You're the attending physician on a teaching service. Your resident says we shouldn't order a CT because CT's are over-used for this condition, and represent overuse, waste, and low-value care. In this case, however, you suspect that's not the resident's real reason. The real reason behind the resident's decision is that they are serial minimizers - residents who make little of potentially important findings. You feel they might be hiding their minimizing behind the sexy, trendy notion of provid...
Sep 19, 2019•43 min
On this weeks podcast, we talk with Krista Harrison about the life of individuals living with moderate dementia, as well as what we know about their caregivers. Krista is is an Assistant Professor in the Division of Geriatrics at UCSF, a social scientist, and something that we learned in this podcast, someone who knows a thing or two about singing opera. Krista recently published a JAGS paper titled "Care Settings and Clinical Characteristics of Older Adults with Moderately Severe Dementia." In ...
Sep 13, 2019•38 min
In this week's podcast we talk with Lew Cohen, MD, about his new book "A Dignified Ending: Taking Control Over How We Die." Eric and I approached reading this book with trepidation. We feared it would be a polemic defending physician aid in dying. It is not. Dr. Cohen does not hide his beliefs and opinions. He also does not shy away from the complexity of the issue - he interviews leading disability rights activists and challenges leaders of the aid in dying movement. His book is filled with sto...
Sep 05, 2019•47 min
In this week's GeriPal podcast we talk with Stacy Fischer, MD and Regina Fink, RN, PhD, both from the University of Colorado, about a lay health navigator intervention to improve advance care planning with Latinos with advanced cancer. The issue of lay health navigators raises several issues that we discuss, including: - What is a lay health navigator? - What do they do? How are they trained? - What do lay health navigators offer that specialized palliative care doesn't? Are they replacing us? -...
Aug 06, 2019•34 min
This week we talk with BJ Miller, hospice and palliative care physician, public speaker, and now author with Shoshana Berger of the book "A Beginner's Guide to the End." As we note on the podcast, BJ is about as close as we get to a celebrity in Hospice and Palliative Care. His TED Talk "What Really Matters at the End of Life" has been viewed more than 9 million times. As we discuss on the Podcast, this has changed BJ's life, and he spends most of his working time engaged in public speaking, bei...
Aug 01, 2019•45 min
This weeks podcast is all about the intersection of geriatrics, palliative care, advanced care planning and surgery with our guest Dr. Vicky Tang. Vicky is an assistant professor and researcher here at UCSF. We talk about her local and national efforts focused on this intersection, including: * Her JAMA Surgery article that showed 3 out of 4 older adults undergoing high risk surgery had no advance care planning (ACP) documentation. * Prehab clinics and how ACP fits into these clinics * The Geria...
Jun 21, 2019•31 min
There are few names more closely associated with palliative care than Diane Meier. She is an international leader of palliative care, a MacArthur "genius" awardee, and amongst many other leadership roles, the CEO of the Center to Advance Palliative Care (CAPC). We were lucky enough to snag Diane for our podcast to talk about everything we always wanted to ask her, including: * What keeps her up at night? * Does palliative care need a national strategy and if so why and what would it look like? *...
Jun 14, 2019•44 min
In this week's podcast, we talk with Dr. Ira Byock, a leading palliative care physician, author, and public advocate for improving care through the end of life. Ira Byock wrote a provocative and compelling paper in the Journal of Pain and Symptom Management titled, "Taking Psychedelics Seriously." In this podcast we challenge Ira Byock about the use of psychedelics for patients with serious and life-limiting illness. Guest host Josh Biddle (UCSF Palliative care fellow) asks, "Should clinicians w...
Jun 06, 2019•38 min
In this week's podcast we talk with Louise Aronson MD, MFA, Professor of Geriatrics at UCSF about her new book Elderhood, available for purchase now for delivery on the release date June 11th. We are one of the first to interview Louise, as she has interviews scheduled with other lesser media outlets to follow (CBS This Morning and Fresh Air with Terry...somebody). This book is tremendously rich, covering a history of aging/geriatrics, Louise's own journey in medicine and as a geriatrician facin...
May 30, 2019•36 min
In this week's GeriPal podcast we discuss the research into delirium with a focus on prevention. We are joined by internationally acclaimed delirium researcher Sharon Inouye, MD, MPH. Dr Inouye is Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center in the Institute for Aging Research at Hebrew SeniorLife.
May 02, 2019•38 min
Estimating prognosis is hard and clinicians get very little training on how to do it. Maybe that is one of the reasons that clinicians are more likely to be optimistic and tend to overestimate patient survival by a factor of between 3 and 5. The question is, aren't we better as palliative care clinicians than others in estimating prognosis? This is part of our training and we do it daily. We got to be better, right?
Apr 25, 2019•36 min
On today's podcast we talk with one of the national experts on multimorbidity, Melissa Wei. Dr. Wei is an Assistant Professor and physician researcher at the University of Michigan. In addition to destroying the lyrics to Bohemian rhapsody, we talk to Dr. Wei about how we should conceptualize multi morbidity, it's impact on older adults, and about her recent JAGS publication titled "Multimorbidity and Mental Health-Related Quality of Life and Risk of Completed Suicide."
Apr 05, 2019•27 min
In this weeks GeriPal podcast we take a deeper dive into this issue of language and medicine. We are joined by guests Anna DeForest, MD, MFA, a resident in Neurology at Yale, and Brian Block, MD, a pulmonary critical care fellow at UCSF.
Mar 25, 2019•41 min
Our first live podcast at the annual meeting for the American Academy of Hospice and Palliative Medicine! We invited Rachelle Bernacki and Jo Paladino to discuss their two papers published today on the the Serious Illness Care Program.
Mar 14, 2019•41 min
As Eric notes in the introduction, this recent study in JAMA by Jeff Williamson and colleagues led to some very contradictory headlines. Some headlines proclaimed that lowering blood pressure prevents dementia, and others stated the opposite, that lowering blood pressure does not prevent dementia. So what exactly did the study show? Do these results apply to patients we commonly see in Geriatrics? What should we make of the fact that after the trial was stopped early the blood pressures in the l...
Mar 08, 2019•35 min
In the 1990s, Susan Tolle helped create the POLST. Now she and Elizabeth Eckstrom want to change it. And personally, I think they're right.
Feb 15, 2019•39 min
On this week's podcast we have Bridget Sumser, a clinical palliative care social worker, board member for the Advanced Palliative Hospice Social Worker certification exam, and now co-author of a new book "Palliative Care: A Guide for Health Social Workers".
Feb 08, 2019•29 min
Three reasons you should listen to this podcast: The issue of patients cycling back and forth between the hospital and skilled nursing facilities near the end of life is common, will ring true to those of you who are clinicians, and has largely been ignored in the literature. It's about a hot off the press article published today in the NEJM. Lynn Flint, Palliative care doc at UCSF in the Division of Geriatrics, first author, and our guest, makes me sing "Hit Me Baby One More Time" by Brittany S...
Jan 30, 2019•34 min
Geriatrics teaches us that older adults with infections often present with non-specific symptoms rather than typical localizing symptoms of infection present in younger adults. Sometimes they present with fever, delirium, malaise, or fatigue. In today's GeriPal/JAGS joint podcast, Jeff Caterino challenges this common teaching by examining the extent to which non-specific symptoms are predictive of infection for older adults presenting to the emergency department. Turns out - they're not so predi...
Jan 23, 2019•31 min
May Hua's study addresses the still unanswered question - do specialized palliative care consults in the ICU do anything? She looked a number of outcomes comparing ICU patients in hospitals with and without palliative care consults. While most outcomes were similar, rates of hospice use were higher in hospitals with palliative care teams.
Jan 08, 2019•36 min
On todays Podcast we talk with Marian (Emmy) Betz about firearm safety, including how to counsel individuals with dementia about guns. Emmy is an Associate Professor in the Department of Emergency Medicine at the University of Colorado School of Medicine, and has written some pretty amazing papers on the subject of firearm safety.
Dec 21, 2018•39 min
In this week's GeriPal podcast we talk with Tim Girard, Plumonary Critical Care physician-researcher at the University of Pittsburgh about his study NEJM study of Haloperidol vs. Ziprasidone vs. Placebo for ICU delirium in critically ill patients.
Dec 14, 2018•47 min
On this weeks podcast we are talking with Aanand Naik about his recent JAGS article titled "Development of a Clinically Feasible Process for Identifying Individual Health Priorities".
Dec 07, 2018•41 min
We thought it would be an excellent time to talk about substance use in older adults as many of us gather around the Thanksgiving dinner table with our extended families. We invited Ben Han, a geriatrician and Assistant Professor of Medicine in Geriatrics at NYU, to talk about the research that he has done in this area. In particular, we talked with Ben about the recent increase in substance use in older adults with the rising baby boomer generation, including use of alcohol, marijuana, heroin a...
Nov 21, 2018•34 min
In this week's GeriPal podcast we interview Randy Curtis, Professor of Medicine and Pulmonary Critical Care and Director of the Palliative Care Center of Excellence at the University of Washington. We address the question: how do we get more patients with chronic and serious illness to engage in goals of care conversations with their doctors.
Nov 14, 2018•34 min
On this weeks podcast, we invited Rebecca Sudore to talk about the results of her PREPARE randomized trial that was published in JAMA Internal Medicine this week. The trial enrolled nearly 1,000 English and Spanish speaking older adults being cared for in a public hospital. The headline results showed that after reviewing the PREPARE For Your Care online program and the easy-to-read advance directive, 98% of older adults reported increased engagement in advance care planning (ACP) and 43% had ne...
Nov 02, 2018•38 min
In this week's GeriPal podcast we talk with Guy Micco, MD, a longtime bioethicists, internist, hospice physician, teacher in the UC Berkeley and UCSF Joint Medical Program, mentor, and friend. Guy and I wrote an article recently for the journal Perspectives in Biology and Medicine about the intersection and issues between the fields of geriatrics, palliative care, and bioethics. The main thrust of the paper is that we need a workforce that is trained in the principles of all three fields to take...
Oct 22, 2018•42 min
All the Questions You Had About Opioids But Were Afraid To Ask: A Podcast with Mary Lynn McPherson by Alex Smith and Eric Widera
Oct 05, 2018•47 min
How do you teach communication in serious illness? Can you? Do you teach it the same way to doctors and nurses in training? What level trainee do you target - medical students, interns, residents? How do we know our teaching is working? We discuss these and other bread and butter communication issues with Dr. Wendy Anderson, a palliative care physician at UCSF, director of the Bay Area Hub for Vitaltalk, and leader of IMPACT-ICU, a project to train ICU nurses in communication. Enjoy! -@AlexSmith...
Sep 26, 2018•31 min
In this week's podcast we talk with Helen Kales, Professor of Psychiatry at the University of Michigan the VA Center for Clinical Management and Research. We've spent a great deal of effort in Geriatrics describing what we shouldn't do to address behavioral symptoms in dementia: physical restraints, antipsychotics, sedating antidepressants. Helen Kales was lecturing around the country about all of these things we shouldn't do a few years back, and people would raise their hands and ask, "Well, w...
Sep 07, 2018•30 min
