Assisted Living Communities (no longer preferable to call them Assisted Living Facilities, as we learned on the podcast) are…what, exactly? That’s the central question on today’s podcast. The problem is the tremendous heterogeneity in services offered and quality of care. If you’ve seen one Assisted Living Community you’ve seen one Assisted Living Community. To address this question, we talk with Sheryl Zimmerman, author of a recent study in JAMA Network Open that used a Delphi process to ascert...
Nov 17, 2022•47 min•Ep. 242
Health care professionals are human, and as humans we experience loss both in and out of work. You’d imagine though that our professional expertise and experiences in helping patients and families cope with loss and grief would be helpful in managing our own personal losses. Turns out, it’s maybe not. That was the lesson I learned from reading a new book edited by Matt Loscalzo along with Marshall Forstein called “ Loss and Grief: Personal Stories of Doctors and Other Healthcare Professionals ”....
Nov 03, 2022•48 min•Ep. 241
Dr. Faith Fitzgerald once quipped that prognostic modeling is the “punctilious quantification of the amorphous.” She has a point. Prognosis is inherently uncertain. As Alex Lee says on our podcast today, all prognostic models will be wrong (in some circumstances and for some patients); our job is to make prognostic models that are clinically useful. As Sei Lee notes, the argument for developing prognostic models has won the day, and we increasingly use prognostic scores in clinical decision maki...
Oct 27, 2022•47 min•Ep. 240
The Department of Health and Human Services helps to guide billions of dollars in investment and direction in research, policy, and health care. The Assistant Secretary for Planning and Evaluation (ASPE), within the HHS, is the principal advisor to the Secretary of HHS on health policy, ranging from legislation to strategic planning to research. How does this relate to aging policy and research? How does coordination occur between the federal, state and local level in aging health policies? And,...
Oct 20, 2022•50 min•Ep. 239
When I’m on service these days there is inevitably a moment when a resident says “Patient so-and-so is on X” - and I have absolutely no idea what X is. Modern subspecialist practice advances at such a remarkably rapid pace, it can be hard to keep up. In this context, we’re excited to hear from infectious disease experts and nephrologists about updates in the care of older adults. Sonali Advani and Lona Mody talk about their recent JAGS article highlighting three recent articles that every clinic...
Oct 13, 2022•48 min•Ep. 238
Earlier this year palliative care was the correct response to the following clue on the game show Jeopardy: From a Latin word for “to cloak”, it’s the type of care given to seriously ill patients to provide comfort without curing What struck me most was not that palliative care was a question, nor that it made it seem that palliative care isn’t provided alongside care directed at curing, nor was it that hospice was the first buzzed in response, but it was that palliative care was the $2000 quest...
Oct 06, 2022•51 min•Ep. 237
Have you had difficulty managing a particular type of cancer pain? For me it’s radiation induced mucositis/esophagitis. Janet Abrahm is one of the world’s experts in pain and symptom management for patients with cancer joins us to talk about (among other things): Ketamine for hyperalgesia and allodynia, how to treat dissociative side effects Lidocaine: worth the hype? Strengths and weaknesses of buprenorphine for cancer pain Fentanyl patch: often missed issues Hypnosis: uses and how to get train...
Sep 29, 2022•47 min•Ep. 236
Have you ever had that moment when talking to a patient, when you realized that the phrase you just uttered, which you’ve uttered a hundred times before, came out rote and scripted? Maybe some phrase you learned from a prominent podcast or VitalTalk? And in response, the family or patient looked at you like you were from another planet? Yeah, I’ve been there too. Josh Briscoe, our guests on today’s podcast, argues that you’ve entered the Uncanny Valley. In robotics, the Uncanny Valley is that st...
Sep 22, 2022•50 min•Ep. 235
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of valvular heart disease for patients with severe aortic stenosis, a condition that affects one in ten adults older than the age of 80. The rates of TAVR have also risen dramatically in the last decade. In 2019, the number of TAVRs exceeded surgical aortic valve replacement (SAVR) in the US for the first time. On today’s podcast we talk with two amazing cardiologists and researchers - Gwen Bernacki and Ashok Krishnas...
Sep 15, 2022•47 min•Ep. 234
Holly Prigerson recalls the moments in which she started investigating prolonged grief disorder. She recalls being “a social scientist [Holly] in room a full of psychiatrists,” who recognized a diagnostic gap in people experiencing profound and potentially harmful grief far after the death of a loved one. This led her on a remarkable journey. Holly has accumulated mountains of evidence for the diagnosis of prolonged grief disorder as a specific condition primarily notable for a yearning over a y...
Sep 08, 2022•46 min•Ep. 233
In day-to-day practice, It’s hard to imagine providing excellent hospice or palliative care services without access to a team social worker. Social workers augment a team’s ability to provide whole-person care, often aiding to identify and meaningfully address the wide variety of challenges and unmet needs faced by individuals and families facing serious illness. But are we really taking full advantage of ALL social workers have to offer our field? On today’s podcast, we are talking with Barbara...
Sep 01, 2022•47 min•Ep. 232
Two major shifts are transforming the landscape of hospice. First, private equity firms are gobbling up hospices . As Melissa Aldridge, a health services researcher and former banker explains, we should be very concerned . Private equity firms try to turn companies as profitable as possible within 3-5 years. Thus, they have little in the way of long term vision for hospices, instead focused on cutting costs and maximizing profits. Second, Hospice was originally designed for patients with advance...
Aug 25, 2022•48 min•Ep. 231
Today we have the honor of interviewing Susan Block, MD, one of the pioneering leaders in the fields of palliative care, particularly psychosocial aspects of palliative care. Susan led the Project on Death in America’s Faculty Scholars program , used her dual training in internal medicine and psychiatry to shine a light on psychosocial aspects of palliative care, and founded the Department of Psychosocial Care at the Dana Farber Cancer Institute and Brigham and Women’s Hospital. We talk with Sus...
Aug 11, 2022•38 min•Ep. 230
A year ago we did our first “Deprescribing Super Special”. Today we are coming back for more (or less given the content), talking about the following articles with their lead authors: First up, we talk with Ariel Green about her article in JAMA Network on preferred phrases a clinician may use to explain why they should reduce or stop the medication . My take home from this is that while the most preferred explanation for deprescribing statins and sedative-hypnotics is one focused on the risk of ...
Aug 04, 2022•45 min•Ep. 229
We are fortunate today to interview two oncologists whose research has catapulted palliative care forward: Jennifer Temel, author of the landmark NEJM study on early outpatient palliative care for patients with advanced lung cancer; and Areej El-Jawahri, author of the landmark JAMA article on inpatient palliative care for patients with blood cancers undergoing stem cell transplant. Jennifer’s study is most widely known for the “kicker” - not only did it improve quality of life, palliative care w...
Jul 28, 2022•51 min•Ep. 228
The science of balancing safety and independence of older drivers has come a long way. Some key points from our podcast today with Emmy Betz (emergency physician-researcher) and Terri Cassidy (occupational therapist and certified driving rehab specialist) include: It’s no longer gouache to say “taking away the keys” - which sound punitive and risks infantilizing Instead the new lingo is “driving retirement” Driving retirement can be a process, similar to a harm reduction model, in which the acti...
Jul 21, 2022•50 min•Ep. 227
“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 was the opening paragraph that I wrote in March of 202...
Jul 14, 2022•45 min•Ep. 226
On today’s podcast we welcome back Haider Warraich to talk about pain. Now this may surprise our frequent listeners as we have had Haider on before to talk about heart failure as well as palliative inotropes , so why are we having him come on to talk about pain? . Well, Haider has an intimate relationship with pain, having experienced chronic pain himself and now having dove deep into the latest research on pain for his new book The Song of Our Scars: The Untold Story of Pain . We discussed the ...
Jul 07, 2022•51 min•Ep. 225
You have a patient with dementia severe enough that she cannot recognize relatives. She falls and breaks her hip. Should she have an operation, and risk the pain, potential complications, and attendant delirium associated with the operation? Should she be treated non-operatively, with aggressive symptom management? A huge part of this decision rests on (1) her previously stated wishes, values, and goals (prior to the onset of dementia); and (2) the outcomes of surgery for patients with dementia....
Jun 30, 2022•42 min•Ep. 224
Cancer screening is designed to detect slow growing cancers that on average take 10 years to cause harm. The benefits of mammography breast cancer screening rise with age, peak when women are in their 60s, and decline thereafter. That is why the American College of Physicians recommendation regarding mammography for women over age 75 is: In average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less, clinicians should discontinue screening for breast cancer. ...
Jun 23, 2022•43 min•Ep. 223
There are a lot of old myths out there about managing urinary tract symptoms and UTI’s in older adults. For example, we once thought that the lower urinary tract was sterile, but we now know it has its own microbiome, which may even provide protection against infections. So giving antibiotics for a positive urine culture or unclear symptoms may actually cause more harm than good. On today’s podcast, we are gonna bust some of those myths. We’ve invited some very special guests to talk about the l...
Jun 16, 2022•48 min•Ep. 222
In the US, geriatrics “grew up” as an academic profession with a heavy research base. This was in part due to the tremendous support of the National Institute on Aging. Clinical growth of geriatrics programs has lagged academic research, despite the rapid aging of the population. Palliative care, in contrast, saw explosive growth in US hospitals . In contrast to geriatrics, the evidence base for palliative care lagged clinical growth, in part because palliative care has no centralized “home” at ...
Jun 09, 2022•45 min•Ep. 221
We are two and a half years into the COVID pandemic. We’ve lived through lockdowns, toilet paper shortages, mask mandates, hospital surges where ICU’s overflowed, a million COVID deaths, prolonged school closures, development and roll out of novel vaccines, an explosion of social isolation and loneliness, and the invention of the “zoom meeting.” But what have we really learned over this seemingly endless pandemic other than how to make a quarantini? Well, on today’s podcast we invite Monica Gand...
Jun 02, 2022•52 min•Ep. 220
It’s been a while since we’ve done a Covid/bioethics podcast (see prior ethics podcasts here , here , here , and here ). But Covid is not over and this pandemic keeps raising challenging issues that force us to consider competing ethical considerations. This week, we discuss an article by bioethicists Govind Persad and Emily Largent arguing that the NIH guidance for allocation of Paxlovid during conditions of scarcity. They argue that the current guidelines, which prioritize immunocompromised pe...
May 26, 2022•47 min•Ep. 219
A patient is on morphine and you want to convert it to another opioid like hydromorphone (dilaudid). How do you do that? Do you do what I do, pull out a handy-dandy opioid equianalgesic table to give you a guide on how much to convert to? Well on today’s podcast we invited Drew Rosielle on our podcast who published this Pallimed post about why opioid equianalgesic tables are broken and why we shouldn't use them, as well as what we need to move to instead. But wait, before you throw out that equi...
May 19, 2022•51 min•Ep. 218
In today’s podcast we talk with Dr. Rajagopal (goes by “Raj”), one of the pioneers of palliative care in India. Raj is an anesthesiologist turned palliative care doctor. He is also author of the book, “ Walk with the Weary: Lessons in Humanity in Health Care ,” and was featured in this Atlantic article . Raj is the founder of Pallium , an organization dedicated to improving palliative care throughout India. We are joined by guest-host Tom McNally, a rehab and pediatric palliative care doc at UCS...
May 12, 2022•47 min•Ep. 217
Think about the last time you attended a talk on communication skills or goals of care discussions. Was there any mention about the impact that hearing loss has in communication or what we should do about it in clinical practice? I’m guessing not. Now square that with the fact that age-related hearing loss affects about 2/3rd of adults over age 70 years and that self-reported hearing loss increases during the last years of life . Screening for addressing hearing loss should be an integral part o...
May 05, 2022•50 min•Ep. 216
Comics. Cartoons. Graphic Novels. Graphic Medicine. I’m not sure what to title this podcast but I’ve been looking forward to it for some time. Heck, I’m not even sure to call it a podcast, as I think to get the most out of it you should watch it on YouTube. Why, because today we have Nathan Gray joining us. Nathan is a Palliative Care doctor and an assistant professor of Medicine at Johns Hopkins. He uses comics and other artwork to share his experiences in palliative care and educate others abo...
Apr 28, 2022•45 min•Ep. 215
In celebration of National Poetry Month , we are delighted to share with you the second podcast in our series on poetry and medicine. In the first podcast, we talked with Guy Micco and Marilyn MacEntyre about poetry and aging . In this second part in our series, we welcome Mike Rabow and Redwing Keyssar to talk about palliative care and poetry. As with aging, poetry operates on multiple levels within the palliative care space. Poetry puts us in our patient’s shoes. As Redwing’s poem says, “why n...
Apr 21, 2022•45 min•Ep. 214
Buprenorphine. It’s been around for a long time but is acting like the hot new kid in town. Just look at this year’s AAHPM meeting, where it felt like every other session was talking about how hot buprenorphine is right now. But does this drug really live up to the hype? On today’s podcast we talk with three experts on buprenorphine on why, when, and how to use it in serious illness. Our experts include Katie Fitzgerald Jones (palliative nurse practitioner and doctoral student at Boston College)...
Apr 14, 2022•55 min•Ep. 213
