My Green Doctor

JULY 2, 2025

in the need for healthcare—translating into over 500 million extra days of inpatient hospital care and more than 100 million emergency department visits across Europe by 2050. In the United States, extreme weather events and air pollution are already costing the healthcare system over $820 billion annually.

Healthcare 52

Healthcare Healthcare Professional Management Community 52

GeriPal

FEBRUARY 15, 2024

The insight started when Carmen, an orthopedic surgeon-researcher, and Katie, a physical therapist- researcher participated in ride-alongs with EMS providers to patient’s homes. Going into patient’s homes was eye opening. It was eyeopening to see patients in their own home. And so that really triggered my interest.

Community 114

Community Transportation IT PCP 114

GeriPal

MAY 22, 2025

Jenny Chen is a palliative care fellow at Yale who regularly sings for her seriously ill patients. Jenny reached out to us because she plays music regularly for her patients, and she said, you should do a podcast about music. And I performed for many palliative patients, and that’s when I started to understand.

IT 96

IT Patient-Centered Patients Board-Certified 96

GeriPal

OCTOBER 26, 2023

Within hours of recording this podcast, I joined a family meeting of an older patient who had multiple medical problems including cancer, and a slow but inexorable decline in function, weight, and cognition. The patient’s capacity to make decisions was marginal, and his sons were shouldering much of the responsibility.

Patient-Centered 132

Patient-Centered Hospital Patients IT 132

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. When I see a patient? Matthew, I get the lyrics.

Primary Care 113

Primary Care Patient-Centered IT Patients 113

GeriPal

NOVEMBER 7, 2024

If the purpose of initiating dialysis is improving function – our complex, frail, older patients are likely to be disappointed. Are we seeing people like more older adults, more nursing home patients starting dialysis, and even at a higher gfr? Let it be (hint hint). So I wonder if I could turn to either of our nephrologists.

Management 116

Management Patient-Centered Patients IT 116

GeriPal

JULY 11, 2024

It’s a jampacked 50 minutes, filled with pearls on taking care of patients with liver disease. Kirsten 04:16 So, in emergency medicine, obviously, we are interacting and caring for these both exciting and interesting, but also very complex and humbling patients to care for in the ED setting. What’s the connection and why?

Patient-Centered 109

Patient-Centered IT Patients Clinic 109

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. 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.

Illness 110

Illness Hospital Patient-Centered Patients 110

GeriPal

FEBRUARY 20, 2025

If you want a deeper dive, check out the following resources: Our Nature of Suffering podcast with BJ Miller and Naomi Saks Dani Chammas Annals paper on countertransference and why we shouldnt say that the patient was difficult rather than that I felt frustrated. So there’s an event or a series of events. Eric 04:19 Yeah.

IT 66

IT Patient-Centered Screening Patients 66

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 116

Patient-Centered Hospital IT Illness 116

GeriPal

FEBRUARY 2, 2024

This week, we talk about the other major palliative care trial of default palliative care consults for hospitalized older adults with COPD, kidney disease, or dementia, published in the same issue of JAMA. And, of course, this is what families of patients undergoing palliative care go through. and consulting for Papa Health.

Consulting 120

Consulting Hospital Patient-Centered IT 120

GeriPal

OCTOBER 20, 2022

And, who within ASPE guides aging policy and connects policy to every day health challenges experienced by patients and clinicians? Alex: And we are delighted to welcome Rasheeda Hall, who is a physician scientist in the division of nephrology at Duke University School of Medicine, and sees patients at the Durham VA.

Complication 52

Complication Patient-Centered IT Patients 52

GeriPal

SEPTEMBER 5, 2024

And Bill Andereck is still haunted by the decision he made to have the police break down the door to rescue his patient who attempted suicide in the 1980s, as detailed in this essay in the Cambridge Quarterly of HealthCare Ethics. The patient case. So while you don’t have to, we’re gonna summarize these articles.

Patients 98

Patients IT Patient-Centered Hospital 98

GeriPal

APRIL 3, 2025

So if you haven’t been to this event, there is a literature review where we. That was actually Ken, you remember that article, Nancy Schoenberg’s article on screening and what to say and what not to say to patients on how to talk. How to talk to patients about screening colonoscopies. Ken 09:56 We did a role play.

IT 64

IT Hospital Screening Patients 64

GeriPal

JUNE 30, 2022

You have a patient with dementia severe enough that she cannot recognize relatives. A huge part of this decision rests on (1) her previously stated wishes, values, and goals (prior to the onset of dementia); and (2) the outcomes of surgery for patients with dementia. Alex: And the Brigham and Women’s Hospital. Transcript.

Patient-Centered 101

Patient-Centered Complication Patients IT 101

GeriPal

MARCH 3, 2022

A little over a decade ago, Ken Covinsky wrote a GeriPal post about a Jack Iwashyna JAMA study finding that older adults who survive sepsis are likely to develop new functional and cognitive deficits after they leave the hospital. GeriPal podcast with Tom Gill on the Precipitating Events Study, distressing symptoms, disability, and hospice.

Patient-Centered 96

Patient-Centered Patients IT Hospital 96

GeriPal

OCTOBER 12, 2023

Summary Transcript Summary For surgeons and patients, deciding if and when to operate can be challenging. Often, the way surgeons communicate about these decisions doesn’t make things any easier for themselves or their patients. We hope you enjoy this episode. I did it before and this guy, he was 85, but he was climbing Mount Everest.”

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IT Family Families Patient-Centered 128

GeriPal

DECEMBER 5, 2024

We talked with Thor Ringler, who helped found the My Life My Story Project at the VA and beyond, and Heather Coats about the evidence base for capturing patient stories. It was like kind of a co op with this common space that different groups could rent for events and meetings and things like that. Ricky 00:38 Great to be back.

IT 107

IT Community Patients Family 107

GeriPal

FEBRUARY 17, 2022

I tell this story because these issues don’t typically register as more than a nuisance for clinicians, who frequently don’t understand why their older patient with osteoporosis is not taking a bisphosphonate. But our patients are walking with their feet, and adherence to bisphosphonates for osteoporosis is poor and decreases with time.

Clinic 67

Clinic IT Patients Medical 67

GeriPal

SEPTEMBER 12, 2024

Eric 04:44 Could just make you a little bit more resilient, you can increase your Rvus so you can see more patients. Naomi 04:59 So we know that we in healthcare, and all of our colleagues are some of the most resilient people that ever existed. If you were just. If you could make it, if we. Eric 05:27 80 2080 20.

IT 110

IT Healthcare Healthcare Professional Patient-Centered 110

GeriPal

MAY 25, 2023

And, you know, I really leaned in from my perspective as a primary care geriatrician to hearing from what my patients and their family caregivers are asking me for and asking me about, and they’re asking me about how they can prepare. Health care system drives where you end up, which hospital, which state you live in.

Community 95

Community IT Patient-Centered Primary Care 95

GeriPal

JUNE 13, 2024

Accreditation In support of improving patient care, UCSF Office of CME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Illness 133

Illness Patient-Centered Patients IT 133

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? In todays podcast we welcome some of the early pioneers in palliative care to talk about the roots of palliative care.

IT 104

IT Patient-Centered Family Families 104

GeriPal

FEBRUARY 8, 2024

Hospital Chaplains, Spirituality, and Pain Management: A Qualitative Study. I think even the word patient, patient, I think, comes from the word suffer, the one who suffers. I’ve had a patient in one room, they have stage four breast cancer. Pain Manag Nurs. 2023 Dec 20:S1524-9042(23)00202-3. doi: 10.1016/j.pmn.2023.11.004.

IT 137

IT Family Families Physicals 137

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. Healthcare staff were afraid of patients with HIV because there wasn’t clarity on how it was transmitted. Welcome to the GeriPal podcast, Michele.

Family 132

Family Families IT Community 132

GeriPal

JANUARY 26, 2023

Ramona: Well, I’ve always been interested in health equity, always been interested in looking at disparities, and the disparities that I have looked at most often have been for patients at the end of their lives. The trainee said to me something like, “But I haven’t seen any geriatric patients yet.” Eric: Yes.

IT 91

IT Patient-Centered Healthcare Patients 91

GeriPal

MAY 29, 2025

Particularly patients, families. I think we have ideas about are these paradoxical events, are they expected? And I think Andrew’s going to have good ideas about, like, why the term paradoxical and are these events paradoxical, truly? People are patients, families are wondering if their loved one is still in there.

Family 93

Family Families IT Patient-Centered 93

GeriPal

OCTOBER 5, 2023

I love this article as it specifically discusses what’s wrong with “ need ” statements and how we can shift our communication and thinking to create space for deliberation about patients’ priorities and the best course of action. Now doctors are unwilling to understand patients’ values and make recommendations, taking the science to it.

Illness 136

Illness IT Patient-Centered Family 136

GeriPal

OCTOBER 27, 2022

As Alex Lee says on our podcast today, all prognostic models will be wrong (in some circumstances and for some patients); our job is to make prognostic models that are clinically useful. I think this is a really difficult topic to talk about with patients. She has a point. Prognosis is inherently uncertain.

IT 95

IT Clinic Screening Patients 95

GeriPal

OCTOBER 3, 2024

Alex 00:08 UCSF’s Division of Palliative Medicine are looking to build on their research and clinical programs and are interviewing candidates for the associate chief of research position and for full time physician faculty to join them in the in-patient and out-patient settings. I wonder why you did that.

IT 122

IT Patient-Centered Patients Relationship 122

GeriPal

MARCH 6, 2025

Michaels Hospital in Toronto, and health justice activist. Michael’s Hospital in the Department of Family and Community Medicine. And this is really traumatic event for his street family and the street community that he knew. You know, we found that 64% of the people we cared for never went to the hospital or ER.

Healthcare 100

Healthcare IT Community Illness 100

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. Those disruptive events or shocks often portend a major decline in function from which people with dementia never fully recover. worsening prognosis.

Illness 93

Illness Hospital IT Patient-Centered 93

GeriPal

SEPTEMBER 19, 2024

Give too much, it may cause harm (even if the higher dose had no significant side effects, it would require patients to take a lot of unnecessary additional pills as well as increase the cost.) So, what is the effective dose of palliative care? Give too little – it may not work. Jennifer, welcome back to the GeriPal podcast.

Patient-Centered 119

Patient-Centered IT Patients Hospital 119

GeriPal

DECEMBER 7, 2023

And so any additional stressor such as heat or an extreme weather event or having to move from your home because of a climate related disaster can really tax an older adult whose window of resilience is more limited. And that’s a good thing to share with an older patient or client that making decisions about your activity.

Healthcare 129

Healthcare IT Education Hospital 129

GeriPal

NOVEMBER 3, 2022

You’d imagine though that our professional expertise and experiences in helping patients and families cope with loss and grief would be helpful in managing our own personal losses. These debriefings create a safe outlet for health care professionals to talk about the feelings resulting from their work. Turns out, it’s maybe not.

Healthcare Professional 102

Healthcare Professional Healthcare IT Relationship 102

GeriPal

JULY 13, 2023

On that podcast he and collaborators tested a combined patient and clinician facing communication priming intervention to promote goals of care conversations. I wonder if we can just start off just going back a little bit because we had Randy on back in 2018 talking about Jumpstart, priming patients to do goals of care conversations.

Patient-Centered 83

Patient-Centered IT Hospital Patients 83

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. And that’s critical. Eric: Yeah.

Community 89

Community Nurse Practitioner Provider IT 89