've never had anything wrong with me, so why would I kind of come in in that situation?" And like I like to educate first and foremost, you know, what screenings are due for different ages. You know, when you need a colonoscopy, if you have a high risk, you know, or family history of it, when you need a mammogram, Pap, different things like that.

And then, the other thing too is preventative. You know, we rather try to catch something in the beginning rather than treat something down the road after someone had an abnormal colonoscopy or CT lung lung cancer screening.

And the big thing is just going over lifestyle modifications as well. You know, say if they've never had any issues with cholesterol or hypertension, at least getting a baseline so that we know, you know, say five or 10 years from now, like changed and, what can lifestyle-wise to change those or prevent those things.

Host: Yeah. And despite all the benefits we've talked about so far, there's still a lot of misconceptions, as usual, with healthcare about primary care and family medicine. What are some of the most common ones that you encounter, and you address those with patients?

James Lierman, FNP: You know, I think a lot of the misconceptions or the things I run into is they use use primary care as just like, "Oh, I need a referral to, like, a specialist" or something like that. But, you know, I think a lot of people misinterpret what kind of what primary care does and, you know, the things that we can do, besides going specialist, which obviously, you know, assess the patient and obviously assess that risk to see if they would need to be seen by a specialist or not.

But I think the biggest thing is just, you know, what a primary care person can or can't do and, you know, sitting down with an established primary care provider or, you know, having a new primary care provider that can, you know, establish what actually we're supposed to do in those situations too.

Host: Yeah. And one thing that's changed healthcare over the years the emphasis on partnering with patients. You know, how do you involve patients their families in those shared decision-making, when there are multiple reasonable options or maybe when guidelines aren't completely clear for them?

James Lierman, FNP: Yeah. So, I think, you know, I do love to see obviously families and, you know, husbands and wives or even, you know, see the husband, the wife, and kids as well. I at least give them, you know, options that are evidence-based and also, you know, what they think about, you know, let's say for example, you know, their glucose is right on the edge and, you know, could we talk to the family about maybe changing diet, exercise, or even trying medication, you know?

And I involve the whole family in that situation, you know, if they're present and everything, and just make everyone aware that, you know, maybe for dinner this is something different, you know, to help dad out or grandpa or something like that too. Obviously, having more emphasis on exercise with younger kids and, you know, getting out and playing and different things like that.

Host: And let's talk about some of the conditions that affect so many people. You kind of touched on it right there, but can you describe how you approach managing common chronic conditions like high blood pressure, diabetes, or high cholesterol, and what good control really means in everyday life for someone?

James Lierman, FNP: Yeah. So, I mean, obviously, everyone's different with how they're controlled and obviously based on age, you know, for glucose and everything like that. But the main thing is just reducing those comorbidities and those risks that can occur from uncontrolled, you know, hypertension, diabetes, and really making sure that we're watching the kidneys, we're watching any vascular concerns and conditions like that too.

And like I said, you know, making sure that over time, you know, let's say you say for three months and blood pressure's been stable and, you know, kidney function has been stable, cholesterol has been stable for six months, and A1c, know, we kind of use that every three months. And if it gets better, you can always, adjust it, obviously, making sure that those conditions that that person has doesn't cause anything worse to happen.

Host: Yeah, and medication is always one piece the puzzle in healthcare, but what role lifestyle factors like nutrition, exercise, sleep, stress management? What kind of role do that play in everyday life for somebody?

James Lierman, FNP: Yeah. And so, I think, you know, and I try to explain to my patients a lot of the times that I'm more focused on, you know, those lifestyle modifications to begin with, as those are primary prevention. Obviously, medication does a great job too. But, you know, things just like talking to patients about, you know, making sure that we're getting, you know, at 150 minutes of activity week.

Also, I like to stress the fact of resistance training for people, especially with insulin resistance. And just the fact that, you know, having that low muscle tone can really set yourself up for a lot of conditions like coronary artery disease, diabetes, and really sure you're moving every day. Like I said, movement is medicine. So, I try to stress those first and then obviously medication if necessary too.

Host: Yeah. And that really highlights the importance of building long-term habits. And also, you know, when it comes to having an ongoing relationship with a primary care provider to help improve those health outcomes over time, and how do you see that playing out with your patients?

James Lierman, FNP: So, I think, you know, having a primary care care provider, you can see this patient for multiple years and can see how they started with, you know, having uncontrolled diabetes or they were struggling with obesity, and you can just see those numbers improve. You know, my favorite thing is seeing someone initially and, you know, they're saying, "Oh, you know, I have these aches and pains and I just don't feel right."

And, you know, they get their diabetes under control, they get their hypertension under control, their weight under control. And, you know, they come to me and it's my favorite thing ever, is, you know, they feel better and they didn't know that they could feel such a way. So, you know, I think that really strengthens significance of having a primary care provider as you age and, you know, going forward too.

Host: Yeah. And a part of it you kind of touched on earlier is I'm talking about coordinating care with specialists, hospitals, and other members of the healthcare team to make sure nothing falls through cracks for your patients. And talk about that relationship when it comes referrals and working with other members of the healthcare team.

James Lierman, FNP: Yeah. So, I mean, we have a great referral process here at Mile Bluff too. And obviously, just talking to the patient and just making sure that, you know, a lot of us live in rural areas. So if there's one that would closer, that's one of the questions I ask patients, if they prefer, you know, a larger facility for referrals, if we don't have here at Mile Bluff, because do have the UW Health Specialty Clinic as well.

And I like to explain to people, you know, wait times, process of the referral department. And I think on my end too is I just have my assistants follow up and see if they were able to get a appointment or, you know, if one has been scheduled for them as well. So, communication is the best for the situation.

Host: Yeah. And for our listeners, what advice would you give patients about making the most of their primary care visits when they come to see you? So, are there things they should do ahead time, like preparing questions, tracking symptoms, or bringing family member along? What kind of advice would you give them?

James Lierman, FNP: Yeah. So, the advice I would give is, you know, I've had patients bring in, you know, like a notebook or something on their phone with notes that they wanted talk about, which I think great as well. Because sometimes, you know, as primary care providers, we get busy and, you know, some of those things don't get touched on. And, you know, I really want patients to bring the most significant symptoms or questions that they have to the appointment, we can address those. And I think really bringing anybody with you too, because especially husband and wife or if an elderly individual like grandfather, you you know, grandma, even bringing someone with you that can help navigate some of those symptoms that they may not be able to describe I think is a good idea too.

Host: Yeah, and shifting gears just a bit, let's talk about you a little bit more. So, what inspired you to become a family nurse practitioner, and what do you find to be the most rewarding part of your everyday work?

James Lierman, FNP: Yeah. So, I think what inspired me is, obviously, initially I went into the military and worked in the healthcare realm, and I worked with a lot of great nurses, nurse practitioners, physicians, PAs. And I think they just always pushed me to want to be in roles, and I always looked up to them and always wanted to be one of providers well. And especially living around Boston, I mean, I have met a lot of great physicians that still work here, and I always wanted to do what they did and how they had an impact on patients as well.

And I think, you know, the biggest impact on me is just seeing that person initially say, you know, they had the diabetes or the hypertension and just how good they feel after they get it under control and, you know, make lifestyle modifications. I think that's the most impressive thing to me. It makes me, you know, feel like, you know, we're doing something and helping people. The big thing is, you know, me helping someone at any site certain ways. But yeah, that's the biggest thing.

Host: Yeah. And finally, as we close out today's episode, we'd love to hear your final thoughts. So, what would you like people to take away from today's conversation?

James Lierman, FNP: So, I think the biggest thing from today's conversation is obviously, you know, I stress the importance of having a primary care provider. You know, not only when you have questions, but the significance is someone that knows you, someone that knows your history, your medications. I mean, maybe someone that knows, like, your family history as well.

And, you know, as primary care, we're set prevent things. That's our sole focus. But obviously, acute issues, you know, having that primary care to make an appointment with quick. And then, obviously, it's, you know, an efficient process if they already know you. But the big thing is just, you know, making sure people are educated, not only preventative screenings, but also lifestyle modifications as they, you know, age and throughout their years.

Host: All right. Well, that wraps this of Mile Bluff Unscripted, we certainly appreciate you spending time with us, and we JD Lierman for sharing his expertise. So if you'd like make an appointment with him, please call 608-847-5000. New patients are always welcome. To explore more topics and connect with our providers, visit milebluff.com. Take care, and we'll see you next time.