Matt sits down with Angela Arnold-Ross, an Australian genetic counsellor living in New Jersey, for a candid and heartfelt conversation about professional resilience and personal growth in the field of genetic counselling. • Sharing the experience of being laid off after 15 years and the emotional impact of unexpected job loss • The stages of grief following a career disruption and how writing became therapeutic • Using networking to rebuild a career path through connections with other genetic counsellors • Navigating the complex landscape of genetic counsellor licensure across different states in America • How the Cures Act has changed counselling approaches when patients receive results immediately • Personal health experiences transforming professional counselling styles and enhancing patient empathy • The importance of advocating for patients and teaching them to navigate complex healthcare systems • Why accurate medical terminology matters for effective patient communication and appropriate care
Demystifying Genetics is sponsored by TrakGene https://www.trakgene.com/
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Matt Burgess (00:01):
Hi, my name is Matt and I am a genetic
counsellor.
I am the host of this podcast,Demystifying Genetics.
Today, my guest is AngelaArnold-Ross.
Angela is an Aussie geneticcounsellor living in New Jersey.
Join us as we unpack ourthoughts and feelings around
many aspects of geneticcounselling.
(00:21):
Hi Angela, and welcome toDemystifying Genetics.
Angela Arnold Ross (00:28):
Hi, thank you for having me.
I'm very excited to talk to youtoday.
Yeah, me too.
Matt Burgess (00:32):
Now I know that this was a good time for you to
record, because you said thatyour husband and daughter are
out of the house, so you're homealone.
They're at a daddy-daughterdaughter dance.
I just assumed that mums wereinvited, our mum's not invited
no, it's definitely daddydaughter.
Angela Arnold Ross (00:51):
So I don't know if people organize that so
that we get a break from the ptoor anything or whether like or
what it is, but it's just them.
They go dancing, but I thinkit's more.
The kids are dancing around,the men are just chatting away,
but they look cute, they lookvery adorable.
When they left, I have to sayoh lovely.
Matt Burgess (01:06):
Well, I hope that this is considered downtime for
you and um.
It's not too stressful and wecan just have a nice chat um
what you ask?
Angela Arnold Ross (01:15):
no, it should be fine.
Matt Burgess (01:16):
I get to distress afterwards, so we are both
genetic counselors fromaustralia and we'll both live in
New Jersey and about a year ohno, a couple of years ago now
the thing that sort of broughtus together or bonded us a
little bit was that we were bothlaid off from our jobs and I
(01:37):
know we sort of you know foundit quite difficult and stressful
and you know lots of differentemotions.
How are you going now?
Sort of looking back at thattough time.
Angela Arnold Ross (01:53):
I'm really good, I'm in a very good place.
Like it's gone so fast, I haveto say yes, because when we
spoke it must have been a yearand a half ago, but when it was
like in January, when I was letgo and by June I'd found this
position that I'm in now at theBassett Centre for Bracca and I
feel like but it took me a lotto get to that spot.
It was very stressful.
I was with my previousworkplace for 15 years and I
(02:17):
didn't think I was going to beleaving and they did this
reduction in force.
It wasn't nothing that I did atall, but I was part-time and
senior.
At least that's what I thinkhappened.
And then you know, coming outinto the workforce without a job
after 15 years, it's verydifferent.
With respect to I didn'trealize that there's AI.
Read your CVs.
(02:37):
I put this big CV I'm amazing,this is fantastic.
And then I didn't get any bites.
I was actually kind ofsurprised.
But then, after a lot ofnetworking, I got to where I am
today.
But yeah, it was a very, as youknow, a very rough time, bad
for the ego.
What happens when that happens?
Matt Burgess (02:55):
Yeah, definitely, and I think that it's something
that genetic counsellors arevery familiar with in America,
but not so much in Australia.
Like in Australia, as you know,most genetic counsellors work
for public health and the ideaof sort of mass redundancies is
(03:16):
not something that we see thatoften, but unfortunately, in the
United States there have been alot of genetic counsellors,
like hundreds and hundreds, Iwould say.
Angela Arnold Ross (03:27):
Yes, I feel like you know, when it happens
to you, you feel like it's justyou right, and then when you
figure it out like there are alot of like from the people
working in labs, they'll get letgo.
You know, I think it's rightafter COVID, you know, it just
was a terrible time those coupleof years.
Matt Burgess (03:41):
Yeah, yeah.
So I know you wrote a couple ofarticles and I think that that
was probably a cathartic thingfor you to sort of, you know, be
able to put your sort ofthoughts together and write
something sort of sensible.
And you know you told me thatthe aim was that you wanted
(04:02):
other people to sort of benefitfrom what you had gone through.
What sort of lessons do youtake away from this horrible
experience?
Angela Arnold Ross (04:14):
Well, it definitely puts you in your
place, I guess in a way.
You know I love what I do.
Genetic counsellors love theirjobs.
It's just an amazing professionand you generally feel very
supported.
But in the moment, especiallywith my redundancy as I'm sure a
lot of others as well, butparticularly for me I had no
idea, so it came out of the blue, so it was extremely shocking.
(04:35):
And, as you said, the piecesthat I wrote, yeah, I just had
this urge to write it down.
I didn't want anyone else to gothrough or feel the way I felt
and in that moment I just waswriting and drafting, and
writing and drafting.
I haven't published them yet.
I sent you the two to read andI actually haven't read it for a
number of months now becauseI'm like, okay, we'll put that
aside for now.
But yeah, I mean it was a lotto deal with.
(04:59):
But that definitely helped wasto write feelings down with an
aim to sort of.
Initially you feel a bit bitter,um, especially when you don't
feel like you've been.
You weren't, we weren't treatedvery well after the fact at all
, it was horrendous, um.
But then after a while it getsless, less bitter and but at the
same time I felt writing myemotions and saying how I felt
in theory could be beneficial toother people.
(05:21):
But then, now that it's beensome time since I wrote it
actually, or or since all thishappened, now that I'm sort of
in a happier place, I have toread it again now that we've
spoken, and see whether I dowant to publish at least one of
them, if it will be beneficialfor others.
But it's like in that momentyou just feel so disrespected.
(05:41):
You feel so, you just feel likeyou.
It's just a terrible feeling,absolutely, absolutely terrible
feeling.
So I put all of those words andeverything into that article and
I just I know it's a biggerpicture and it's not just me, it
was a whole lot of people andbut as a clinician I felt like
we weren't treated very well anddoctors weren't treated very
(06:03):
well.
We were just put out to pasturelike right after a big clinic
day and told it was effectiveimmediately, no chance to sort
of sign off notes or say goodbyeto anyone, and then that sort
of set the tone, I think, forwhat happened afterwards, when
no one would contact you, and itwas just a really horrendous
time.
So I don't know.
You'll have to tell me, whenyou've read my pieces, if you
(06:24):
think it's, if it's helpful orif it's just, as you said, a
good way to get it out on paperyeah, so you said that you had
no idea that it was coming.
Matt Burgess (06:34):
Like, do you mean you literally had no idea?
Like you walked into a meetingand you didn't know what it was
about and then you found outthat you'd been let go.
Is that what you mean?
Angela Arnold Ross (06:46):
Absolutely so we knew there was going to be
a reduction in force across thewhole system.
I was working at a cancerhospital and a comprehensive
cancer hospital, so we knewthere were going to be layoffs.
I'm 15 years senior.
I'd gone down to four days aweek for family, you know, for
work-life balance regardless.
But we're extremely, extremelybusy in the clinic, like crazy
(07:08):
busy.
And so the day that thishappened, I mean I was thinking
that maybe admin staff weregoing to be let go.
You know, I really didn't thinkthat clinicians would be let go
and I saw five patients back toback.
Very, you know, those days arevery long.
I love my cases, but you butlong days with one of my bosses
that I work with no inkling wascalled into a meeting and I
(07:29):
thought it was to say look, theadmin staff are being let go.
We have to do more of this.
X, y, z, and it was horrendous.
I was like wow.
And for some others they had afeeling there was a reason.
There were sort of situationsfor certain people that they
sort of had an inkling that theymight be, but for me, honestly,
I had no warning You'reblindsided.
Matt Burgess (07:51):
Yeah, that's really tough, like I know for my
team.
Our whole team were let go andwe were given like because we
all worked remotely, we wereinvited to a meeting the
following day.
So it was Thursday night atabout 6 pm and my team started
talking and we kind of thoughtmaybe this was one of the
(08:13):
reasons.
So I mean, it was still sort of, you know, maybe 12 hours
notice and we had like aninkling, but but yeah, still
wasn't pleasant.
Angela Arnold Ross (08:25):
It still makes you feel terrible.
Right, I mean you feel,although it's not.
If they said, it's not you blah, blah, blah it doesn't.
It feels like it's you.
You know, in that moment, youknow it's gut wrenching and I,
you know I went through prettymuch the stages of grief it was.
It was so shocking and and I'msure you sort of felt the way
too, you know, you're angry andyou're sad and you're this and
you're that because it's justblindside you.
But then to top it off, notonly just losing your, your
(08:47):
position, what you love doing,it was then being treated so
badly afterwards, like reallynot in a very, um, empathic way
at all.
And then I've actually hearddifferent um.
This is actually new news thatI've heard recently um, gathered
just from talking to people,like one of my colleagues was
allowed to go back to theiroffice and collect their stuff.
Um, out in jersey, where I wasworking um one of their off
(09:09):
sites, they wouldn't even let mein the building to collect my
stuff, and it's just, you know.
And no one picked up the phoneand called me.
If you can believe it, that wasreally tough after 15 years
that no one picked up the phoneand called me at least my bosses
, the genetic councils I couldget, because everyone was
probably afraid of losing theirposition.
Um, and I think they were toldnot to make any concerted
(09:30):
efforts, was that were the words.
But um, my bosses didn't evenwho I've been working with for
10, 15, then 10 years.
Didn't call yeah's upsetting.
Matt Burgess (09:41):
That's my ego.
Yeah, I was kind of thinkingsort of how can we put a
positive, something positive,out of it?
You know, what can we take awayfrom it or what advice can we
give?
I know for me and it soundslike for you as well one of the
hard things was just some of myteammates that I've been working
with.
Like I never spoke to themagain and I just thought it
(10:05):
would be really nice if theyreached out just to say you know
, I know what happened, sucks,and I hope you're okay.
Angela Arnold Ross (10:13):
So the people that weren't laid off,
the ones that were still at thejob, didn't hear from them again
.
Matt Burgess (10:16):
Yeah, I mean, some of them did like some of my
close sort of workmates.
But you know, there were peoplethat you know I would see every
couple of months and we workedtogether and then I just never
heard from them again.
Angela Arnold Ross (10:29):
And I thought oh, that sort of upset
me.
Did you feel like you couldreach out to them or not?
Or you felt in the momentyou're like they?
Matt Burgess (10:40):
should reach out to me.
I'm the one who lost my job.
Yeah, I did kind of feel likethat Like yeah, they all knew
kind of what happened, they kepttheir job.
I mean, that was sort of theraw emotion at the time and you
know, it happened to me abouttwo years ago now.
So you know, if I needed toreach out to any of them or ask
them questions, I would, youknow, not hesitate to do that.
(11:01):
But I've just I don't that thethe people who did reach out
just to, even if it was just atext message, and they said hey,
matt um, you know that that wasreally horrible what you went
through.
I hope you're okay.
I don't think they realized howsignificant or how much that
actually helped me.
Angela Arnold Ross (11:21):
Yeah, yeah absolutely, and that's what I
say in my piece.
You know, it just would be niceif someone reached out and
acknowledged that you didn't doanything wrong and made it.
You know, sort of made it sortof, yeah, put it into
perspective, and but you knowwhat I think?
What I've realized, though, is,look, everyone goes on with
their lives.
It's like, oh, that's terrible,and they move on.
And I loved when I got so I got, I was able to.
(11:43):
I lost my email like midnightthat night or something, so I
was scrambling, sending emailsto as many people that I could
you know off the top of my head,the people I had relationships
with in the in the hospital tosay I'm so sorry.
I thought I actually wrote avery good email.
I should have uncopied it outfor you, but it was kind of a
cool message to say goodbye, um,and the responses were
wonderful, um and um and I andyet I absolutely agree the ones
(12:07):
that reached out even just saidthe minimalist thing was just so
nice because it really sort of,you know, boosted you up.
And advice I'd give to otherpeople, like especially people
in superior positions, just tothink a little bit more about
what's happened in that momentand reach out, and that's, you
know.
Then life goes on, I guess, but, um, but, like one thing that
(12:28):
really made it aware, and isthat one of the doctors that I
work with, she, she said, sheemailed me eventually, like
after 10 days, one of my bosses,right after 10 days, and then
said I'm sorry it took so long,I was busy.
I'm like really, you know, soit's those sort of things.
But then at the same time it'slike, well, they don't think
about me, it's work, you know,but, but, but I guess it's be
(12:52):
nice to people and this goesacross to finance, people who
get let go all the time, um,which a different thing, you
know.
When you can, um, you know, cansteal money, but for clinicians
we abide by hipper in theory.
Practically, we're like, well,I'm not going to go publish a
famous person's pedigree in thenew york times or something.
But I felt like, just if theyunderstand the emotion, how we
(13:13):
feel as people, just for a shorttime, I think that would just
be such a nice way.
I get it's HR, you know, I'verationalized it so many times
like, oh, but I get it's HR,it's not them, but then is it?
They could have picked up thephone, so many things around and
but you know it's it's it'sbecause I was trying to think of
(13:33):
something.
I'd like to be helpful with thisbecause, as you can already
tell, with my emotion, I stillget very upset by it, um, and I
feel slighted, but when it comesdown to it I was an employee
and I really, but then I reallyfelt like one afterwards.
You know what I mean.
I thought I had I went my wholelife.
You know I came to the statesto get the job and I had met my
husband, had my daughter and allof that stuff.
So it meant a lot for me, but Iunderstand it's not a lot for
(13:56):
everyone else.
Matt Burgess (13:57):
Yeah, and I think you know, as genetic counsellors
we're used to the idea ofhaving supervision and talking
about our feelings and you knowwe're experienced with sort of
that therapeutic relationshipand like I know part of it, for
me I kind of felt like it was aninteresting sort of social
(14:18):
experiment.
Like, even though I was sort ofangry and upset and go through
all these stages of grief, asyou mentioned, part of me was
sort of it was like I wasobserving as an outsider,
thinking oh, wow, isn't thisinteresting?
Like, oh, I didn't think thiswould happen, oh, this is a
surprising emotion.
And I kind of feel maybe alittle bit grateful that I did
(14:40):
have that training and, like youknow, with our colleagues that
maybe were in finance or youknow, admin, who don't have that
sort of background, like maybeit was extra hard for them.
Angela Arnold Ross (14:56):
Yeah, absolutely, because I've had
people in finance and I knowthey get a gardening leave, they
get laid off and all of youknow, even if they quit, you
know all that thing happens, butthey could just be let go in an
instant and out the door then.
But yes, going through ityourself really makes you aware
of what people go through,absolutely for sure.
But then when I was similar towhat you just said, when I was
(15:16):
writing the pieces that I wroteone very emotional one and one
kind of this might help people.
As I said, I haven't read themfor a while because it does
bring up a lot of emotions, butthat's when I realised I'm going
through.
I made that up myself.
I'm like this is like grief,like I'm mad, and I didn't
realize that.
So I agree, it's a good point.
I think that our backgroundhelped me a little bit.
(15:37):
I don't know well good or bad,because maybe I overthought it a
little bit, because I couldanalyze it in my head, but then
I guess, having an irrationalanswer or sort of being able to
think it through, you know whythis happened.
I'm going through this moment.
I'll get through it.
This happened.
I'm going through this moment.
I'll get through it.
But again, you know, also, Ifeel like my age was a bit I
find it's almost funny 15 years.
(15:57):
I had my CV and everything.
Yes, it was a surprise, butthen, oh my goodness, going out
to, you know, going to try tofind another job LinkedIn was
amazing, I have to say but thenall the stuff that I just took
for granted, you know, I justdidn't realise.
You know, I had to do the CVagain and then somehow I figured
out AI people read it and thenI'm like, oh my goodness, so I
(16:18):
had to do this.
But it was a good learningexperience.
Looking back, it was six monthsof tough work, but I did find
my way, but it wasn't easy.
Matt Burgess (16:28):
Yeah, I think, if you know, really think about
this horrible event that we wentthrough from, you know, through
the lens of you know, stages ofgrief, you know the last stage
is sort of acceptance and Ithink, you know, both of us have
got new jobs and we've moved onand I think that we have kind
(16:49):
of.
You know, we're definitely inthat sort of final stage.
We're able to look back and,you know, maybe we get sort of
um a little bit emotional, but Ithink, you know, with time it
does help oh, it does, and I'veactually, now that we're doing
this um, this podcast, I'm goingto go back and read my articles
again.
Angela Arnold Ross (17:06):
I one I was going to my boss, who I love.
Dr Domchek was amazing.
She read them through um for meand supported me in every way,
but I didn't.
I've held off on publishingthem.
I think the perspectives wantedto publish one of them or
whatever, but I just want totake a step back making them do
to make sure I'm doing the rightthing for the benefit of other
people.
Because, look, although thatwas terrible, I had amazing 15
(17:27):
years.
Like I had the best experience.
I can't even I can't even saythat that is not true.
Like I really had a great timein those 15 years and I love my
position so much.
I mean, I moved from Australiato the UK here to take that
position and it was wonderful.
It just ended sooner.
But, as you said, like I don'tknow about you, but everything
(17:47):
I've done in life, it's almost Idon't know if I should believe
in fate being a scientist, right, but everything I've done.
Matt Burgess (17:52):
You can look back and go oh.
Angela Arnold Ross (17:54):
So now, in that moment, I went crazy.
I did all my CEUs, probably forthe next certification.
I've did all so many webinarsand I sent out my CV.
I was LinkedIn, as I said, wasa very good professional working
, but I ended up finding thisposition through networking.
I did a presentation for Myriadand I you know all sorts of
things like that and I found myway, but, looking, I'm like I
couldn't have landed anywherebetter.
(18:15):
You know it's like so.
It worked out in the end, butin the moment you really don't
feel that way.
So if anyone can learn fromanything like it does get better
, but it does suck in the moment.
Matt Burgess (18:26):
Yeah, and I think that's an interesting point.
You know, like you said, thatyou became very involved and
sort of did lots of things anddoing all of your professional
development, and I think part ofthat is, you know, when you're
laid off you've got absolutelyno control, and part of taking
(18:48):
back some of that control iskind of maybe overdosing or
going sort of in the otherdirection.
Angela Arnold Ross (18:57):
Yeah, because you don't know what's
going to happen.
I mean, you know, I love my jobso much I really really do.
I didn't relax at all in thosesix months.
I was looking back.
I'm like gosh, I wish I tooksome time to myself, but I was
so frantically panicking.
The other thing is healthcareinsurance.
You know, we lost that.
We had to go on what we callCobra over here and it's so
(19:17):
expensive, like it's crazy.
If you work for a hospitalsystem in America, they
subsidize some of yourhealthcare.
So that was one thing.
But then also, I love.
I love doing what I, what Iwant to do.
But yes, you're right, I did somuch stuff.
I was like my old self, like Iwas like when I was like 20 and
young and I did, you know,energetic and doing, writing
things and doing so much.
And I'm like I've fallen backinto my oh, I'm so busy I don't
(19:39):
have time to do that anymore.
Matt Burgess (19:41):
But um, but yeah I know I listened to um a couple
of podcasts about, um, you know,reduction in force and being
laid off, and it wasn't sort ofgenetic counseling specific.
It was sort of um yeah, wasn'tsort of science related or
health related at all, but oneof the key takeaways was the
importance of networking and Ikind of was like I don't feel
(20:05):
like networking or I don't wantto, but I think that genetic
counsellors are just really goodat networking anyway.
Is that like how significant doyou think networking was in
that period of?
Angela Arnold Ross (20:19):
time for you .
It was amazingly wonderful inthe sense of the support I felt
for people I didn't know Likethe part of our National Society
of Genetic Counsellors at thetime because, again, I was being
I guess what's the word, it wasbeing very insular.
I thought this is just me, I'mgoing through this right.
But at the time that thishappened, they were doing
presentations on what you do toget jobs and how to handle and
(20:42):
how to get, and it was justamazing timing.
There was one geneticcounsellor I wish I could
remember her name now.
She was fantastic, giving metips about how to do my cv, how
to approach um people and andbecause again 15 years, I really
didn't know and I didn'trealize.
I didn't know what to do, ifthat makes sense, and she was.
She didn't know me from a barof soap and she she got on
(21:02):
separately and she emailed me.
She missed.
She was so wonderful at justgiving me a hand just for her
own benefit and the nsgc headsas a whole, because I I shared
something.
I can't even remember what itwas about now, but I just felt
so supported and just so heard.
You know what I mean, because Ididn't get any boost of
confidence from when it happened.
(21:23):
But the community is amazingand I fell into certain things.
But I was definitely active soI sort of pushed myself forward.
But just from doing apresentation, speaking to
so-and-so, who listened to it,finding so-and-so, and then
eventually someone was lookingfor temporary work because
people were going on maternityleave and I'm like I'm free.
I wish we could do that as acompany, but you need the
(21:46):
benefits.
Networking is so important and,as I said, I'm not being paid
by LinkedIn, but that was areally good resource, because
Facebook and Instagram I don'tthink so, but it really was good
, like business orientated, andyou could sort of you know, make
connections and I've still madesome connections on there
actually that are stillbeneficial for me as a whole or
(22:07):
for what I do, givingpresentations and things.
Matt Burgess (22:10):
Yeah.
Angela Arnold Ross (22:11):
So yeah.
Matt Burgess (22:12):
I think it's Not what I meant you.
The benefit that I find fromLinkedIn.
What I really like is you knowI've connected to people and you
know they've sort of reachedout to me and you don't know
them from a bar of soap, but youknow you work in the same
industry or you know we're allgenetic counsellors, but then
(22:32):
when you do actually go to aconference and you meet these
people, you've already it's likeyou've already done that first
step.
Angela Arnold Ross (22:40):
It's lovely, it's very nice.
It's so nice?
No, it is, it's really nice andit makes you believe more in
people being more humane, peoplebeing nice.
Because you know, and I think,like I had people coming we just
went to a national conferencefor inherited GI cancers in
Philly and one of thecounsellors had I was going to
do I do a lot of interviews if Ican, for student projects or
(23:00):
whatever and she came up to me.
I wouldn't have known what shelooked like, but I think with my
accent people can really figureout who I am.
So a lot of people go, hey,ange, how are you?
And I'm like hi, how are you?
They come up and say hi and itjust sets the stage, I think,
just for making, as you said, alittle bit easier.
But everyone's so willing tohelp people generally, you know
(23:21):
they really aren't out forthemselves.
Our communities are wonderful.
I mean NSGC.
As I wrote in my article, nsgcwas amazing.
This particular counsellor wasamazing.
It was yeah, it was.
It was wonderful.
That was a wonderful experience.
Matt Burgess (23:34):
Oh, go ahead.
Join thousands of geneticsprofessionals worldwide who
trust TractGene.
Built specifically for geneticsclinics, tractgene makes
pedigree creation, data entryand reporting easy and efficient
.
Get a free demonstration todayand see Trackgene in action.
University students andacademics can also access
(23:57):
Trackgene's pedigree drawingsoftware for free.
Head to trackgenecom that'sT-R-A-K-G-E-N-E dot com and
explore what it can do for you.
Well, one thing I wanted tosort of get your opinion on was
licensure of genetic counselors.
(24:18):
Now I think you know super likewhen I was thinking of it
initially, maybe a bitsuperficially, I thought, oh,
this is a great idea.
Um, but logistically orpractically in america, it does
seem to cause a few problems.
Yes, like, for example, youlive in New Jersey, you were
(24:40):
working in New York.
Angela Arnold Ross (24:42):
Now you work in Pennsylvania.
Matt Burgess (24:44):
Pennsylvania and New Jersey yeah, what has been
your sort of like experience oflicensure and are there any
issues and how do you think thatthe Americans can sort of fix
up the system?
Angela Arnold Ross (25:04):
Yeah, well, it's funny because in my other
position in New York we don'thave licensure yet, so we could
never use our billing code.
We weren't really billing underthe physicians and still seeing
patients.
But I guess we weren't really.
We were billing under thephysicians and still seeing
patients, but I guess we weren't, as weren't that autonomous.
Now that I'm at and again thisis, this is being let go from
that position to this positionhas actually been very good at
(25:24):
making me aware of like it was acancer hospital.
That's all I knew.
Now I'm at a big hospital,comprehensive, like oh, the PCPs
are part of the system, got it,you know those sort of things.
And so now I'm licensed in NewJersey and licensed in PA, which
means that I can see patientsin PA and New Jersey and I can
bill for my services.
We're not recognized by Medicare, the CMS recognized, which
(25:48):
means we can't.
There's logistics in Americawhen it comes to the healthcare
system, but if anyone's over 65on Medicare, they don't
recognize us as clinicians, sowe can't.
Actually we're not meant to see, bill or order tests for
patients who don't meet criteriaor not.
So that's a hurdle to jumpthrough because there's a lot of
people who might suffer fromthat if there's not enough
(26:08):
doctors to see patients.
You know, in Medicare we justdon't.
We managed to see them with thedoctors in PA and see people,
but that's a big hurdle thatpeople have to jump through, or
the genetic counselors stumbleupon the logistics of that.
I mean, I think it would bewonderful for the profession as
(26:29):
a whole or just for people whoneed genetic counselors.
I heard at this meeting there'sa shortage of genetic
counselors.
Now I'm like what?
Not when I was looking for jobs, but you know they.
But by being licensed and look,we don't get paid much.
It's not, it's not.
I don't get paid, by the way,for my services.
I'm working in a hospital butwe're allowed to bill and we
should be able to bill becausewe put a lot of work into into
(26:49):
our patients and prep andeverything and follow upup.
But I guess it would allowpeople to.
Then we could, if we could billfor our services or most people
around you know the country wecould see patients autonomously
for new visits and follow-ups.
We could, you know, berecognised for what we do.
I must admit I was very excitedto be able to bill for a code
(27:11):
for what I do and what I lovedoing.
You know I'm not getting thebenefit from the benefit from
the payment from the service,but I'm like it was fun to put
the code in and know how to doit because I'd never done that
before.
So I think and the other flipside, again to realize it's made
me realize all about thelicensure as well, which I
(27:31):
didn't think big picture is.
You know, then we have themedical.
The liability would be on us ifwe're licensed fully with
Medicare.
Do we want to take that on?
You know, at the moment we'vegot that buffer.
The physicians, you know, areliable for everything, which is
also fine.
I don't know, I don't see, Idon't know if you've thought of
any huge negatives to licensure,because I just think it would
(27:53):
be beneficial for the system,you know, to have genetic
counsellors that could freelysee people you know, and often
it's under supervision, rightversus you know there's such
backlogs in clinics to seepatients, you know,
unfortunately, and a lot ofthat's because we, you know you
need physicians and physicianscan only do so much, they're so
busy.
Matt Burgess (28:13):
I mean, it's something that I have thought
about a little bit and, um, it'ssomething that I mentioned, uh,
with my students in the classthat I teach, uh, but I I guess
the the drawback.
I mean, there are a lot ofbenefits that I can see, but the
drawbacks, I think, areprobably, you know, in states
like new york, how do wegrandfather in people Like I
(28:36):
think that maybe you know, thereare genetic counsellors with
literally decades and decades ofexperience who may not meet the
criteria and then it's kind ofokay, like if you live in the
middle of one state and you'relicensed by that state and you
only work in that state.
It's great, um, if you live onthe border of one state and, you
(29:00):
know, maybe you work intelehealth or yeah, like
logistically you know if youemploy, you know you're a
telehealth company and you'reemploying 10 genetic counselors
and you can only put a callthrough to one that is licensed
in that you know that iscomplicated yeah, that is
complicated, yeah, that iscomplicated.
Angela Arnold Ross (29:21):
Well, so I mainly see telemedicine because
I actually live in North Jerseyand south of me is where Philly
is and where Penn is, but to meI think it's where the patient
is, though.
Right, so I can be in NewJersey, Philly, but the
patient's got to be in Jersey.
So when a patient you know saysthey're going to go to Florida,
I say you've got to see mebefore you go to Florida.
I can't do that, but I guessit's the licensure itself.
(29:41):
Did you get licensed when youwere working here?
Matt Burgess (29:45):
No, I couldn't sit the board exam.
Angela Arnold Ross (29:47):
See, that's a whole nother discussion.
Matt Burgess (29:49):
And.
Angela Arnold Ross (29:50):
I can actually see.
I was on one of the boards forreciprocity between the UK,
australia and America and it wasinteresting because I got to
see initially I'm like, why not?
But then it's different.
With the healthcare systems itis definitely a different take.
But I never want to take thatexam again so I'll make sure I'm
up to date with all my CEUs.
That was tough, but you know, Ifeel like and I was actually
(30:12):
just on a meeting earlier whereyou know it was pointed out that
the PAs and the nursepractitioners they now can build
, they're now recognised asclinicians, but that took time
for them to get to that pointright and so hopefully you know
we'll get to that point as well.
But telemedicine, well, thisnew code that's coming out.
Have you heard about the newcode that's coming?
Matt Burgess (30:32):
out.
I actually wrote a blog piecefor Tr gene on the new code in
america and how, because inaustralia we're sort of trying
to fight or, you know, bargainto or negotiate to get uh many
care item numbers as well.
Angela Arnold Ross (30:49):
So okay, I sort of compared and contrasted
the two differences.
Oh, I want to see that you'llhave to send it to me or tell me
where to find it for sure.
Well, that's very new.
We just were talking about thattoday.
But it would be lovely if wecould get billed for the pre,
you know, not just for the 15,30 minutes, but for anything we
do before and after.
I think that's justified.
So we're just seeing how thatgoes when we call out results.
(31:14):
We're not billing for any ofthat.
So that side of things becauseagain, we don't really make
money for the hospitals asgenetic counsellors, but we
should be able to sort of atleast contribute a little bit in
that way.
So it sounds like if we do withthis new code, it will give a
little bit more flexibility.
For that which will benon-patient-facing billing is
(31:34):
what it is, for that which willbe non-patient facing billing is
what it is for that, whichwould be nice.
But yeah, there's hurdles tojump through and there's, you
know, the States.
I was trying to think why dopeople not want this to happen,
you know?
But there's a lot of stuff thatgoes on behind the scenes that
we just sort of don't realise.
But we just want more geneticcounsellors out there.
I can't believe there's ashortage now.
There wasn't when I was lookingfor a job out there.
(31:55):
I can't believe there's ashortage now.
Matt Burgess (31:56):
There wasn't when I was looking for a job.
It's funny how things sort ofchange and, yeah, like swings
and roundabouts, like you know,the rollercoaster of needing
more people and there not beingenough jobs.
Angela Arnold Ross (32:07):
But also getting yourself away from
yourself, because I think, gosh,we're all so busy, like, how
can you even think about peoplebeing let go?
We don't think you know thebigger picture, obviously,
because not everyone wants tolet people go, but yeah, it's.
And, as you said, you know,this reduction in force just
opened our eyes up to otherthings, I guess.
Matt Burgess (32:27):
One of the other things that I wanted to ask you
about, which is something veryAmerican in healthcare, which is
not something that we have inAustralia or other parts of the
world, is the Cures Act.
Now can you sort of maybe giveus a little bit of a summary of
(32:48):
what the Cures Act is and thenhow it relates to your job
specifically as a geneticcounsellor?
Angela Arnold Ross (32:58):
relates to your job specifically as a
genetic counsellor.
Sure, so now, instead of whenwe're healthcare providers, we
could, when we order tests orget, do you know if we can have
a mammogram or if we have acolonoscopy and we have a biopsy
of anything?
All of the records that youknow go to the ordering
physician and then they transmitthe results to the patient and
then the patient's allowed tohave a copy of the results.
You know whether they ask forit or not.
I'm not too sure.
They probably often did not.
(33:18):
But now there's a law in theStates where any report or test
that you have immediately assoon as it's released into the
electronic health system, nowthe patient gets it as soon as
you get it, which again opensthe open sort of access to
records.
And you know the big picturethat people have access to what
they, what they've, you knowwhat they've done and what they
(33:40):
um, their diagnoses andeverything.
But it's, it's.
I can see that.
But if you think about thereports that we often see, so as
a cancer genetic counselor I'mseeing mammogram reports that
say, oh, there's something there.
I've seen, I see, you know,other pathology reports where
they might say lobular carcinomain situ, which actually isn't
cancer but it says carcinoma,and people are not reading these
(34:03):
, can have access to thesereports, that have no
understanding of what these are.
It puts a lot of pressure onthe doctors especially as well,
because if a patient sees adiagnosis of cancer like which
you could which I've heard andit sounds like it's not ideal
for most people is that then thepatient?
If it's on a Friday, saturday,sunday, the patient of course
(34:26):
wants to speak to the physician.
So there's a whole lot of toand fro with this act.
I'm learning to accept itbecause before know, before this
act, you know, we with geneticcounseling reports, our genetic
counseling reports or genetictesting reports, are very
detailed and very hard to read.
Sometimes even we have troublesort of understanding all of all
of what's in there, um and so,but we would always be able to
(34:48):
have the reports and review themwith the patient, show the
patient, you know, walk themthrough the report and go
through it with them, um, beforeeven handing it to them, or
sometimes not even giving theresults until they come and see
you.
Or there's something contractedto how you're going to give the
results to patients, but nowpatients basically see the
results as soon as they'resigned out.
And I've realized within myselfI'm having trouble with it,
(35:11):
just internally.
I mean, they're adults, that wesee, and they, they, they seem
to be okay, um, receiving themthat way, or they're accepting
it, cause what we tell themisn't always there's, often not
as bad as what they've been toldif, if they have a cancer
diagnosis, um but um, but yeah,we, it just causes a bit of
anxiety for me when it when it'sthat, because if someone's it
(35:32):
says positive, like on thereport, or uncertain.
So I've actually changed, Ichanged my, my counseling style
a little bit, depending on howyou know the day, depending on
who's in front of me, and alsoI'm trying to think, I was
trying to think of ways to okay,so if someone opens a report,
how might they feel about that?
Now, this could be totallyoverkill, because I've even
(35:52):
admitted that to patients look,this could be totally me,
because they're like, oh fine,I'll see it when it's released.
But I start saying now that youknow if you see positive, it
doesn't mean you have a cancerdiagnosis, it doesn't mean it's
a high risk, you know, and I'mavailable to speak to you and
sort of go through it that way,but that's.
I think it's probably moregenetic counselors having
trouble with that, you know, inour niche, in our niche with our
(36:13):
reports, than maybe patients.
I mean, they don't think aboutit probably.
But it's been a bit to getthrough.
You know a bit to work my headaround, I guess, to get used to
it.
Matt Burgess (36:23):
Yeah, like I worked for some genetic testing
labs in the United States and soyou know this was a big issue
for us.
Like you know when do we uploada result and you know how, you
know logistically what happensand how is the q.
Is that going to sort ofinteract with that?
And I think, as a patient, likeif I think of myself as a
(36:46):
patient, like if, if my doctorhas ordered like cholesterol or
you know, like um, iron orvitamin d or something sort of
like that, I feel like I don'treally need them to explain it,
like I can look at that result.
Yeah, but you know, it makes methink of sort of medical
paternalism.
Like, as genetic counsellors,we are very conscious about okay
(37:09):
, we order this test, how are wegoing to give it to the person?
When are we going to make theresults appointment?
Are we going to give it to theperson?
When are we going to make theresults appointment?
Like I think that we are verymindful in organizing the best
way to give it to a patient.
However, you know, maybe wehave our clinic on a Thursday
morning but the report isreported on Monday morning and
(37:33):
you know, in the past it's likeokay, well, three days isn't
going to make much of adifference.
I can be prepared, I can lookthings up, I can, you know,
gather information, I'll meetwith a patient and then we can
go through it, whereas now, asyou said, they can see these
incredibly detailed andcomplicated and complex reports
by themselves and you know, likeis it fair for us to say, well,
(37:58):
maybe they shouldn't, becausethey are adults and you know
they can choose not to read it.
I don't know.
Yeah, it's an interesting thing.
Angela Arnold Ross (38:07):
Well, I mean , I'm not saying I'm.
In a way it's a bit freeing, Ihave to say, because we get
sometimes slammed with resultsall at once, whatever reason.
Down south it comes in waves.
I don't know what it is.
You'll have a week full oftesting and I'll have maybe a
week of no testing, people, youknow, deferring or just people
who didn't want testing.
So the one thing because I cansee when a patient's read the
results and if they haven'treached out to me, then you know
(38:29):
I'm going to get to them forsure.
But then I feel like, okay,they're not upset, because I
always worry that someone'sgoing to get a result and be
upset and again, that's probablyme.
Transference right, it istransference, it's probably
totally me than anyone else.
But yeah, I think that's mademe calm down is that they're
adults, they know what'shappening because we do contract
(38:50):
with them and I'd say look theresults when you see them, I see
them.
I sometimes tailor it because wecan hold them back for a short
time, I think with reason.
But then I'm thinking if theysay it's okay, I'm like, okay,
you can send it to that, buthere's some warnings and then
you know I'm available.
That's my main thing is forthem to know that I'm available.
But I agree, I've had oneperson say that they think they
(39:11):
were very strong, that this hasto happen.
It's wonderful and I have it.
I mean, a lot of people arekind of like, well, I sort of
wish I didn't open it becauseit's you know, a lot of.
I read an article, I think forthe New Yorker, I think a doctor
wrote it about and it wasreally good to see the doctor's
perspective of it and how muchpressure that puts on the
physician because also,whoever's signing these out,
they do it on like Friday nightsor Saturdays and you know, and
(39:35):
it's not easy for someone to sitfor that long.
Not sort of understanding orknowing, but you know there's
probably things.
Matt Burgess (39:42):
And then you sort of get onto Google and then, if
you're a layperson, you may notunderstand exactly what you're
Googling, and then you getresults.
It's like, oh, is this relevantto my case?
Angela Arnold Ross (39:54):
Yeah, Well, I actually say every day I say,
look, I'm available to you, youcan message me on the portal.
It doesn't wake me up.
But by you contacting me firstmeans you want to talk about it
and I'll get back to you as soonas I can.
Just don't Dr Google.
I say that and they all laughand they probably do it anyway.
But you know, yeah, that'scrazy getting stuff from there.
(40:16):
But again, that is opening itup to that.
I guess If you're getting areport, you can't speak to the
doctor immediately.
It's like you can't help it.
I mean, I'm hypocritical, I'dprobably do the same thing.
Yeah, me too.
Matt Burgess (40:27):
So you sort of mentioned how your counselling
has changed because of the CuresAct and what I wanted to ask
was how has your counsellingchanged more generally?
You know you're a seniorgenetic counsellor.
You've been working for acouple of decades now.
Can you see how your style or,you know, the way that you
(40:52):
counsel people has changed orevolved?
Angela Arnold Ross (40:55):
Yeah, absolutely, and you make me feel
old decades.
Yes, oh, my goodness, it's goneso fast.
Yeah, no, it's funny.
You said that because I'vethought a lot about this and in
fact I was trying to get aproject together with students.
I've been mentoring students,but because, you know, some
things have happened in my lifethat have made me change the way
I speak to patients and it mademe think gosh, I wonder.
(41:16):
I'm sure I'm not the only one,and how can we sort of bring it
to the forefront?
I know there's been a lot ofstudies about pregnancy.
You know people who arepregnant and things like that.
But as a whole I don't know ifI remember reading anything
about it, but there's a wholelot to break down here.
So, for example, when I wasyounger and we did our rotations
and back two decades ago, itwas all prenatal.
(41:36):
I was in my twenties, I didn'tknow, I haven't been pregnant or
anything.
So I was told, you know, a CVSis a push and a pull.
You know you repeat whateveryone says or you listen to
people, you do rotations and youtake a little bit from someone
else, if you like the way theyspeak to patients and explain
things to patients and thathappens, I think, across the
board.
You change things whenever youspeak to someone else or things.
(41:58):
Board.
You change things whenever youspeak to someone else or things
if we learn more informationabout certain syndromes.
But I remember I loved prenataltesting at the time.
That was always sort of had tooffer and then I fell into
cancer, as my fate thing, gotinto cancer and ended up being a
cancer genetic counselorpredominantly.
And then I got pregnant andthen and it was amazing and you
(42:21):
know, apart from wanting to be,by the time I was pregnant you
could test for anything Likewhen I started two decades ago
it was like 10 Jewish geneticdiseases and cystic fibrosis a
very small panel.
Now it's like exomes and things.
And number one.
My OBGYN said well, you'd knowbetter than me.
When I asked about the testing,I went no, I don't.
(42:43):
And then I said, well, I, youknow.
Look, I'm an older mom and Iwent to the best doctor in New
York for prenatal testing and Iwanted to do a CVS.
And for those that don't know,people might know this, but a
CVS is a sampling of theumbilical cord before you know,
very early on, so you could seeif there's maybe some chromosome
abnormalities or something.
And so I went there and then Ihad it and he must have hit my
(43:07):
uterus or something or hit mycervix Like I jumped, I screamed
and my first thought was Istarted crying and said I lied
to all of these patients for somany years that it was a push
and a pull and it's not.
That's the first thing I thoughtof.
Was that?
So I can laugh about that now.
But then I would have tailoredwhat I said to patients more
(43:30):
like with my life experience.
But I know that geneticcounselors don't always have
that life experience to do it,but it did make me think people
have to be careful about whatthey.
I never did anything wrongwrong, but you know what I mean,
in that moment I recognizedthat I really didn't know what I
was talking about.
And I know it's not doesn't hitthe cervix all the time, I
don't want anyone to think that,but you, you just made it sound
(43:50):
much easier than possibly itwas.
And there's a spectrum of.
It could go well, it could gobadly, all sorts of things like
that.
Um, you know.
So that would have changed.
And then I think, as we getmature and get more life
experience, you learn to speakto people differently in certain
ways.
And another thing that stuck outto me and why I started to get
more interest was I had ahysterectomy for non-cancerous
(44:14):
reasons, but I had a reallytough time recovering.
All sorts of stuff happenedthat I didn't expect and
whatever.
And the doctors were very oh,it's this, cause, they see it
all the time, right.
Then they they, they don'tdidn't explain it to me that
they saw whatever happened.
You know, because, yes, youcould think, okay, they brushed
it off, that's good.
But in that moment you're likewhat?
And you've?
(44:44):
You know, I try it's hard, Itry not to bring myself too much
into it, but I'm more aware ofyou know.
Look, most people have a, evenputting the word most.
Most people have a goodexperience.
It's laparoscopic.
Laparoscopic I wish I was cutwhatever to me, but you know
what I mean.
To at least tailor a little bitwith life experience without
having to necessarily shareunless you wanted to.
Like you know most people findit, you know, find it simple.
(45:07):
It's laparoscopic versus likeoh, it's laparoscopic, it's easy
.
Often you know you're back towork the next day, you know sort
of things like that.
I found that, that I tailoredit and I'll also never forget a
moment.
A patient came in because againtaught to say this and not say
this and again, you're neversaying it in a bad way and you
don't mean to say anythingincorrect and generally you're
(45:27):
correct.
But with having laparoscopicoophorectomy, this is before my
situation.
A patient came in and shedecided she had to.
She and her surgeon ended updeciding on a vaginal
hysterectomy and she came in andshe was in absolute agony.
I'll never forget how shelooked.
It was horrendous.
It wasn't.
What was what we talked about.
You know cause we, we justwe're not doctors.
(45:48):
We generally spoke about it andand but I'll but that's another
thing.
I'll never forget just how shereacted.
You said it was.
It wasn't to me.
You said it was simple andalthough you know it wasn't what
we'd said, it don't matter inthat moment and she was just.
It was just horrendous for herand that opened my eyes up.
So I feel like life experiencein certain situations or
(46:10):
interactions with patientsabsolutely tailor the way you
might speak to people or mightmake you more aware of how you
speak to people.
And I guess, just because I'mthinking, I'm decades old now,
look how old I am but I'm justreflecting a lot more on that
now and in my mind, and if Ispeak to students or I'm talking
to students, I try and moveaway from like I understand,
(46:32):
they're young and you haven'tgone through it, and I'm not
saying go get pregnant to gothrough it, but I'm saying, you
know, this is be a bit moregeneral and or or something like
that.
Um, just and again, that's justwhat I've gone, what I feel
I've gone through.
Matt Burgess (46:45):
Yeah, I had some something similar happen with me
.
I um, you know, as a cancergenetic counselor.
We speak to women that um testpositive to particular changes
in genes that increases theirrisk to ovarian cancer and sort
of the gold standard or therecommendation is for women to
(47:06):
have their ovaries removed afterthey've finished having their
families, and usually it is aquick and simple operation.
As operations go, you know, itdoesn't take very long, it is
quick.
Angela Arnold Ross (47:19):
You're in and out in a day which freaks me
out is quick.
Matt Burgess (47:20):
You're in and out in a day which freaks me out,
but yeah, in and out in one dayyeah, and like I remember that
was how I counseled women,that's how I explained it to
women and there was a patientshe actually wasn't someone I
saw, but I I heard about her shehad, um, her ovaries removed.
It was a quick and simpleoperation.
However, she hemorrhaged andshe actually nearly died and
(47:43):
luckily she didn't die, but itwas life and death.
Angela Arnold Ross (47:47):
You know, it was a very serious situation
and I mean that hardly everhappens when you have an
oophorectomy, but it really didmake me think about how I
describe these operations topeople Like yeah, you're not
going to scare them and say,well, I know someone who almost
died with it, you know, but youwant exactly a couple of extra
(48:09):
words, or the way you present it.
Absolutely, yeah, I'm sorry youhad to go through that.
That is very traumatic.
Yeah, being a positiveAustralian, you you know.
You take these things, though,and you do learn from them,
right and to sort of use it tothe best, best of your ability
pretty much, which is which isgood, I think, but we're always
growing as genetic counselors.
Matt Burgess (48:30):
we're always learning and I guess, on that
point, how do you feel that youadvocate for patients?
I know that advocating forpatients is one thing that's
really important to you.
Can you tell me a little bitabout that?
Angela Arnold Ross (48:48):
Yeah, again, this has gone through my.
I mean, I've always, as I said,I love what I do, I love my
patients and we always geneticcounsellors.
We always want the best for ourpatients, as do doctors and
everyone else, of course.
But I guess I'm used to.
As I'm getting older, I knowmore people who are having
surgeries, more people who are,you know, have cancer, all sorts
of.
I've had some surgeries, thingslike that.
So it does make you more awareand I've just realized I know
(49:10):
how to navigate.
Like if something happens withmy friends, I'm on it.
I'm like, okay, I know how totalk to the doctor.
You'd be very nice, but you'revery strong, Like you know, like
you, this is how you, we knowhow to navigate the hospital.
And some situations wherepeople have asked for my advice
and just the way they spoke, I'mlike, wow, you really.
Yeah, you, you, you know, youdon't know.
My dad, for example, went into,went into hospital and he was
(49:33):
cold and I'd say, dad, ask thenurse for a blanket.
Oh, she's busy, she's busy,she's got more to do than that.
And I'm like, oh, dude, likeyou know, like you can be very
nice to nurses, but you can askfor a blanket and a lot of
people think they can't questionthe doctors.
So I just have a big passionnow and again this does stem a
lot from when I went through mysurgery as well of just to help
(49:53):
people and make peopleunderstand that write down
questions, because you alwaysget nervous when the doctor
comes in.
It just happens regardless.
You can always there's nostupid questions.
You can within reason, butgenerally there's no stupid
questions you can.
They can spend time with you,Like if you shouldn't be feeling
rushed, you might, but you knowthey can spend time with you.
You're allowed to ask what you,what you want to ask, and make
(50:14):
sure you get an answer.
And then you know if someonedoesn't call you back, you don't
.
You don't badger them, but youdeserve a response.
If you've, if you put in a call, either send it.
I said to someone recently.
I said why don't you put in aportal message Cause then it's,
it's, it's documented.
When you've contacted them andjust you know, ask them for a
response, or you know call themback and insist on being cause
(50:40):
you're allowed to get answers,um, and so yeah, that sort of is
.
I just love sort of guidingpeople that way a little bit now
, um, how to, how to sort ofnavigate the health care system,
because that can be such astress to people, right not
having, especially whensomeone's diagnosed with cancer.
You've got this appointment,this appointment, I don't know.
And I had someone recently whowas diagnosed and she's she's
like well that so well, theydon't think it's cancer, don't
know if it's cancer, but likeshe was telling me about
mastectomies and whatever and it, you know, it's like the woman
(51:03):
pretty much knew it was going tobe cancer and just did, wasn't
direct, Right, but again,everyone does things differently
.
But I feel I try and give peoplesome confidence when I'm
speaking to them.
If, if, if it comes up inconversation I mean I'm not a
physician or anything like thatbut if they, if I say, oh, just
a little tip, you know mightthink about X, y, z and so on
and so forth, just to just to,to reduce as much stress as they
(51:26):
can, as I can, if, if I feelthat that's warranted, right,
because they're going through somuch.
It's just just terrible.
Um, but yeah, that's what I'vebeen interested in.
I'd love to.
Or the other thing is goingwith advocating I think I told
you this as well is it's allabout the lingo?
So I've had a number ofsituations where be it with my
(51:47):
10-year-old daughter.
She could come in and say thesky is red, and I'm like, is it
Because she's so confident?
She really is.
And for a a second, you totallybelieve it.
Right, in health care, thatpeople come to you my, my
sister's got a BRCA mutation, ormy sister's got the BRCA gene,
(52:08):
okay, what gene?
Or breast gene, or ovarian gene, right?
Um, and so it's, and.
And then you believe them.
And if you didn't get a report,you know things could happen.
So I guess a couple ofcircumstances have been that,
like someone's come to me withinformation, I'm a real stickler
for getting a report, eventhough it can be a bit of a pain
.
So if I can, I like to getpathology reports.
(52:28):
I know they're not alwaysavailable, but pathology reports
, specifically genetic testingreports, um, the incidents I'm
thinking of specifically waslike um, the family history
wasn't very strong but youthought there was a genetic
mutation, one of the genes withthat links with breast cancer.
But there was no family historybut she was told it was.
It was her sister's got amutation.
(52:48):
In the end she did it.
It was uncertain variant and itwasn't and she didn't really
need testing, you know.
So, um, and then, but but itwas the way it was transmitted
to her.
You know she was told she had amutation and then and of course
they don't know to get reportsor anything, and this is how
it's disseminated.
So in my presentations I usuallyhave a slide like it's all
about the lingo I want.
My doctor said I need screening.
(53:09):
Screening for what?
Mammogram or genetic testing,because some people say that
screening testing or I need thetest what test?
Big stickler for televisionshows.
Oh my gosh, do they not haveconsultants?
If anyone's listening andthey've seen TV, I'm happy to
consult with you.
It's great that people bring itinto their shows.
But number one genetic testingresults are not available in 24
(53:31):
hours.
And number two, just sayingI've got the BRCA gene or I've
got the breast gene, we all havethem.
We've got two copies of them.
Most people have got copiesthat are working fine, but then
sometimes people are born withmutations and it elevates the
risk.
It isn't a diagnosis of cancer,right?
So in my little world I try tochange the way it's said.
(53:52):
But also the reason forthinking that through is a lot
of the way you speak to doctorsor the admin staff affects the
way you're triaged.
You know what I mean.
So if you don't give anaccurate information and again,
I'm never saying this to thepoint that people are giving it,
they're silly or whatever.
I'm saying just practicallyfrom experience if you can be as
(54:15):
clear and concise as you can,have a report, know what it is,
or something like like that,that's going to be so much
beneficial for you than runningaround.
And then someone said can I getthe report?
Can I do this?
You know what I mean.
Oh, you want screening?
We'll send you to the the mapsclinic, like the high-risk
breast clinic.
Oh, she hasn't had genetictesting yet.
Oh, she comes back, you know.
Just things like that, I think,can help you navigate the
health care system.
Matt Burgess (54:36):
But it just sounds like in lots of different areas
you're really empowering youknow your patients and your
students and probably othergenetic counsellors as well, so
it has been so fabulous talkingwith you today.
Thank you so much for your timeand, yeah, I hope you've
enjoyed your time chatting onthe podcast.
Angela Arnold Ross (54:59):
Well, you can tell I'm very passionate
about what I do.
I could talk all day on thistopic, but thank you for giving
me the opportunity to talk toyou.
For sure it's been a lot of funand I hope people have learned
something or it's beenbeneficial for someone in some
way.
Excellent Thanks, Angela.
Matt Burgess (55:16):
Thank you.
Hi, my name is Matt and I am a genetic
counsellor.
I am the host of this podcast,Demystifying Genetics.
Today, my guest is AngelaArnold-Ross.
Angela is an Aussie geneticcounsellor living in New Jersey.
Join us as we unpack ourthoughts and feelings around
many aspects of geneticcounselling.
(00:21):
Hi Angela, and welcome toDemystifying Genetics.
Angela Arnold Ross (00:28):
Hi, thank you for having me.
I'm very excited to talk to youtoday.
Yeah, me too.
Matt Burgess (00:32):
Now I know that this was a good time for you to
record, because you said thatyour husband and daughter are
out of the house, so you're homealone.
They're at a daddy-daughterdaughter dance.
I just assumed that mums wereinvited, our mum's not invited
no, it's definitely daddydaughter.
Angela Arnold Ross (00:51):
So I don't know if people organize that so
that we get a break from the ptoor anything or whether like or
what it is, but it's just them.
They go dancing, but I thinkit's more.
The kids are dancing around,the men are just chatting away,
but they look cute, they lookvery adorable.
When they left, I have to sayoh lovely.
Matt Burgess (01:06):
Well, I hope that this is considered downtime for
you and um.
It's not too stressful and wecan just have a nice chat um
what you ask?
Angela Arnold Ross (01:15):
no, it should be fine.
Matt Burgess (01:16):
I get to distress afterwards, so we are both
genetic counselors fromaustralia and we'll both live in
New Jersey and about a year ohno, a couple of years ago now
the thing that sort of broughtus together or bonded us a
little bit was that we were bothlaid off from our jobs and I
(01:37):
know we sort of you know foundit quite difficult and stressful
and you know lots of differentemotions.
How are you going now?
Sort of looking back at thattough time.
Angela Arnold Ross (01:53):
I'm really good, I'm in a very good place.
Like it's gone so fast, I haveto say yes, because when we
spoke it must have been a yearand a half ago, but when it was
like in January, when I was letgo and by June I'd found this
position that I'm in now at theBassett Centre for Bracca and I
feel like but it took me a lotto get to that spot.
It was very stressful.
I was with my previousworkplace for 15 years and I
(02:17):
didn't think I was going to beleaving and they did this
reduction in force.
It wasn't nothing that I did atall, but I was part-time and
senior.
At least that's what I thinkhappened.
And then you know, coming outinto the workforce without a job
after 15 years, it's verydifferent.
With respect to I didn'trealize that there's AI.
Read your CVs.
(02:37):
I put this big CV I'm amazing,this is fantastic.
And then I didn't get any bites.
I was actually kind ofsurprised.
But then, after a lot ofnetworking, I got to where I am
today.
But yeah, it was a very, as youknow, a very rough time, bad
for the ego.
What happens when that happens?
Matt Burgess (02:55):
Yeah, definitely, and I think that it's something
that genetic counsellors arevery familiar with in America,
but not so much in Australia.
Like in Australia, as you know,most genetic counsellors work
for public health and the ideaof sort of mass redundancies is
(03:16):
not something that we see thatoften, but unfortunately, in the
United States there have been alot of genetic counsellors,
like hundreds and hundreds, Iwould say.
Angela Arnold Ross (03:27):
Yes, I feel like you know, when it happens
to you, you feel like it's justyou right, and then when you
figure it out like there are alot of like from the people
working in labs, they'll get letgo.
You know, I think it's rightafter COVID, you know, it just
was a terrible time those coupleof years.
Matt Burgess (03:41):
Yeah, yeah.
So I know you wrote a couple ofarticles and I think that that
was probably a cathartic thingfor you to sort of, you know, be
able to put your sort ofthoughts together and write
something sort of sensible.
And you know you told me thatthe aim was that you wanted
(04:02):
other people to sort of benefitfrom what you had gone through.
What sort of lessons do youtake away from this horrible
experience?
Angela Arnold Ross (04:14):
Well, it definitely puts you in your
place, I guess in a way.
You know I love what I do.
Genetic counsellors love theirjobs.
It's just an amazing professionand you generally feel very
supported.
But in the moment, especiallywith my redundancy as I'm sure a
lot of others as well, butparticularly for me I had no
idea, so it came out of the blue, so it was extremely shocking.
(04:35):
And, as you said, the piecesthat I wrote, yeah, I just had
this urge to write it down.
I didn't want anyone else to gothrough or feel the way I felt
and in that moment I just waswriting and drafting, and
writing and drafting.
I haven't published them yet.
I sent you the two to read andI actually haven't read it for a
number of months now becauseI'm like, okay, we'll put that
aside for now.
But yeah, I mean it was a lotto deal with.
(04:59):
But that definitely helped wasto write feelings down with an
aim to sort of.
Initially you feel a bit bitter,um, especially when you don't
feel like you've been.
You weren't, we weren't treatedvery well after the fact at all
, it was horrendous, um.
But then after a while it getsless, less bitter and but at the
same time I felt writing myemotions and saying how I felt
in theory could be beneficial toother people.
(05:21):
But then, now that it's beensome time since I wrote it
actually, or or since all thishappened, now that I'm sort of
in a happier place, I have toread it again now that we've
spoken, and see whether I dowant to publish at least one of
them, if it will be beneficialfor others.
But it's like in that momentyou just feel so disrespected.
(05:41):
You feel so, you just feel likeyou.
It's just a terrible feeling,absolutely, absolutely terrible
feeling.
So I put all of those words andeverything into that article and
I just I know it's a biggerpicture and it's not just me, it
was a whole lot of people andbut as a clinician I felt like
we weren't treated very well anddoctors weren't treated very
(06:03):
well.
We were just put out to pasturelike right after a big clinic
day and told it was effectiveimmediately, no chance to sort
of sign off notes or say goodbyeto anyone, and then that sort
of set the tone, I think, forwhat happened afterwards, when
no one would contact you, and itwas just a really horrendous
time.
So I don't know.
You'll have to tell me, whenyou've read my pieces, if you
(06:24):
think it's, if it's helpful orif it's just, as you said, a
good way to get it out on paperyeah, so you said that you had
no idea that it was coming.
Matt Burgess (06:34):
Like, do you mean you literally had no idea?
Like you walked into a meetingand you didn't know what it was
about and then you found outthat you'd been let go.
Is that what you mean?
Angela Arnold Ross (06:46):
Absolutely so we knew there was going to be
a reduction in force across thewhole system.
I was working at a cancerhospital and a comprehensive
cancer hospital, so we knewthere were going to be layoffs.
I'm 15 years senior.
I'd gone down to four days aweek for family, you know, for
work-life balance regardless.
But we're extremely, extremelybusy in the clinic, like crazy
(07:08):
busy.
And so the day that thishappened, I mean I was thinking
that maybe admin staff weregoing to be let go.
You know, I really didn't thinkthat clinicians would be let go
and I saw five patients back toback.
Very, you know, those days arevery long.
I love my cases, but you butlong days with one of my bosses
that I work with no inkling wascalled into a meeting and I
(07:29):
thought it was to say look, theadmin staff are being let go.
We have to do more of this.
X, y, z, and it was horrendous.
I was like wow.
And for some others they had afeeling there was a reason.
There were sort of situationsfor certain people that they
sort of had an inkling that theymight be, but for me, honestly,
I had no warning You'reblindsided.
Matt Burgess (07:51):
Yeah, that's really tough, like I know for my
team.
Our whole team were let go andwe were given like because we
all worked remotely, we wereinvited to a meeting the
following day.
So it was Thursday night atabout 6 pm and my team started
talking and we kind of thoughtmaybe this was one of the
(08:13):
reasons.
So I mean, it was still sort of, you know, maybe 12 hours
notice and we had like aninkling, but but yeah, still
wasn't pleasant.
Angela Arnold Ross (08:25):
It still makes you feel terrible.
Right, I mean you feel,although it's not.
If they said, it's not you blah, blah, blah it doesn't.
It feels like it's you.
You know, in that moment, youknow it's gut wrenching and I,
you know I went through prettymuch the stages of grief it was.
It was so shocking and and I'msure you sort of felt the way
too, you know, you're angry andyou're sad and you're this and
you're that because it's justblindside you.
But then to top it off, notonly just losing your, your
(08:47):
position, what you love doing,it was then being treated so
badly afterwards, like reallynot in a very, um, empathic way
at all.
And then I've actually hearddifferent um.
This is actually new news thatI've heard recently um, gathered
just from talking to people,like one of my colleagues was
allowed to go back to theiroffice and collect their stuff.
Um, out in jersey, where I wasworking um one of their off
(09:09):
sites, they wouldn't even let mein the building to collect my
stuff, and it's just, you know.
And no one picked up the phoneand called me.
If you can believe it, that wasreally tough after 15 years
that no one picked up the phoneand called me at least my bosses
, the genetic councils I couldget, because everyone was
probably afraid of losing theirposition.
Um, and I think they were toldnot to make any concerted
(09:30):
efforts, was that were the words.
But um, my bosses didn't evenwho I've been working with for
10, 15, then 10 years.
Didn't call yeah's upsetting.
Matt Burgess (09:41):
That's my ego.
Yeah, I was kind of thinkingsort of how can we put a
positive, something positive,out of it?
You know, what can we take awayfrom it or what advice can we
give?
I know for me and it soundslike for you as well one of the
hard things was just some of myteammates that I've been working
with.
Like I never spoke to themagain and I just thought it
(10:05):
would be really nice if theyreached out just to say you know
, I know what happened, sucks,and I hope you're okay.
Angela Arnold Ross (10:13):
So the people that weren't laid off,
the ones that were still at thejob, didn't hear from them again
.
Matt Burgess (10:16):
Yeah, I mean, some of them did like some of my
close sort of workmates.
But you know, there were peoplethat you know I would see every
couple of months and we workedtogether and then I just never
heard from them again.
Angela Arnold Ross (10:29):
And I thought oh, that sort of upset
me.
Did you feel like you couldreach out to them or not?
Or you felt in the momentyou're like they?
Matt Burgess (10:40):
should reach out to me.
I'm the one who lost my job.
Yeah, I did kind of feel likethat Like yeah, they all knew
kind of what happened, they kepttheir job.
I mean, that was sort of theraw emotion at the time and you
know, it happened to me abouttwo years ago now.
So you know, if I needed toreach out to any of them or ask
them questions, I would, youknow, not hesitate to do that.
(11:01):
But I've just I don't that thethe people who did reach out
just to, even if it was just atext message, and they said hey,
matt um, you know that that wasreally horrible what you went
through.
I hope you're okay.
I don't think they realized howsignificant or how much that
actually helped me.
Angela Arnold Ross (11:21):
Yeah, yeah absolutely, and that's what I
say in my piece.
You know, it just would be niceif someone reached out and
acknowledged that you didn't doanything wrong and made it.
You know, sort of made it sortof, yeah, put it into
perspective, and but you knowwhat I think?
What I've realized, though, is,look, everyone goes on with
their lives.
It's like, oh, that's terrible,and they move on.
And I loved when I got so I got, I was able to.
(11:43):
I lost my email like midnightthat night or something, so I
was scrambling, sending emailsto as many people that I could
you know off the top of my head,the people I had relationships
with in the in the hospital tosay I'm so sorry.
I thought I actually wrote avery good email.
I should have uncopied it outfor you, but it was kind of a
cool message to say goodbye, um,and the responses were
wonderful, um and um and I andyet I absolutely agree the ones
(12:07):
that reached out even just saidthe minimalist thing was just so
nice because it really sort of,you know, boosted you up.
And advice I'd give to otherpeople, like especially people
in superior positions, just tothink a little bit more about
what's happened in that momentand reach out, and that's, you
know.
Then life goes on, I guess, but, um, but, like one thing that
(12:28):
really made it aware, and isthat one of the doctors that I
work with, she, she said, sheemailed me eventually, like
after 10 days, one of my bosses,right after 10 days, and then
said I'm sorry it took so long,I was busy.
I'm like really, you know, soit's those sort of things.
But then at the same time it'slike, well, they don't think
about me, it's work, you know,but, but, but I guess it's be
(12:52):
nice to people and this goesacross to finance, people who
get let go all the time, um,which a different thing, you
know.
When you can, um, you know, cansteal money, but for clinicians
we abide by hipper in theory.
Practically, we're like, well,I'm not going to go publish a
famous person's pedigree in thenew york times or something.
But I felt like, just if theyunderstand the emotion, how we
(13:13):
feel as people, just for a shorttime, I think that would just
be such a nice way.
I get it's HR, you know, I'verationalized it so many times
like, oh, but I get it's HR,it's not them, but then is it?
They could have picked up thephone, so many things around and
but you know it's it's it'sbecause I was trying to think of
(13:33):
something.
I'd like to be helpful with thisbecause, as you can already
tell, with my emotion, I stillget very upset by it, um, and I
feel slighted, but when it comesdown to it I was an employee
and I really, but then I reallyfelt like one afterwards.
You know what I mean.
I thought I had I went my wholelife.
You know I came to the statesto get the job and I had met my
husband, had my daughter and allof that stuff.
So it meant a lot for me, but Iunderstand it's not a lot for
(13:56):
everyone else.
Matt Burgess (13:57):
Yeah, and I think you know, as genetic counsellors
we're used to the idea ofhaving supervision and talking
about our feelings and you knowwe're experienced with sort of
that therapeutic relationshipand like I know part of it, for
me I kind of felt like it was aninteresting sort of social
(14:18):
experiment.
Like, even though I was sort ofangry and upset and go through
all these stages of grief, asyou mentioned, part of me was
sort of it was like I wasobserving as an outsider,
thinking oh, wow, isn't thisinteresting?
Like, oh, I didn't think thiswould happen, oh, this is a
surprising emotion.
And I kind of feel maybe alittle bit grateful that I did
(14:40):
have that training and, like youknow, with our colleagues that
maybe were in finance or youknow, admin, who don't have that
sort of background, like maybeit was extra hard for them.
Angela Arnold Ross (14:56):
Yeah, absolutely, because I've had
people in finance and I knowthey get a gardening leave, they
get laid off and all of youknow, even if they quit, you
know all that thing happens, butthey could just be let go in an
instant and out the door then.
But yes, going through ityourself really makes you aware
of what people go through,absolutely for sure.
But then when I was similar towhat you just said, when I was
(15:16):
writing the pieces that I wroteone very emotional one and one
kind of this might help people.
As I said, I haven't read themfor a while because it does
bring up a lot of emotions, butthat's when I realised I'm going
through.
I made that up myself.
I'm like this is like grief,like I'm mad, and I didn't
realize that.
So I agree, it's a good point.
I think that our backgroundhelped me a little bit.
(15:37):
I don't know well good or bad,because maybe I overthought it a
little bit, because I couldanalyze it in my head, but then
I guess, having an irrationalanswer or sort of being able to
think it through, you know whythis happened.
I'm going through this moment.
I'll get through it.
This happened.
I'm going through this moment.
I'll get through it.
But again, you know, also, Ifeel like my age was a bit I
find it's almost funny 15 years.
(15:57):
I had my CV and everything.
Yes, it was a surprise, butthen, oh my goodness, going out
to, you know, going to try tofind another job LinkedIn was
amazing, I have to say but thenall the stuff that I just took
for granted, you know, I justdidn't realise.
You know, I had to do the CVagain and then somehow I figured
out AI people read it and thenI'm like, oh my goodness, so I
(16:18):
had to do this.
But it was a good learningexperience.
Looking back, it was six monthsof tough work, but I did find
my way, but it wasn't easy.
Matt Burgess (16:28):
Yeah, I think, if you know, really think about
this horrible event that we wentthrough from, you know, through
the lens of you know, stages ofgrief, you know the last stage
is sort of acceptance and Ithink, you know, both of us have
got new jobs and we've moved onand I think that we have kind
(16:49):
of.
You know, we're definitely inthat sort of final stage.
We're able to look back and,you know, maybe we get sort of
um a little bit emotional, but Ithink, you know, with time it
does help oh, it does, and I'veactually, now that we're doing
this um, this podcast, I'm goingto go back and read my articles
again.
Angela Arnold Ross (17:06):
I one I was going to my boss, who I love.
Dr Domchek was amazing.
She read them through um for meand supported me in every way,
but I didn't.
I've held off on publishingthem.
I think the perspectives wantedto publish one of them or
whatever, but I just want totake a step back making them do
to make sure I'm doing the rightthing for the benefit of other
people.
Because, look, although thatwas terrible, I had amazing 15
(17:27):
years.
Like I had the best experience.
I can't even I can't even saythat that is not true.
Like I really had a great timein those 15 years and I love my
position so much.
I mean, I moved from Australiato the UK here to take that
position and it was wonderful.
It just ended sooner.
But, as you said, like I don'tknow about you, but everything
(17:47):
I've done in life, it's almost Idon't know if I should believe
in fate being a scientist, right, but everything I've done.
Matt Burgess (17:52):
You can look back and go oh.
Angela Arnold Ross (17:54):
So now, in that moment, I went crazy.
I did all my CEUs, probably forthe next certification.
I've did all so many webinarsand I sent out my CV.
I was LinkedIn, as I said, wasa very good professional working
, but I ended up finding thisposition through networking.
I did a presentation for Myriadand I you know all sorts of
things like that and I found myway, but, looking, I'm like I
couldn't have landed anywherebetter.
(18:15):
You know it's like so.
It worked out in the end, butin the moment you really don't
feel that way.
So if anyone can learn fromanything like it does get better
, but it does suck in the moment.
Matt Burgess (18:26):
Yeah, and I think that's an interesting point.
You know, like you said, thatyou became very involved and
sort of did lots of things anddoing all of your professional
development, and I think part ofthat is, you know, when you're
laid off you've got absolutelyno control, and part of taking
(18:48):
back some of that control iskind of maybe overdosing or
going sort of in the otherdirection.
Angela Arnold Ross (18:57):
Yeah, because you don't know what's
going to happen.
I mean, you know, I love my jobso much I really really do.
I didn't relax at all in thosesix months.
I was looking back.
I'm like gosh, I wish I tooksome time to myself, but I was
so frantically panicking.
The other thing is healthcareinsurance.
You know, we lost that.
We had to go on what we callCobra over here and it's so
(19:17):
expensive, like it's crazy.
If you work for a hospitalsystem in America, they
subsidize some of yourhealthcare.
So that was one thing.
But then also, I love.
I love doing what I, what Iwant to do.
But yes, you're right, I did somuch stuff.
I was like my old self, like Iwas like when I was like 20 and
young and I did, you know,energetic and doing, writing
things and doing so much.
And I'm like I've fallen backinto my oh, I'm so busy I don't
(19:39):
have time to do that anymore.
Matt Burgess (19:41):
But um, but yeah I know I listened to um a couple
of podcasts about, um, you know,reduction in force and being
laid off, and it wasn't sort ofgenetic counseling specific.
It was sort of um yeah, wasn'tsort of science related or
health related at all, but oneof the key takeaways was the
importance of networking and Ikind of was like I don't feel
(20:05):
like networking or I don't wantto, but I think that genetic
counsellors are just really goodat networking anyway.
Is that like how significant doyou think networking was in
that period of?
Angela Arnold Ross (20:19):
time for you .
It was amazingly wonderful inthe sense of the support I felt
for people I didn't know Likethe part of our National Society
of Genetic Counsellors at thetime because, again, I was being
I guess what's the word, it wasbeing very insular.
I thought this is just me, I'mgoing through this right.
But at the time that thishappened, they were doing
presentations on what you do toget jobs and how to handle and
(20:42):
how to get, and it was justamazing timing.
There was one geneticcounsellor I wish I could
remember her name now.
She was fantastic, giving metips about how to do my cv, how
to approach um people and andbecause again 15 years, I really
didn't know and I didn'trealize.
I didn't know what to do, ifthat makes sense, and she was.
She didn't know me from a barof soap and she she got on
(21:02):
separately and she emailed me.
She missed.
She was so wonderful at justgiving me a hand just for her
own benefit and the nsgc headsas a whole, because I I shared
something.
I can't even remember what itwas about now, but I just felt
so supported and just so heard.
You know what I mean, because Ididn't get any boost of
confidence from when it happened.
(21:23):
But the community is amazingand I fell into certain things.
But I was definitely active soI sort of pushed myself forward.
But just from doing apresentation, speaking to
so-and-so, who listened to it,finding so-and-so, and then
eventually someone was lookingfor temporary work because
people were going on maternityleave and I'm like I'm free.
I wish we could do that as acompany, but you need the
(21:46):
benefits.
Networking is so important and,as I said, I'm not being paid
by LinkedIn, but that was areally good resource, because
Facebook and Instagram I don'tthink so, but it really was good
, like business orientated, andyou could sort of you know, make
connections and I've still madesome connections on there
actually that are stillbeneficial for me as a whole or
(22:07):
for what I do, givingpresentations and things.
Matt Burgess (22:10):
Yeah.
Angela Arnold Ross (22:11):
So yeah.
Matt Burgess (22:12):
I think it's Not what I meant you.
The benefit that I find fromLinkedIn.
What I really like is you knowI've connected to people and you
know they've sort of reachedout to me and you don't know
them from a bar of soap, but youknow you work in the same
industry or you know we're allgenetic counsellors, but then
(22:32):
when you do actually go to aconference and you meet these
people, you've already it's likeyou've already done that first
step.
Angela Arnold Ross (22:40):
It's lovely, it's very nice.
It's so nice?
No, it is, it's really nice andit makes you believe more in
people being more humane, peoplebeing nice.
Because you know, and I think,like I had people coming we just
went to a national conferencefor inherited GI cancers in
Philly and one of thecounsellors had I was going to
do I do a lot of interviews if Ican, for student projects or
(23:00):
whatever and she came up to me.
I wouldn't have known what shelooked like, but I think with my
accent people can really figureout who I am.
So a lot of people go, hey,ange, how are you?
And I'm like hi, how are you?
They come up and say hi and itjust sets the stage, I think,
just for making, as you said, alittle bit easier.
But everyone's so willing tohelp people generally, you know
(23:21):
they really aren't out forthemselves.
Our communities are wonderful.
I mean NSGC.
As I wrote in my article, nsgcwas amazing.
This particular counsellor wasamazing.
It was yeah, it was.
It was wonderful.
That was a wonderful experience.
Matt Burgess (23:34):
Oh, go ahead.
Join thousands of geneticsprofessionals worldwide who
trust TractGene.
Built specifically for geneticsclinics, tractgene makes
pedigree creation, data entryand reporting easy and efficient
.
Get a free demonstration todayand see Trackgene in action.
University students andacademics can also access
(23:57):
Trackgene's pedigree drawingsoftware for free.
Head to trackgenecom that'sT-R-A-K-G-E-N-E dot com and
explore what it can do for you.
Well, one thing I wanted tosort of get your opinion on was
licensure of genetic counselors.
(24:18):
Now I think you know super likewhen I was thinking of it
initially, maybe a bitsuperficially, I thought, oh,
this is a great idea.
Um, but logistically orpractically in america, it does
seem to cause a few problems.
Yes, like, for example, youlive in New Jersey, you were
(24:40):
working in New York.
Angela Arnold Ross (24:42):
Now you work in Pennsylvania.
Matt Burgess (24:44):
Pennsylvania and New Jersey yeah, what has been
your sort of like experience oflicensure and are there any
issues and how do you think thatthe Americans can sort of fix
up the system?
Angela Arnold Ross (25:04):
Yeah, well, it's funny because in my other
position in New York we don'thave licensure yet, so we could
never use our billing code.
We weren't really billing underthe physicians and still seeing
patients.
But I guess we weren't really.
We were billing under thephysicians and still seeing
patients, but I guess we weren't, as weren't that autonomous.
Now that I'm at and again thisis, this is being let go from
that position to this positionhas actually been very good at
(25:24):
making me aware of like it was acancer hospital.
That's all I knew.
Now I'm at a big hospital,comprehensive, like oh, the PCPs
are part of the system, got it,you know those sort of things.
And so now I'm licensed in NewJersey and licensed in PA, which
means that I can see patientsin PA and New Jersey and I can
bill for my services.
We're not recognized by Medicare, the CMS recognized, which
(25:48):
means we can't.
There's logistics in Americawhen it comes to the healthcare
system, but if anyone's over 65on Medicare, they don't
recognize us as clinicians, sowe can't.
Actually we're not meant to see, bill or order tests for
patients who don't meet criteriaor not.
So that's a hurdle to jumpthrough because there's a lot of
people who might suffer fromthat if there's not enough
(26:08):
doctors to see patients.
You know, in Medicare we justdon't.
We managed to see them with thedoctors in PA and see people,
but that's a big hurdle thatpeople have to jump through, or
the genetic counselors stumbleupon the logistics of that.
I mean, I think it would bewonderful for the profession as
(26:29):
a whole or just for people whoneed genetic counselors.
I heard at this meeting there'sa shortage of genetic
counselors.
Now I'm like what?
Not when I was looking for jobs, but you know they.
But by being licensed and look,we don't get paid much.
It's not, it's not.
I don't get paid, by the way,for my services.
I'm working in a hospital butwe're allowed to bill and we
should be able to bill becausewe put a lot of work into into
(26:49):
our patients and prep andeverything and follow upup.
But I guess it would allowpeople to.
Then we could, if we could billfor our services or most people
around you know the country wecould see patients autonomously
for new visits and follow-ups.
We could, you know, berecognised for what we do.
I must admit I was very excitedto be able to bill for a code
(27:11):
for what I do and what I lovedoing.
You know I'm not getting thebenefit from the benefit from
the payment from the service,but I'm like it was fun to put
the code in and know how to doit because I'd never done that
before.
So I think and the other flipside, again to realize it's made
me realize all about thelicensure as well, which I
(27:31):
didn't think big picture is.
You know, then we have themedical.
The liability would be on us ifwe're licensed fully with
Medicare.
Do we want to take that on?
You know, at the moment we'vegot that buffer.
The physicians, you know, areliable for everything, which is
also fine.
I don't know, I don't see, Idon't know if you've thought of
any huge negatives to licensure,because I just think it would
(27:53):
be beneficial for the system,you know, to have genetic
counsellors that could freelysee people you know, and often
it's under supervision, rightversus you know there's such
backlogs in clinics to seepatients, you know,
unfortunately, and a lot ofthat's because we, you know you
need physicians and physicianscan only do so much, they're so
busy.
Matt Burgess (28:13):
I mean, it's something that I have thought
about a little bit and, um, it'ssomething that I mentioned, uh,
with my students in the classthat I teach, uh, but I I guess
the the drawback.
I mean, there are a lot ofbenefits that I can see, but the
drawbacks, I think, areprobably, you know, in states
like new york, how do wegrandfather in people Like I
(28:36):
think that maybe you know, thereare genetic counsellors with
literally decades and decades ofexperience who may not meet the
criteria and then it's kind ofokay, like if you live in the
middle of one state and you'relicensed by that state and you
only work in that state.
It's great, um, if you live onthe border of one state and, you
(29:00):
know, maybe you work intelehealth or yeah, like
logistically you know if youemploy, you know you're a
telehealth company and you'reemploying 10 genetic counselors
and you can only put a callthrough to one that is licensed
in that you know that iscomplicated yeah, that is
complicated, yeah, that iscomplicated.
Angela Arnold Ross (29:21):
Well, so I mainly see telemedicine because
I actually live in North Jerseyand south of me is where Philly
is and where Penn is, but to meI think it's where the patient
is, though.
Right, so I can be in NewJersey, Philly, but the
patient's got to be in Jersey.
So when a patient you know saysthey're going to go to Florida,
I say you've got to see mebefore you go to Florida.
I can't do that, but I guessit's the licensure itself.
(29:41):
Did you get licensed when youwere working here?
Matt Burgess (29:45):
No, I couldn't sit the board exam.
Angela Arnold Ross (29:47):
See, that's a whole nother discussion.
Matt Burgess (29:49):
And.
Angela Arnold Ross (29:50):
I can actually see.
I was on one of the boards forreciprocity between the UK,
australia and America and it wasinteresting because I got to
see initially I'm like, why not?
But then it's different.
With the healthcare systems itis definitely a different take.
But I never want to take thatexam again so I'll make sure I'm
up to date with all my CEUs.
That was tough, but you know, Ifeel like and I was actually
(30:12):
just on a meeting earlier whereyou know it was pointed out that
the PAs and the nursepractitioners they now can build
, they're now recognised asclinicians, but that took time
for them to get to that pointright and so hopefully you know
we'll get to that point as well.
But telemedicine, well, thisnew code that's coming out.
Have you heard about the newcode that's coming?
Matt Burgess (30:32):
out.
I actually wrote a blog piecefor Tr gene on the new code in
america and how, because inaustralia we're sort of trying
to fight or, you know, bargainto or negotiate to get uh many
care item numbers as well.
Angela Arnold Ross (30:49):
So okay, I sort of compared and contrasted
the two differences.
Oh, I want to see that you'llhave to send it to me or tell me
where to find it for sure.
Well, that's very new.
We just were talking about thattoday.
But it would be lovely if wecould get billed for the pre,
you know, not just for the 15,30 minutes, but for anything we
do before and after.
I think that's justified.
So we're just seeing how thatgoes when we call out results.
(31:14):
We're not billing for any ofthat.
So that side of things becauseagain, we don't really make
money for the hospitals asgenetic counsellors, but we
should be able to sort of atleast contribute a little bit in
that way.
So it sounds like if we do withthis new code, it will give a
little bit more flexibility.
For that which will benon-patient-facing billing is
(31:34):
what it is, for that which willbe non-patient facing billing is
what it is for that, whichwould be nice.
But yeah, there's hurdles tojump through and there's, you
know, the States.
I was trying to think why dopeople not want this to happen,
you know?
But there's a lot of stuff thatgoes on behind the scenes that
we just sort of don't realise.
But we just want more geneticcounsellors out there.
I can't believe there's ashortage now.
There wasn't when I was lookingfor a job out there.
(31:55):
I can't believe there's ashortage now.
Matt Burgess (31:56):
There wasn't when I was looking for a job.
It's funny how things sort ofchange and, yeah, like swings
and roundabouts, like you know,the rollercoaster of needing
more people and there not beingenough jobs.
Angela Arnold Ross (32:07):
But also getting yourself away from
yourself, because I think, gosh,we're all so busy, like, how
can you even think about peoplebeing let go?
We don't think you know thebigger picture, obviously,
because not everyone wants tolet people go, but yeah, it's.
And, as you said, you know,this reduction in force just
opened our eyes up to otherthings, I guess.
Matt Burgess (32:27):
One of the other things that I wanted to ask you
about, which is something veryAmerican in healthcare, which is
not something that we have inAustralia or other parts of the
world, is the Cures Act.
Now can you sort of maybe giveus a little bit of a summary of
(32:48):
what the Cures Act is and thenhow it relates to your job
specifically as a geneticcounsellor?
Angela Arnold Ross (32:58):
relates to your job specifically as a
genetic counsellor.
Sure, so now, instead of whenwe're healthcare providers, we
could, when we order tests orget, do you know if we can have
a mammogram or if we have acolonoscopy and we have a biopsy
of anything?
All of the records that youknow go to the ordering
physician and then they transmitthe results to the patient and
then the patient's allowed tohave a copy of the results.
You know whether they ask forit or not.
I'm not too sure.
They probably often did not.
(33:18):
But now there's a law in theStates where any report or test
that you have immediately assoon as it's released into the
electronic health system, nowthe patient gets it as soon as
you get it, which again opensthe open sort of access to
records.
And you know the big picturethat people have access to what
they, what they've, you knowwhat they've done and what they
(33:40):
um, their diagnoses andeverything.
But it's, it's.
I can see that.
But if you think about thereports that we often see, so as
a cancer genetic counselor I'mseeing mammogram reports that
say, oh, there's something there.
I've seen, I see, you know,other pathology reports where
they might say lobular carcinomain situ, which actually isn't
cancer but it says carcinoma,and people are not reading these
(34:03):
, can have access to thesereports, that have no
understanding of what these are.
It puts a lot of pressure onthe doctors especially as well,
because if a patient sees adiagnosis of cancer like which
you could which I've heard andit sounds like it's not ideal
for most people is that then thepatient?
If it's on a Friday, saturday,sunday, the patient of course
(34:26):
wants to speak to the physician.
So there's a whole lot of toand fro with this act.
I'm learning to accept itbecause before know, before this
act, you know, we with geneticcounseling reports, our genetic
counseling reports or genetictesting reports, are very
detailed and very hard to read.
Sometimes even we have troublesort of understanding all of all
of what's in there, um and so,but we would always be able to
(34:48):
have the reports and review themwith the patient, show the
patient, you know, walk themthrough the report and go
through it with them, um, beforeeven handing it to them, or
sometimes not even giving theresults until they come and see
you.
Or there's something contractedto how you're going to give the
results to patients, but nowpatients basically see the
results as soon as they'resigned out.
And I've realized within myselfI'm having trouble with it,
(35:11):
just internally.
I mean, they're adults, that wesee, and they, they, they seem
to be okay, um, receiving themthat way, or they're accepting
it, cause what we tell themisn't always there's, often not
as bad as what they've been toldif, if they have a cancer
diagnosis, um but um, but yeah,we, it just causes a bit of
anxiety for me when it when it'sthat, because if someone's it
(35:32):
says positive, like on thereport, or uncertain.
So I've actually changed, Ichanged my, my counseling style
a little bit, depending on howyou know the day, depending on
who's in front of me, and alsoI'm trying to think, I was
trying to think of ways to okay,so if someone opens a report,
how might they feel about that?
Now, this could be totallyoverkill, because I've even
(35:52):
admitted that to patients look,this could be totally me,
because they're like, oh fine,I'll see it when it's released.
But I start saying now that youknow if you see positive, it
doesn't mean you have a cancerdiagnosis, it doesn't mean it's
a high risk, you know, and I'mavailable to speak to you and
sort of go through it that way,but that's.
I think it's probably moregenetic counselors having
trouble with that, you know, inour niche, in our niche with our
(36:13):
reports, than maybe patients.
I mean, they don't think aboutit probably.
But it's been a bit to getthrough.
You know a bit to work my headaround, I guess, to get used to
it.
Matt Burgess (36:23):
Yeah, like I worked for some genetic testing
labs in the United States and soyou know this was a big issue
for us.
Like you know when do we uploada result and you know how, you
know logistically what happensand how is the q.
Is that going to sort ofinteract with that?
And I think, as a patient, likeif I think of myself as a
(36:46):
patient, like if, if my doctorhas ordered like cholesterol or
you know, like um, iron orvitamin d or something sort of
like that, I feel like I don'treally need them to explain it,
like I can look at that result.
Yeah, but you know, it makes methink of sort of medical
paternalism.
Like, as genetic counsellors,we are very conscious about okay
(37:09):
, we order this test, how are wegoing to give it to the person?
When are we going to make theresults appointment?
Are we going to give it to theperson?
When are we going to make theresults appointment?
Like I think that we are verymindful in organizing the best
way to give it to a patient.
However, you know, maybe wehave our clinic on a Thursday
morning but the report isreported on Monday morning and
(37:33):
you know, in the past it's likeokay, well, three days isn't
going to make much of adifference.
I can be prepared, I can lookthings up, I can, you know,
gather information, I'll meetwith a patient and then we can
go through it, whereas now, asyou said, they can see these
incredibly detailed andcomplicated and complex reports
by themselves and you know, likeis it fair for us to say, well,
(37:58):
maybe they shouldn't, becausethey are adults and you know
they can choose not to read it.
I don't know.
Yeah, it's an interesting thing.
Angela Arnold Ross (38:07):
Well, I mean , I'm not saying I'm.
In a way it's a bit freeing, Ihave to say, because we get
sometimes slammed with resultsall at once, whatever reason.
Down south it comes in waves.
I don't know what it is.
You'll have a week full oftesting and I'll have maybe a
week of no testing, people, youknow, deferring or just people
who didn't want testing.
So the one thing because I cansee when a patient's read the
results and if they haven'treached out to me, then you know
(38:29):
I'm going to get to them forsure.
But then I feel like, okay,they're not upset, because I
always worry that someone'sgoing to get a result and be
upset and again, that's probablyme.
Transference right, it istransference, it's probably
totally me than anyone else.
But yeah, I think that's mademe calm down is that they're
adults, they know what'shappening because we do contract
(38:50):
with them and I'd say look theresults when you see them, I see
them.
I sometimes tailor it because wecan hold them back for a short
time, I think with reason.
But then I'm thinking if theysay it's okay, I'm like, okay,
you can send it to that, buthere's some warnings and then
you know I'm available.
That's my main thing is forthem to know that I'm available.
But I agree, I've had oneperson say that they think they
(39:11):
were very strong, that this hasto happen.
It's wonderful and I have it.
I mean, a lot of people arekind of like, well, I sort of
wish I didn't open it becauseit's you know, a lot of.
I read an article, I think forthe New Yorker, I think a doctor
wrote it about and it wasreally good to see the doctor's
perspective of it and how muchpressure that puts on the
physician because also,whoever's signing these out,
they do it on like Friday nightsor Saturdays and you know, and
(39:35):
it's not easy for someone to sitfor that long.
Not sort of understanding orknowing, but you know there's
probably things.
Matt Burgess (39:42):
And then you sort of get onto Google and then, if
you're a layperson, you may notunderstand exactly what you're
Googling, and then you getresults.
It's like, oh, is this relevantto my case?
Angela Arnold Ross (39:54):
Yeah, Well, I actually say every day I say,
look, I'm available to you, youcan message me on the portal.
It doesn't wake me up.
But by you contacting me firstmeans you want to talk about it
and I'll get back to you as soonas I can.
Just don't Dr Google.
I say that and they all laughand they probably do it anyway.
But you know, yeah, that'scrazy getting stuff from there.
(40:16):
But again, that is opening itup to that.
I guess If you're getting areport, you can't speak to the
doctor immediately.
It's like you can't help it.
I mean, I'm hypocritical, I'dprobably do the same thing.
Yeah, me too.
Matt Burgess (40:27):
So you sort of mentioned how your counselling
has changed because of the CuresAct and what I wanted to ask
was how has your counsellingchanged more generally?
You know you're a seniorgenetic counsellor.
You've been working for acouple of decades now.
Can you see how your style or,you know, the way that you
(40:52):
counsel people has changed orevolved?
Angela Arnold Ross (40:55):
Yeah, absolutely, and you make me feel
old decades.
Yes, oh, my goodness, it's goneso fast.
Yeah, no, it's funny.
You said that because I'vethought a lot about this and in
fact I was trying to get aproject together with students.
I've been mentoring students,but because, you know, some
things have happened in my lifethat have made me change the way
I speak to patients and it mademe think gosh, I wonder.
(41:16):
I'm sure I'm not the only one,and how can we sort of bring it
to the forefront?
I know there's been a lot ofstudies about pregnancy.
You know people who arepregnant and things like that.
But as a whole I don't know ifI remember reading anything
about it, but there's a wholelot to break down here.
So, for example, when I wasyounger and we did our rotations
and back two decades ago, itwas all prenatal.
(41:36):
I was in my twenties, I didn'tknow, I haven't been pregnant or
anything.
So I was told, you know, a CVSis a push and a pull.
You know you repeat whateveryone says or you listen to
people, you do rotations and youtake a little bit from someone
else, if you like the way theyspeak to patients and explain
things to patients and thathappens, I think, across the
board.
You change things whenever youspeak to someone else or things.
(41:58):
Board.
You change things whenever youspeak to someone else or things
if we learn more informationabout certain syndromes.
But I remember I loved prenataltesting at the time.
That was always sort of had tooffer and then I fell into
cancer, as my fate thing, gotinto cancer and ended up being a
cancer genetic counselorpredominantly.
And then I got pregnant andthen and it was amazing and you
(42:21):
know, apart from wanting to be,by the time I was pregnant you
could test for anything Likewhen I started two decades ago
it was like 10 Jewish geneticdiseases and cystic fibrosis a
very small panel.
Now it's like exomes and things.
And number one.
My OBGYN said well, you'd knowbetter than me.
When I asked about the testing,I went no, I don't.
(42:43):
And then I said, well, I, youknow.
Look, I'm an older mom and Iwent to the best doctor in New
York for prenatal testing and Iwanted to do a CVS.
And for those that don't know,people might know this, but a
CVS is a sampling of theumbilical cord before you know,
very early on, so you could seeif there's maybe some chromosome
abnormalities or something.
And so I went there and then Ihad it and he must have hit my
(43:07):
uterus or something or hit mycervix Like I jumped, I screamed
and my first thought was Istarted crying and said I lied
to all of these patients for somany years that it was a push
and a pull and it's not.
That's the first thing I thoughtof.
Was that?
So I can laugh about that now.
But then I would have tailoredwhat I said to patients more
(43:30):
like with my life experience.
But I know that geneticcounselors don't always have
that life experience to do it,but it did make me think people
have to be careful about whatthey.
I never did anything wrongwrong, but you know what I mean,
in that moment I recognizedthat I really didn't know what I
was talking about.
And I know it's not doesn't hitthe cervix all the time, I
don't want anyone to think that,but you, you just made it sound
(43:50):
much easier than possibly itwas.
And there's a spectrum of.
It could go well, it could gobadly, all sorts of things like
that.
Um, you know.
So that would have changed.
And then I think, as we getmature and get more life
experience, you learn to speakto people differently in certain
ways.
And another thing that stuck outto me and why I started to get
more interest was I had ahysterectomy for non-cancerous
(44:14):
reasons, but I had a reallytough time recovering.
All sorts of stuff happenedthat I didn't expect and
whatever.
And the doctors were very oh,it's this, cause, they see it
all the time, right.
Then they they, they don'tdidn't explain it to me that
they saw whatever happened.
You know, because, yes, youcould think, okay, they brushed
it off, that's good.
But in that moment you're likewhat?
And you've?
(44:44):
You know, I try it's hard, Itry not to bring myself too much
into it, but I'm more aware ofyou know.
Look, most people have a, evenputting the word most.
Most people have a goodexperience.
It's laparoscopic.
Laparoscopic I wish I was cutwhatever to me, but you know
what I mean.
To at least tailor a little bitwith life experience without
having to necessarily shareunless you wanted to.
Like you know most people findit, you know, find it simple.
(45:07):
It's laparoscopic versus likeoh, it's laparoscopic, it's easy
.
Often you know you're back towork the next day, you know sort
of things like that.
I found that, that I tailoredit and I'll also never forget a
moment.
A patient came in because againtaught to say this and not say
this and again, you're neversaying it in a bad way and you
don't mean to say anythingincorrect and generally you're
(45:27):
correct.
But with having laparoscopicoophorectomy, this is before my
situation.
A patient came in and shedecided she had to.
She and her surgeon ended updeciding on a vaginal
hysterectomy and she came in andshe was in absolute agony.
I'll never forget how shelooked.
It was horrendous.
It wasn't.
What was what we talked about.
You know cause we, we justwe're not doctors.
(45:48):
We generally spoke about it andand but I'll but that's another
thing.
I'll never forget just how shereacted.
You said it was.
It wasn't to me.
You said it was simple andalthough you know it wasn't what
we'd said, it don't matter inthat moment and she was just.
It was just horrendous for herand that opened my eyes up.
So I feel like life experiencein certain situations or
(46:10):
interactions with patientsabsolutely tailor the way you
might speak to people or mightmake you more aware of how you
speak to people.
And I guess, just because I'mthinking, I'm decades old now,
look how old I am but I'm justreflecting a lot more on that
now and in my mind, and if Ispeak to students or I'm talking
to students, I try and moveaway from like I understand,
(46:32):
they're young and you haven'tgone through it, and I'm not
saying go get pregnant to gothrough it, but I'm saying, you
know, this is be a bit moregeneral and or or something like
that.
Um, just and again, that's justwhat I've gone, what I feel
I've gone through.
Matt Burgess (46:45):
Yeah, I had some something similar happen with me
.
I um, you know, as a cancergenetic counselor.
We speak to women that um testpositive to particular changes
in genes that increases theirrisk to ovarian cancer and sort
of the gold standard or therecommendation is for women to
(47:06):
have their ovaries removed afterthey've finished having their
families, and usually it is aquick and simple operation.
As operations go, you know, itdoesn't take very long, it is
quick.
Angela Arnold Ross (47:19):
You're in and out in a day which freaks me
out is quick.
Matt Burgess (47:20):
You're in and out in a day which freaks me out,
but yeah, in and out in one dayyeah, and like I remember that
was how I counseled women,that's how I explained it to
women and there was a patientshe actually wasn't someone I
saw, but I I heard about her shehad, um, her ovaries removed.
It was a quick and simpleoperation.
However, she hemorrhaged andshe actually nearly died and
(47:43):
luckily she didn't die, but itwas life and death.
Angela Arnold Ross (47:47):
You know, it was a very serious situation
and I mean that hardly everhappens when you have an
oophorectomy, but it really didmake me think about how I
describe these operations topeople Like yeah, you're not
going to scare them and say,well, I know someone who almost
died with it, you know, but youwant exactly a couple of extra
(48:09):
words, or the way you present it.
Absolutely, yeah, I'm sorry youhad to go through that.
That is very traumatic.
Yeah, being a positiveAustralian, you you know.
You take these things, though,and you do learn from them,
right and to sort of use it tothe best, best of your ability
pretty much, which is which isgood, I think, but we're always
growing as genetic counselors.
Matt Burgess (48:30):
we're always learning and I guess, on that
point, how do you feel that youadvocate for patients?
I know that advocating forpatients is one thing that's
really important to you.
Can you tell me a little bitabout that?
Angela Arnold Ross (48:48):
Yeah, again, this has gone through my.
I mean, I've always, as I said,I love what I do, I love my
patients and we always geneticcounsellors.
We always want the best for ourpatients, as do doctors and
everyone else, of course.
But I guess I'm used to.
As I'm getting older, I knowmore people who are having
surgeries, more people who are,you know, have cancer, all sorts
of.
I've had some surgeries, thingslike that.
So it does make you more awareand I've just realized I know
(49:10):
how to navigate.
Like if something happens withmy friends, I'm on it.
I'm like, okay, I know how totalk to the doctor.
You'd be very nice, but you'revery strong, Like you know, like
you, this is how you, we knowhow to navigate the hospital.
And some situations wherepeople have asked for my advice
and just the way they spoke, I'mlike, wow, you really.
Yeah, you, you, you know, youdon't know.
My dad, for example, went into,went into hospital and he was
(49:33):
cold and I'd say, dad, ask thenurse for a blanket.
Oh, she's busy, she's busy,she's got more to do than that.
And I'm like, oh, dude, likeyou know, like you can be very
nice to nurses, but you can askfor a blanket and a lot of
people think they can't questionthe doctors.
So I just have a big passionnow and again this does stem a
lot from when I went through mysurgery as well of just to help
(49:53):
people and make peopleunderstand that write down
questions, because you alwaysget nervous when the doctor
comes in.
It just happens regardless.
You can always there's nostupid questions.
You can within reason, butgenerally there's no stupid
questions you can.
They can spend time with you,Like if you shouldn't be feeling
rushed, you might, but you knowthey can spend time with you.
You're allowed to ask what you,what you want to ask, and make
(50:14):
sure you get an answer.
And then you know if someonedoesn't call you back, you don't
.
You don't badger them, but youdeserve a response.
If you've, if you put in a call, either send it.
I said to someone recently.
I said why don't you put in aportal message Cause then it's,
it's, it's documented.
When you've contacted them andjust you know, ask them for a
response, or you know call themback and insist on being cause
(50:40):
you're allowed to get answers,um, and so yeah, that sort of is
.
I just love sort of guidingpeople that way a little bit now
, um, how to, how to sort ofnavigate the health care system,
because that can be such astress to people, right not
having, especially whensomeone's diagnosed with cancer.
You've got this appointment,this appointment, I don't know.
And I had someone recently whowas diagnosed and she's she's
like well that so well, theydon't think it's cancer, don't
know if it's cancer, but likeshe was telling me about
mastectomies and whatever and it, you know, it's like the woman
(51:03):
pretty much knew it was going tobe cancer and just did, wasn't
direct, Right, but again,everyone does things differently
.
But I feel I try and give peoplesome confidence when I'm
speaking to them.
If, if, if it comes up inconversation I mean I'm not a
physician or anything like thatbut if they, if I say, oh, just
a little tip, you know mightthink about X, y, z and so on
and so forth, just to just to,to reduce as much stress as they
(51:26):
can, as I can, if, if I feelthat that's warranted, right,
because they're going through somuch.
It's just just terrible.
Um, but yeah, that's what I'vebeen interested in.
I'd love to.
Or the other thing is goingwith advocating I think I told
you this as well is it's allabout the lingo?
So I've had a number ofsituations where be it with my
(51:47):
10-year-old daughter.
She could come in and say thesky is red, and I'm like, is it
Because she's so confident?
She really is.
And for a a second, you totallybelieve it.
Right, in health care, thatpeople come to you my, my
sister's got a BRCA mutation, ormy sister's got the BRCA gene,
(52:08):
okay, what gene?
Or breast gene, or ovarian gene, right?
Um, and so it's, and.
And then you believe them.
And if you didn't get a report,you know things could happen.
So I guess a couple ofcircumstances have been that,
like someone's come to me withinformation, I'm a real stickler
for getting a report, eventhough it can be a bit of a pain
.
So if I can, I like to getpathology reports.
(52:28):
I know they're not alwaysavailable, but pathology reports
, specifically genetic testingreports, um, the incidents I'm
thinking of specifically waslike um, the family history
wasn't very strong but youthought there was a genetic
mutation, one of the genes withthat links with breast cancer.
But there was no family historybut she was told it was.
It was her sister's got amutation.
(52:48):
In the end she did it.
It was uncertain variant and itwasn't and she didn't really
need testing, you know.
So, um, and then, but but itwas the way it was transmitted
to her.
You know she was told she had amutation and then and of course
they don't know to get reportsor anything, and this is how
it's disseminated.
So in my presentations I usuallyhave a slide like it's all
about the lingo I want.
My doctor said I need screening.
(53:09):
Screening for what?
Mammogram or genetic testing,because some people say that
screening testing or I need thetest what test?
Big stickler for televisionshows.
Oh my gosh, do they not haveconsultants?
If anyone's listening andthey've seen TV, I'm happy to
consult with you.
It's great that people bring itinto their shows.
But number one genetic testingresults are not available in 24
(53:31):
hours.
And number two, just sayingI've got the BRCA gene or I've
got the breast gene, we all havethem.
We've got two copies of them.
Most people have got copiesthat are working fine, but then
sometimes people are born withmutations and it elevates the
risk.
It isn't a diagnosis of cancer,right?
So in my little world I try tochange the way it's said.
(53:52):
But also the reason forthinking that through is a lot
of the way you speak to doctorsor the admin staff affects the
way you're triaged.
You know what I mean.
So if you don't give anaccurate information and again,
I'm never saying this to thepoint that people are giving it,
they're silly or whatever.
I'm saying just practicallyfrom experience if you can be as
(54:15):
clear and concise as you can,have a report, know what it is,
or something like like that,that's going to be so much
beneficial for you than runningaround.
And then someone said can I getthe report?
Can I do this?
You know what I mean.
Oh, you want screening?
We'll send you to the the mapsclinic, like the high-risk
breast clinic.
Oh, she hasn't had genetictesting yet.
Oh, she comes back, you know.
Just things like that, I think,can help you navigate the
health care system.
Matt Burgess (54:36):
But it just sounds like in lots of different areas
you're really empowering youknow your patients and your
students and probably othergenetic counsellors as well, so
it has been so fabulous talkingwith you today.
Thank you so much for your timeand, yeah, I hope you've
enjoyed your time chatting onthe podcast.
Angela Arnold Ross (54:59):
Well, you can tell I'm very passionate
about what I do.
I could talk all day on thistopic, but thank you for giving
me the opportunity to talk toyou.
For sure it's been a lot of funand I hope people have learned
something or it's beenbeneficial for someone in some
way.
Excellent Thanks, Angela.
Matt Burgess (55:16):
Thank you.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.