The Clinical Problem Solvers

APRIL 24, 2025

Simon is a pediatric addiction medicine psychiatrist at Boston Children’s Hospital; an assistant professor in psychiatry at Harvard Medical School; a recent Commonwealth Fund fellow in health policy at Harvard University; and the medical director of Wayside Youth & Family Support Network.  References 1. Benton TD , Boyd RC , Njoroge WF.

Mental Health 52

Mental Health Community Hospital Appointment 52

GeriPal

APRIL 27, 2023

Attendee 12: I’m hopeful for more access to people to have palliative care early, and I’m hopeful that we’re able to provide patients and families what they need, which is a lot more caregiving, which I feel like is a big thing that we’re missing in our healthcare. Eric: Here’s our contact information.

Specialization 93

Specialization Illness Healthcare Patient-Centered 93

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. What is the role of the family caregiver system, how they play a role? We don’t need to check sugars all the time,” that also is a shock for patients and families.

Diabetes 73

Diabetes Management Patient-Centered Family 73

GeriPal

MAY 5, 2022

And when you think about that, they’re hearing pieces of the information and their brain is trying to make sense of it. It’s because they literally couldn’t access the information. I wonder if you could engage their family in the goals of care discussion.” It changes the words. Eric: Great. Anecdote away.

IT 102

IT Screening Hospital Clinic 102

GeriPal

FEBRUARY 2, 2024

This week, we talk about the other major palliative care trial of default palliative care consults for hospitalized older adults with COPD, kidney disease, or dementia, published in the same issue of JAMA. and consulting for Papa Health. And, of course, this is what families of patients undergoing palliative care go through.

Consulting 120

Consulting Hospital Patient-Centered IT 120

GeriPal

AUGUST 29, 2024

We must often deliver complex medical information that carries heavy emotional weight in pressured settings to individuals with varying cultural backgrounds, values, and beliefs. And one of the hardest things is to distill it down to a sentence or two about what is information, what does it mean? And then be quiet and listen.

IT 132

IT Illness Family Families 132

GeriPal

FEBRUARY 23, 2023

The patient is sick and getting sicker, and refuses to let you talk with family or other members of her inner circle. We owe it to the patient to explore the reasons behind the “no,” commonly not wanting to be a burden to their family. And the sort of the ask was, “Oh yeah, you can talk to the family, right?

Family 97

Family Families Patient-Centered IT 97

GeriPal

OCTOBER 10, 2024

For instance, a family meeting or an update or communication with families. I’ve worked in palliative care for years, and there’s some times where I’m in the family meeting, I’m facilitating the family meeting, and then I’m reporting out to the referring doctors, and I say, what happened?

Screening 119

Screening IT Family Families 119

GeriPal

JANUARY 25, 2024

It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. I was really passionate about helping the people and also their families. Let’s say, family-centered care for heart and lung disease wasn’t really going on a few decades ago.

Patient-Centered 122

Patient-Centered IT Illness Patients 122

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. Consultations versus telehealth. You get a consult if you get a consult.

Telehealth 105

Telehealth Patient-Centered IT Patients 105

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. Bernie Lo discloses being an Honorarium Recipient and consultant for Takeda starting on 01/23/2024.

Family 112

Family Families Patient-Centered IT 112

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. So it defines unrepresented as someone who lacks decisional capacity to provide informed consent to a particular medical treatment. This is Eric Widera.

Patient-Centered 109

Patient-Centered IT Patients Healthcare 109

GeriPal

JUNE 9, 2022

But definitely always had the bug to be the one to jump into the family meetings in the ICU, lead them. And palliative care was as a program was just growing at Penn moving from just consult hospice to actually having a team when I was training. And I practiced both on the palliative care consult team and in the ICU.

Consulting 99

Consulting Patient-Centered Diagnosis IT 99

GeriPal

OCTOBER 12, 2023

” Somehow, there’s this signal that the patients and families had to pick up that maybe the surgeon wasn’t so enthusiastic, or if I just dump risk on them, maybe they’ll say, “I don’t want this.” And that’s how we connected. Justin: That’s probably the million dollar question.

IT 128

IT Family Families Patient-Centered 128

GeriPal

JUNE 15, 2023

Charlotta: Yeah, I think it will be in reducing the need to spend so many hours on documentation and looking through the EHR for information. And what we are seeing in our research is that, we’re working on GPT four, is volunteering information that we didn’t ask for. The information there and you limit it in that way.

IT 99

IT Patient-Centered Patients Healthcare 99

GeriPal

MARCH 28, 2024

We all, when bombarded with information have to take certain elements of a decision and focus on those; and in the ICU, you can imagine, we’re bombarded with information a lot. It did not change the frequency of palliative care consultation, the timing of such, ICU mortality, or six-month mortality.

Consulting 115

Consulting Patient-Centered IT Patients 115

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. Tamra: I wrote this… Eric: Thinking that the perceived role for inpatient physical therapist is a discharge consultant.

Patient-Centered 132

Patient-Centered Hospital Patients IT 132

GeriPal

MAY 4, 2023

It is really difficult for the patients and the families. They do choose to rely more on their family and parents in ways that might feel like a step backwards and is yet, still developmentally appropriate and autonomous. Eric: Yeah. I wonder from a provider perspective, if you’re open to talking about your team.

IT 83

IT Family Families Illness 83

GeriPal

FEBRUARY 15, 2024

It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Eric: Well, what are the odds that two family members focus on a similar topic and do research together? laughter] Alex: We love the family theme. Katie: Thanks for the opportunity.

Community 114

Community Transportation IT PCP 114

GeriPal

OCTOBER 24, 2024

Eloise 10:29 Yeah, I think what we saw in California was, prior to legalization, there was curiosity, but also a lot of their healthcare professionals didn’t know enough about it, so they didn’t discuss it with them. David 12:31 Yeah, if you believe the results of an informal. Is that your feeling, too?

Medical 98

Medical IT Patient-Centered Healthcare 98

GeriPal

OCTOBER 5, 2023

And I have gone through my not-so-long career, but it’s coming up on nine years now, seeing the way that we have talked about CPR in such problematic ways, in ways that really do not enable true informed consent. So I first want to just say thank you to Ernesto’s family. Eric: And can you tell me about Ernesto? Sunita: Yes.

Illness 136

Illness IT Patient-Centered Family 136

GeriPal

JUNE 5, 2025

Kathleen 03:47 I think any of us who’ve spent any time in nursing homes have spent time working in a nursing home setting, have visited, had family members in nursing homes and looked around and seen the population there. So we see a lot of problems with symptom management, a lot of family conflict. That’s a big question.

Nurse Practitioner 78

Nurse Practitioner Referral Consulting Board-Certified 78

GeriPal

FEBRUARY 13, 2025

You did a rural tele-palliative care consultation study. And so the video consult was what became the mode. Marie 03:42 So probably the most important thing is we developed the consultation as a culturally based consultation process. And then we incorporated that information into the consultation process.

Consulting 63

Consulting Community Patient-Centered Family 63

GeriPal

SEPTEMBER 22, 2022

And in response, the family or patient looked at you like you were from another planet? Coming off as rote and scripted during a serious illness conversation can have a similar off-putting impact on patients and families. Links: – Uncanny Valley post on Josh’s fantastic substack Notes from a Family Meeting.

Illness 101

Illness IT Patient-Centered Patients 101

GeriPal

JUNE 19, 2025

And I think a big part of that journey was just having that right time, that right moment, with the right network and support groups of individuals, including my family, to really lift me up and allow me to celebrate my authentic self. If we think of discrimination, how people are treated by their biological family. Caregivers too.

Individual 85

Individual Community IT Chronic Condition 85

GeriPal

NOVEMBER 21, 2024

But if we’re going to have a family meeting, that’s a different circumstance. It’s amazing how often when we’re taking care of somebody in the hospital, if you have Say, you know, a family member who is not showing up for visits with the medical team or who is. So help serves and hinders in everybody.

Illness 125

Illness IT Patient-Centered Patients 125

GeriPal

JUNE 22, 2023

Through a series of events, I started working as a consultant to the Department of Corrections in around 2006, and I was assigned to the California Medical Facility. In many cases, the families were the victims of the crime. And we’ve really tried to serve that hospice mission of serving the patient and the family.

Family 132

Family Families IT Community 132

GeriPal

JANUARY 18, 2024

It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. But the cancer specific databases just don’t have this information. Have you had a family history of substance use disorder? Most of our population has trauma. Katie: Yeah.

Illness 136

Illness Patient-Centered Screening IT 136

GeriPal

JUNE 30, 2022

And then, the family, her kids got together, my wife and her brother and sister got together and said, wait a minute, mom did not want this, right? But they don’t really have a lot of condition-specific or procedure-specific information at all. Eric: So what do we do with the information? She has advance dementia.

Patient-Centered 101

Patient-Centered Complication Patients IT 101

GeriPal

MAY 15, 2025

Prior podcasts on the ethics of nudging , and a different trial conducted by Kate and Scott in which the default for hospitalized seriously ill patients was to receive a palliative care consult. At one end of the spectrum you can provide decision makers with information that doesn’t work very well in most contexts.

Patient-Centered 116

Patient-Centered Hospital IT Illness 116

GeriPal

MARCH 6, 2025

We discuss the principles of harm reduction, social determinants of health, and trauma informed care. Michael’s Hospital in the Department of Family and Community Medicine. And this is really traumatic event for his street family and the street community that he knew. Naheed, welcome to the GeriPal Podcast.

Healthcare 100

Healthcare IT Community Illness 100

GeriPal

DECEMBER 14, 2023

It’s the clinicians on the rounding team, yes, but also the multidisciplinary team is really important, how they support the patient, the family, the doctors, the nurses, but also how the broader institutional structures such as ethics committees, et cetera, how they support. Is that right too?

Hospital 125

Hospital IT Patient-Centered Patients 125

GeriPal

JANUARY 20, 2023

It’s also what are the pieces of information we’re bringing to the table when we start providing care for residents? Those are evidence-based or evidence-informed tools that have been in practice. Eric: So Jasmine, we hit on care delivery, we also hit apparently on health information technology. Jasmine: Technology.

Finance 95

Finance Board-Certified IT Provider 95

GeriPal

MARCH 24, 2023

2021 Association of Hospice Profit Status With Family Caregivers’ Reported Care Experiences. I’m very proud of the work that we do every day and we take care of patients and families no matter where they live or who they are to help them meet their end of life goals. JAMA Health Forum. Eric: Great. And this is on average.

IT 113

IT Provider Patients Family 113

GeriPal

FEBRUARY 16, 2023

So when we encounter anger clinically, when we’re in an encounter with a patient and their family, what are perhaps three steps, and we have the three step model for how we can look within ourselves and respond. What feelings do we have toward the patient and toward their families? And countertransference is everywhere.

Patients 109

Patients IT Family Families 109

GeriPal

APRIL 24, 2025

Daneila Lamas wrote about this issue in the New York Times this week -after we recorded – in her story, a family requested an herbal infusion for their dying mother via feeding tube. Jill Schneiderhan, a family medicine and integrative medicine doc, helps us think through this. Ivermectin to treat cancer. Stem cell treatments.

Patient-Centered 77

Patient-Centered IT Patients Illness 77

GeriPal

APRIL 10, 2025

I think that study was really important, especially I think the message that I give people is you can do something as simple as calling a consultation and improve quality of life months later. And it’s very traumatic obviously for the family and all of that and the team really. So that’s great. That’s not news to us.

Patient-Centered 77

Patient-Centered IT Hospital Patients 77