In today's podcast we talk with Zara Cooper, Rachelle Bernacki, and Ricky Leiter about the state of COVID at the Brigham and Women's hospital and Dana Farber Cancer Center in Boston. While they have flattened the curve somewhat in Boston, they're still seeing huge numbers of seriously ill Covid patients in Massachusetts. They have 143 out of their ~1000 bed hospital filled with COVID19 patients, including 78 Covid patients in ICU, many of which are followed by palliative care. This has resulted ...
Apr 21, 2020•52 min
"It's not about perfection...it's about connection." - Keri Brenner This week's podcast features a dynamic duo of palliative care psychiatrists, Dr. Keri Brenner from Stanford, and Dr. Dani Chammas from UCSF. Dani was a huge hit as a guest on one of our earliest podcasts talking about "Formulations in Palliative Care." This week, Keri and Dani talk about "Therapeutic Presence," an important concept in both psychiatry and palliative care (links to articles about this concept and application at ht...
Apr 14, 2020•52 min
The vast majority of hospice services are delivered in patient's homes or other places of residence like nursing homes. This makes the traditional model of hospice care vulnerable in this coronavirus pandemic, especially in the era of social distancing and limited personal protective equipment (PPE). So how are hospice's responding to the COVID-19 pandemic? On this weeks podcast, we talk to two leaders of two large hospice agencies, Drs. Kai Romero and Todd Cote, to get their views on this quest...
Apr 10, 2020•45 min
Imagine that you are the medical director of a large (>150 bed) nursing home. Two-thirds of the patients in the home now have COVID-19. Seventeen of your patients are dead. The other physicians who previously saw patients in the nursing home are no longer coming to your facility because you have COVID positive patients. You're short on gowns and facemasks. You're short on nurses and nurse aids so now you have to help deliver meals. This is what Dr. Jim Wright, the medical director at Canterbu...
Apr 06, 2020•55 min
In today's podcast we talk with Audrey Chun, Professor in the Department of Geriatrics and Palliative Medicine at Mount Sinai, and Sheila Barton, a social worker in the Geriatrics practice at Mt. Sinai. Mt. Sinai has a HUGE outpatient geriatrics service, with a mean age of 85. We talk with Audrey and Sheila about the challenges they face in overcoming obstacles. Everything is harder now, such as how to get basic needs met for older adults isolating in the community, such as food and assistance w...
Apr 03, 2020•34 min
In the latest in our series of talking with front line providers in the midst of the COVID pandemic, we talk with Drs. Craig Blinderman, Shunichi Nakagawa, and Ana Berlin of the palliative care service at Columbia University Irving Medical Center. We cover a host of topics, including the urgent need to conduct advance care planning with our outpatients (including Craig's new Epic dotphrase below, and guide to COVID advance care planning); the need to be flexible to suit shifting demands; to stoc...
Mar 31, 2020•51 min
New York is the current epicenter of the COVID-19 outbreak in the US, with over 30,000 confirmed cases as of March 25th. Hospitals and ED's are seeing a surge of patients, and geriatrics and palliative care providers, like Cynthia Pan, are doing their best to meet the needs of these patients and their family members. Today, we talk with Dr. Pan, the Chief of the Division of Geriatrics and Palliative Care Medicine, and the current attending on the palliative care service at New York-Presbyterian ...
Mar 26, 2020•35 min
Many of us with clinical roles are waiting for the other shoe to drop. Today we hear from Dr. Darrell Owens, DNP, MSN, head of palliative care for the University of Washington's Northwest campus, a community hospital in Seattle. The UW Northwest hospital has born the brunt of the COVID epidemic in one of our nation's hardest hit areas. Darrell has stepped up the the plate in remarkable, aspirational ways. First, he is on call 24/7 to have goals of care conversations with elderly patients in the ...
Mar 23, 2020•39 min
You are caring for two adults with COVID-19. One who is a previously healthy 70 year old. One is 55 with multiple medical comorbidities. Both are now requiring mechanical ventilation, but there is only one ventilator left in the hospital and all attempts to transfer the patients to another hospital for care have failed. Which patient would you give the life saving treatment to and why? On today's podcast with talk with Doug White, Professor of Critical Care Medicine at the University of Pittsbur...
Mar 19, 2020•50 min
Covid19 is changing the way we interact with each other (from 6 feet away or via Zoom) the way we care for out patients (increasingly by video or telephone) and for some unfortunate few, the way we die (alone, in a hospital for days, isolated from family and friends). This is the first podcast in a series of podcasts about Covid 19. In this first podcast we talk with Lona Mody, Professor of Medicine at Michigan Medicine and John Mills, Associate Epidemiologist with Michigan Medicine. We cover te...
Mar 18, 2020•36 min
Project ENABLE is a landmark palliative care intervention. And yet, I will admit (Eric did too) we didn’t really understand what it was. So we interviewed ENABLE founder Dr. Marie Bakitas and ENABLE distinguished protégée Dr. Nick Dionne-Odom to learn more about ENABLE. During the interview, we learned a great deal about ENABLE, how it has evolved, iterated, and shifted over time to include persons with diseases other than cancer, minorities with serious illness, and caregivers. We break the res...
Mar 12, 2020•51 min
"Tell me about the problems you have with your medications." A simple open-ended question that is probably rarely asked, but goes beyond the traditional problems that clinicians worry about, like non-adherence, inappropriate prescribing, and adverse reactions. What do you find when you go deeper? Well we talk with Francesca Nicosia and Mike Steinman about the work they have done around deprescribing and medication related problems, including a recent JGIM study that attempts to better understand...
Mar 05, 2020•40 min
Home-based palliative care is booming. And with the growth of home-based palliative care come unique struggles and challenges: how can it be financed, what does the ideal team look like (or do you need a team?), retaining clinicians who may feel isolated doing this work, identifying patients who are most likely to benefit. In this week's podcast we talk about these and other issues with Brook Calton, home-based palliative care physician in the Division of Palliative Medicine at UCSF and Grant Sm...
Feb 27, 2020•41 min
On this week's podcast we have the honor of talking with David Reuben about health care for older adults and how it's time to think different. It really is a smörgåsbord of topics, ranging from how to think about population health for older adults (and how we as individuals providers can provide at least some level of population health), the UCLA Alzheimer's and Dementia Care Program and its outcomes, Medicare Advantage for All, working with community partners through voucher systems, and tips f...
Feb 20, 2020•39 min
We had fun on this in-studio podcast with Dan Matlock, geriatrician and palliative care clinician researcher at the University of Colorado, and frequent guest and host on GeriPal. We most recently talked with Dan about Left Ventricular Assist Devices and Destination Therapy. Today we talked with Dan about Implantable Cardiac Defibrillators (ICD) and Cardiac Resynchronization Therapy (CRT) - everything a geriatrician or palliative care clinician should know. Dan and his team have developed a numb...
Feb 13, 2020•37 min
In this week’s podcast we talk about food insecurity in older adults with UCSF’s Hilary Seligman, MD. Hilary has done pioneering work in this area. Some of this work was funded by Archstone Foundation (full disclosure: Archstone is a GeriPal funder). Hilary's expertise runs the gamut from federal nutrition programs (including SNAP), food banking and the charitable feeding network, hunger policy, food affordability and access, and income-related drivers of food choice. I have a confession. I knew...
Feb 06, 2020•47 min
Should Geriatric Assessments be part of the routine ontological care for older adults with cancer? On this weeks podcast we attempt to answer this question with national experts in Geriatric Oncology: Dr. Supriya Mohile from the University of Rochester and William Dale from City of Hope, as well as UCSF's Melissa Wong. Lucky for us, they also have a little evidence on their side thanks to a recently published JAMA Oncology article that they authored titled "Communication With Older Patients With...
Jan 30, 2020•42 min
You’ve probably heard patients say, “Of course I’m depressed, I’m dying. Wouldn’t you be?” This is a fundamental question - to what extent are depressive symptoms “normal” at the end of life? To what extent are they maladaptive, a fancy word for psychological conditions that have a negative impact on your life. In this week’s GeriPal podcast we talked with Elissa Kozlov, a psychologist-researcher at Rutgers, and Claire Ankuda, a palliative care physician-researcher at Mt. Sinai about their JAGS ...
Jan 23, 2020•44 min
Do opioids improve breathlessness? A simple question that unfortunately doesn't seem to have a simple answer. We get into the nitty-gritty of potential answers to this question with a preeminent researcher in this field, David Currow. David is a Professor of Palliative Medicine at University of Technology Sydney. His research has challenged common practices in Hospice and Palliative Care, including randomized control trials on oxygen for breathlessness, octreotide for malignant bowel obstruction...
Jan 16, 2020•44 min
In this weeks podcast we talk with Kirsten Bibbins-Domingo, general internist, Professor of Medicine and Epi/Biostats at UCSF, and chair of a National Academies of Sciences task force on Integrating Social Care into the Delivery of Health Care. See Kirsten's JAMA paper summary here (https://jamanetwork.com/journals/jama/article-abstract/2752359), and the full report here (http://nationalacademies.org/hmd/Reports/2019/integrating-social-care-into-the-delivery-of-health-care). This podcast spans t...
Dec 19, 2019•38 min
On this weeks podcast we talk to Julie Bynum on the question "Do Nurses Die Differently?" based on her recent publication in JAGS titled "Serious Illness and End-of-Life Treatments for Nurses Compared with the General Population." Julie is a Professor of Geriatric and Palliative Medicine at the University of Michigan, and Geriatric Center Research Scientist at the Institute of Gerontology, as well as a deputy editor at the Journal of the American Geriatrics Society. Overall, Julie's study found ...
Dec 05, 2019•37 min
We have had some amazing guests on our Podcast. True luminaries in geriatrics and palliative care. This week we are fortunate to be joined by none other than Mary Tinetti, MD, to talk about her recent JAMA Internal Medicine trial of Patient Priorities Care (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2752365). In this study of older adults with multiple chronic conditions, patients are guided through a process of identifying their health priorities and objectives, and ...
Nov 27, 2019•45 min
On today's podcast we take a moment to celebrate 100 episodes of the GeriPal podcast. Yes, 100 episodes that have covered everything from cranberry juice for UTIs to medical aid in dying. In this episode, Anne Kelly, Lynn Flint and Ken Convinsky lead us down memory lane, asking Alex and me hard hitting questions about the birth of the podcast, our favorite episodes, and our most memorable moments. We also take time to listen to the feedback that we received from our call in listener line (929-Ge...
Nov 20, 2019•36 min
Nursing homes are a tough place to do palliative care. There is extremely high staff turnover, physicians are often not present except for the occasional monthly visit, many residents die with untreated symptoms usually after multiple hospitalizations and burdensome life-prolonging treatments, and specialty palliative care - well that is nowhere to be found in most nursing homes outside of hospice. So what can we do to improve the palliative care outlook in nursing homes? On todays podcast we ta...
Nov 14, 2019•46 min
A recent study by Vince Mor published in JAMA Oncology found that veterans with advanced lung cancer treated in Veterans Affairs (VA) Medical Centers with high hospice use were more likely to receive concurrent cancer care and also less likely to receive aggressive care. On top of that, veterans treated at facilities with high levels of hospice use also incurred lower costs of care. This is a strong case for the concept of concurrent care in which individuals can avoid the "terrible choice" betw...
Oct 31, 2019•36 min
Do you remember the scene from the movie The Graduate where Ben's dad says, "One word: Plastics"? Well, I write this blog post from the National Palliative Care Research Center's annual Foley retreat, a who's who of palliative care researchers. The words on everyone's lips: "Lay Health Navigators." This is not to draw equivalency between environmentally destructive materials and people who help those with serious illness and caregivers navigate our complex health care system. Rather, it's to poi...
Oct 24, 2019•39 min
Before we get into this week's topic, would you please take 1 MINUTE to complete this GeriPal survey! It will really help us out. We swear, only 1 minute! Click the link below to access the survey (or copy and paste in your browser). Thank you! GERIPAL SURVEY https://ucsf.co1.qualtrics.com/jfe/form/SV_esS7pUAOgSIbNGZ Now on to this week's topic... Alex: What do you get when you mix a doctor and an architect? Eric: An Archidoc? Alex: No a Dochitect. What do you get when you mix a gerontologist wi...
Oct 17, 2019•47 min
What happens in Long Term Acute Care Hospitals, or LTACs (pronounced L-tacs)? I've never been in one. I've sent patients to them - usually patients with long ICU stays, chronically critically ill, with a gastric feeding tube and a trach for ventilator support. For those patients, the goals (usually as articulated by the family) are based on a hope for recovery of function and a return home. And yet we learn some surprising things from Anil Makam, Assistant Professor of Medicine at UCSF. In his J...
Oct 10, 2019•36 min
Ok, I'll admit it. When I hear the phrase "the biology of aging" I'm mentally preparing myself to only understand about 5% of what the presenter is going to talk about (that's on a good day). While I have words like telomeres, sirtuins, or senolytics memorized for the boards, I've never been able to see how this applies to my clinical practice as it always feels so theoretical. Well, today that changed for me thanks to our podcast interview with John Newman, a "geroscientist" and geriatrician he...
Oct 03, 2019•47 min
Joanne Lynn, a geriatrician and palliative care physician who leads Altarum’s work on eldercare, wrote a recent JAGS editorial titled The “Fierce Urgency of Now”: Geriatrics Professionals Speaking up for Older Adult Care in the United States” which is very much a call to action for those who care for older adults. We talk with Joanne about this article and some meaningful things clinicians in both geriatrics and palliative care can do to be advocates for a growing population of older adults. One...
Sep 26, 2019•42 min
