Physician Assistant, Jennifer Carlquist

[00:00] Michelle: Meet Jennifer Carlquist, a physician assistant who is a true expert in her field, with a wealth of experience in both cardiology and emergency medicine. Somewhat of a private detective with her patients, she has a keen ability to get to the heart of the matter, which is not always the presenting problem. She achieves this by connecting with them on a personal level, understanding their human condition in addition to their medical condition. As a PA, Jennifer practices with great autonomy, is at the top of her game, and is truly living her passion, which is to save lives. When she's not working with patients, she actively shares her knowledge through her business, Cardiology Made Easy. Jennifer has a strong presence on social media with accounts on Instagram, Facebook, YouTube, and LinkedIn. Her content includes case studies, EKG interpretation classes, workshops, conferences, and my personal favorite, her popular What's Wrong With This Patient? series on Instagram. In the five-minute snippet, a bike ride along the beach, I must be in heaven.
[01:38] Michelle: Hi, Jennifer. Welcome to the podcast.
[01:40] Jennifer: Thank you so much, Michelle. I'm so happy to be here.
[01:44] Michelle: I'm so happy to talk to you as well. I think we met on Instagram, and I always try to remember where I met my guests and if somebody referred them, or if you just popped up in my feed. And when I was thinking about you, I thought, yeah, I think that's what happened. I think your Instagram Cardiology Made Easy popped up because I'm a nurse and you talk about lots of nursing things and medical things, and I said, oh, my gosh, this looks really interesting because my Achilles heel cardiology. So I'm learning so much from you. But let's just start by kind of telling us what's your history. How did you get where you are now?
[02:33] Jennifer: That's a great question. So it all started when I was starting my paramedic career and in paramedic school. I remember just wanting to save lives and wanting to make a difference and being really young and making this decision. And I remember sitting in class and when the EKG section came up, I felt like I just hit a brick wall. And I was doing great up until then. I was addicted to medicine. I could clearly tell I would be at a stoplight and I would have my textbook open, reading a snippet at the stoplight just to sneak in a little bit more knowledge. I was in love with medicine. But then when I hit that brick wall, I started to question, could I do this? And I had to really kind of recommit and dedicate and figure out a strategy to get around it. So I ended up finding, luckily, a nurse at my local ER who took me under his wing, thankfully, as a favor from a friend, and he ended up mentoring me on EKGs because it turned out I wasn't someone who learned from the books. So I ended up making it through the EKG section and passing paramedic school. Our class hemorrhaged from I think it was like 50 students down to 14 who made it out.
[03:54] Michelle: Oh, my goodness.
[03:55] Jennifer: It was a very hard program. I didn't know at the time what I was signing up for, but once I got out in the field, I realized, okay, then I had that fear of, oh, wow, wait a second. I'm the highest level of medical authority on the scene. I need to actually really know this. And that scared me even more. And so that fear is what made me sit down one day and write a list of all the things on the EKG that if I missed, someone would die. And that's where my class was born. Because I realized, A, not everybody learns from the book, and B, sometimes people need a little guidance,  C, they need to be lifted up when they're learning hard things like this and not kind of drug over the coals. Kind of like the old style teaching we used to do. If you remember back in the day, ACLS, at least when I took it, you were upside down in a car with a penlight in your mouth, having to intubate. People were screaming at you, and you failed. It's like the kindler, gentler learning environment now, but I really feel like in the EKG space, people need that extra bit of not TLC, but just like, let's take the pressure off and make it a non-threatening environment because it's already challenging enough. So it was my fear, and it was my experience going through the program and almost not going into medicine, which would have been a shame, because as it turns out, I've been able to influence a lot of other people and teach them EKGs in a way that makes sense to them. And so that would have been lost if I didn't keep going. So I think it's always really when you really come against something that's hard, you really have to look deep in your heart, like, how bad do I want this? How bad? And I wanted it so bad, so I knew I was going to do whatever it took. It was just hard.
[06:00] Michelle: Well, I love your teaching style, and you do so much teaching, and I love that you are gentle. I have responded a few times to your impromptu instagram quizzes, and I always make sure not to look at any of the other responses because you challenge me to challenge myself and dust out the cobwebs of my NICU brain. Because I've only ever worked Peds and NICU and I really don't know very much at all about adult medicine. So it's been so fun to respond. And you're always so encouraging. Like, every response that you give, even if somebody gives the wrong response, you're just encouraging in how you respond back to them. And I think that just promotes such a great learning environment. And it would really be a sad day if you had never gone this route, because you're such a good teacher. And I know you have influenced and taught so many others to excel in their practice as you have excelled in yours. So I'm glad you made all those choices.
[07:20] Jennifer: Well, thank you. I'll tell you why I am so encouraging. And it's not just the obvious reason for that, it's what I would have wanted when I was learning, but it's also because people don't learn well when we shouldn't eat our young. People don't learn well under that stress. But ultimately, my biggest reason is because at the end of the day, if I can help anyone who wants to do medicine or is in medicine, if I can help them even learn one thing and they save one life, it's about that patient's life. And at the end of the day, like, what do I have to do to help you help others so that we can save all the lives? That's really what it comes down to.
[08:06] Michelle: Absolutely. And you're so effective in what you do. Okay, so now you're a PA and you have all this history behind you from 13 years as a paramedic, and you obviously are going to bring a lot of that to your practice. And my personal experience with PAs, the hospital where I was employed for 40 years, we employed PAs and they were mainly in the emergency room setting. And I would see them when I would go down to the ED to start an IV or resuscitate a baby. And they always seemed like a mystery to me. I didn't quite know what they were all about, what they did, how long they had to go to school. So talk a little bit about that.
[09:03] Jennifer: Yeah. So the school was a two-year program. I went to the UC Davis FNP/PA program. It was a combo program. So I was side by side with NPs, which was great. And it really fostered a collegial relationship. So if they went in as a nurse, they came out as an NP. Anybody who went in as anything other than a nurse came out as a PA. And the school is quite intense and consisted of didactics testing and of course, rotations. And it really was a lot of cramming. So, the advice I've given to people who are thinking of doing it, I always tell them, to take care of literally every single thing in your life before you go into this because it will completely consume you. People joke it's like a mini medical school crammed in, and it's really true. And the testing is rigorous. But I feel like the one thing we don't do enough in school and this is just my opinion is probably because we don't have enough time. I don't feel like we teach enough critical thinking, enough differentials, and enough how to talk to people and also how to read body language, because in an everyday interaction, there's so much being said by someone's body language, and if you're not picking up on it, you could be going down the wrong pathway with somebody and you won't even know it. For example, if you start talking about a statin and somebody crosses their arms or tilts their head or leans back or furrows their brow or tightens their lips, they're not going to take your statin and they're not going to ultimately get better. And there are little things like that. There are differentials. And so that's why I've been trying to fill a gap. Currently. I don't know if you've been following, but for the past two weeks, I've been doing a segment every day called Guess What's Wrong With the Patient or What Should We Do Next? Because those are little bite-sized pearls. People can watch on their break really quickly and learn a little something that's very valuable. And it also forces us, like you said, to think about something, because we're not taught how to think about things. And the biggest thing that I think is missing too, Michelle, is that I think we're not teaching people the why. We're teaching them the what. Oh, hypertension. Here's how to identify it, here's the pill, maybe some lifestyle sprinkled in, but we're not really taught to ask why. We're not looking for a root cause. And that is a piece of medicine that needs to be at the core, because if you think about it, even something as simple as hypertension, a lot of people have sleep apnea. I'm the one diagnosing it in the cardiology clinic. It's not happening in primary care, and it's not happening because we're not taught the model of why. Honestly, that should be one of our first questions for any chief complaint, well, why aren't they having that? What could be at the root? Because we just have this mentality of giving the patient a pill for the ill. Oh, you have a rash? Okay, here are some steroids, here are some benefits. But why do they have the rash? A case at the ER yesterday where same thing, and she ended up actually having a rash from stress. There's something called stress urticaria, and that was what was going on. But if you don't ask the questions, you won't know. And you'll just blanket medication somebody, but you're not fixing the problem, and it's going to keep coming back. So I really feel like our new generation of teachers and educators would benefit from incorporating that. Because here's the other thing. As I get older and I'm looking back now, I'm thinking, we have to do better, because those generate the next generation coming through. They are going to take care of us one day, and they are going to be the ones that pass along our knowledge to the next group right and the next group. And so I feel like it's the onus on any PA or NP to give back in any way you can, whether you have a new person hanging around, a new orientation person, just teach them what you know because we're all in this together.
[13:29] Michelle: Well, I like a lot of what you said, but in particular, this is like, about having a relationship with your patient, right, and getting to know them, asking the whys, asking them what's going on, asking the open-ended questions. And I want to touch on a publication that I read of yours that was in EMS World from 2007, and something in it just really popped out at me, and I thought, wow, she's really my person. It's Difficult Situations and How to Talk Your Way Out of Them. And there was a quote that you said, "By treating these patients like the people they are instead of the problems they have, you will avoid making a bad situation worse. " And then in your bio, you said, "On my clinic day, I see no more than 17 people a shift." Now, you could have easily said, "I see no more than 17 patients a shift", but you said, people. And that's where I just really connected with you. I just had an interview with a fantastic nurse in tech, and he also has an ER background, and he said that patients are people. And he said, I will say it again, patients are people. And I think if you go into it with that mindset, you're just going to come out on such a positive side.
[15:11] Jennifer: I 100% agree. It's really true.
[15:15] Michelle: And medical professionals are people, too, right? We have feelings, we have hopes, we have dreams. And the way that you teach, I think it really recognizes that.
[15:27] Jennifer: Well, thank you.
[15:30] Michelle: Okay, so where do you mainly work, Jennifer? I know you work in a cardiology clinic, and so just talk about some of the places that you work.
[15:40] Jennifer: I work in a cardiology clinic, and I have to say that it is the best job I have ever had. I've been there, I think, 15, 14 or 15 years, and I love my job so much because not only who I work with, my docs and my staff and the patients, all of them, but I love the fact that I get to go to work. I wake up every day, I'm not burned out at all, and I get to go because I know that I'm going to change some lives. I know I'm going to make a difference. I know I'm going to take away some pain emotionally or physically in some way. I'm going to give someone peace of mind. And if someone's having an end-of-life situation, I'm going to be the one that's going to help them through that and be the soft shoulder or ear that they need. And I guess it just kind of amounts to I get to bring my knowledge. I get to solve puzzles all day. I get to be there for people, and that is so exciting. But I also work in the emergency department, and I love that, too, because it goes back to my EMS roots, where I get to I'm not there to connect with patients as much. I'm there to get in and get out, get them patch up the proverbial tire, and get them back on the road. Right. But of course, I'm still connecting and making their experience as amazing as possible, but it's different. And I like doing that kind of medicine, too, because you get to sort of get into someone's field really quickly, ask a lot of questions, and it's just normal. You just get down to business, and you have access to all the testing, whereas, like, in the clinic, you have to get authorization from insurance. But in the ER, it's like, okay, what do I think is going on? What do I want to order? And you get to order it and figure it out in that visit. And there's something super satisfying about that because a lot of times in outpatient medicine, you're like, oh, I have to wait.
[17:48] Michelle: It's that instant gratification that we love, right?
[17:51] Jennifer: Airplane.
[17:52] Michelle: Yeah. Are you at an airport?
[17:56] Jennifer: No.
[17:59] Michelle: I know where you are.
[18:00] Jennifer: Okay.
[18:00] Michelle: Yeah. You're in Salinas. Is there a base there?
[18:04] Jennifer: No, I think we're in a flight path.
[18:08] Michelle: Okay.
[18:09] Jennifer: But the other place I work is telemedicine, and I do urgent care Telemedicine. That's a whole different ball of wax, which is fun. It's challenging, though. It's fun, but it's challenging. It's fun to be home. It's fun to have very low-acuity things to think about. You're not really diving into anything complex, which is really nice, but it's also hard because most of them are phone visits, so you can't see the patient and the physical clues are missing. So that's quite challenging in and of itself, but it's nice to change it up so you can work many different specialties. As a PA, you can kind of like nursing and pick your pick what you like, and if you get tired or bored, you can go specialize in something else. And it's just so fluid, which is great. I mean, you could easily transition. Not as easily as nursing, I think, but it's still possible.
[19:11] Michelle: Yeah, it sounds very similar to nursing in that there are so many different fields that you could go into and so many different settings that you can work in. How did you end up in the cardiology clinic? How did that happen?
[19:27] Jennifer: So, I ended up being during school, I knew that I loved the heart, and I figured it out pretty quickly when I was a paramedic because I would go on trauma calls, and I would, like, just be bored out of my mind. I mean, you could have, like, the craziest trauma, and I would just be like, snooze fest, popping a line. Let's go. But then if I had a chest pain call, my ears perked up, my eyes perked up. And I was loving getting to watch the heart try and tell me what was wrong with it, using its electricity to put waves on the paper. And I was like, sold. And I saw so many sick hearts. Of course, being on the ambulance, I saw so many dynamic changes. And I always felt like it was a race. Like it was a race to figure out what was wrong. It's a race to get them to the hospital. I'm going to keep them alive until I get there. And it was just such I don't know, the heart speaks to me on so many different levels, really. And it's funny because I tried going when I got out of school, I tried going into primary care, and I worked in primary care for about two months. And every time I heard hypertension or chest pain, I would literally just leave whatever I was doing. I would go wherever that patient was, and I would just be like, I didn't care if the doctor was there. I didn't care. I was like, just like this moth to a flame. And I realized, okay, this is clearly something I need to do. And so I ended up interning a little bit. And then eventually it's kind of a funny story because I was working at the ER. At the time as well. I've always worked in the ER the whole time. And the cardiologists would come into the ER. And they were so busy, and I was always trying to find a reason to have to talk to them. I have to ask them because I love them all now. I'm really close to them, but I have to ask them, did you think I was like, this complete mosquito just bothering you? Because they'd be like, looking at any kidney or talking to a doc. And I would just sidle up next to them. They would look at me like, who are you? And I would be like, oh, I was just wondering, did you see that article about they'd be like, what are you doing here? Go see that runny nose. They're like, Leave me alone. And then eventually, I started taking care of the sicker patients, and then I was getting to interact with them, and they could see they were like, oh, she actually knows what she's talking about. And then eventually they hired me. And flash forward to many years later, the cardiologist that I was most afraid of. That was so intimidating. He actually ended up walking me down the aisle as my dad to marry my husband. And he really comes full circle. Yeah. And it's funny because my husband and I worked 24 years ago. I think in the end, I was together as partners, so many full circle things. But it's funny if you're meant to do something, you're going to find your path or it's going to find you, and it's all going to work out. And I think that's something that we have to have faith in. You can't escape your purpose. You just can't.
[22:53] Michelle: Yeah, well, like the stoics say amor fati, right? Like, love of fate. It's like it's going to happen, really, whether you wanted it to or not. It was kind of destined. I do believe in that. So in your cardiology clinic, what type of patients do you see? What kind of things do you handle?
[23:19] Jennifer: All of it, so post-ICD implant, new consults for chest pain, shortness of breath, palpitations, weakness, fatigue, abnormal EKG, pre-op clearance. You name it, we see it. And the really cool thing is that I get to fly as high in the sky as I want to. Meaning I don't get micromanaged. My docs know that I know my limits, I know when to ask for help, and they're there if I need them, but otherwise, they just let me run my practice pretty much just solo so I can sometimes be in a clinic and there's no doc. I mean, of course, we always have electronic communication, but it's so much fun because every day is different, and you have a mix of new folks that you really get to. I love that moment of building the rapport and taking somebody who's so nervous and so scared and walking through what you think it is and what the plan is and what's going to happen next, and they leave smiling. I love that. And then I also love seeing the patients who they've had something happen to them, and you've been there all seven years with them through the thick and thin, and that's really neat as well. So it kind of feels like you become part of their tribe. And I never, ever, ever thought I would like that part of it, because being a medic and being in the ER, I really liked that I didn't have to connect with anybody, but it's really kind of transitioned to where I love that connection. In fact, recently, a couple of patients have passed on. Their spouses will be like, hey, just wanted to let you know. Thank you. He really enjoyed his visits with you. We really appreciate your care, and it's nice that you got to be part of that.
[25:18] Michelle: Yeah, it's a special relationship, for sure. And there are so many parallels. Just talking about the feeling that you get when you've helped somebody through a really difficult moment. That's one of the things I loved about the NICU parents would come in and the mom's having a 25 week and the dad has this deer-in-the-headlights look. And you talk them through everything and get the baby settled and start providing so much education and comfort for the family. And you're there with them for several months as their baby grows and develops and they learn about their baby. And it's just such a special relationship when you can see them going from very scared, unsure, is my baby going to die? To feeling confident and competent as parents, to see that progression is really satisfying.
[26:22] Jennifer: Yeah, that's a whole nother level, for sure.
[26:26] Michelle: Yeah. And it sounds like you're working at the top of your scope of practice and that you have so much freedom, and that has to feel really good.
[26:36] Jennifer: It does.
[26:40] Michelle: One of the questions I had was, have you encountered individuals either in the emergency room or your practice, that said, I want to see the doctor?
[26:50] Jennifer: Yeah, actually, there have been a few times. Yeah. I mean, honestly, that's their right. I don't ever take offense to it. They usually can't see the doctor that day because they're booked. I just use this as an opportunity, say, okay, definitely get you in with the doc. Well, if they're in the ER, it's easy. Right. In those cases, that's fine, but in the cardiology office, it's a little different because those docs are booked out, and so they probably know that because that's me if they're like, a chronic patient of the other doc. But anyway, what I do is I use it as an opportunity to immediately say, yes, we will make that happen for you, no problem. Take care of that. As soon as we leave, I'll walk you right up to the desk and we will pull all the strings for you. In the meantime, I'm looking at your chart here. I noticed you came here for shortness of breath. Do you want to talk about that a little bit and maybe I can perhaps get some tests started for you? And then once they're like, oh, well, I didn't realize you could order. Yeah, we can order some tests, and if you tell me more about your symptoms, we might be able to get some labs going. And then by the time you see the doctor, you'll have some more answers for him or her to look at, and that way you can get to the answer quicker. And then once they interact and they see that I know what I'm talking about, I'm confident and not frazzled, I think they're like, okay, well, yeah, there is some value here. Let's do that. I like that idea.
[28:26] Michelle: Wow. I love your approach. Imagine a different approach where you got defensive and how that would really impact the relationship. I think it's just a misconception of the public of what your scope actually is.
[28:42] Jennifer: It's going to take a long time to fix it, and honestly, not every provider, doc, PA, or otherwise, sets a good example. So I think there's always going to be that bad apple somewhere along that patient's lineage too, right?
[28:56] Michelle: Yeah.
[28:57] Jennifer: It's just a matter of going back to those very basic skills that I really think we should all be taught, which is building the rapport quickly with somebody deescalating a situation, and getting to the root of what they're really asking. If they're saying, I want to see the doctor, what are they really asking? Are they asking, they don't trust you. What's the root issue? And you can even call it out. Sometimes if I have patients and I know I'm not going to get anywhere with them, they come in and they seem angry. Sometimes I know I'm not getting anywhere. They have closed body language and they're just really short answers. I will just call it out and I'll say, it seems like you may be feeling upset. Would that be an accurate description? And sometimes people don't even know how they're coming across. And once you kind of call out the pink elephant in the room, they can say it is that or it isn't that. I don't feel like often we have the time in visits to do that. In those situations, I always make time because when you can feel that emotion bubbling and it's right there and it's just about to come out, I'm going to sit there, I'm going to be patient, I'm going to coax it, coax it out. Because once people let that bubble burst, they feel so much better, and then they're not coming back with chest pain and palpitations and they're happy.
[30:24] Michelle: That's an art form. Is that something that is just inherent in your personality? Or did you have any kind of training along the way just to be able to talk to people in that way or connect with people like that?
[30:40] Jennifer: I think it's just something innate. Yeah. I don't know how or where I got it, but there is just this quality of being able to connect. And I think it's a combination of things. It's honestly, listening to your intuition. I think that we're taught in medicine not to do that. Science, science, science. But if you use both, what's my gut instinct? Back it up with your testing. I think that's a great recipe. But listen to your intuition. Read the body language, and see how the room feels. Because we don't realize it a lot of times, but when you walk into a room of a patient, sometimes you just feel yourself, like, really anxious. You don't know why. It's because it's exuding from the patient. We pick up a lot, a lot of things that we don't really realize we pick up on, and that's part of it. So I think just being more aware and then how people respond and then word choices is a super huge thing because you always want to make sure you're not being judgmental, not using judgmental words, and making it a safe place so the patient feels comfortable to lay that stuff out because it can be a vulnerable time. And honoring that vulnerability and providing them that safe place to trust because a lot of people just don't have it anywhere else. And honestly, therapists are very hard to get to access-wise, at least in our area. And so some of these patients are just wandering around with nobody to really talk to, and sometimes you can be that person. Now, honestly, should it be me as cardiology? Probably not. Should it be family practice? Probably. But you know what? Why don't we just all take a little bit of it and be there for our patients in any way we can?
[32:26] Michelle: Like I said, it's an art, and not everybody can do it.
[32:32] Jennifer: It's funny because my boss, he always says, if there's a difficult patient, give them to Jennifer. And I'm like, I don't mind that, actually. I don't really feel like there are difficult patients, there are just difficult situations and it's just a matter of finding how to reach them.
[32:51] Michelle: Yeah. So, you know, you're like the patient whisperer.
[32:54] Jennifer: I do love that title. It makes me really happy. I really do love that, being able to be that for patients. It's what I would want as a patient.
[33:05] Michelle: Exactly. Well, what's your schedule look like when you're in the clinic and then when you're in the ER? Like, what kind of hours do you work?
[33:14] Jennifer: So in the emergency department, I work 2-10:30 and you don't get a lunch, but you sneak off to eat when it's slower, but it goes by fast and you bring snacks and it's fine. I used to work ten-hour shifts prior to that in urgent care. When I did do a little urgent care, I was working ten to twelve-hour shifts. Those were really hard. But in the clinic, I usually work from 8:30 to 5 pm with an hour of lunch and it just goes by fast. I do not look at my watch. It's already lunchtime. Oh my gosh. So the hours are great for obviously spending time with family clinic hours. And it's interesting because my whole entire life working in the ER as well, I always have worked holidays as well, and as a paramedic. And so we just kind of do holidays on a different day because my husband was a paramedic for a long time too, so we would just reschedule. Oh yeah. Christmas we're going to do on the 27th.
[34:19] Michelle: Been there, done that many years as a nurse, and your kids know that Christmas this year is not going to be on Christmas. It's a different day.
[34:33] Jennifer: Yeah.
[34:34] Michelle: It's just part of the work. Right?
[34:38] Jennifer: Yeah.
[34:40] Michelle: Well, I saw that you have several certifications, so tell me what those are.
[34:44] Jennifer: I have a CAQ for the ER, so it's a certificate of added qualifications. It's sort of I guess the closest thing it would be would like the board certification. And in ER, you have to pass a special test and you have to renew C for that specifically. I am working on getting there's a new one coming out by the American College of Cardiology in October and yet another plane. And I'll actually be working on getting that. I'm going to be leading a study group, actually, for a bunch of NPs and PAs. We're going to study together and try to get ready for that test that's a little bit more similar for board certification for NPs or PAs through American College Cardiology. So that'll be coming. But yeah, I think at the end of the day, I got to tell you a secret about certifications. They look good on your resume, but to me, I'm not always that impressed by the certifications. I'm impressed by, let's see what you can do with a patient and let's see what you can do in the room with somebody. And then let's share notes because somebody can come out with all these degrees and certifications, but they can't get the same answer, right?
[36:09] Michelle: I mean, there's those people that are very book smart and they test well and they get all those letters behind their name, but clinically they don't cut it.
[36:21] Jennifer: Yeah.
[36:22] Michelle: So the perfect practitioner would be someone who can cut it and has all those letters behind their name. Right?
[36:31] Jennifer: Yeah.
[36:32] Michelle: Well, I also saw that from a publication that Governor Jerry Brown appointed you to the California Physician Assistant Board. And that was in 2016.
[36:44] Jennifer: Yes. And I was reappointed, so I complete my term in about a year.
[36:49] Michelle: Very cool. Tell me what kind of work you're doing on there.
[36:52] Jennifer: So actually, really what we do is we monitor the legislation coming through that affects PAs, and we also sort of act as a jury. I guess there are nine of us, and when we go into closed session, if there are accusations and claims and suits that have been brought against providers for whatever reason, we decide if we are going to accept the proposed decision or if we would like to propose an alternative solution or decision. So it's made up of a couple of PAs and then also just like an accountant, an attorney, just random members of the community. And it's supposed to balance out the whole board. But it's really a pleasure to serve because the basic goal is public protection, and I end up feeling very passionate about public protection at the end of the day. So I like that role. And there's a lot of great people doing some great work.
[38:02] Michelle: It's really neat to see that meeting with all those different people and seeing what they're doing for the main goal of safety.
[38:14] Jennifer: Right.
[38:15] Michelle: Yeah. That's cool. I'm going to venture out and say that, you know, 100% everything about the heart, right?
[38:30] Jennifer: No.
[38:32] Michelle: Oh, good. I'm so glad you said no, because, of course, we can't ever know everything. But, you know, 99.9% but for that .1%, who do you go to? Who's your guru? What resources do you when you need to brush up on something or learn?
[38:54] Jennifer: Well, there's Up-to-Date that's obviously the best. There are two people that I like that I resource for patients when we need to go more of an alternative naturopath route. And there's a cardiologist that's working out of Scripps in San Diego. Her name is Dr. Mimi Guineari, and she was an interventional cardiologist turned into sort of a holistic cardiologist. And she opened up a center where they have like, acupuncture, yoga, cooking demos, healthy eating, supplements, blah, blah, blah, all the things right, and mindfulness. And I love her resource because she did something called a great course, and it's available on Audible, and she talks about ways to naturally lower your lipids and naturally lower your blood pressure with different foods and supplements, and she gives the science to back it up. And so I always refer patients to that course because it's easily accessible as you can get it for 19, I think, dollars now, on Audible and just download that one thing and be done. And it's such a great resource. And then for patients who come that are like post-stent or have any coronary artery disease, there's a book called the 30-Day Heart Tune-Up by Dr. Steven Masley. And that is a book that when patients ask, hey, I have the stent now. And the whole visit we're talking about like, take your beta blocker, take your aspirin, cardiac rehab, blah, blah, blah, all the things that we need to talk about. There's this whole other piece that we can't ever get to, not ever, but rarely, and it's the nutrition lifestyle piece. And he talks about that and how to actually regress plaque progression. And so his book was made aware to me, actually, both of these resources by my cardiologist, my interventional cardiologist. And he said when I got there, he said, Jen, I need you to know this book because people are going to ask you a lot of questions about things and you're not going to know or you're not going to have time to give them all the answers. But this book was a great resource. So he told me about that book. And finally, the third one is for patients who have issues with AFib. And honestly, I feel like the AFib visit is one of the most time-intensive because not only are there so many treatments and therapies and options, but there are always a lot of questions and you can't answer every question. And then a visit that a patient has, they'll think of something. Later, they'll talk to a friend. So there's a book called Restart Your Heart by Dr. Asim Desai. He's also out of Southern California, seems like that's where the talent is. And he does a book, it's half written. Like, half the book is written for the patient. All the things that they should ask, logs they should keep. He explains triggers, he explains treatments, what to expect, and how this works. And then the other half is actually for providers where he talks about the anti arrhythmics. When do you use them, what are the side effects? And it's just a great resource as well. So those are my three go-to things.
[42:15] Michelle: Well, I want you to send me the links to those because I'll definitely add those to the show.
[42:19] Jennifer: Oh, great. Yeah, definitely.
[42:21] Michelle: Yeah. Well, do you have any advice for someone who's considering a career as a physician assistant? Maybe they're on the line.
[42:30] Jennifer: Do it. It's the best job in the world. I mean, we need you, but also, it's so great. I feel like it's the best of both worlds. You have somebody, your collaborating physician to help you if you need it, but you also can fly as high as you can at the highest of your scope, and it's just such a great position. And patient satisfaction with PAs and NPs is through the roof when you look at the data because maybe it's because we have more time to spend, maybe I'm not sure what it is, but patients are really happy with us, and so their satisfaction patients are satisfied. Our job satisfaction is usually good, especially if you pick a profession you like. And when you are choosing, choose something that you would go to work and not get paid for. Like, I would never tell my boss, but I would literally do my job for free if, like, in another universe because it's so fulfilling. That's the great thing about being a PA. Nursing, I think, is fulfilling too. But for me, the reason I didn't choose nursing was because I need to be able to create my own recipes, so to speak. I need to do that critical thinking piece and really craft my plan. And that's always been really important to me. So that's why I chose the PA route. Otherwise, I would have gone nursing. Just there's so much more flexibility, and honestly, the pay is a lot better a lot of times for nurses, so there's a lot less liability for nurses too, which is nice. But still, I think at the end of the day, a PA is a great position.
[44:20] Michelle: Well, I love that you said that you would do it for free. I feel like that's how you know you're in the right profession. And I will say the last ten years of my career, I was a developmental and lactation specialist for the NICU. So it was kind of a niche job. And I really would find myself saying that many times, like, I can't believe they're paying me to do this. This is the best. Yeah, I loved it. Well, before we get to Cardiology Made Easy, I wanted to just touch on some professional organizations that I saw that are out there for physician assistance. So there's the Physician Assistant Education Association, the American Academy of Physician Assistance, the Accreditation Review Commission, the National Commission on Certification of Physician Assistance, the American Medical Association, and then a couple of California Academy of Physician Associates and the California Medical Association. Familiar with any of those?
[45:32] Jennifer: Absolutely.
[45:35] Michelle: And again, those are great resources for publications, seminars. I'm a big fan. I talk a lot on here about professional organizations. So there's a lot of them for your specialty.
[45:50] Jennifer: There sure are.
[45:52] Michelle: Well, let's talk about Cardiology Made Easy. So you create a ton of content. You have a website, you have an Instagram, you have a YouTube, you have a Facebook, you have a LinkedIn. How do you do it all, Jennifer?
[46:14] Jennifer: So it's so funny because my cardiologist, we were out at this dinner learning about one of the drugs, and he literally, literally said that to me. Are there two of you? I don't know.
[46:30] Michelle: Yeah. Or ten?
[46:33] Jennifer: It is. I'm really efficient and I commit to it. So it's on the priority list. Like, for example, when I drop off my dog in the morning, usually in the parking lot before I head off to work, I do a quick Instagram video that goes on to my Facebook page. I download it, goes on to my TikTok. I do free trainings. I just did a whole free three-night EKG training last week for our Facebook group, which has almost 18,000 people in it. And that's just something I love to come home and do after work. Luckily, I have a supportive husband. You just do it, I guess. I love it. And I'm actually getting ready to go on tour across the country and speak at six different conferences starting in August.
[47:31] Michelle: Oh, my God.
[47:32] Jennifer: Yeah. I'm going to be doing the Skin, Bones, Hearts, Private Parts conference in five locations. And I'm doing the North Carolina Association of PAs in Myrtle Beach. So those days and the Skin, Bone Hearts days, I actually do a whole eight-hour day of all my cardiology content and EKG content. And I still have more leftover, so it's fun. And I also have this 30-day EKG challenge group, which is like, our paid group. And we have guests all the time. And we have lipid corner. We have sleep apnea corner. We have, of course, obviously, EKG training, but we kind of keep it spicy. We change up the topics and really keep it interesting for people. As new guidelines come out, we keep people updated. And as new things change, we definitely keep them apprised. So it's just fun. And you just get really good at juggling.
[48:32] Michelle: Well, I have such respect as a podcaster, so I'm almost at my one-year mark.  I've had to navigate kind of all this social media stuff, and I'm getting better. I post at least once a week, but I'm trying to up it to, like, three times a week. I always say I don't want to pester people, but you got to get your word out there and you got to be seen. And you do it with such flair and such fun. As I said, I love those impromptu quizzes. I'm always like, okay, get your brain ready. Don't look at any of the comments. And that one that I got right. You should have seen the look on my face, like, oh my gosh, I'm a NICU nurse and I got that right. I can't believe it. So I'm challenging myself, and I know that a lot of other people out there are doing the same thing, too. So thank you for all the education that you're doing.
[49:45] Jennifer: It's my pleasure. I really love doing I think I like interacting with people. Like, I feel like it's just I have a big classroom and get to interact 24 hours a day. If I'm awake in the middle of the night, I can answer the questions. So here's something interesting. I don't want to bombard people either, but the reality is that about two to three weeks ago, I started these guest diagnosis things just because I wanted to have fun with people. I wanted just to enjoy just being present and hearing what people have to say and going bigger, being louder. Right. So since doing that, I think something went viral, and I think it has to do with doing something. Every day, the followers have grown, like, in a week, like 4000. I can't keep up with the comments and I feel like something went viral somehow. But I think when I was first learning about marketing, I was always taught to be consistent. The algorithms like it, and I think there's something to that. So I would say for you, if you want to post more than once a week, I think the algorithms like that.
[51:03] Michelle: Yeah, I have really upped it. I'm doing some weekend posts now, and I just started doing ICYMI Mondays, where I post like, a previous guest and the link to their episode. And I have really seen a lot of growth with that, just adding a couple of days a week. Because with social media, as you said, you want to be seen and there are people looking. Right. That's the other thing, because I say I don't want to pester people, but people are out there looking for what you are putting out there. So why not put it out there?
[51:44] Jennifer: Yeah, if they don't want to watch it, they don't have to. That's great.
[51:46] Michelle: There you go.
[51:47] Jennifer: You're not bombarding anybody.
[51:50] Michelle: Yeah. And one of the things that I saw was a beautiful collaboration with your friend and mine, Nicole Cromwell.
[51:58] Jennifer: I'm glad you brought her up.
[52:01] Michelle: She's amazing. And you're an artist as well, so tell me about that.
[52:07] Jennifer: Okay, so first of all, just got to tell you the backstory is that I've known Nicole since I was a paramedic. I used to bring patients to her at the emergency department when she was an ER nurse. And even back then, I loved her. I have a picture of her and me and another nurse or my EMT partner, standing together looking like Charlie's Angels. We were doing that pose. She had an IV bag in her hand. I had a catheter. And I just knew the second I met her, she's someone important in my life. You know that when you meet her, she's amazing. So recently she's had this brainchild cooking for a long time, this therapeutic painting course. And so she came to me because we paint together sometimes and the things we make just turn out beautiful. I think it's our energies, like mingling, which makes them so pretty. She said, Jen, actually I would like you to help me with this painting course and come be part of it and let's bring both of our magic together. And so we are now doing that. And so we're planning our painting retreat that's going to be free and it's going to be at the end of the month. And it's basically designed to give healthcare providers a place to decompress, to get out of their heads, to have something creative to do. And it is so stress relieving. And her whole mission, I know you know this, but just to reiterate, is like she wants to save all the health care providers, right? To make sure that they don't suffer. And this is a great way that she found to decompress. Literally, my whole cardiology office is covered in paintings that I've made. It's therapy. And if it can be therapy for us, it can be therapy for others. And even if people don't paint well, in their opinion, it doesn't matter. It's the act of putting the paint on the canvas and just the process. And so it's funny because one of the guys where I'm editing my videos for the course, this is so funny. He's non-medical, he's not anything. And he said, hey, are you going to have any more of those painting videos for me to edit? Relaxing. And I was like, that's the proof right there. That's it. So I think it's going to be a success. We're going to announce this very soon, so you're hearing about it first. But we're going to be putting in we have this course that's being created and almost ready to go. And it's going to be mostly geared towards our ends, but also to EMS who could benefit. And, of course, PAs MDs, anybody medical.
[55:00] Michelle: Well, it's just such a great community that we belong to: nurses, PAs, nurse practitioners, first responders, and we're all here to support one another in our endeavors. And we all have the same goal, and that's to help people. And I like that we are adding helping each other to that goal.
[55:25] Jennifer: Me too.
[55:28] Michelle: Yeah. So I'm going to add that link to the Monterey County Weekly story that talks about you and your art and shows your art. Yeah. Really beautiful. I love what you're doing on so many levels Jennifer.
[55:43] Jennifer: Thank you.
[55:45] Michelle: Yeah, it's been such a pleasure to talk to you. I really appreciate you being here today.
[55:49] Jennifer: My pleasure.
[55:52] Michelle: Well, you know, at the end we do the five-minute snippet. And I know you're up for it because you're a former kind of adrenaline junkie. So are you ready to get started?
[56:04] Jennifer: I'm ready.
[56:06] Michelle: Okay. I'm going to put my timer on, and we will just start. What is the one thing that you'll be disappointed about if you never get to experience it?
[56:25] Jennifer: Owning a bakery.
[56:29] Michelle: Oh, my gosh. What do you bake?
[56:34] Jennifer: Brownies, cupcakes, cookies. A second, though, would be and I may do this, I'm pretty sure I probably will at some point. I want to open up a German shepherd rescue.
[56:46] Michelle: Oh, wow. Okay. You got to work on that. That's awesome. I love it. Okay. This is a would you rather,  so with a stranger, WYR play 20 questions or truth or dare?
[57:01] Jennifer: 20 questions, because I want to get to know them.
[57:06] Michelle: Man, I pegged you for that. That is so perfect. Okay, what scares you that doesn't scare most people?
[57:17] Jennifer: Becoming too emotionally attached to my patients.
[57:23] Michelle: Wow. Okay, that's deep. But I expected a deep response from you. Would you rather perform singing telegrams or would you rather be a wedding singer?
[57:37] Jennifer: Singing telegrams. Because the element is surprise.
[57:42] Michelle: Surprise, and then it's just over. Right? It's just like, here I am. Here's your song. Goodbye.
[57:49] Jennifer: But people smile. Who's not going to smile at that?
[57:53] Michelle: Absolutely. What specific work of art do you admire?
[58:03] Jennifer: Right now? There's a heart painting that Nicole and I made that is in our office, and it's my favorite piece ever. I just can't get enough that probably a second favorite would be there's a painting by Flora Bowley who inspired both Nicole and me in the very beginning. I don't remember the name of it, but it's jewel-toned and it's just gorgeous. It's got a goddess on it. And so a lot of my paintings have goddesses in them as well.
[58:36] Michelle: Sounds lovely. Would you rather for an entire month, would you rather have insomnia or amnesia? Just one month.
[58:48] Jennifer: Amnesia, yes.
[58:52] Michelle: Sleep is so important. Yes, it is so important. And for the heart, too.
[58:58] Jennifer: For everything.
[59:00] Michelle: What do you do when you want to get out of your own head?
[59:04] Jennifer: Go on a bike ride.
[59:06] Michelle: Did you do that this morning? I knew it. That's why we're recording in the afternoon because I think you said you have to go on your ride this morning. Where do you ride?
[59:16] Jennifer: Along the beach.
[59:19] Michelle: Oh, my God. What are you superstitious about?
[59:34] Jennifer: Saying quiet in the ER.
[59:36] Michelle: Disastrous. Does your name have a special or significant meaning, and if so, what?
[59:45] Jennifer: I don't know, and I'm not sure.
[59:49] Michelle: Well, I'll tell you what. I looked up your name, because my sister also has the same name, my sister Jennifer, and it means the fair one. And I said that is perfect for Jennifer.
[01:00:03] Jennifer: Yes.
[01:00:06] Michelle: So you are the fair one. And I'm out of questions, and we still have 56 seconds left. That's crazy.
[01:00:14] Jennifer: I don't need to think about things. I just snap.
[01:00:21] Michelle: You did so well. I love it. And it's been really fun for me to talk to you and meet you, Jennifer. I just appreciate you being here and bringing all of your knowledge and your expertise and your advice to my listeners.
[01:00:38] Jennifer: Keep guessing on the guess what's wrong with the patient post. And keep having fun with that.
[01:00:45] Michelle: You know I will. I appreciate you going easy on me. I think I had said a comment like, let me down easy. I'm a NICU nurse. And you were so sweet, so thank you so much.
[01:00:57] Jennifer: I always appreciate anybody guessing because it's vulnerable. So I'm going to honor that.
[01:01:02] Michelle: Yes. I love it. And that's what we're looking for, engagement, right?
[01:01:06] Jennifer: Yeah, absolutely.
[01:01:08] Michelle: Well, you take care then.
[01:01:09] Jennifer: All right. Thank you so much. Have a great day.