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Hiding Behind High Value Care: A Podcast with Vinny Arora and Chris Moriates

You're the attending physician on a teaching service.  Your resident says we shouldn't order a CT because CT's are over-used for this condition, and represent overuse, waste, and low-value care.  In this case, however, you suspect that's not the resident's real reason.  The real reason behind the resident's decision is that they are serial minimizers - residents who make little of potentially important findings.  You feel they might be hiding their minimizing behind the sexy, trendy notion of providing "high value care."

Does this sound familiar to you?  It did to me.  I've been in the awkward situation of being the consulting palliative care physician saying to the primary team, I know they have cancer and that's the most likely explanation for this abdominal pain.  I also worry that this pain is out of proportion and different from other pain I've seen, and I think it should be evaluated with further testing.  Kind of strange to say tha…
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The Life of Individuals with Moderate Dementia: A Podcast with Krista Harrison

On this weeks podcast, we talk with Krista Harrison about the life of individuals living with moderate dementia, as well as what we know about their caregivers.  Krista is is an Assistant Professor in the Division of Geriatrics at UCSF, a social scientist, and something that we learned in this podcast, someone who knows a thing or two about singing opera.

Krista recently published a JAGS paper titled "Care Settings and Clinical Characteristics of Older Adults with Moderately Severe Dementia."   In this paper, which we discuss in the podcast, she gives us a snapshot of older adults in the United States who have experienced the onset of moderately severe dementia within the past year.  We learn that 2/3'rds of these individuals are living in the community.  Interestingly, older adults living at home were 2 to 5 times more likely to be members of disadvantaged populations and had more medical needs.  In the podcast we discuss some potential reasons why this may be the cas…

Aid in Dying: A Podcast with Lewis Cohen

In this week's podcast we talk with Lew Cohen, MD, about his new book "A Dignified Ending: Taking Control Over How We Die."

Eric and I approached reading this book with trepidation.  We feared it would be a polemic defending physician aid in dying.  It is not.  Dr. Cohen does not hide his beliefs and opinions.  He also does not shy away from the complexity of the issue - he interviews leading disability rights activists and challenges leaders of the aid in dying movement.  His book is filled with stories of the people and family, doctors and activist who have defined this movement.

As Eric says, he takes the controversy meter up to 11 with notions of approving aid in dying and euthanasia for progressive neurological conditions such as dementia (with thoughtful safeguards).

We challenge Lew, somewhat forcefully at times.  Personally, I disagree with many of his stances (as you will hear/read), but I can respect how thoughtfully he's gone about putting together his st…