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. Should you stop at “no?” Anne Kelly: Hi there. Nice to be here. Eric: Lynn or Anne?

Family 97

Family Families Patient-Centered IT 97

GeriPal

JUNE 9, 2022

By diagnosis? We can’t possibly meet the needs of all people with newly diagnosed serious illness. But definitely always had the bug to be the one to jump into the family meetings in the ICU, lead them. We all focused on studying the outcomes for patients and families of our intervention and then the processes to get there.

Consulting 99

Consulting Patient-Centered Diagnosis Referral 99

GeriPal

SEPTEMBER 1, 2022

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. And so when you have that, that’s so good for the family. That’s so good for us. What did you learn?

IT 102

IT Family Families Clinic 102

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. Summary Transcript CME Summary It is a battle royale on this weeks GeriPal podcast. But watch out!

Telehealth 105

Telehealth Patient-Centered IT Patients 105

GeriPal

JANUARY 18, 2024

If somebody has cancer and they’re recently diagnosed, somebody has cancer and they’re undergoing active treatment, somebody has cancer and they’re in early remission, now they’re a year or two years, three years, four years out and they still have pain. Jessie: Yes. And then, looking at- Eric: Wow. So, one out of 10?

Illness 136

Illness Patient-Centered Screening Clinic 136

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

JUNE 16, 2022

We discuss with her how we should work-up and manage “urinary tract infections” (I’ve added air quotes to “UTI” in honor of Tom Finucane’s JAGS article titled “Urinary Tract Infection”—Requiem for a Heavyweight in which he advocated to put air quotes around the term UTI due to the ambiguity of the diagnosis.). Alex: This is Alex Smith.

Management 122

Management IT Medical Patient-Centered 122

GeriPal

OCTOBER 17, 2024

And so, unfortunately, I think for a while, this condition, for many people, isn’t diagnosed until you end up seeing a cardiologist or a heart failure doctor who’s really honed in on this to say, actually, this is a heart failure syndrome. Eric 12:05 Any pearls on the diagnosis of HFpEF. A pill organizer, having family.

Primary Care 113

Primary Care Patient-Centered IT Patients 113

GeriPal

JUNE 15, 2023

Now actually suggesting perhaps that you missed a diagnosis that you should have considered? And this case has been worked out the best in terms of the artificial intelligence suggesting diagnoses the clinician may have missed. Eric: Yeah. And I think that’s where it gets really interesting from the standpoint of ethics.

IT 99

IT Patient-Centered Patients Healthcare 99

GeriPal

AUGUST 17, 2023

There is a lot to digest with these draft clinical guidelines but the big change from the 2018 guideline is moving Alzheimers to a biological diagnosis (biomarker evidence only) not just for a research framework but now from a clinical one. And we’ve been diagnosing it at Penn. And that could extend beyond 18 months.

Patient-Centered 98

Patient-Centered IT Clinic Patients 98

GeriPal

AUGUST 25, 2022

Second, Hospice was originally designed for patients with advanced cancer, but the fastest growing admitting diagnosis is dementia. And yet, disenrollment from hospice, either due to patient/family revoking the benefit or stabilization of illness (extended prognosis) is remarkably high for people with dementia among some hospices.

Family 106

Family Families IT Patients 106

GeriPal

APRIL 14, 2022

But that just didn’t really resonate with what I saw clinically which was that there was lots of suffering both in the patient, their family and on the clinical team and just felt it was really this space where I didn’t have a lot of evidence to guide me. And sometimes you can make a use disorder of diagnosis in hindsight.

Illness 102

Illness Patient-Centered IT Patients 102

GeriPal

JULY 28, 2022

This is my early father’s day gift from the family. 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. Alex: I’ve got to show you the back of the Jersey. Eric: Yeah. Alex: That’s right. Jennifer: Oh nice.

Illness 110

Illness Hospital Patient-Centered Patients 110

GeriPal

MAY 9, 2024

Alex: And Sammy Winemaker, who’s a palliative care physician and Associate Clinical Professor at McMaster University in the Department of Family Medicine, Division of Palliative Care. It’s just normal kind of talking to people because you are scuppered if you can’t connect with the patients and families in their home.

Education 127

Education IT Illness Healthcare 127

GeriPal

AUGUST 31, 2023

I was asking about what was going to be special about the trip or if they were going to do things with their family. So she had them early in diagnosis and then a little bit later. I just love her conclusion because what she realizes is when you’re first diagnosed… This is research. Brad: Yeah. ” Brad: Yeah.

Illness 128

Illness IT Diagnose Medical 128

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. ” I think the family would like you to consider how to work with that. That dawned on me.

Provider 117

Provider Illness IT Healthcare 117

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

FEBRUARY 22, 2024

We might say, “Of course you’re sad, you just got a very serious diagnosis.” They’re still engaging fully with their family and with the activities and the hobbies that they’re still able to do. And having a cancer diagnosis and treatment is freaking stressful. Is this a new onset depression?

Mental Health 122

Mental Health Patient-Centered Illness Screening 122

GeriPal

JANUARY 11, 2024

What happened is that firstly, in terms of my clinical background, my background is psycho-oncology, so that’s working with patients with cancer and their families, including when they’re going through periods. Alex: Self-administer and psychiatric illness is not considered a qualifying diagnosis. Eric: Yeah. Eric: Yeah.

Illness 144

Illness IT Medical Provider 144

GeriPal

JULY 3, 2025

And I was curious to learn about how people were talking about what to expect after a diagnosis of advanced cancer, how clinicians were counseling patients, how patients were understanding their prognosis and making decisions. Alex 10:22 So just to say that again, from the time of diagnosis. Like at the time of diagnosis.

52

52

GeriPal

FEBRUARY 9, 2023

And when you and I talk about, what’s the key medical decision or diagnosis that we’re making all the time, we’re making a decision about like, “Is this patient sick enough to die? So we did a perfect cross so that the race and actual primary diagnosis was perfectly matched across groups.

Patient-Centered 111

Patient-Centered Patients IT Healthcare 111

GeriPal

OCTOBER 27, 2022

Someone who’s healthy in their 60s and just got diagnosed with diabetes, yeah, they might benefit, if they have a very long life expectancy, to prevent that decline in kidney function. So we wanted to create a model that’s going to reflect that sort of risk and what it also means for their families and financial decisions.

IT 95

IT Clinic Screening Patients 95

GeriPal

APRIL 18, 2024

The results were that the chat bots got the diagnoses right and had an escalation strategy that was better than the doctors, as judged by blinded specialists reading the transcripts. You and I would listen to a suggested list of diagnoses and say, “That’s a reasonable idea. They had no idea. I’m connecting.

IT 139

IT Electronics Patients Healthcare 139

GeriPal

SEPTEMBER 19, 2024

So, for example, everyone who was diagnosed with an advanced or metastatic lung cancer had a prognosis on the order of months. Within eight weeks of diagnosis of advanced disease. Eric 16:38 So everybody was diagnosed with an advanced lung cancer sometime in the last twelve weeks and then they were randomized.

Patient-Centered 119

Patient-Centered IT Patients Hospital 119

GeriPal

JULY 25, 2024

So we really wondered, you know, in modern palliative care practice, where we’re seeing patients a lot farther upstream than we used to, and we’re seeing patients with a wider range of diagnoses, we wanted to update, sort of. So it’s not just like the patient or the family, but it’s also the healthcare system.

Family 106

Family Families Patient-Centered Patients 106

GeriPal

JULY 6, 2023

Administration on Aging connecting you to services for older adults and their families California’s Master Plan for Aging New York’s Master Plan for Aging Transcript Eric: Welcome to the GeriPal Podcast. I have 24,500 veterans on our caseload, 14,000 individuals with diagnosed mental health issue, 8,500 with an alcohol and substance abuse.

Community 89

Community Nurse Practitioner Provider IT 89

GeriPal

JUNE 26, 2025

We focus on function and mortality because these are outcomes that really are important to patients and families. May not even know that the patient has dementia, or they might think that, but it’s not been diagnosed. Lauren 19:01 Yeah, so in our second paper, we asked that exact question. What is your function? And do you die?

Illness 93

Illness Hospital IT Patient-Centered 93

GeriPal

MAY 1, 2025

One in 10 people with newly diagnosed HIV is an older adult. And over that first 15 years, which was a very difficult time when there was no treatment at all available, everybody died and usually within months or a year or two of when they were diagnosed. And I also read that 1 out of 10 newly diagnosed HIV cases are in older adults.

Primary Care 94

Primary Care IT Clinic Provider 94

GeriPal

MARCH 27, 2025

And so this is our way of supporting non English speaking families in advanced care planning. But most people with dementia are initially diagnosed and medically managed in primary care, and they really desire clinicians to initiate these conversations but there are a number of really important barriers for these conversations taking place.

Primary Care 79

Primary Care IT Clinic Illness 79

GeriPal

DECEMBER 1, 2023

If you are interested in learning more about the draft guidelines and the response from AGS to these guidelines, check out the following links: Revised Criteria for Diagnosis and Staging of Alzheimer’s Disease: Alzheimer’s Association Workgroup AGS’s response to the revised criteria Transcript Eric: Welcome to the GeriPal Podcast.

IT 115

IT Clinic Illness Hypertension 115

GeriPal

AUGUST 22, 2024

I love these topics, too, because even how do we define what is a diagnosis? Patients families want to know whether their loved one has died. And one would be when care is continuing a case where people believe that the patients died, or oftentimes, this is also a source of controversy between families and clinicians.

IT 113

IT Families Family Patient-Centered 113

GeriPal

JUNE 6, 2024

So this is about two and a half, three years out from leukemia diagnosis. And the point of that is that so many people, in my experience, and I’m sure it’s the same initial diagnosis of cancer, that’s the last thing that I want to talk about. And I said, sure. And I had that mortified look on my face of God.

Illness 130

Illness IT Physicals Patients 130

GeriPal

DECEMBER 21, 2023

Don’t get me wrong, the evidence points to cost savings, but as Chris Callahan and Kathleen Unroe pointed out in a JAGS editorial in 2020 “in comprehensive dementia care models, savings may accrue to Medicare, but the expenses accrue to a fluid and unstable network of local service providers, patients, and their families.” Malaz: I love it.

Patient-Centered 125

Patient-Centered IT Family Families 125

GeriPal

APRIL 21, 2022

Mike Rabow shares his award winning poem about coming out to the world about his diagnosis with multiple sclerosis. . Redwing: So I grew up in a pretty intellectual family, but my brother and sister were six and 10 years older than me, and they were always feeding me literature and poetry. Eric: Like since a little kid? Eric: Yeah?

Patient-Centered 93

Patient-Centered IT Community Illness 93

GeriPal

SEPTEMBER 14, 2023

But as we talked to patients and providers, there was, really, this need for patients who wanted services, like IV antibiotics and IV fluids, but wanted to be able to spend that time at home, with their family, even if it meant it was their last days or weeks. You can broaden the scope of diagnoses. There are some subtleties there.

Hospital 115

Hospital Patient-Centered Supply Chain IT 115

GeriPal

JULY 16, 2024

Ken Covinsky reminds us that we should not be making a diagnosis based on what we see on TV, and that if a patient’s daughter expressed a concern that their parent “wasn’t right,” we would conduct an in depth evaluation that might last an hour. Cecilia Poon says, what are some best practices to highlight professional ethics?

Diagnosis 141

Diagnosis Diagnose IT Physicals 141