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Living with and studying serious illness: Podcast with Randy Curtis

  Randy Curtis, a paragon of palliative care research, was diagnosed with ALS in March.  Randy is in a unique position as someone who studies and cares for people living with serious illness, who now shares his reflections on being on the other side, to reflect on the process of living with serious illness.  His reflections are illuminating and inspiring. We talk with Randy about his experience being in the patient role, rather than the physician or researcher role.  We ask if knowing the prognosis for his subtype of ALS is helpful to him, and if he’s seeing a palliative care clinician.  We talk with Randy about his legacy, principally his focus on mentoring.  We talk about how his approach to his life, his clinical work, and research has shifted in the face of living with serious illness.  We end by talking about our favorite “Randy Curtis” studies. Thank you Randy for modeling vulnerability and willingness to talk about ALS. Thank you for your mentoring which has nurtured a veritable
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Palliative Care's Diversity Problem: A Podcast with Lindsay Bell, Tessie October, and Riba Kelsey

  Palliative care has a diversity problem.  The workforce of palliative care looks nothing like the patient population that we care for in the hospital and in our clinics.   For example, in 2019-2020 academic year only 4% of Hospice and Palliative Care fellows identified as black, compared to 12% of the overall US population using the most recent census information.   These issues are similar for hospice and geriatrics. On today’s podcast we talk about this diversity problem with Lindsay Bell, Tessie October, and Riba Kelsey. Lindsay, Riba, and Tessie recently published an article in JPSM that found that trainees at historically black colleges and universities and residents at institutions with the highest percentage of black medical students lack access to palliative care training.  Riba Kelsey is the Family Medicine residency director at Morehouse School of Medicine, and we talk with her about the implications of these findings at historically black colleges and universities (HBCUs

Grief and Academia: Podcast with Krista Harrison

  Much has been written in geriatrics and palliative care about anticipatory grief, about the grief of caregivers, and even the grief clinicians experience following the deaths of their patients.  Krista Harrison, in a Piece of My Mind essay in JAMA , writes about something different.  She writes about coping, as an academic hospice and palliative care researcher, with personal grief from the deaths of her dad and step-dad within 5 months of each other. There are many reasons this essay likely touched so many people (it seemed to be all over Twitter).  One is that there’s a silence around this experience of death.  Krista’s essay opens up a space to talk about it.  Another is that the experience of grief is in fact universal, whether it’s the loss of a loved one, the loss of a colleague or mentor to illness or a move, the loss of “a return to normal” following COVID. Krista wanted to add a couple of things not mentioned in the podcast that she found helpful.  First, she treasures video

#AcademicLifeHacks: A Podcast About Tips and Tricks to Thrive in Academic Medicine

  Today’s podcast is on academic life hacks, those tips and tricks we have seen and developed over the years to succeed in academic medicine in fields that are somewhat generalist in nature. While the podcast is meant for fellows and junior faculty, we hope some of it applies to the work that all of our listeners do, even in non-academic settings.  Why are we doing a podcast on #academiclifehacks?   You will notice that at the start of the podcast, we spent a couple minutes to recognize my co-host, Alex Smith, for a particularly important award he received at the 2021 AGS meeting – the  Thomas and Catherine Yoshikawa Award for Outstanding Scientific Achievement in Clinical Investigation.  As part of this award he presented a talk titled "Confessions of an Unfocused Researcher."  We (and when I say we, everyone on this podcast except for Alex who we kept in the dark) thought it would be a good idea both to celebrate Alex’s award and talk about some of the topics he brought up

Loneliness and Social Isolation: Podcast with Carla Perissinotto and Ashwin Kotwal

  “Loneliness is different than isolation and solitude.  Loneliness is a subjective feeling where the connections we need are greater than the connections we have.  In the gap, we experience loneliness.  It’s distinct from the objective state of isolation, which is determined by the number of people around you.” - Vivek Murthy, two time (and current) Surgeon General. We have heard a lot about loneliness and social isolation, particularly during the pandemic with enforced social distancing and near imprisonment of older adults in nursing homes. In this context, we bring in two experts on these topics, Carla Perissinotto and Ashwin Kotwal, to explain: How loneliness and social isolation overlap and are distinct How common these measures of social well being are in geriatrics and palliative care Why we should care as clinicians How we can ask about them How we should respond to care for patients who are lonely or isolated Some key references from among the many we discuss on the podcast:

Aducanumab (Aduhelm) for the Treatment of Alzheimers: A Podcast with Aaron Kesselheim and Jason Karlawish

  On June 7th, 2021 FDA approved the amyloid beta-directed antibody aducanumab (Aduhelm) for the Treatment of Alzheimers.  This approval of aducanumab was not without controversy. Actually, let me restate that.  The approval of aducanumab was a hot mess, inside a dumpster fire, inside a train wreck. After the approval, three members of the FDA advisory panel, which unanimously was not in favor of the approval of aduhelm, quit.  One of them, Aaron Kesselheim (who we have on our podcast today) described it as “the worst drug approval decision in recent U.S. history" in his resignation letter . Then the FDA had to revise the label one month after publishing it because the original didn't even come close to looking like the population in which treatment was initiated in clinical trials.  Then, wait for it, after a firestorm of criticism the FDA’s commissioner had to ask for an independent investigation to look into the interactions between Biogen representatives and FDA members. 

Cannabis in Older Adults: A Podcast with Bree Johnston and Ben Han

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Polypharmacy and Deprescribing Super Special: Podcast with Anna Parks, Matthew Growdon, and Mike Steinman

  In a new study in JAGS , Matthew Growdon found that the average number of medications people with dementia took in the outpatient setting was eight, compared to 3 for people without dementia.   In another study in JAGS , Anna Parks found that among older adults with atrial fibrillation, less than 10% of disability could be explained by stroke over an almost 8 year time period.  She also talked about the need for a new framework for anti-coagulation decisions for patients in the last 6 months of life, based on an article she authored in JAMA Internal Medicine with Ken Covinsky. In today’s podcast we talk with Matthew and Anna, joined by co-author Mike Steinman, to talk about polypharmacy, deprescribing, where we are and what we need to do to stop this freight train of ever more medications for older adults and those living with serious illness. We start by addressing the root cause of the problem.  Clinicians want to “do something” to help their patients.  And one thing we know how t

Program of All-Inclusive Care for the Elderly (PACE): A Podcast with Dan Drake and Jay Luxenberg

  Older adults often turn to institutional settings like nursing homes when they need more help than they can get at home. However, since the 1970s, there has been a program that allows older adults to receive nursing home-level care outside of nursing homes. That model of care is known as the Program of All-inclusive Care for the Elderly, or PACE. On today’s podcast, we discuss PACE with two leaders in the PACE community, Dan Drake and Jay Luxenberg. Dan is the President and CEO of Trinity Health PACE, the second largest provider of PACE in the country, and Jay is the Chief Medical Officer of On Lok, the very first PACE demonstration site in the nation. We talk with Dan and Jay about all things PACE, including: What is PACE and what is included in it that makes it able to care for nursing home level care in peoples homes? How is PACE paid for, what does it need to cover, and who is eligible? How did PACE start and what’s the evidence that it works? What are the challenges to PACE im

Race/ethnic differences in end-of-life care: Podcast with Rashmi Sharma and Zhi Jia

  We have made remarkable progress in reducing the use of feeding tubes for patients with advanced dementia.  This has been due to the leadership of people like Susan Mitchell and Joan Teno, among others.  One might hope that this reduction in use of feeding tubes has been in part due to advance care planning discussions that helped align care and treatment with patients goals.  How then, do we explain the concerning findings in a pair of recent papers demonstrating high rates of mechanical ventilation among patients with dementia?  In today’s podcast, we talk with Rashmi Sharma, who in JAGS found that rates of mechanical ventilation rose from 4% to 12% among whites with advanced dementia and 9% to 22% among blacks between 2001 and 2014.  One in five blacks with advanced dementia admitted from a nursing home received mechanical ventilation.  That’s startling.   And Zhi Jia found in a Medicare sample that Asians were more likely to receive mechanical ventilation than whites, and disp

Neuropalliative Care: A podcast with Benzi Kluger, Edward Richfield, and Christine Ritchie

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