Carl Maronich (Host): Welcome to Wellness First, the St. Joseph Hospital Podcast, where we hear and learn directly from the experts on all things health and wellness. Joining us today is Allyson Janosz. Allyson is a Advanced Practice Nurse with St. Joseph Hospital Primary Care. And I'm Carl Moronich, your host. Allyson, welcome to the podcast.

Allyson Janosz, NP: Thanks for having me.

Host: You are very welcome. The topic today is the hidden side of primary care, which may sound a little ominous, but actually it's really the idea is sharing information about primary care that can help patients as they go on their health journey. So let's start with what do primary care providers do that most people don't see?

Allyson Janosz, NP: There's a lot. Most of the day we're seeing people back to back, either like a 20 minute or a 40 minute appointment. And in between all of that, we're trying to squeeze in as many things as we possibly can. Most of the time we're working on just interpreting lab results for people, lab results, imaging results, referrals, looking at charts where we may have sent somebody to a specialist and then they cc us on their visit with them. So that way we have good follow-up care. That's most of the in-basket portion of things and refills too. I guess that's a really important thing. Anytime someone requests a refill most often it will go through the clinical team first.

They'll process things if we have protocol for it. Otherwise, it has to come to us for sign off. The second thing that takes most of our time is dealing with insurance companies. Usually we're either writing letters of appeal, if for some reason our test or lab result or lab test that we ordered was denied through insurance, we're trying to basically say, okay, this is why we need to actually have you have this test done, even if they're disagreeing with us.

Sometimes it gets to the point where we're doing an actual, like peer to peer where the insurance company will require us to actually call them and speak with a representative, usually in an MD or a DO whoever they've employed technically that would be a specialist in the field, and we basically have to say why we think that you actually need this test, imaging or lab work done to support our case.

Host: So really becoming a patient advocate.

Allyson Janosz, NP: Yes, most of the time, basically trying to say everything that we possibly can in order to get a test done, for whatever reason, we think that it's logical to have it done. Sometimes those phone calls can take a while.

Host: I'm sure. So there's a lot of coordination I would imagine, with other providers that a patient may be seeing. Maybe you can speak a little to all that goes into the coordination of care, which is probably a pretty significant thing.

Allyson Janosz, NP: Yeah. When we're able to refer inside the St. Joe's network, everything really is pretty seamless. We refer, they call to make an appointment, and we're able to see the follow through on care, which is really important for us too. Because when we see the patient back in the office, they're going to wonder, Hey, did you have a chance to look at, I saw the specialist that you referred me to, and what do you think about all of this?

So it's pretty seamless when we're internal. Sometimes things can get a little bit more complicated when we're doing an external referral, just because the timing and we're usually not cc'd on the appointment notes in real time. So it just takes a little bit longer to get through to stuff like that.

But it's really important to be able to coordinate with all of the specialists because sometimes in primary care we just don't have the answers to everything. We try to know a lot of everything, but it's impossible to know everything about everything.

Host: As we know, healthcare is a very emotional topic, an emotional experience for a lot of patients. How do you handle those emotional situations with patients?

Allyson Janosz, NP: I feel like it's impossible sometimes to not get emotional for patients too. I feel like as a healthcare provider, you're naturally an empathetic person and you go into this profession knowing that you're just trying to help people and you care about people's health and wellbeing. So just being an empathetic person, sometimes it's hard to separate your job and feeling for somebody emotionally, and sometimes we bring these things home with us too.

Things do impact us throughout the day, and sometimes it's hard to separate those things and not taking them home. Healthcare in general is a really emotional thing most of the time, but the good things are what keeps us going. Majority of the things are good things.

Host: How, do you care for yourself? I mean, when you're taking things home and that's what do you do as a provider to make sure that you're staying at, you know, at your best and not, having those things weigh too heavily on you.

Allyson Janosz, NP: A lot of self-care. Taking it home to family, sometimes they just know knowing that what your job is, that sometimes you just need to be able to talk with them in general about certain situations, just to kind of get it off your chest. And then we do rely closely on our work network.

So like my providers that I work with, they're usually really understanding and if we come out of a room and we're just like, oh, I just need to talk with you about this, or, you know, get your opinion on this, or vent about something that maybe didn't go as you had planned. It's really good in terms of work environment and then home environment, just knowing that you have somebody to kind of be your sounding board, even if they don't specifically know what to do about it. Just kind of having somebody to listen sometimes is great.

Host: I would guess one of the joys of primary care is that you see patients long term, so you're able to follow them and help them. That's gotta be a very rewarding part of the job.

Allyson Janosz, NP: Yeah, it's really great. I mean, you see people throughout their life and how they progress. So I see people who are 13 and above and seeing them from a young teenager to late teenage years and even seeing someone going through even like their sixties or something like that. There's so much progression that can happen and

you're able to grow with people and you just are able to develop that relationship with people at the same time where they trust you, they see you every three to four months or six months, or even every year if they're healthy and not having any specific problems. Just knowing that they have that continuous, solid touch point in terms of longevity, I feel like makes them very comfortable and it helps us in terms of quality of care.

Because we know them, we've been able to take care of them for multiple years now, and it just makes them comfortable knowing that there's this one touchpoint person that really knows most everything about them that we can continue to follow up on.

Host: Maybe this is a good opportunity to remind people the importance of seeing your primary care provider pretty regularly.

Allyson Janosz, NP: Yeah, at least every single year for your physical at a minimum. Some people will go longer than that. It really depends. But we usually tell people at a minimum, try to get in for your physical every year. That way we can touch base and get at least a set of vital signs. Sometimes, depending on your age, a basic set of lab work, cholesterol, complete blood count, kidneys and liver function, just some basic stuff or even just to check in and see, Hey, how are you doing emotionally, mentally, those types of things.

I feel like we do a lot of, not just physical care, but we're looking at multiple different sides of things. Especially as a nurse practitioner, we're looking at so many things holistically.

Host: In a way, becoming a human sounding board for patients, and that's an important element to it.

Allyson Janosz, NP: Definitely. I mean, there's a lot of things going on in the world that typically get brought up during the appointments, kind of no matter what, sometimes indirectly, sometimes directly. I mean, we have people who will come in with financial concerns related to insurance that are things that are out of their control, and sometimes it's just natural to progress into those topics for people.

Even if we can't 100% address them ourselves. It's important just to be empathetic and understand where they're coming from. Because it does impact the care that we can provide them to in terms of coverage and out-of-pocket costs and stuff like that. We do get a lot of environmental concerns and like political concerns in our job.

Yeah.

Host: I'm guessing you also get a lot of patients who come in and may have done some research on their own, on the internet and, and bring you information related to what they think they might have. How, do you navigate those waters?

Allyson Janosz, NP: I find it helpful. I appreciate when people come in and they've done their research on things. When they come in, they say, I think you probably always hear, I talked to Dr. Google or something like that, but I appreciate when someone comes in and they're informed and they've looked up their symptoms and they at least have an idea on possibly what they may be dealing with.

It kind of gives me insight at the same time, like maybe they've already kind of thought of something that Google may have told them or something like that, but I never discourage people from looking things up. But it's just important to know where are you getting your sources and where are you specifically looking.

Host: Great, advice. Allyson, what do you see as kind of the biggest challenges, of primary care right now?

Allyson Janosz, NP: Probably credibility of sources and online misinformation. There's a lot of places that will try to tell you certain things. There's social media environment where there's a lot of people trying to give you certain information and take that information with what you will, but I usually will always just encourage people to take that information, do your due diligence online, and always contact us if you have any questions about what kind of information is being told to you and whether or not we specifically agree with that information or not.

Host: And we touched on it a little bit earlier, but let me just ask directly, what keeps you going on hard days?

Allyson Janosz, NP: I think just knowing that I'm helping people. Some of the days are really hard and we're working all day. Sometimes we're taking actual, like follow ups at home. I've called people on my way home from work before to follow up on X-ray results or even pertinent labs, let's say it's a Friday evening and you know, they're not going to get any follow up from us over the weekend. Because we're not seven days a week kind of thing. But I think just knowing that I'm there for people and I'm helping them, making a difference in their life really. I think that's probably just what keeps me going. It's a hard job, but it's rewarding.

Host: Allyson Janosz, family nurse practitioner. Thanks so much for joining us and sharing a lot of great information about primary care.

Allyson Janosz, NP: Thanks for having me.

Host: If you enjoyed this podcast, please share it on your social channels and explore our entire library of podcasts for topics of interest. I'm Carl Moronich, and this is Wellness First.

Thanks for listening.