GeriPal

JULY 21, 2022

I’ve worked in hospital settings as an occupational therapist, inpatient rehab and outpatient rehab. Emmy: I was seeing people in the hospital setting, saying they had had a massive brain injury. Emmy: Ended up starting a program, outpatient at our hospital at the time. How did you get interested in this? Alex: Yeah.

IT 102

IT Family Families Diagnosis 102

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 9, 2022

Palliative care, in contrast, saw explosive growth in US hospitals. By diagnosis? They were at the VA, but not so much at our main hub hospital where I trained. I do tend to focus in the hospital setting. That’s just not how the hospital works. By prognosis? Can nudges help? It’s where I practice.

Consulting 99

Consulting Patient-Centered Diagnosis Referral 99

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 the answer is no, that probably was more just about do you need anybody to support you kind of emotionally or during this hospital stay, just give information to.

Families 97

Families Family Patient-Centered IT 97

GeriPal

JULY 28, 2022

Alex: And we are also delighted to welcome Areej El-Jawahri, who is an oncologist at Massachusetts General Hospital as well, who specializes in blood cancers. Jennifer: They have a meaningful impact on what happens to them during the hospitalization and after. They all self-identified as a hospital based practice.

Illness 110

Illness Hospital Patient-Centered Patients 110

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.

ER 52

ER Telehealth Primary Care Doctor Appointment 52

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

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

JANUARY 30, 2025

But in reality, given workforce shortages and just the challenges and the resources necessary to be able to provide early integrated palliative care from the time of diagnosis of advanced cancer, the model simply is not implementable, at least not in our current state with our available infrastructure and resources. Joe 41:30 Yeah.

Telehealth 105

Telehealth Patient-Centered IT Patients 105

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.

Illness 136

Illness Patient-Centered Screening IT 136

BMJ

MAY 10, 2022

Family physicians and family health workers, considered reliable sources of vaccine information, have a unique position where individuals in rural and urban areas can access frequently, uninterruptedly, cheaply, and easily [2]. Two hundred seventy-six of the healthcare professionals were reached (response rate: 85.4%).

Vaccination 40

Vaccination Healthcare Professional Healthcare Primary Care 40

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. Gordon 41:13 The hospital is also on fire. What should I say? So you got to be better than AI. And I want.

IT 132

IT Illness Family Families 132

GeriPal

OCTOBER 19, 2023

Certainly SOME of those avoided hospitalizations, CPR, and ICU stays were due to documentation of those orders in the POLST. Additional links mentioned in the podcast: Recent JGIM article on POLST in California nursing homes, hospitalization, and nursing home care Karl’s GeriPal post on appropriate use of POLST Enjoy!

Patient-Centered 126

Patient-Centered IT Patients Illness 126

GeriPal

JULY 11, 2024

So if one of my patients gets admitted, I also see them on the inpatient side of our hospital. Like, with a cancer diagnosis, there’s relatively a smooth, smooth prognosis. Is that, and we try to use, often use the term prognostic humility, that unlike more than any other diagnosis, really, we truly need to be humble, right.

Patient-Centered 109

Patient-Centered IT Patients Clinic 109

GeriPal

APRIL 14, 2022

Zachary: So seeing a non-onc population at the VA and out-patient at Dana-Farber, and that when someone comes to me with a diagnosis of opioid use disorder, it is much easier you kind of have an idea of where you’re going to start. They have poor pain, they have poor function, but you also can’t clearly make a diagnosis.

Illness 102

Illness Patient-Centered IT Patients 102

GeriPal

AUGUST 31, 2023

Alex: She’s also associate professor at Massachusetts General Hospital in Harvard Medical School. So she had them early in diagnosis and then a little bit later. Alex: She is working in Sweden and researching in Sweden, in Lund. Did I say it right, Lund? Juliet: Lund, yeah. Alex: Lund. Juliet: You got it right. Brad: Yeah.

Illness 128

Illness IT Diagnose Medical 128

GeriPal

JANUARY 11, 2024

Alex: Self-administer and psychiatric illness is not considered a qualifying diagnosis. So I didn’t mention this at the beginning, but after my time as President of Canadian Psychiatric Association, I actually also went on to be the physician chair of my former hospital’s MAID team. So they have to self-administer.

Illness 144

Illness IT Medical Provider 144

GeriPal

FEBRUARY 17, 2022

When we have a medication with up front harms and downstream benefits, it’s critical that we consider the time to benefit, or how long it will take an individual to benefit from a test or treatment. For individuals with a life expectancy less than the time to benefit, the up front harms outweigh the downstream benefits. .

Clinic 67

Clinic IT Patients Medical 67

GeriPal

MAY 9, 2024

And then for Hsien and for Sammy, this is a real social movement that you’re trying to… The movement upstream, getting people to consider what are the serious issues at the time of diagnosis with serious illness. Alex: Generally in the hospital-based hospice. Matt: I’m more of a hospital guy. Sammy: Oh, okay.

Education 127

Education IT Illness Healthcare 127

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.

IT 83

IT Family Families Illness 83

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? It also feels like, I also grew up in med school in a three hospital system. There’s that recognition piece. Eric: Yeah.

Patient-Centered 111

Patient-Centered Patients IT Healthcare 111

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? I think it is just about any clinician.

Patients 72

Patients Clinic Patient-Centered Illness 72

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. It’s easier to concentrate on cure, diagnosis, cure. People who are suffering are not very visible. They shared their experiences.

Community 115

Community IT Relationship Healthcare 115

GeriPal

AUGUST 25, 2022

Second, Hospice was originally designed for patients with advanced cancer, but the fastest growing admitting diagnosis is dementia. For-profit hospices having much higher rates of their patients visiting the emergency department and being hospitalized, in addition to disenrollment. There’s a cost avoidance aspect to it, too.

Family 106

Family Families IT Patients 106

GeriPal

JUNE 22, 2023

When they built a new prison hospital in Stockton, the dialysis went there. Eric: So in some ways, this is kind of like the VA, where you don’t have to follow Medicare guidelines, but you can actually actively do concurrent care for these individuals. These older patients are costing a ton in healthcare costs.

Family 132

Family Families IT Community 132

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. What does this diagnosis mean to you? You begin with psychosocial assessment and care.

IT 102

IT Family Families Clinic 102

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. For more details, please click here. (AP

Illness 101

Illness Mental Health IT Patient-Centered 101

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

GeriPal

JUNE 26, 2025

But from our clinical work, many of us are familiar with people with dementia who experience sudden shocks to their health, think hip fracture, think hospitalization for pneumonia. And then when you see clinically patients coming into hospital, they’ll have, you know, they’ll be admitted for aspiration pneumonia.

Illness 93

Illness Hospital IT Patient-Centered 93

GeriPal

SEPTEMBER 19, 2024

Alex 00:34 We are delighted to welcome back Jennifer Tem e l, who is a thoracic oncologist at Massachusetts General Hospital in Boston. Within eight weeks of diagnosis of advanced disease. Eric 26:47 How soon after from a hospitalization, all. They’ve been in the hospital twice in the last six weeks.

Patient-Centered 119

Patient-Centered IT Patients Hospital 119

GeriPal

JULY 6, 2023

The idea was to create a robust community-based infrastructure that could help older adults succeed in their homes and communities, whether they were healthy, how to keep them healthy or they were at imminent risk of emergency room visits, hospitalizations, or nursing home placements. To Susan’s point. They touch every single system.

Community 89

Community Nurse Practitioner Provider IT 89

GeriPal

APRIL 20, 2023

Today we talk with Margot Kushel about how we got here, including: That sense of powerlessness as a clinician when you “fix up” a patient in the hospital, only to discharge them to the street knowing things will fall apart. What are the structural factors and individual factors that contribute to homelessness? What was I doing?

Mental Health 123

Mental Health IT Community Individual 123

GeriPal

JULY 25, 2024

First time on the GeriPal podcast, Liz Lilley, who’s a surgeon and faculty in surgery at the Brigham Women’s Hospital and Harvard Medical School. Eric 07:03 And those classic studies, were those done in the hospital and PALP care units and clinic? Alex 00:18 Prognosis, super special today. And we have some great guests.

Family 106

Family Families Patient-Centered IT 106

GeriPal

MAY 1, 2025

And when she was here, she co founded the Golden Compass Clinic at San Francisco General Hospital for older adults living with HIV. Alex 16:55 My guess is probably not something that most geriatricians or internists or family medicine docs caring for older people have on their differential diagnosis. Is a new diagnosis of HIV.

Primary Care 94

Primary Care IT Provider Clinic 94

GeriPal

MARCH 27, 2025

And is it at all individualized to the patient? Danny 12:07 I don’t know how individualized it is. You didn’t ask about it, but for us, it was very important to examine differences for older adults with a diagnosis of dementia. It’s a lot. Eric 12:01 Does it talk about like outcomes, like the outcomes of cpr?

Primary Care 79

Primary Care IT Clinic Illness 79

GeriPal

DECEMBER 21, 2023

The way we were treating him with dementia in the hospital, the way we talked about him, that he’s not there. But what happened when we finally… When he did get the diagnosis, it all fell into place. Malaz: … to restrain them in the hospital. And I was terrified. I didn’t know how to manage it.

Patient-Centered 125

Patient-Centered IT Family Families 125

GeriPal

SEPTEMBER 14, 2023

Summary Transcript Summary Hospitals are hazardous places for older adults. These hazards include delirium, malnutrition, falls, infections, and hospital associated disability (which about ⅓ of older adults get during a hospital stay). 2020 Hospital at Home-Plus: A Platform of Facility-Based Care. Annals of Int Med.

Hospital 115

Hospital Patient-Centered Supply Chain IT 115