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 my hypothesis is that’s because it’s no longer the individual managing their own diabetes, it’s the nursing home staff managing their diabetes.

Diabetes 73

Diabetes Management Patient-Centered Families 73

GeriPal

NOVEMBER 9, 2023

Alex: We’re delighted to also welcome Greg Pawlson, who’s Senior Faculty at Lodestar Consulting & Executive Coaching and former President of the American Geriatric Society. Beth: Right now, I’m actually just doing individual coaching, but we are writing a grant to start group coaching next year. Beth: Thank you.

Board-Certified 109

Board-Certified IT Primary Care Referral 109

GeriPal

JUNE 12, 2025

I didn’t know where they existed within the hospital. Eric 07:04 You actually created things like a curriculum for hospital medicine fellows in radiation oncology. So you have the consultation. Sometimes individuals have lung tumors that make it difficult for them to breathe. There really was very little.

Patient-Centered 101

Patient-Centered Referral Patients IT 101

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. Today Liz Dzeng discusses her journey towards studying this issue in detail. I guess the VA is federal though.

Hospital 124

Hospital IT Patient-Centered Patients 124

GeriPal

JANUARY 25, 2024

You can also listen to an audio interview with Alex and JAMA Deputy Editor Preeti Malani about this study and the other RCT of default palliative care for hospitalized older adults with noncancer serious illness published in the same issue. People had to be in the top 20th percentile of risk for being hospitalized or dying in the next year.

Patient-Centered 121

Patient-Centered IT Illness Patients 121

GeriPal

FEBRUARY 15, 2024

So it’s just a wide-opening lens that most of us never really get to see if we’re on the hospital-based side. I was like, “I have all these things I’m doing in the hospital to try to make people better and then I might be sending them right back to a big hazardous environment.”

Community 113

Community Transportation IT PCP 113

GeriPal

MARCH 28, 2024

Kate: It was done in 10 hospitals, 17 ICUs in Atrium Health down in North Carolina. Asking clinicians to document prognosis did not change the primary outcome of hospital length of stay or really any of the secondary outcomes, which I’ll get into. Also the same hospital system? That’s when they got enrolled.

Consulting 114

Consulting Patient-Centered IT Patients 114

GeriPal

JUNE 9, 2022

Palliative care, in contrast, saw explosive growth in US hospitals. 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. I have never myself called a palliative care consult as a trainee because we didn’t have one.

Consulting 99

Consulting Patient-Centered Diagnosis Referral 99

GeriPal

OCTOBER 26, 2023

Today we talk with Sarguni Singh, hospitalist-researcher at the University of Colorado, Ann Henshaw, Occupational Therapist who teaches at George Washington and works clinically at Georgetown, and Tamra Keeney, Physical Therapist-researcher at Mass General Hospital and Harvard Medical School. Tamra, welcome to the GeriPal podcast.

Patient-Centered 131

Patient-Centered Hospital Patients IT 131

GeriPal

FEBRUARY 23, 2023

Imagine her hearing for the first time that you’re sick, that you’re hospitalized, that you’re in the ICU, and that you can’t make your own decisions? And then we were involved, palliative care was consulted when the patient was really sick and decompensating in the ICU. That’s a huge amount of news all at once. This is Eric Widera.

Families 97

Families Family Patient-Centered IT 97

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 104

Telehealth Patient-Centered IT Patients 104

Doctor On Demand

APRIL 28, 2025

In fact, most sore throat symptoms resolve in three days for 60-70% of patients, according to March 2025 UpToDate, an evidence-based clinical decision support system used by healthcare professionals. Paramedics can provide life-saving treatment on the way to the hospital. A doctor can help determine the cause.

ER 52

ER Telehealth Primary Care Doctor Appointment 52

GeriPal

DECEMBER 8, 2022

As Thor notes, capturing patient stories has face validity as positively impacting the patients who share their stories and have them documented, and for the clinicians who get to truely and deeply know their patients in far greater depth than “what brought you to the hospital?” Within the VA it’s now at 70 VA hospitals.

Patient-Centered 114

Patient-Centered Illness Healthcare IT 114

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. Many were community hospitals. The intervention was a negative study for the primary outcome, hospital length of stay.

Patient-Centered 115

Patient-Centered Hospital IT Illness 115

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. I mean, how do you negotiate that with the oncologist who is the one who consulted you, by the way, Eric, who does that go to? And it’s a lot of if, if.

IT 131

IT Illness Families Family 131

GeriPal

APRIL 4, 2024

The hospital refused without a court order, and the case eventually made its way to the Supreme Court. 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.

Families 111

Families Family Patient-Centered IT 111

GeriPal

APRIL 10, 2025

Today we discuss: Why the study was negative for the primary (hospitalization) and all secondary outcome (e.g. Tammie 03:04 Depends on how long they were pre-hospital. So that study was focused on patients admitted to the hospital. hospice use). Tammie 02:56 It usually doesn’t work no matter what. So that’s great.

Patient-Centered 76

Patient-Centered IT Hospital Patients 76

GeriPal

OCTOBER 20, 2022

And so there was a report in 2009 by the Institute of Medicine saying that we need to equip all of these individuals in caring for older person in an evidence based manner. So transmission of other drug resistant organisms and C difficile to other patients in the hospital reduces if you control. Diff rates, for example at a unit level.

Complication 52

Complication Patient-Centered IT Patients 52

GeriPal

DECEMBER 15, 2022

Been in the hospital four times, vented, been told the story to her family, she won’t live. Tell me how your illness has impacted your relationships with others, your healthcare team, your family, friends, your beliefs, your values, your preferences. So those questions we ask when we’re doing a palliative care consult.

IT 104

IT Patient-Centered Healthcare Illness 104

GeriPal

JANUARY 16, 2025

These individuals may become unrepresented, meaning they lack the capacity to make a specific medical decision, do not have an advance directive for that decision, and do not have a surrogate to help. How should we care for unrepresented individuals in inpatient and outpatient settings? Why not use the older term unbefriended?

Patient-Centered 108

Patient-Centered IT Patients Healthcare 108

GeriPal

JUNE 30, 2022

Joel: The Brigham and Women’s Hospital likes me to say that too. Alex: And the Brigham and Women’s Hospital. Eric: So we’re going to be talking about dementia and considerations around surgery for individuals with dementia. And she was rushed to the hospital. Did I get that right? Joel: Oh yeah.

Patient-Centered 101

Patient-Centered Complication Patients IT 101

GeriPal

FEBRUARY 13, 2025

You did a rural tele-palliative care consultation study. Marie 03:08 So, living in Alabama, which is our palliative care desert in the south, there were no palliative care services in any of the small rural hospitals. And so the video consult was what became the mode. NCP guideline, standard consultation.

Consulting 62

Consulting Community Patient-Centered Families 62

GeriPal

JUNE 5, 2025

So, how can we improve palliative care for individuals in nursing homes? And so they’re in there for a very short time, couple weeks, get a little bit stronger and transition home after a hospitalization. And so we do have consultants who come in the building. And usually it’s simply for a consultation.

Nurse Practitioner 78

Nurse Practitioner Referral Consulting Board-Certified 78

GeriPal

MAY 8, 2025

Vincent’s Hospital in Melbourne, Australia. So classically with preparation, in individual settings or even in group settings, you have one or two people supporting people through psychoeducation, what to expect, life review. Now they’re getting psychedelic experiences, you know, and transformation in a consulting office.

Illness 106

Illness IT Patient-Centered Patients 106

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. Jessie: Exactly. Eric: Which brings us to an article. Katie: Yeah.

Illness 135

Illness Patient-Centered Screening IT 135

GeriPal

MARCH 6, 2025

Michaels Hospital in Toronto, and health justice activist. link] PEACH Good Wishes Program A program that provides meaningful gifts for unhoused individuals who are terminally ill. Michael’s Hospital in the Department of Family and Community Medicine. Today we talk with Naheed Dosani, a palliative care physician at St.

Healthcare 99

Healthcare IT Community Illness 99

GeriPal

MARCH 13, 2025

Summary Transcript CME Summary As far as weve come in the 50 years since Balfour Mount and Sue Britton opened the first palliative care at the Royal Victoria Hospital in Quebec, have we lost something along the way? I was trained in the hospital where it started, and we were trained to be bedside nurses. Sue 01:26 Thank you.

IT 103

IT Patient-Centered Families Family 103

GeriPal

FEBRUARY 27, 2025

I see this in the hospital when I’m doing addiction medicine consults. We got admitted to the hospital, our inpatient palliative team developed their skill set because they had a place to send patients when they got discharged. For those individuals, how do you think about that? They’re often angry.

Patients 71

Patients Clinic Patient-Centered Illness 71

GeriPal

MAY 4, 2023

We remember bucking the rules, figuring out who you are, hair on fire, feeling invulnerable, trying to figure out who you are – and now those adolescents are stuck in the hospital, with doctors and parents telling them what to do, having their autonomy crushed by the medical institution, realizing they’re not invulnerable. Eric: Yeah.

IT 83

IT Families Family Illness 83

GeriPal

MARCH 24, 2023

I think some individuals thought there was cherry-picking of stories that made it seem like hospice is this bad thing, that it’s taking advantage of vulnerable individuals and it didn’t talk enough about the good things that hospice does. We don’t want people dying in the hospital if their goal is to be at home.

IT 112

IT Provider Patients Families 112

GeriPal

OCTOBER 5, 2023

I have never had a patient come into the hospital and say, Doctor, regardless of what you do, do a little CPR that’ll make me feel better. I would say most of the time we offer CRT in the hospital. I point this out a lot more nowadays to the resident teams that consult. This is Eric Widera. Alex: This is Alex Smith.

Illness 135

Illness IT Patient-Centered Families 135

GeriPal

APRIL 13, 2023

And so I was really thinking about why are some of my people that are hospitalized doing better than others? I think some of that is from some of my thinking about maybe what I can potentially think about with the individual to support them. And so really thinking about people’s individual experiences, what might help for them.

IT 98

IT Community Patient-Centered Medical 98

GeriPal

JANUARY 11, 2024

And so in that context, knowing that there was going to be some evolution of policy in this area, that’s how I got involved consulting with members, trying to understand the situation better, that type of thing. Because in medicine as somebody who works in the hospital, there’s always other treatment options.

Illness 144

Illness IT Medical Provider 144

GeriPal

MAY 12, 2022

I mean, just such struggles around corruption in hospitals, access to opioid pain medication, and you almost had to wait until a friend of yours was in power, so you could have access, get permission. Alex: I love the story of this book, how it starts so locally and then moves on to the Kerala region and then moves to India.

Community 114

Community IT Relationship Healthcare 114

GeriPal

DECEMBER 19, 2024

* This episode of the GeriPal Podcast is sponsored by the Zuckerberg San Francisco General Hospital Division of Hospital Medicine , which is committed to providing outstanding, compassionate care to all patients, advancing health equity, and fostering excellence in hospital medicine. Eric 12:11 And we consult psychiatry.

Illness 100

Illness Mental Health IT Patient-Centered 100

GeriPal

SEPTEMBER 22, 2022

I like to tell my trainees… Often with the earliest stage trainees, they’ll go in the room and they’ll ask the patient what brought them to the hospital. And that’s not the information that we’re looking for as much when we’re the palliative care consult team. Josh: Mm-hmm. Yeah, totally.

Illness 101

Illness IT Patient-Centered Patients 101

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. When they built a new prison hospital in Stockton, the dialysis went there. These older patients are costing a ton in healthcare costs. Michele: Yep. Michele: Yeah.

Families 131

Families Family IT Community 131