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Time to Remove Feeding Tubes from POLST: Podcast with Susan Tolle and Elizabeth Eckstrom

In the 1990s, Susan Tolle helped create the POLST.  Now she and Elizabeth Eckstrom want to change it.  And personally, I think they're right.  Times have changed, and the POLST has gained a clearer purpose, distinct from Advance Directives.  

POLST is for emergency situations.  When does the EMS provider ever say, "Quick!  Get the PEG tube kit!  We need to insert a PEG tube stat."  


Feeding tubes are a decision that can be discussed in advance and a preference recorded in an advance directive.  But it's the odd one out on the POLST form - and more than the CPR preferences and Scope of Care sections, is the outlier.  It's the most "list-based" approach to advance care planning - do you want a feeding tube?  How about dialysis?  An LVAD?  In certain situations, with certain illnesses, these are fine questions to have.  But in general for older adults, they make no sense.  Advance care planning should be directed by goals and values, not lists of int…
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The Future of Palliative Care

by: Olivia Gamboa, MD (@Liv_g_g)

As palliative care providers, we are lucky to be a part of a relatively new and growing field.  This provides us with both an innovative energy and the opportunity to shape what our specialty will look like in the coming years.  Concurrently, medicine as a whole is at the precipice of many sea changes in therapies and care models brought about by improved analytics (most notably artificial intelligence) and novel biotechnology.  The confluence of these technological currents means that new trends in practice are emerging quickly.  These are my thoughts about the possible directions our specialty will take and the opportunities (and challenges) this will present over the next several years.

Disclaimer: I’m just a palliative care fellow who likes to muse about these things.  These predictions do not necessarily reflect the views of my institution and are not projections nor certainties and should not be taken as such.  And remember, as Yogi Berra opine…

The Grey Continuum Between Specialty and Primary Palliative Care Social Work: A Podcast with Bridget Sumser

On this week's podcast we have Bridget Sumser, a clinical palliative care social worker, board member for the Advanced Palliative Hospice Social Worker certification exam, and now co-author of a new book "Palliative Care: A Guide for Health Social Workers". 

We go over a host of subjects with Bridget about the space between primary and specialty social work when caring for seriously ill patients and families.  Her new book, organized by the domains of the National Consensus Project Guidelines for Quality Palliative Care, is aimed toward all social workers who care for seriously ill adults.  We also talk about the role of social workers who practice within palliative care teams and the new Advanced Practice Palliative and Hospice Social Work Certification Exam.

I'll leave you off with a quote from Bridget about the "gray continuum":
" the building of a specialty, within social work practice, I think a lot of people experience a lot of turf issues…

Remembrance of Things Past: Preparing for the Future of Aging

The following is a guest post from Minakshi Raj (@MinaRaj91), 4th year PhD candidate at the University of Michigan in Health Management and Policy and Theodore Suh, MD, PhD, MHS, Clinical Associate Professor in Geriatric and Palliative Medicine at the University of Michigan and Medical Director of the Ann Arbor Geriatrics Clinic.

In my parents’ home, one of our many photo albums is inaugurated by a photograph of me, in diapers, standing by my grandfather as he holds my hand. If panoramic photography had been available in the 1990s, we’d likely see my grandmother warning him not to let go as I might fall onto the wooden floor and develop a fear of taking my next step. In another, much thicker photo album, I’m taller and a decade older with my arm circled around my grandmother’s elbow as she leans against a walker supported by tennis balls to help her glide gracefully across the floor. As she clutches the walker, I can recall her saying, “Take the picture quickly; I can’t stand much lon…

Rehabbed to Death NEJM Perspective: Podcast with Lynn Flint

Three reasons you should listen to or watch this podcast:

The issue of patients cycling back and forth between the hospital and skilled nursing facilities near the end of life is common, will ring true to those of you who are clinicians, and has largely been ignored in the literature.  This is core bread and butter geriatrics and palliative care.  Unfortunately, it's not something we have focused on to the same extent as "code status" or "advance care planning."  But you can make the argument that it's as or more important as those issues.It's about a hot off the press article published today in the NEJM.  I think the NEJM was interested because this issue is driven by a number of health policies that create perverse incentives to cycle patients back and forth between hospital and skilled nursing facilities, rather than care for them at home.  We wrote it up primarily because we were interested in the communication failures issues that perpetuate this cy…