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

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. Is your impression that HFpEFde is under diagnosed in older adults? Alex 45:43 Okay.

Primary Care 113

Primary Care Patient-Centered IT Patients 113

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. Gender expression is your physical outward manifestation of how you express your gender identity.

Individual 85

Individual Community IT Chronic Condition 85

GeriPal

FEBRUARY 6, 2025

So, the question becomes, what, if anything, should we do differently in the primary care setting to diagnose the disease? We address the following questions with Nate: Has anything changed for the primary care doctor when diagnosing Alzheimers? But these tests were never designed to diagnose. Does a good history matter anymore?

Primary Care 95

Primary Care Diagnosis Screening IT 95

GeriPal

JUNE 16, 2022

Alex: Today we are delighted to welcome Chrissy Kistler, who is a geriatrician researcher in the Department of Family Medicine and Vision of Geriatrics at the University of North Carolina, Chapel Hill. 50 to 70% of people who are diagnosed with UTIs probably don’t have a UTI. I hear it’s over diagnosed. Alex: Right.

Management 122

Management IT Medical Patient-Centered 122

GeriPal

JUNE 15, 2023

And this case has been worked out the best in terms of the artificial intelligence suggesting diagnoses the clinician may have missed. I actually like reading books and the physical,” and what the internet 2.0 And I think that’s where it gets really interesting from the standpoint of ethics. Alex: Mm-hmm. Charlotta: Yeah.

IT 99

IT Patient-Centered Patients Healthcare 99

GeriPal

JUNE 9, 2022

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. Thank you, Eric.

Consulting 99

Consulting Patient-Centered Diagnosis Referral 99

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. How you actually physically started doing this and built up so many followers over time and why are you doing it? Hsien: Hey, great to be here.

Education 127

Education IT Illness Healthcare 127

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

JUNE 13, 2024

And the truth is we don’t want, I don’t want any patient or family to perceive that when Brera goes to see me, there’s a second interest, a second gain. We have an epidemic of BMI and therefore never use the way the patient looks like to diagnose cachexia. Alex 24:58 I’m so glad you mentioned the family.

Illness 133

Illness Patient-Centered Patients IT 133

GeriPal

FEBRUARY 22, 2024

A lot of those symptoms of depression can also be attributed to different kinds of physical symptoms. They’re still engaging fully with their family and with the activities and the hobbies that they’re still able to do. If you’re low energy, well, is that the illness or depression?

Mental Health 122

Mental Health Patient-Centered Illness Screening 122

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

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

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. Had multiple physical, psychological complications as a result of that.

Patient-Centered 98

Patient-Centered Patients IT Illness 98

GeriPal

FEBRUARY 9, 2023

They look at the signs and symptoms, they do a physical exam, maybe some lab tests or some imaging. And if the doctors still come up with different diagnoses or perceptions of what’s happening with the patient and or treatment plans, that’s all on them. Try to really understand what’s happening.

Patient-Centered 111

Patient-Centered Patients IT Healthcare 111

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. So being well and also potentially periods of dying. But that was separate from MAID. Eric: Thank you Bill.

Illness 144

Illness IT Medical Provider 144

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

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. Eric 16:38 So everybody was diagnosed with an advanced lung cancer sometime in the last twelve weeks and then they were randomized. It’s not just about physical symptom management.

Patient-Centered 119

Patient-Centered IT Patients Hospital 119

GeriPal

JUNE 26, 2025

Wait, so one key message is that social health is linked to physical and cognitive health?!? 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.

Illness 93

Illness Hospital IT Patient-Centered 93

GeriPal

JULY 25, 2024

So how physically active the patient is, how much time they spend awake, how much they’re eating, how much care they need, that type of thing. And just like cultural background, there are some individuals and families that would really never have their loved one enter a nursing home, choosing instead to take care of them.

Family 106

Family Families Patient-Centered IT 106

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

JUNE 6, 2024

And so clearly it matters how you bring up the topic, who brings up the topic, and probably the timing when this comes up for patients and families, just like we think about conversations about illness and prognostic understanding, I wish there was a good prevalent state data on how big this is of a problem in serious illness at large.

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

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

Eric Widera reminds us of the history of the Goldwater Act created by the American Psychological Association in the 1960s which states that psychiatrists should refrain from diagnosing public figures, and the American Medical Association code of ethics which likewise discourages armchair diagnosis (rule established in 2017).

Diagnosis 141

Diagnosis Diagnose IT Physicals 141