In her essay “ Why Read a Poem in a Time Like This? ”, Marilyn McEntyre writes: All of us need it. We need it because good poems do something prose can’t do. They invite and enable us to notice the precarious fissures in what we think is solid ground. They direct us toward the light at the edge of things — the horizon, the fragment of dream before dawn, the feeling that’s hard to name, and can only be accurately captured by metaphor. They take us to the edge of “what can’t be said,” and ambush u...
Mar 31, 2022•43 min•Ep. 212
One of my favorite Piece of My Mind essays in JAMA is by Rebecca Sudore, titled, “ Can We Agree to Disagree? ” And today our guests agree to disagree. And yet, and yet… They also agree across a whole range of issues, some of which surprised us. This is the latest in our series of podcasts on concerns about, and potential of advance care planning. If you’re new to this discussion, don’t start with this podcast! Start by reading this article by Sean Morrison, Diane Meier, and Bob Arnold in JAMA , ...
Mar 24, 2022•57 min•Ep. 211
If you develop dementia, odds are you will spend the last months to years of your life in a nursing home or assisted living facility. While we like to think about how our goals and preferences will influence what that life looks like, including whether you will get potentially burdensome interventions, your fate is probably influenced more by factors like where you live and what nursing home you happen to end up in. On today’s podcast we dive into drivers of invasive procedures and hospitalizati...
Mar 10, 2022•45 min•Ep. 210
A little over a decade ago, Ken Covinsky wrote a GeriPal post about a Jack Iwashyna JAMA study finding that older adults who survive sepsis are likely to develop new functional and cognitive deficits after they leave the hospital. To this day, Ken’s post is still one of the most searched and viewed posts on GeriPal. This idea that for critically ill patients in the ICU, geriatric conditions like disability, frailty, multimorbidity, and dementia should be viewed through a wider lens of what patie...
Mar 03, 2022•47 min•Ep. 209
There is a lively debate going on in academic circles about the value of Advance Care Planning (ACP). It’s not a new debate but has gathered steam at least in palliative care circles since Sean Morrisons published a JPM article titled “ Advance Directives/Care Planning: Clear, Simple, and Wrong .” Since then there has been a lot of back and forth, with even a couple of podcasts from us, several JAMA viewpoints, and most recently a series of published replies from leaders in the field on why ACP ...
Feb 24, 2022•49 min•Ep. 208
My mom is an Asian woman in her 70s with osteoporosis. She tried an oral bisphosphonate and had horrible esophagitis. She said never again, though she eventually tried an IV bisphosphonate. She had terrible flu-like symptoms. She said never again. But based on reports that symptoms are worse the first time, she tried the IV again the next year and fortunately experienced no symptoms. (Story used with permission, thanks mom!). I tell this story because these issues don’t typically register as mor...
Feb 17, 2022•45 min•Ep. 207
This week many of our listeners will gather for the annual American Academy of Hospice and Palliative Medicine (AAHPM) & Hospice and Palliative Nursing Association (HPNA) annual meeting. While the majority of this meeting is focused on subspecialty care in the US, the majority of individuals who are in need of palliative care live in low and middle-income countries without even basic access to palliative care. On this week's podcast, we talk with three leaders in helping improve palliative c...
Feb 10, 2022•43 min•Ep. 206
In prior podcasts we talked about racism and COVID , lack of diversity in the palliative care workforce , racial and ethnic differences in end of life care , and implicit bias in geriatrics and palliative care . Today our focus is on structural, institutional, and interpersonal racism, and how these different but related constructs negatively impact the care of older adults and people with serious illness. We are joined by Deborah Ejem, a medical sociologist and Assistant Professor in the School...
Feb 03, 2022•49 min•Ep. 205
Patients with end stage liver disease and decompensated cirrhosis have an average life expectancy of 2 years without transplant . Outcomes are worse among those who are frail . Symptoms are common, including pain, ascites, encephalopathy, and pruritus. Patients with end stage liver disease are often some of the most disadvantaged patients we care for. Caregiver burden is immense; divorce is common. Some will go on to receive a transplant, but many will not. Many are confused about the diagnosis ...
Jan 27, 2022•51 min•Ep. 204
More Health Policy this week! Today, we discuss “SNPs” but this is not a podcast about haircuts during the pandemic. We take a deeper dive into the world of Medicare Advantage and what it means for vulnerable patients facing serious illness and those at the end of life. We are joined by UCSF geriatrics fellow Alex Kazberouk to talk to Dr. Claire Ankuda (Assistant Professor at Icahn School of Medicine at Mount Sinai and Palliative Care Physician) and Dr. Cheryl Phillips (President and CEO of the ...
Jan 20, 2022•46 min
Investor money and venture capital funding is pouring into Medicare Advantage (MA) plans. Enrollment in MA plans has more than doubled from 12 million members in 2011 to 26 million in 2021. What does this mean for us and our patients? Do these plans deliver better care for vulnerable older adults? Or are they a money making machine driving up healthcare costs in the name of profit? On today’s podcast, we are joined by UCSF geriatrics fellow Alex Kazberouk to talk with Dr. Don Berwick (founder of...
Jan 13, 2022•47 min•Ep. 202
Three months ago we did a podcast with Randy Curits about his recent diagnosis of ALS in March and what it was like for someone who studies and cares for people living with serious illness, to now be someone who is living with serious illness. It was one of our favorite podcasts we’ve done, but also got us to think “wait, how come we’ve never done a podcast on ALS?” We fix that on today’s podcast. We’ve invited Elizabeth Lindenberger and Kara Bischoff to talk about what every geriatrician and pa...
Jan 06, 2022•50 min•Ep. 201
It’s GeriPal’s 200th episode. Yup, we started the podcast in 2016 and over the years we have grown from basically podcasting for Alex’s mom to now getting over 25,000 plays per month. So to celebrate our 200th, and given that the last two years kinda sucked in a lot of ways, we are going to pivot to appreciative inquiry. We have invited leaders in geriatrics and palliative care to quickly share: One thing that you are grateful for in Geriatrics and Palliative Care (other than GeriPal!) One thing...
Dec 30, 2021•51 min•Ep. 200
Geriatric Oncology has arrived. Yes, Louise Walter has been leading the fight to improve cancer screening in older adults for years. But when it came to geriatricizing the way we assess and treat older adults with cancer, the evidence was thin. In our prior podcast with Supriya Mohile and William Dale on geriatric assessment in oncology, we couldn’t say for certain if a geriatric assessment was helpful for patients with cancer. Well now we can. We are joined by Melisa Wong, a geriatric oncologis...
Dec 16, 2021•45 min•Ep. 199
Geriatric anesthesia is a thing. The average age of people getting surgery is increasing . Anesthesiologists and surgeons feel that with new techniques and approaches they can perform surgery on patients at ever older ages, patients who they previously would have excluded from surgery. One of the key advances in geriatric anesthesia is the use of spinal anesthesia, a form of regional anesthesia that also includes epidurals and peripheral nerve blocks. When older adults experience a hip fracture,...
Dec 10, 2021•42 min•Ep. 198
The great resignation is upon us. One in five health-care workers has left their job since the pandemic started . Geriatrics and palliative care are not immune to this, nor are we immune to the burnout that is associated with providers leaving their jobs. In today’s podcast, we talk with Janet Bull and Arif Kamal about what we can do to address burnout and increase resiliency, both from an institutional and individual perspective. Janet Bull is the Chief Medical Officer and Chief Innovations off...
Dec 02, 2021•44 min•Ep. 197
I don’t consider myself spiritual. For some in palliative care, this would be considered heresy as we are told “everyone is spiritual.” But, hey, I’m not. So there. However, despite not being spiritual, I do believe that spiritual care is fundamental to the care I give patients and families. I also recognize it is the one palliative care domain I am most uncomfortable with and the one that as a field, we actually don’t support very well (odds are, if your palliative care team doesn’t have a full...
Nov 24, 2021•48 min•Ep. 196
Though “breath” is in the title of Wes Ely’s book (and his song choice by the Police), relationships are its beating heart. The book operates on two levels. On one level, Wes Ely’s book is an autobiography of a critical care doctor’s horror and shame at discovering that his ICU practice of heavily sedating patients for days on end was leading to lifelong physical, cognitive, and psychological harm; and the arc of his redemptive journey to find a better way to care for patients in the ICU. But th...
Nov 18, 2021•53 min•Ep. 195
Anyone who cares for individuals with serious illness must live in a messy space where tough conversations about treatment decisions are common and complicated. On today’s podcast we talk with James Tulsky about living in this messy space of medical decision making and the challenges that come with communication around advanced treatment decisions. We talked about James’ path to the work that he has done, including early studies he did that included audio recording DNR discussions between physic...
Nov 11, 2021•46 min•Ep. 194
“The secret sauce of the Transitions, Referral and Coordination (TRAC) team was including a lawyer.” This is brilliant and will ring true to those of us who care for complex older adults who end up in the hospital for long, long, long admissions. On today’s podcast we talk with Kenny Lam, Jessica Eng, Sarah Hooper, and Anne Fabiny about their successful interdisciplinary intervention to reduce prolonged admissions, published in NEJM Catalyst . Many of the problems that older adults face are not ...
Nov 04, 2021•45 min•Ep. 193
Most studies in geriatrics have used metrics such as survival time or disability in activities of daily living as their outcome measure. Many palliative care interventions are evaluated on the basis of ability to change symptoms such as pain. But these outcomes represent a thin view of the human experience. What older adults and those with serious illness often care about most is being able to do the activities that animate their lives with meaning and purpose. Participating in meaningful activi...
Oct 28, 2021•43 min
The FDA label for the amyloid antibody aducanumab (Aduhelm) started off exceedingly broad, basically including anyone with Alzheimer's disease, but was subsequently narrowed to to patients with mild cognitive impairment (MCI) or mild dementia due to Alzheimer disease (AD). Should, though, the label be even more restrictive to mirror the populations studied in the two still unpublished trials of the drug, EMERGE and ENGAGE? Or should CMS consider restricting coverage for aducanumab to populations...
Oct 21, 2021•46 min•Ep. 191
“The take home message of this study is NOT that primary palliative care does not work.” So says Yael Schenker of the negative study of an oncology nurse-led primary palliative care intervention for people with advanced cancer. And we pushed Yael and Bob Arnold (senior author) on this point - we have several negative studies of primary palliative care (see links below to podcasts) - is it time to start to question the effectiveness of primary palliative care? We certainly all agree on the proble...
Oct 14, 2021•47 min•Ep. 190
Time-limited trials. We’ve all probably used them before. We meet with patients and families. We agree to either start or continue a particular treatment to see if it helps in some specific way over some defined period of time. If it works as hoped, great, we continue the treatments. If not, we stop them. At least that is how it’s supposed to go. On today’s podcast we talk all about these time-limited trials with Dong Chang and Ricky Leiter. Dong was the lead author of a JAMA IM article looking ...
Oct 07, 2021•47 min•Ep. 189
I’m going to start this introduction the way Eric ended our podcast. You are a GeriPal listener. Like us, you care deeply about our shared mission of improving care for older adults and people living with serious illness. This is hard, complex, and deeply important work we’re engaged in. Did you know that most GeriPal listeners have given us a five star rating and left a positive comment in the podcasting app of their choice? We will assume that you are doing the same right now if you haven’t do...
Sep 30, 2021•49 min•Ep. 188
Randy Curtis, a paragon of palliative care research, was diagnosed with ALS in March. Randy is in a unique position as someone who studies and cares for people living with serious illness, who now shares his reflections on being on the other side, to reflect on the process of living with serious illness. His reflections are illuminating and inspiring. We talk with Randy about his experience being in the patient role, rather than the physician or researcher role. We ask if knowing the prognosis f...
Sep 16, 2021•43 min•Ep. 187
alliative care has a diversity problem. The workforce of palliative care looks nothing like the patient population that we care for in the hospital and in our clinics. For example, in 2019-2020 academic year only 4% of Hospice and Palliative Care fellows identified as black, compared to 12% of the overall US population using the most recent census information. These issues are similar for hospice and geriatrics. On today’s podcast we talk about this diversity problem with Lindsay Bell, Tessie Oc...
Sep 09, 2021•46 min
Much has been written in geriatrics and palliative care about anticipatory grief, about the grief of caregivers, and even the grief clinicians experience following the deaths of their patients. Krista Harrison, in a Piece of My Mind essay in JAMA , writes about something different. She writes about coping, as an academic hospice and palliative care researcher, with personal grief from the deaths of her dad and step-dad within 5 months of each other. There are many reasons this essay likely touch...
Sep 02, 2021•44 min•Ep. 185
Today’s podcast is on academic life hacks, those tips and tricks we have seen and developed over the years to succeed in academic medicine in fields that are somewhat generalist in nature. While the podcast is meant for fellows and junior faculty, we hope some of it applies to the work that all of our listeners do, even in non-academic settings. Why are we doing a podcast on #academiclifehacks? You will notice that at the start of the podcast, we spent a couple minutes to recognize my co-host, A...
Aug 26, 2021•56 min•Ep. 184
“Loneliness is different than isolation and solitude. Loneliness is a subjective feeling where the connections we need are greater than the connections we have. In the gap, we experience loneliness. It’s distinct from the objective state of isolation, which is determined by the number of people around you.” - Vivek Murthy, two time (and current) Surgeon General. We have heard a lot about loneliness and social isolation, particularly during the pandemic with enforced social distancing and near im...
Aug 19, 2021•41 min•Ep. 183
