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So you want to be a hospice medical director? Podcast with Tommie Farrell and Kai Romero

So what exactly does a hospice medical director do?  Why do some choose to become hospice physicians?  What additional training is needed, if any, beyond Hospice and Palliative Medicine fellowship and boards?  Who should take the new Hospice Medical Director Certification Board Examination ?  A recent study in JAGS found high rates of hospice disenrollment (“live discharge”) for people with dementia - is that a good thing or a bad thing?  Hmmm… We address these and other questions in this week’s podcast with Tommie Farrell, hospice physician in West Texas and Chair of the Hospice Medical Director Certification Board, and Kai Romero, Chief Medical Officer for Hospice By the Bay (that’s San Francisco Bay). And I get a re-do attempt at REM’s “Everybody Hurts!”   Apologies for the first attempt!   -@AlexSmithMD
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It's Time We Started Talking Openly About Near-Death Experiences and After Death Communication

  by Scott Janssen "For months as I visited Joe as his hospice social worker, he had remained silent about World War II. Now he was bedbound and dependent on others for help with personal care. The hardest part though was “being stuck in bed with too much time to think.” When I asked what he thought about he started talking about friends killed during the war. These memories, it turned out, had recently begun intruding into his mind and stirring intense feelings of grief and guilt. Talking about combat or other psychologically traumatic events can overwhelm patients, potentially triggering defensive behaviors, intense physiological sensations, or distressing emotions. I was careful not to push too hard, letting Joe decide how much he wanted to unpack. At one point I asked if he had ever thought he was going to die amidst the war’s cataclysmic violence. “All the time,” he said. “Did you ever experience anything unusual? Anything you couldn’t explain?” He asked what I meant. I told

The Problem of Alzheimer's: A Podcast with Jason Karlawish

  Where are we with Alzheimers?  Are we about to see a revolution in how we diagnose and treat it with Amyloid PET scans and the amyloid antibody aducanumab (which is currently on FDA’s desk for approval)?  Or are we still in the same place where there is no meaningfully effective treatment?  Or is it somewhere in between, given the data that we have on comprehensive dementia care? We talk today with Jason Karlawish, a professor of medicine, medical ethics and health policy, and neurology at the University of Pennsylvania Perelman School of Medicine. In addition to being a geriatrician extraordinaire, he is the author of the new book “The Problem of Alzheimer’s: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It.” In addition to talking about PET scans and new drugs like aducanumab, we discuss with Jason about the history of Alzheimers, the history of how we care for and fund caregivers, and where we go from here. So take a listen and che

Pallimed GeriPal virtual party Wed 2/17 6pm PST/9pm EST - RSVP for invite

Short notice, but yes, there will be a Pallimed/GeriPal virtual party this year. Have we planned a lot around this? No. Do we want to see friends and colleagues and meet new people? Yes. Can we do it with minimal expectations? We hope so! We are not sure what to expect, but when we did this in person there was never that much of a plan anyway, except where to go next, and even that was up for improvisation. So what might we do. Probably hang out in different Zoom rooms talking about different subjects, playing games, talking about palliative care things, or maybe not palliative care things. When : Wednesday, Feb 17, 2012 6-8pm PST/9-11pm EST Where : Zoom invite via email sent by email at 5p CT RSVP here so we know how many to expect.   Reserve time on your calendar now! Share this with your friends. Get them registered too.  Keep an eye out on the Twitter accounts of Pallimed and GeriPal just in case this thing goes big and we need to make alternative plans. -Alex, Eric, and friends at

Importance of Function in COVID Prognosis: Podcast with Orestis Panagiotou, Elizabeth White, and Marlon Aliberti

  Nursing home residents have been devastated by COVID.  Somewhere around 40% of deaths from COVID have been among nursing home residents, though they make up just a sliver of the US population. Prognostication among nursing home residents who have COVID is important for a host of reasons - for counseling patients and families about what to expect, for making clinical decisions, and potentially for allocation of scarce resources such as treatments. In today’s podcast, we talk with Orestis Panagiotou and Elizabeth White, the authors of a JAMA IM study that finds that physical and cognitive function are key predictors of mortality prediction for nursing home residents with COVID.  We also talk with Marlon Aliberti, who authored a commentary .   Physical and cognitive function are easy to assess measures that should be routinely captured for older adults, in nursing homes and elsewhere.  Study after study document the importance of function to risk prediction. We also have a brief debate

LGBT Care for Older Adults and Serious Illness: Podcast with Carey Candrian & Angela Primbas

Lesbian, gay, bisexual and transgender (LGBT) older adults have lived through a lifetime of discrimination, social stigma, prejudice, and marginalization. Is the care that we are giving them in later life changing any of that or are we pushing them back into the closet? This is what we talk about in this week's podcast with Carey Candrian from the University of Colorado School of Medicine, and Angela Primbas from Stanford University (and future geriatrics fellow at UCSF!).   Carey has published a wonderful article in the Gerontologist titled “She’s Dying and I Can’t Say We’re Married?”: End-of-Life Care for LGBT Older Adults , in which she describes how older LGBT adults may be at higher risk for having their health care wishes ignored or disregarded, their families of choice are less likely to be included in their decision making, and they may experience increased isolation, bullying, mistreatment, or abuse, which ultimately contribute to receipt of poor-quality health care.  We t

Let It Break

by: Abigail Nathanson, Bridget Sumser, Shirley Otis-Green, and BJ Miller These are survival times. The pandemic, the drawn-out election, the climate crisis, the parading of white supremacy - the last year has changed how many of us see ourselves, care for ourselves, and engage in the world. Our sense of impact and control are ever changing, rapidly redefined by external forces and perhaps some internal ones too. Without our familiar sense of control, death feels more salient, more real, and not as far away as we are used to. Our ICU’s are full. We have countless videos of Black people being killed by police with little to no accountability. The Capital stormed. Wildfires, hurricanes, earthquakes. We refresh our news feeds hoping for a different story; we don’t get it. Our usual ways of coping aren’t cutting it - many of us feel unsure how to forge a meaningful path forward. From this uncertainty comes the invitation to explore a new path, one that involves a more personal r

Medications Safety/Quality Update: Podcast with Nagham Ailabouni

On the one hand, every year we are fortunate to have new medications that help older adults and people living with serious illness.  New treatments for lung cancer with remarkable survival outcomes come to mind, for example.   On the other hand, the tremendous growth in medications has led to an explosion of prescribing, polypharmacy, with attendant side effects and harms.   In this week's podcast, we talk with Nagham Ailabouni, a pharmacist and researcher joining us from Australia (song choice: Down Under!) about her review of major articles on medication safety and quality for older adults.  Dr. Ailabouni summarized the top four hardest hitting in a recent publication in the Journal of the American Geriatrics Society, or JAGS.  The four articles are: Older Medicare Beneficiaries Frequently Continue Medications with Limited Benefit Following Hospice Admission Prescribing of oral anticoagulants in the emergency department and subsequent long-term use by older adults with atrial f

Living with Death: A Podcast with BJ Miller

Most of us know we are going to die.  How often though do we actually let ourselves really internalize that understanding?   To imagine it?  To feel it?  To try to accept it? On today’s podcast we invited BJ Miller back on our podcast to talk about death using as our guide his recent NY Times editorial What Is Death?  How the pandemic is changing our understanding of mortality . In addition to being the author of this NY Times article, BJ is a Hospice and Palliative Care doc, and the founder of Mettle Health which aims to provide personalized, holistic consultations for any patient, caregiver or clinician who need help navigating the practical, emotional and existential issues that come with serious illness and disability. We start off with BJ appropriately picking the song "Ebony Eyes" as our intro song, which is a good analogy to talking about death, as it was initially banned by the BBC from airplay as its lyrics were considered too upsetting to play on the radio.  We t

Caregivers: Podcast with Jessica Zitter

  “In the beginner's mind there are many possibilities, but in the expert's there are few” - Zen Master Shunryu Suzuki Many of us in geriatrics and palliative care assume that we are the experts in health care when it comes to understanding the caregiver experience.  Every once in a while, we are humbled and reminded of what we don’t know. Jessica Zitter had such an experience.  Jessica, as many of you know, is an award winning author (link to our podcast about her book Extreme Measures) and was featured in an Academy Award winning film titled Extremis.  She sought out to make another movie about the story of one of her patients who enrolled in hospice. The idea was it would be a film about all of the support that hospice provides and how it’s a transformative experience.  What she realized, however, is that the real story in this film is about the caregiver in the film, who is overworked, overburdened, and has few options for supportive to care for his wife’s daily needs.   Th

Guardianship and End-of-Life Decision Making: A Podcast with Andy Cohen and Liz Dzeng

  Surrogate decision‐making around life-sustaining treatments in the hospital even in the best of circumstances is hard. It’s maybe even harder when caring for those who are conserved or have a professional guardian. The conservator may not have known the patient prior to them losing capacity, they may not know their values or goals that can help guide decisions, and they may be restricted by state statutes on what decisions they can make without getting a judge's approval. The prevailing wisdom is all of the barriers to decision making while under guardianship likely leads to delays in decision making or one that errs on choosing high‐intensity treatment even if it is unlikely to benefit the patient. But is that really the case?    On today's podcast, we talk with Andy Cohn, lead author of a recent Journal of the American Geriatrics Society (JAGS) paper titled “ Guardianship and End‐of‐Life Care for Veterans with Dementia in Nursing Homes ” and Liz Dzeng, the lead author of t

Caregiving Boot Camp: Podcast with Zaldy Tan

  “Diagnose and adios.” That’s the sad phrase that I’ve heard quoted more than once, representing caregivers' sentiment of what it’s like to be told by a clinician that your loved one has dementia. This week we talked with Zaldy Tan, Geriatrician and Director of the Memory and Aging program at Cedars Sinai in Los Angeles.  With David Reuben at UCLA and others working LA realized that current caregiver training programs were lacking.  Caregivers for people with dementia are stressed, short on time, and thirsty for high impact information and skills training that can be delivered efficiently.  To meet this need they launched a new caregiver “bootcamp” 1-day training (with the help of Archstone Foundation which also funds GeriPal).  We cover many topics, including dissemination of the bootcamp to Spanish-speaking caregivers, converting to video boot camp during COVID, and ways you can partner with them to create your own boot camp. Listen to the podcast to learn more!   (And “Remembe