GeriPal

DECEMBER 2, 2022

So on today’s podcast we invite four brilliant individuals to talk about their perspective on how to change how we as a society and health care system partner with individuals with dementia. She directs UCSF MERI’s patient, family, and clinician support with classes and consultation on resiliency, well-being, and grief.

Community 101

Community IT Individual Patient-Centered 101

GeriPal

JUNE 8, 2023

So my background clinically is working with cancer patients and families and those who underwent bone marrow transplant, and a lot of times for their treatment regimen, it includes steroids. What is the role of the family caregiver system, how they play a role? Tamryn: Yes, 100%.

Diabetes 73

Diabetes Management Patient-Centered Family 73

GeriPal

MAY 11, 2023

I just thought there was so much we could learn and offer from every sense, from the clinical point of view, from the family point of view, from prevention, from treatment, epidemiology, et cetera. Physical activity is a big one. One might argue they still are. So, that’s how I ended up there. That’s really falling apart.

Physicals 85

Physicals IT Hypertension Education 85

GeriPal

FEBRUARY 6, 2025

Eric 00:27 So we’re going to be talking about making the diagnosis of Alzheimer’s disease in a primary care setting, not specialty care, but maybe we could talk a little bit about that. How much should it change how we think about making a diagnosis of Alzheimer’s disease in primary care? Great to be back. Absolutely.

Primary Care 95

Primary Care Diagnosis Screening IT 95

GeriPal

JUNE 19, 2025

Noelle Marie 01:24 I think it really speaks a lot to my own personal journey and I’m pretty sure a lot of trans and gender diverse individuals also resonate with and it really speaks about our transition, celebrating our authentic selves, how society views us and how we view ourselves when we stand in front of a mirror.

Individual 85

Individual Community IT Chronic Condition 85

GeriPal

JULY 21, 2022

Often the work of the certified driving rehab specialist is to assess the older drivers goals, assess prognosis for driving, and help the family navigate discussions around driving cessation (hmmm…sounds like an approach to family meetings). Were those people self referring, or family members calling you asking? Alex: Yeah.

IT 102

IT Family Families Diagnosis 102

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. So the first thing, explain the diagnosis. And you’re in the ICU family meeting, and it gets heated. So it’s a lot, but it’s good.

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. 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

PEMBlog

MARCH 27, 2024

Consider it a supplement to what you remember from Biochemistry and the instructions on the family’s laminated care plan sheet. Inborn errors of metabolism in infancy: a guide to diagnosis. Meaning that an individual must inherit two copies of the mutation, so one from each of his or her parents, to be affected.

Consulting 59

Consulting Individual Family Families 59

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. You’re recognizing that, wow, this could happen to me, and I wonder sometimes about the challenges.

IT 83

IT Family Families Illness 83

GeriPal

JUNE 9, 2022

By diagnosis? 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. Eric: Our outpatient service does have guides around diagnosis and prognosis.

Consulting 99

Consulting Patient-Centered Diagnosis Referral 99

GeriPal

JULY 11, 2024

Like, with a cancer diagnosis, there’s relatively a smooth, smooth prognosis. I think for families and for other providers who are not trained in that, it’s very hard to predict. And you’re working with a patient that almost is like a dementia patient, depending on how much lactulose they’ve been taking.

Patient-Centered 109

Patient-Centered IT Patients Clinic 109

GeriPal

OCTOBER 17, 2024

We talk about what is heart failure, particularly HFpEF, how we treat it (including the use of sodium–glucose cotransporter-2 inhibitors (SGLT2’s), and how we should apply guidelines to individual patients, especially those with multimorbidity who are taking a lot of other medications. Eric 12:05 Any pearls on the diagnosis of HFpEF.

Primary Care 113

Primary Care Patient-Centered IT Patients 113

GeriPal

JUNE 22, 2023

We really like the community doctors to know, so those of you listening, that our patients, they’ve lost their physical freedom, but they have autonomy in terms of their medical decision-making just like anybody else. In many cases, the families were the victims of the crime. Michele: Yeah. We have that. Alex: Mm-hmm.

Family 132

Family Families IT Community 132

PEMBlog

DECEMBER 14, 2023

Early diagnosis is crucial as it can impact a child’s growth and development. Learn all about diagnosis and management of this common problem in this brief podcast episode. Expiratory airway sounds are commonly heard in addition to the stridor, and diagnosis needs scope. We’ll talk more about those in a moment.

Diagnosis 52

Diagnosis IT Diagnose Patients 52

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

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

FEBRUARY 29, 2024

Eric: I do not want my family to listen to my podcasts. So, I generally don’t listen to the podcast afterwards, nor force them on my family. We’re willing to spend $50,000 a year for individuals for their expensive pharmacy medication. Alex: We are only on the fourth of 10. They ordered mild to hot.

IT 126

IT Patient-Centered Illness Education 126

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

MAY 12, 2022

It’s easier to concentrate on cure, diagnosis, cure. What she called total pain, physical, psychosocial, and spiritual, and she started addressing it. We know that this is necessary in theory, we know that health is not only absence of disease, but physical, social, and mental wellbeing. Healthcare industry cannot do it.

Community 115

Community IT Relationship Healthcare 115

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? They look at the signs and symptoms, they do a physical exam, maybe some lab tests or some imaging. And so have some of my mentees.

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. Alex: Self-administer and psychiatric illness is not considered a qualifying diagnosis. Eric: Yeah. Eric: Yeah.

Illness 144

Illness IT Medical Provider 144

GeriPal

DECEMBER 19, 2024

So we’re going to be talking about palliative care for individuals with mental illness. It’s one of the core things that we think about palliative care is you got the physical, psychological, social and spiritual symptoms. Like 80 to 90% of patients we see have a psychiatric diagnosis. Eric 05:46 So I got a question.

Illness 101

Illness Mental Health IT Patient-Centered 101

GeriPal

SEPTEMBER 8, 2022

Holly has accumulated mountains of evidence for the diagnosis of prolonged grief disorder as a specific condition primarily notable for a yearning over a year after the death. And what we mean is like they’re physical numbness or they trip over that particular symptom, but it’s that sense of detachment from living people.

IT 100

IT Relationship Complication Specialization 100

GeriPal

OCTOBER 27, 2022

James: Yeah, so I guess just to start… I mean, prognosis in general is kind of a term for predicted course of disease, and I think people commonly use it to refer to an individual’s life expectancy or how long the person has to live. I think this is a really difficult topic to talk about with patients.

IT 95

IT Clinic Screening Patients 95

Vida Family Medicine

MARCH 1, 2023

Factors such as a history of trauma (abuse, neglect, sexual assault, attachment trauma, etc), life stressors including serious physical or mental illness, and social influences that portray thinness as an ideal and promote dieting combine with an underlying genetic predisposition to contribute to development of an eating disorder.

Mental Health 52

Mental Health Physicals Family Medicine DO 52

GeriPal

SEPTEMBER 19, 2024

Within eight weeks of diagnosis of advanced disease. We did not just rely on a physical symptom measure, which many of our colleagues are doing. It’s not just about physical symptom management. So I think that was one of the key eligibility criteria. English or spanish speakers. And they had to be within.

Patient-Centered 119

Patient-Centered IT Patients Hospital 119

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. This is a particularly interesting topic because we know that individuals with dementia have a high rate of entering nursing home. Eric 05:50 Yeah. What’s in it again?

Family 106

Family Families Patient-Centered Patients 106

GeriPal

JUNE 26, 2025

Wait, so one key message is that social health is linked to physical and cognitive health?!? Those are all things that could dramatically be a major health shock for an individual. We focus on function and mortality because these are outcomes that really are important to patients and families. Alex 14:28 Yeah, yeah.

Illness 93

Illness Hospital IT Patient-Centered 93

GeriPal

APRIL 20, 2023

What are the structural factors and individual factors that contribute to homelessness? We would drill down on the tenth differential diagnosis of medium vessel vasculitis, and then we would discharge them back out to the streets. The worse the structural factors are, the fewer individual factors you need to become homeless.

Mental Health 123

Mental Health IT Community Individual 123

GeriPal

MARCH 27, 2025

And so this is our way of supporting non English speaking families in advanced care planning. And I have a long interest in identifying family caregivers and supporting them in care delivery. And so this was really, in my view, a perfect window for reinforcing the role of family in primary care. Eric 02:32 Great, Alex.

Primary Care 79

Primary Care IT Clinic Illness 79

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. Bruce: This is, Ghostbusters, basically, a ham radio. Eric: Yeah.

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. Of note, we talk about candidates from all parties today. Eric 04:17 How do you think about that?

Diagnosis 141

Diagnosis Diagnose IT Physicals 141