Taking Healthcare by Storm: Industry Insights with Tiwana Miller

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Tiwana Miller, PA-C, a physician assistant and community health advocate.

Tiwana shares her career journey from clinical laboratory science to various healthcare settings, emphasizing the importance of empathy, preventative care, and patient empowerment. She discusses the impact of COVID-19 on her work, her research in obesity and diabetes, and her dedication to improving access to healthcare for underserved communities.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

Publication number QI-101725-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

 Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical Director of Quality Insights, and today we are highlighting an individual who's making a difference, both in the clinic and in the community. Today we're joined by Tiwana Miller, PAC, a dedicated physician assistant.

Researcher and community health advocate with a powerful story to share. A native of Wilmington, Delaware Tiwana begin her career in clinical laboratory science before earning her master's degrees in biomedical chemistry and medical science. Over the years, she's worked in a variety of clinical settings from adolescent health and correctional medicine.

To Cancer Care, planned Parenthood and now school-based healthcare and a free clinic serving indigenous populations. So she has a tremendous amount of experience. Her journey has been guided by one clear mission, expanding access to high quality care for underserved communities. In this conversation, we're gonna talk about how COVID-19.

The pandemic shaped her perspective, what she learned from her research in obesity and diabetes, and how her work in diverse care settings has informed her approach to preventative medicine, outreach and advocacy. Tiana, thank you so much for joining us today. Sure. Thank you for having me. You began your career in clinical laboratory science, as I stated, and later became a physician assistant.

Can you share what drew you towards becoming a PA and how your background in lab science shaped your perspective on patient care? Sure. So initially I'm gonna be 100% honest with you. I've, I actually set out to be a physician.  That was a desire of mine since I was seven. My dad even still recalls me telling him when he gets old, quote unquote, I was going to take care of him.

So I thought that was super cute. But of course, you know, life happens. I started college and I realized that  I went to a really prestigious university. I went to University of Delaware  and I realized that, you know, it was gonna be a little challenging, more challenging than I thought it was going to be.

 And to get into med school, you have to have a really strong science GPA. So therefore, I pivoted as a sophomore into the clinical laboratory science program  where I was told. If I wanted to do pre-med, this would be a great, you know, pivot for me. They would help me get my GPA up and help me to keep my eyes, focused on the prize.

And that was med school.  But again, life happened. I really enjoyed being a lab scientist. When I got outta school I was able to see. The patient from a different perspective. And I always tell people they  chuckle  when I tell them  that, you know  specimens speak so  the patient is still talking to you  but they're just talking to you in a different way.

 So there are specimens usually what we're real, what's going on with. Within their body, and that is whatever is  causing their condition or the diagnosis. So over time I became more comfortable there. I still was working towards getting to med school. I started going to Jeff  and working on a master's in biomedical chemistry.

Again, to boost that science. GPA started doing some research. It again, it really enlightened me.  And the things that I was interested in, and over time I would see my old classmates rotate through the lab who were PAs. And so they were working at the time in the lab as well, but going to school full-time and working part-time to become a pa and I really  got, you know, interested in what this profession was.

So hence for Fast Forward, you know, a year or two I ended up applying to PA school  and I got picked. I love when you said the specimens speak to you. Yeah. Great. I never heard that and I, I love that perspective. So you've worked in such a wide range of settings from adolescent health and correctional medicine, cancer care, school-based health, as I mentioned in the intro.

What is each phase of your journey taught you about the healthcare needs of different populations?  Sure. Yeah. So. Again, sadly  I didn't start off intentionally trying to be so diverse in medicine, but I'm really grateful for it  because it's really, it was kind of like a full circle for me or almost a complete package.

 When I got outta school. It's actually the recession. Okay. So they weren't hiring everywhere. I really didn't have my choice to do what I set out to do. I kind of just had to take what was available. And believe it or not, pain management was before it became crazy as it is now. It was the only option, so was as the pain boom was about to emerge in births.

 So I actually learned the art and skill of doing pain management  because it, it really is a skillset.  And I started doing that as an outpatient. And then eventually I migrated to cancer treatment centers where I did do pain management. And that's how I got to see, sadly a lot of things in the cancer world.

And sadly because that was really heavy for me, I ultimately ended up working in the geriatric population. So literally it was like full circle.  So again  same thought process. You know, I'm working now with more populations that I'm used to. When I was a kid um, the community, I came out of seeing people who look like me and were going through the struggles that, you know, my parents went through as I was growing up, and that.

Became my base, to be honest with you. It's really funny. It's like I'm a magnet, I attract them.  I think it's because I see them as a person.  I don't see their disease, I don't see their background, and I have a lot of empathy and compassion for them.  So wherever I went, it's like, I hate to say quote unquote, some doctors will call, you know, the patient a trained wreck or  I guess the more practical word would be their high acuity.

I always. I collected the high acuity patients.  But they were just the sweetest people who just really wanted an ear for someone to listen to them, to take time out, to take care of them, hear what it is that they're struggling with, and then we would come together and work on plans to improve their health.

And that was just the mission for me thereafter, to listen to people have compassion, have empathy, and actually be that provider that they're seeking out. Yeah. I love that. So the COVID pandemic, reshaped healthcare for many providers, and I know a lot of people wanna forget that it even happened.

 But how did it impact your work and your outlook on  the kind of care that communities truly need? So at the very beginning of COVID, I actually, I was really already suffering from this condition a lot. Practitioners were called burnout.  And it, my patients begin to see it.

And by COVID it really, I  got pushed over the edge because by then, you know, they had shut down all the practices. If somebody wanted to come in, we had to put on a hazmat suit. It was really bothersome mentally, to be honest with you.  A lot of the people who had mental health issues, who had been managing them on their own, COVID kind of pushed them over so they were coming out of the woodwork.

So like we would be inundated by phone visits because again, we didn't have anything in place yet. We had never experienced anything like this. Virtual medicine hadn't really been birthed yet. We had played around with it, but it wasn't really a big thing. So we had to, you know   jump into action is the best way I can put it.

And,  fly as high as we could. As fast as we could, as best as we could. So  I began to see a lot of patients, again doing phone visits, not even virtually yet with video.  And just hearing them crying out for help. Support. So we began to do a lot of counseling over the phone.  We began to start prescribing a lot of mental health meds, anxiety meds.

 We were able to work closer with our counterparts. So again, we had to do all this stuff through teams and online because they weren't even coming into the office. Right? So I had to refer.  And to be honest with you, it really kind of helped to get you, you,  you were able to meet and really engage with your colleagues on a different level because the goal was different at this point.

It wasn't about you, it wasn't what you felt.  It was about making sure that you were helping somebody who was locked in their house, who you couldn't see or touch. So it was really different. I really do feel like it changed the game plan of medicine, but I think it also helped birth a new way to help reach people who we haven't been able to reach before on a consistent basis, like those in our rural populations, those, again, in the underserved populations.

  and it, it, I feel like it brought healthcare to their door. To be, I,  yeah. That's the best way I would put it. It brought healthcare to their doorsteps. Yeah. And that it's needed. Very much needed. Yes. So while working at Cancer Center treatments, cancer Treatment Centers of America, especially in pain management  what were the biggest takeaways for you in caring for patients with these serious illnesses? Wow.  It was very eyeopening.  It was humbling. It really taught me to be appreciative of the life I have and what I have.  And just live every day like it's my last. And I know it sounds pretty sad, but that's truly how I felt.

I met so many awesome people. Their stories were just really. Sad.  But to meet them and to talk to them, you wouldn't know that they had cancer.  Because most of the time, I know this sounds weird, they often inspire you. You left feeling better than you did when you met them because they left a piece of themselves with you.

  And that'll always be memorable for me, and that'll also be something I will, I can always cherish. That's great. So shifting a little bit to something that's. Very much in the forefront of  the news these days and a challenge in the United States, obesity and diabetes. So your research in these areas gave you a unique lens into some of the most common chronic conditions today.

How did that research change how you approach prevention and treatment in your current work? Sure. Yeah. So I really think my past project, I didn't get to publish it, we went through a reorganization smack in the middle. I put a lot of work into it and it really sucks, but  I know I can't take credit for it, but I'm quite sure the research I did led to modern day Ozempic, to be honest with you.

 We did studies and diabetic mice, and we did the same thing that people do. We put them on a diet, they lost weight. Then we gave them this medicine to help them continue to lose weight. And then we fed them junk food to see if they could continue to keep the weight off. Sadly, like most of us do, you know, we lose weight.

 We feel great. We continue to take the medicine and then eventually we do what we revert back to old habits.  And so that is the cutting edge of the research I did. And to be honest with you, it was nice to see that, even though they're animals, they behaved the same as we do, just as people do.

 So it really helped me to get to the bottom of a lot of the behaviors that cause us to do the things that we do. To go back to incorporate, in all honesty, counseling, because again, we need to learn what our triggers are in our lives, what makes us tick, what makes us react the way we do in certain situations.

  As you know, the new word is, you know, people say triggered a lot. Now what is it that you know causes you to return to those past behaviors?  Instead of staying on this new straight and narrow path to take? Ownership of your health. I guess that's the best way I could put it. Yeah. People just say Move more, eat less.

But it's not, yeah. Yeah. Not as easy as that. Exactly. You know? And then once we identify those issues and deal with them, let's be real, we don't really get a chance as Americans to deal with our issues. We're always on the go. Once we get a chance to actually deal with those. Issues  and treat them and acknowledge them, acknowledge our issues.

I think then we're able to carve out that new path and work on ways to stay consistent. So  related to this, when we talked before the, recording  you mentioned that you're interested in pursuing certification as a health coach. Yes. What inspired this step and how do you see health coaching complimenting your clinical work as a pa?

Sure.  Well, because I, to be honest with you, I already do it  most times. When you're working on something as far as training is concerned, it's something that you already do.  So I would love to learn strategies and ways to be more even effective and efficient with that. It's really hard when I was in primary care to incorporate all of that in the great 20 minutes that they give you in a visit.

Right. But wouldn't it be cool after you talk to your provider for that 20 minutes in person, that then maybe you can jump online with them or, you know, on video and actually have a discussion as to, again, what in my life made me like this? Why do I behave the way that I behave? How can I work on the better me?

And let's put some steps in place to do that and have the time to actually, work through that. Yeah. I love that idea. So you're deeply involved in school-based health and work with indigenous populations in a free clinic. Yes. What do you see as, the biggest barriers to healthcare in your community in both of these areas, and how are you helping to bridge those gaps?

So  it's sad, but it's the same age old issue,  money. I'm being honest with you, it's finances, money. I'm sure everybody is aware they're not immune to a lot of the changes that we're going through now politically in our country and our our nation. You're seeing all the cuts and  the different things that are being targeted based off your population and your race and your origin.

And to be honest with you, a lot of it has to do with not only ignorance, but money.  So like for instance, at the free clinic, we do have a trust. There are wealthy people who would donate to that trust. But as time goes on, it's not as many philanthropists out there that. It used to be that, that I acknowledged anyway.

 So a lot of our funding is slowly drying up.  We do work with local pharmacies. They discount our medications, which is great. We have a partnership also with a pharmacy. Should we write prescriptions that they'll give them to us at a reduced rate and then we stock meds in-house.  But the challenge for that group is once they leave race season is over, they go back to their countries, they go back home to whatever state they live in, and just access to healthcare, continuing care  thereafter.

So I might see you in October. Your diabetes is great, but I might not see you again into next April when race raising starts. So, you know, just con continuity of care.  Again, finances, they can't physically afford to continue to,  buy the medications we prescribe or there's a great agent out there that would work better, but they can't afford  to get it because it's just too expensive.

 And the carryover for that, I might have their kids here in school base, same issue, you know  they get great care when they're here in school, but what happens after hours or what happens when they graduate?  They might not qualify  for benefits here, depending on their status or income. Yeah  big challenges.

So you're clearly passionate about empowering patients. Yeah. What do you believe are the most important steps individuals can take, especially in underserved communities? To take ownership of their health and make use of preventative care, like regular screenings and vaccinations.  Yeah, so I, really encourage people  as best you can.

 I know it's hard sometimes, based off, again, financial limitations, but when you're able to, get out there, exercise it's good for your mental health, it's good for your entire body. you know, if you can jog, jog if you can run, run, uh, if you can walk, walk, get out there, get moving.

These also serve again for things for your mental health, which will carry over into your physical body.  And be mindful of that, what you put in, right? They say garbage in is garbage out. Same thought process. You know, be mindful of that, what you're eating. If you can, if you have access to fresh produce.

Eat fresh produce.  Be mindful of, junk food, soda, all the things that we shouldn't have that ultimately not only are bad for us, they make us feel bad.  I try my best to just. Teach them why we should eat the things that we should eat, why we should avoid the things that are bad for us. And then I even teach my patients how to shop in a grocery store regarding where to go to get what.

And when you get into certain areas in a search in a grocery store, I consider them the danger zones. So  if we could start there with those habits and then teaching those same habits to our children and our families, I think we'll go a long way. Those are some awesome tips. And I love, like you teach your patients how to shop in a grocery store.

 That's amazing. Amazing. Things. Thank you. Yeah. Well, Tiwana Miller, thank you very much for joining us today. I've, yeah, it's been an inspiring conversation and I'm sure you inspired a lot of providers and listeners. So thank you again for joining us. Thank you so much for having me. You guys have a great day.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.