GeriPal

DECEMBER 2, 2022

So on today’s podcast we invite four brilliant individuals to talk about their perspective on how to change how we as a society and health care system partner with individuals with dementia. She directs UCSF MERI’s patient, family, and clinician support with classes and consultation on resiliency, well-being, and grief.

Community 101

Community IT Individual Patient-Centered 101

GeriPal

AUGUST 4, 2022

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. About, was it how to talk to patients?

Specialization 104

Specialization Medical Patient-Centered Provider 104

GeriPal

MAY 5, 2022

We talk with Nick and Meg about: Why hearing loss is important not just in geriatrics but also for those caring for seriously ill individuals. Communication techniques we can use when talking to individuals with hearing loss. But individuals who have hearing loss, there’s several problems. Transcript.

IT 102

IT Screening Hospital Clinic 102

Pamela Wible MD

JUNE 20, 2025

He overheard the term and used it to describe himself and clinic staff in a 1974 article on staff burnout detailing long-term physical and psychological job stress. Psychiatrists define burnout as a job-related dysphoria in an individual without major psychopathy—meaning you’re normal; your job is killing you. So what’s the real issue?

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Medical Student Diagnosis Physicals Medical 246

GeriPal

JUNE 8, 2023

When I’m on palliative care consults and attending in our hospice unit we have to counsel patients about deprescribing and de-intensifying diabetes medications. And we invited Tamryn Gray from the Dana Farber joins us to ask insightful questions, including: What blood sugar range should we target for patients in the nursing home or hospice?

Diabetes 74

Diabetes Management Patient-Centered Families 74

GeriPal

MAY 8, 2025

Summary Transcript CME Summary Weve covered psychedelics on the podcast beforefirst in 2019 with Ira Byock, where we explored their potential role in medicine , and then again in 2023 with Stacy Fischer, Brian Anderson, and Theora Cimino, focusing on the reasons to approach psychedelic use in patients with caution. This is Eric Widera.

Illness 107

Illness IT Patient-Centered Patients 107

Rao Doctor

APRIL 3, 2025

In my previous article I covered the types of illness and the causes. Rectal method is more appropriate for infants, children and unconscious or comatose patients who are not able to hold the thermometer in their mouth. Understanding the patient’s medical history is crucial for an accurate diagnosis.

Diagnosis 130

Diagnosis Management Illness Diagnose 130

GeriPal

APRIL 14, 2022

On today’s podcast we talk with three experts on buprenorphine on why, when, and how to use it in serious illness. And if you want to learn more about buprenorphine from these amazing palliative care clinicians and others, check out of some of these articles: Learn more about caring for those with substance use disorder: . Transcript.

Illness 102

Illness Patient-Centered IT Patients 102

GeriPal

JANUARY 18, 2024

We start off the conversation by talking about whether patients with cancer and cancer pain are really that different, and their paper that was just published on January 11 th in JAMA Oncology showing that substance use disorder is not uncommon in individuals with cancer. Transcript Eric: Welcome to the GeriPal podcast. It’s me.

Illness 136

Illness Patient-Centered Screening Clinic 136

GeriPal

AUGUST 31, 2023

Summary Transcript Summary How do people react when they hear they have a serious illness? And some people, in addition or instead, engage in deep introspection on how to make meaning or live with or understand this experience of serious illness. Shock, “like a car is rushing straight at me” (says Bill Gardner on our podcast).

Illness 128

Illness IT Diagnose Medical 128

GeriPal

OCTOBER 5, 2023

Summary Transcript Summary Communicating about a serious illness is hard. Last week’s podcast we talked about the challenge around miscommunication in serious illness. This week we dive into the challenges with communication when it comes to life sustaining treatments and CPR. This is Eric Widera. Alex: This is Alex Smith.

Illness 136

Illness IT Patient-Centered Families 136

GeriPal

JANUARY 25, 2024

Summary Transcript Summary In a JAMA 2020 systematic review of palliative care for non-cancer serious illness, Kieran Quinn found many positives, as we discussed on our podcast and in our editorial. He also found gaps, including very few studies of patients with lung disease, and little impact of trials on quality of life.

Patient-Centered 122

Patient-Centered IT Illness Patients 122

GeriPal

DECEMBER 19, 2024

Still, we havent talked about integrating palliative care into psychiatry or in the care of those with severe mental illness. What does it look like to take a palliative approach to severe mental illness? Is “terminal” mental illness a thing? Eric 01:34 Oh, I love that. Dani 01:36 More to talk about there.

Illness 101

Illness Mental Health IT Patient-Centered 101

GeriPal

FEBRUARY 27, 2025

Today we talk with experts Janet Ho, Sach Kale, and Julie Childers about opioid use disorder and serious illness. We address: Why is caring for patients with this overlap so hard? Sach Kale set up an outpatient clinic focused on substance use disorder for patients with cancer. What is making this hard for me? What do they do?

Patients 73

Patients Clinic Patient-Centered Illness 73

GeriPal

JANUARY 30, 2025

In one corner, weighing in at decades of experience, well known for heavy hits of bedside assessments, strong patient-family relationships, and a knockout punch of interdisciplinary collaboration, we have in-person palliative care consults. What do different patient populations need? But watch out! Alex 01:06 Yeah, go in person.

Telehealth 105

Telehealth Patient-Centered IT Patients 105

GeriPal

JULY 28, 2022

GeriPal post on “fast food” style palliative care in chronic critical illness. And I just want to highlight, Jennifer has a great JPSM article that just came out. But at that time I was struck by how in that field, there wasn’t a focus or really interest in symptom management and support for patients and their families.

Illness 110

Illness Hospital Patient-Centered Patients 110

GeriPal

MARCH 9, 2023

Early data on efficacy in patients with anxiety and demoralization are promising. Two of our guests today, Stacy Fischer and Brian Anderson, are involved in large multicenter trials of psychedelics for patients with advanced cancer (Fischer) or life-limiting illness (Anderson). Research is exploding. You’ve been trained?

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Patient-Centered Community IT Medical 91

GeriPal

DECEMBER 8, 2022

Clinicians “catching” patient life stories. . Our patients aren’t “the 76 year old with heart failure in room 202,” as Heather Coats astutely noted. Storytelling Helps Hospital Staff Discover The Person Within The Patient. What Mattered Then, Now, and Always: Illness Narratives From Persons of Color. What’s in a story?

Patient-Centered 115

Patient-Centered Illness Healthcare IT 115

GeriPal

OCTOBER 20, 2022

And, who within ASPE guides aging policy and connects policy to every day health challenges experienced by patients and clinicians? Alex: And we are delighted to welcome Rasheeda Hall, who is a physician scientist in the division of nephrology at Duke University School of Medicine, and sees patients at the Durham VA.

Complication 52

Complication Patient-Centered IT Patients 52

GeriPal

OCTOBER 26, 2023

Within hours of recording this podcast, I joined a family meeting of an older patient who had multiple medical problems including cancer, and a slow but inexorable decline in function, weight, and cognition. The patient’s capacity to make decisions was marginal, and his sons were shouldering much of the responsibility.

Patient-Centered 132

Patient-Centered Hospital Patients IT 132

GeriPal

FEBRUARY 23, 2023

Summary Transcript Summary You know when you walk out of a patient’s room and have that sense, “This isn’t going to go well.” The patient is sick and getting sicker, and refuses to let you talk with family or other members of her inner circle. Should you stop at “no?” AlexSmithMD Transcript Eric: Welcome to the GeriPal podcast.

Families 98

Families Family Patient-Centered IT 98

GeriPal

JANUARY 16, 2025

Summary Transcript CME Summary Many older adults lose decision-making capacity during serious illnesses, and a significant percentage lack family or friends to assist with decisions. How should we care for unrepresented individuals in inpatient and outpatient settings? Is the patient in your descriptor?

Patient-Centered 109

Patient-Centered IT Patients Healthcare 109

GeriPal

DECEMBER 15, 2022

In an article in the NEJM (a published article this time, wonder of wonders!) Along the way we address: Is this degree of slowed cognitive decline meaningful to patients or care partners? She was a heart failure patient. But wait, there’s a shiny new anti-amyloid drug, lecanemab! (No Alex: It’s a great choice.

IT 105

IT Patient-Centered Healthcare Illness 105

GeriPal

NOVEMBER 7, 2024

If the purpose of initiating dialysis is improving function – our complex, frail, older patients are likely to be disappointed. Eric 00:13 And, Alex, I am very excited today because there was an awesome article on Annals on conservative management versus dialysis. This is Eric Widera. Alex 00:12 This is Alex Smith.

Management 116

Management Patient-Centered Patients IT 116

GeriPal

FEBRUARY 29, 2024

Accreditation In support of improving patient care, UCSF Office of CME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

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IT Patient-Centered Illness Education 126

GeriPal

MARCH 24, 2023

For a deeper diver into these issues, check out some of the following links: Ira’s Stat new article “Hospice care needs saving” GeriPal’s episode on the growing role of private equity in hospice care Acquisitions of Hospice Agencies by Private Equity Firms and Publicly Traded Corporations. Ira: I like the article. Thank you, Anne.

IT 114

IT Provider Patients Families 114

GeriPal

MAY 4, 2023

But when I have, I find that they’re often some of the hardest patients to care for. I just had this experience where in the space I was in, very few people believed that this was even a legit thing to study and certainly that it would make a difference for the patients we cared for. Young adulthood is super hard.

IT 83

IT Families Family Illness 83

GeriPal

APRIL 4, 2024

The Cruzan ruling led to a flood of interest in Advance Directives, and eventually to the Patient Self Determination Act, which mandates provision of information about advanced directives to all hospitalized patients. You write about this, you’ve written this New England Journal article, you’ve written past articles.

Families 112

Families Family Patient-Centered IT 112

GeriPal

OCTOBER 19, 2023

Caveat as well that RCTs should not be placed on pedestal as the only answer- often patients enrolled in RCTs do not represent real world patients – observational studies do. For a trial to have value, it should not exclude patients over age 80, or those with dementia, or patients residing in nursing homes.

Patient-Centered 126

Patient-Centered IT Patients Illness 126

GeriPal

JUNE 30, 2022

You have a patient with dementia severe enough that she cannot recognize relatives. 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. Summary Transcript Summary. She falls and breaks her hip.

Patient-Centered 101

Patient-Centered Complication Patients IT 101

GeriPal

FEBRUARY 8, 2024

The illness narratives suffering, healing, and the human condition. I think even the word patient, patient, I think, comes from the word suffer, the one who suffers. Alex: I wonder when we talk about it, because we’ll have links to both Eric Cassell’s argument, and we mentioned another article from Tate.

IT 137

IT Families Family Physicals 137

GeriPal

MARCH 24, 2022

Start by reading this article by Sean Morrison, Diane Meier, and Bob Arnold in JAMA , and this response from Rebecca Sudore, Susan Hickman, and Anne Walling. Assigning a surrogate decision maker is important for everyone, including those who don’t have serious illness. Where does POLST fit in with this debate? This is Eric Widera.

Illness 73

Illness IT Healthcare Patient-Centered 73

GeriPal

MAY 25, 2023

I’m not sure if you read that article and whether or not it’s changed your mind or whether or not you want to do any more research in advance care planning. And as you know, it’s a great article. Advance care planning doesn’t work. Your thoughts? LJ: Definitely read it. Alex: LJ, are you going to add to that?

Community 96

Community IT Patient-Centered Primary Care 96

GeriPal

AUGUST 24, 2023

Harvey is probably best known for his work in developing dignity therapy, a psychological intervention designed specifically to address many of the psychological, existential, and spiritual challenges that patients and their families face as death approaches. Just an extraordinary cast of individuals who were really so incredibly inspiring.

Patient-Centered 98

Patient-Centered Patients IT Illness 98

GeriPal

APRIL 24, 2025

We and our guests have noticed that in our clinical practices, patients and caregivers seem to be asking for such treatments more frequently. We discuss an article they wrote about PULET for the American Journal of Hospice and Palliative Medicine, including: What makes a PULET a PULET? Ivermectin to treat cancer. Stem cell treatments.

Patient-Centered 77

Patient-Centered IT Patients Illness 77

GeriPal

DECEMBER 14, 2023

More recently Sharon Kaufman ‘s book And a Time to Die described the ways in which physicians, nurses, hospital systems, and payment mechanisms influenced the hour and manner of patient’s deaths. We discuss the moral distress that clinicians felt including, as one physician put it, a sense of your soul being ripped out.

Hospital 125

Hospital IT Patient-Centered Patients 125

GeriPal

JANUARY 11, 2024

In further contrast to the United States, MAID in Canada is almost entirely administered by a clinician, whereas in the United States patients must self administer. A planned expansion of MAID to include people with mental illness was placed on hold until March 2024. They could have a prognosis of years, or decades.

Illness 144

Illness IT Medical Provider 144