The Clinical Problem Solvers

AUGUST 25, 2020

Pearls Defining Structural Racism Structural racism is a term that acknowledges that racism is perpetuated beyond individual interactions and interpersonal racism, but is present in the systems and policies that govern our everyday lives. Greenwood, Rachel R. Hardeman, Laura Huang, Aaron Sojourner.

Community 52

Community Patient-Centered Education Relationship 52

GeriPal

OCTOBER 13, 2022

When I’m on service these days there is inevitably a moment when a resident says “Patient so-and-so is on X” – and I have absolutely no idea what X is. 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 97

Complication Patient-Centered IT Patients 97

GeriPal

JULY 19, 2024

What should we use to screen individuals? What hasn’t been shown, Eric, is that if you apply tools like this, clinical outcomes down the road are better for patients. They’re dedicated, committed, they’re there for their patients and they understand it’s really important. Who should get it if anyone?

Screening 119

Screening Primary Care Patient-Centered IT 119

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

MAY 11, 2023

Now, that doesn’t mean it’s a one-to-one, and this is very hard as we see it with our patients who have done all these things. I’m thinking of chronic pain, for example, and individuals with chronic pain often have disturbed sleep or other conditions. AlexSmithMD Transcript Eric: Welcome to the GeriPal Podcast.

Physicals 85

Physicals IT Hypertension Education 85

Rao Doctor

APRIL 3, 2025

Rectal method is more appropriate for infants, children and unconscious or comatose patients who are not able to hold the thermometer in their mouth. The choice of method depends on the patient’s age, condition, and preference, with rectal measurements often being the most precise for infants and young children.

Diagnosis 130

Diagnosis Management Illness Diagnose 130

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

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. What do different patient populations need? But watch out! Alex 01:06 Yeah, go in person.

Telehealth 105

Telehealth Patient-Centered IT Patients 105

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?

Primary Care 113

Primary Care Patient-Centered IT Patients 113

GeriPal

NOVEMBER 14, 2024

Summary Transcript CME Summary Falls are very common among older adults but often go unreported or untreated by healthcare providers. Patients may feel like falls are just part of normal aging. I think both the patients feel that. And if the answer is yes, then the patient’s at risk. I think providers feel that way.

IT 124

IT Screening Patient-Centered Community 124

GeriPal

JANUARY 16, 2025

These individuals may become unrepresented, meaning they lack the capacity to make a specific medical decision, do not have an advance directive for that decision, and do not have a surrogate to help. How should we care for unrepresented individuals in inpatient and outpatient settings? Is the patient in your descriptor?

Patient-Centered 109

Patient-Centered IT Patients Healthcare 109

GeriPal

JULY 21, 2022

Initially, it was just because there weren’t really answers for my patients. That’s where it really gets to this individual risks and balances, individual situation. We’re going to go into how to talk to patients about this, because Emmy, you’ve done some research on it. Alex: Yeah. Absolutely.

IT 102

IT Family Families Diagnosis 102

GeriPal

APRIL 3, 2025

Annie 02:31 So if you go to the A G S meeting every year, you know that this group of three individuals comprises the AGS literature update. But in spite of that, it is a lot of work for three individuals to pull all this together. How to talk to patients about screening colonoscopies. So this is something. We did a role play.

IT 64

IT Hospital Screening Patients 64

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

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. And I think that’s just, like.

IT 110

IT Healthcare Healthcare Professional Patient-Centered 110

GeriPal

DECEMBER 8, 2022

Clinicians “catching” patient life stories. . Our patients aren’t “the 76 year old with heart failure in room 202,” as Heather Coats astutely noted. Many links: VA Presents: My Life, My Story: George: A Voice To Be Heard on Apple Podcasts. Storytelling Helps Hospital Staff Discover The Person Within The Patient.

Patient-Centered 115

Patient-Centered Illness Healthcare IT 115

GeriPal

MAY 8, 2025

Summary Transcript CME Summary Weve covered psychedelics on the podcast beforefirst in 2019 with Ira Byock, where we explored their potential role in medicine , and then again in 2023 with Stacy Fischer, Brian Anderson, and Theora Cimino, focusing on the reasons to approach psychedelic use in patients with caution. Then fast forward a year.

Illness 107

Illness IT Patient-Centered Patients 107

GeriPal

FEBRUARY 23, 2023

Summary Transcript Summary You know when you walk out of a patient’s room and have that sense, “This isn’t going to go well.” The patient is sick and getting sicker, and refuses to let you talk with family or other members of her inner circle. Should you stop at “no?” AlexSmithMD Transcript Eric: Welcome to the GeriPal podcast.

Family 97

Family Families Patient-Centered IT 97

GeriPal

MARCH 28, 2024

Well, as a kick off to this year’s first in-person State of the Science plenary, held in conjunction with the closing Saturday session of the AAHPM/HPNA Annual Assembly, 3 randomized clinical trials were presented. Eric: And who are the patients including in this trial, again? Kate: These are very sick patients. Kate: Thank you.

Consulting 115

Consulting Patient-Centered IT Patients 115

GeriPal

DECEMBER 15, 2022

Along the way we address: Is this degree of slowed cognitive decline meaningful to patients or care partners? Eric: So patient narrative storytelling, independent of what we call it, I’d like to turn to both of you and just how you got interested in this as a subject. She was a heart failure patient.

IT 105

IT Patient-Centered Healthcare Illness 105

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

AUGUST 17, 2023

However, as noted in our editorial published with the donanemab trial , the modest benefits of amyloid antibodies would likely not be questioned by patients, clinicians, or payers if amyloid antibodies were low risk, inexpensive, and simple to administer. I think geriatricians seed to decide whether they want to get on board as individuals.

Patient-Centered 98

Patient-Centered IT Clinic Patients 98

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

OCTOBER 19, 2023

Caveat as well that RCTs should not be placed on pedestal as the only answer- often patients enrolled in RCTs do not represent real world patients – observational studies do. For a trial to have value, it should not exclude patients over age 80, or those with dementia, or patients residing in nursing homes.

Patient-Centered 126

Patient-Centered IT Patients Illness 126

GeriPal

MAY 25, 2023

Summary Transcript Summary Our guests today present an important rejoinder to the argument that we should refocus away from advance care planning (ACP). LJ: And I think that’s one of the reasons that we’ve not done a very good job in research around… Eric: How are patients defining it? Yeah, I agree.

Community 95

Community IT Patient-Centered Primary Care 95

GeriPal

JANUARY 26, 2023

Second, as we discussed in last week’s podcast , older adults, particularly those in nursing homes, were far more likely to die than younger individuals. It’s baked into people’s belief systems, who ultimately make laws and make policies, and it can influence healthcare. I probably should have said GFR. Eric: Yes.

IT 91

IT Patient-Centered Healthcare Patients 91

GeriPal

APRIL 4, 2024

The Cruzan ruling led to a flood of interest in Advance Directives, and eventually to the Patient Self Determination Act, which mandates provision of information about advanced directives to all hospitalized patients. Other states set lower bars, including oral assignment of surrogate decision-makers. What words to use?

Family 112

Family Families Patient-Centered IT 112

GeriPal

APRIL 13, 2023

But, should we as clinicians care about the social lives of our patients? Are there meaningful ways of assessing loneliness and social isolation in clinical settings and connecting patients with interventions? Has kept me interested, the patient experience and the older adults in the community, their experience.

IT 99

IT Community Patient-Centered Medical 99

GeriPal

MARCH 7, 2024

In addition to being a palliative and hospice RN, she is the Executive Director for Goodwin Hospice , a large non-profit hospice that added end-of-life doula care to their services in collaboration with Jane and John’s doula organization, Present for You. It sets space between us and the individuals we’re trying to take care of.

Provider 117

Provider Illness IT Healthcare 117

GeriPal

FEBRUARY 8, 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.

IT 137

IT Families Family Physicals 137

GeriPal

FEBRUARY 9, 2023

For example, we spend the first half talking about a RCT simulation study of clinician verbal and non-verbal communication with a seriously ill patient with cancer. In one room the physician under study interacts with a white patient-actor, and in another room interacts with a Black patient-actor.

Patient-Centered 111

Patient-Centered Patients IT Healthcare 111

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. We’re just like, “Okay, I see this patient has a need. Okay, I see this team member has a need.

IT 102

IT Families Family Clinic 102

GeriPal

FEBRUARY 6, 2025

That screening influences kind of further treatment, actually, probably more importantly, patient outcomes. And when I asked the patient, well, what happened, the test was sprung on them. Well, even for somebody like you, who’s pretty familiar with the instruments, it might cause distress for the patient, maybe their family.

Primary Care 95

Primary Care Diagnosis Screening IT 95

GeriPal

MARCH 13, 2025

Yes, it means to cloak, but theres more Whole-person-care Total pain Healing as a process distinct from the deterioration of the body Sympomatologists The patient and family as the unit of care Our guests referenced many articles on this podcast, linked above and below. We each had an average between 23 and 25 patients each.

IT 104

IT Patient-Centered Families Family 104

GeriPal

SEPTEMBER 21, 2023

I started going to the literature and I noticed that communities of color, those with the Hispanic background, Black individuals were disproportionately impacted by dementia, and I couldn’t believe it. I think, again, it’s the person’s individual, their preference. Alex: Yeah, I like that approach too.

Community 128

Community Family Families IT 128

GeriPal

SEPTEMBER 22, 2022

Have you ever had that moment when talking to a patient, when you realized that the phrase you just uttered, which you’ve uttered a hundred times before, came out rote and scripted? And in response, the family or patient looked at you like you were from another planet? Well, it’s not just being present, though. Eric: Yeah.

Illness 101

Illness IT Patient-Centered Patients 101

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. Some of them are really deeply individual experiences. Kate 07:35 Yeah.

IT 66

IT Patient-Centered Screening Patients 66