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 yet we’re also in a different place in diabetes monitoring and management. Eric: And you can probably tell already, the topic at hand is diabetes management in late life.

Diabetes 73

Diabetes Management Patient-Centered Family 73

GeriPal

APRIL 27, 2023

The company has expanded its palliative care services through partnerships with hospitals and other managed care providers, according to AccentCare CEO Stephan Rodgers. Attendee 13: I am most hopeful that we will continue to really promote culture change for our healthcare system that desperately needs it.

Specialization 93

Specialization Illness Healthcare Patient-Centered 93

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

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

AUGUST 29, 2024

It feels nearly impossible if you add another degree of difficulty, whether it be a crying interpreter or a grandchild from another state who shows up at the end of a family meeting yelling how you are killing grandma. And you’re in the ICU family meeting, and it gets heated. Is the sort of task to manage.

IT 132

IT Illness Family Families 132

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. But watch out! Alex 01:06 Yeah, go in person.

Telehealth 105

Telehealth Patient-Centered IT Patients 105

GeriPal

JANUARY 25, 2024

And so, three years of seeing over and over people having really difficult end of life experiences in the ICU, not being able to advocate for themselves, a lot of trauma for their families, I just thought, we have to do better than this. I was really passionate about helping the people and also their families. Eric: Oh, wow.

Patient-Centered 122

Patient-Centered IT Illness Patients 122

GeriPal

MARCH 28, 2024

It did not change the frequency of palliative care consultation, the timing of such, ICU mortality, or six-month mortality. Kate: I think the main one for me being asked on the fly is that one of the nudged specialist palliative care consultation, which we know has limitations. Eric: So how do you put that all together?

Consulting 115

Consulting Patient-Centered IT Patients 115

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. And so I tried to get her actually to pain management, and I couldn’t. That’s a big question.

Nurse Practitioner 78

Nurse Practitioner Referral Consulting Board-Certified 78

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.” What I need to navigate with that patient and their family, is it valuable to you? Every time.

IT 128

IT Family Families Patient-Centered 128

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

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. And so there’s complexity in Understanding how each state manages this. Because I mean, California is different. They have an advance directive.

Patient-Centered 109

Patient-Centered IT Patients Healthcare 109

GeriPal

DECEMBER 8, 2022

Our loves, our triumphs, our failures, our work, our families. . So I think as palliative care clinicians, we use narrative as we try to understand more about the persons that we’re caring for and their families. Been in the hospital four times, vented, been told the story to her family, she won’t live.

Patient-Centered 115

Patient-Centered Illness Healthcare IT 115

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

JANUARY 18, 2024

In particular, we talk about Katie’s and Jesica’s paper in NEJM titled “ Juggling Two Full-Time Jobs — Methadone Clinic Engagement and Cancer Care ,” which described the difficulty in managing cancer pain and methadone for opioid use disorder. Have you had a family history of substance use disorder? Jessie, welcome back to GeriPal.

Illness 136

Illness Patient-Centered Screening IT 136

GeriPal

OCTOBER 24, 2024

If you believe the evidence for efficacy to manage symptoms like neuropathic pain, how do you even start to think about recommending these products to patients? I actually do some consulting work with a company called the Farmstand that’s based in a community called the Villages in Florida. Is that your feeling, too?

Medical 98

Medical IT Patient-Centered Healthcare 98

GeriPal

DECEMBER 15, 2022

So I think as palliative care clinicians, we use narrative as we try to understand more about the persons that we’re caring for and their families. Been in the hospital four times, vented, been told the story to her family, she won’t live. So those questions we ask when we’re doing a palliative care consult.

IT 105

IT Patient-Centered Healthcare Illness 105

GeriPal

JUNE 15, 2023

So there’s some stuff out there like that, but also using AI to determine who at high risk and should get a palliative care consult. And patients and family members tell us that they worry that their clinician is going to be overly focused on that mortality number now. Like who is at high risk or low risk? Alex: Go ahead Matt.

IT 99

IT Patient-Centered Patients Healthcare 99

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

DECEMBER 14, 2023

And it was amazing just seeing the differences in how end-of-life care is managed at those three institutions, which were all a subway right away from each other. ” And they’re like, “Well, it would be unethical not to talk to the family.” I guess the VA is federal though. Liz: Right. Is that right too?

Hospital 125

Hospital 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

NOVEMBER 21, 2024

Like, how do we help ourselves maintain psychological integrity in the face of the stressors that we have to manage? But if we’re going to have a family meeting, that’s a different circumstance. That’s how I managed without screaming at my 4 year old who was coping. So help serves and hinders in everybody.

Illness 125

Illness IT Patient-Centered Patients 125

GeriPal

APRIL 14, 2022

Management of chronic pain in the elderly: focus on transdermal buprenorphine. And how am I going to manage their pain? And then part of our role as folks in palliative care who as Katie mentioned, really try to help folks manage distress around serious illness. Two great videos on buprenorphine initiation. Transcript.

Illness 102

Illness Patient-Centered IT Patients 102

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 30, 2022

Should she be treated non-operatively, with aggressive symptom management? 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? She has advance dementia. Eric: So, let’s talk about that. So, decision-making and surgical procedures.

Patient-Centered 101

Patient-Centered Complication Patients IT 101

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. Management, it’s hard. JAMA Health Forum.

IT 113

IT Provider Patients Family 113

GeriPal

FEBRUARY 15, 2024

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. Same thing with kind of medication management. Welcome, Katie, to the GeriPal podcast. Katie: Thanks for the opportunity. This is a first for our GeriPal podcast, right, Alex?

Community 114

Community Transportation IT PCP 114

GeriPal

MARCH 6, 2025

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. 80% died exactly where they wanted to and 83% were reconnected to family or friends through a psychosocial support system that we put into place. Yeah, yeah.

Healthcare 100

Healthcare IT Community Illness 100

GeriPal

MARCH 13, 2025

Yes, it means to cloak, but theres more Whole-person-care Total pain Healing as a process distinct from the deterioration of the body Sympomatologists The patient and family as the unit of care Our guests referenced many articles on this podcast, linked above and below. A good prescriber, a good symptom control manager. Balfour amount.

IT 104

IT Patient-Centered Family Families 104

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. And so we simply asked clinicians, have you offered this patient and, or their family the option of care focused on comfort? What is sludge?

Patient-Centered 116

Patient-Centered Hospital IT Illness 116

GeriPal

FEBRUARY 16, 2023

Managing anger is hard, it’s really hard. And yet we don’t ever talk about how to manage it. 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.

Patients 109

Patients IT Family Families 109

GeriPal

APRIL 13, 2023

Summary Transcript Summary Social connections impact our health in profound ways, whether it is the support we receive from family and friends in navigating serious illness, the joy from shared social activities, or connecting with our community. They may have few family members, live alone. I called my parents, and we talked.

IT 99

IT Community Patient-Centered Medical 99

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

JANUARY 20, 2023

If you own and operate a nursing home and you’re taking people in, and you’re admitting new residents, what’s their accountability for how they manage compensation and quality delivery? I think we should get back to the residents and their family members and care partners when we’re talking about accountability.

Finance 95

Finance Board-Certified IT Provider 95

GeriPal

MAY 12, 2022

In this podcast, we cover a great deal of ground, including: Early challenges Dr. Raj faced in pain management: access to opioids, corruption, a system that doesn’t see addressing suffering as a priority. But from what we read was much better as century back, is in communities manage their own affairs. What do you think about that?

Community 115

Community IT Relationship Healthcare 115

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. No, no, no. Absolutely.

Patient-Centered 77

Patient-Centered IT Hospital Patients 77

GeriPal

MARCH 7, 2024

We’ve invited two death doulas, Jane Euler and John Loughnane (who is also a family doc and palliative care physician), to talk about the role of a doula at the end of life. John: I am what I am, which is a family practice doctor. Eric: When I try to think about what a doula does, should I call it a consult? That dawned on me.

Provider 117

Provider Illness IT Healthcare 117