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The View From Here

Imagine walking into a mythological epic and giving advice. Center stage, Achilles is about to take out Hector. From stage right, a guy in a white coat, Orthopedicus, confidently strides up to Achilles and offers reconstruction of the big tendon that joins his calf to his heel, noting that if he cuts it and reattaches it, Achilles will do better as he has seen with so many other patients. Achilles is distracted by the battle, only half listening to Orthopedicus, and nods his assent. Tragically, he dies on the table the moment the tendon is cut.

I propose this is exactly how most medical care is offered. We see a problem, we fix it. The back story (whom the problem is attached to, for instance) is too hard to gather in the midst of a busy clinic, a busy emergency room, a busy day of hospital rounds.

We have created a specialty that takes time to consider the whole person. Palliative care often improves outcomes, alleviates suffering and saves money. It is a wonderful thing. In my expe…
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Effect of Palliative Care in ICUs: Podcast with May Hua

In this week's GeriPal podcast we talk with May Hua, an anesthesiologist, critical care physician, and researcher from Columbia (in NY, not the country).   We've had a number of podcasts and blog posts about palliative care in the ICU:

Bill Ehlenback on primary palliative care in the ICUJessica Zitter on palliative care in the ICUDoug White on a nurse-led communication intervention in the ICU
May Hua's study addresses the still unanswered question - do specialized palliative care consults in the ICU do anything?  She looked a number of outcomes comparing ICU patients in hospitals with and without palliative care consults.  While most outcomes were similar, rates of hospice use were higher in hospitals with palliative care teams.   

One issue Eric raises toward the end deserves highlighting.  We know of no trial demonstrating the effect of cardiology, endocrinology, or gastroenterology consults in the ICU.  Why do we feel compelled to study and prove the effect of palliative c…
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#ThisIsOurLane - Firearm Safety and Dementia: A Podcast with Emmy Betz

#ThisIsOurLane.  While I guess that hashtag could make you think we are going to be talking about dementia and driving, it really is a reference to a recent viral discussion on twitter about firearm safety.   It began with the NRA’s tweet in response to the American College of Physicians’ position paper on reducing firearm injuries and death, which said: “Someone should tell self-important anti-gun doctors to stay in their lane.”


This tweet was met by a pretty immediate online reaction by many members of the medical community using the hashtags #ThisIsMyLane and #ThisIsOurLane.  The responses frequently included graphic depictions of the aftermath of firearm violence.


Well, on today's Podcast we talk with Marian (Emmy) Betz, one of the authors of a recent NEJM piece on #ThisIsOurLane and an expert on the topic of dementia and guns.  Emmy is an Associate Professor in the Department of Emergency Medicine at the University of Colorado School of Medicine, and has written some prett…
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Antipsychotics for ICU delirium don't work: Podcast with Tim Girard

In this week's GeriPal podcast we talk with Tim Girard, Plumonary Critical Care physician-researcher at the University of Pittsburgh about his study NEJM study of Haloperidol vs. Ziprasidone vs. Placebo for ICU delirium in critically ill patients.

When I was on service last month, the ICU team said to me, "We've just started treating Mr. X's delirium today.  We started him on haloperidol."


Haloperidol and other antipsychotics for ICU delirium are ubiquitous.  When I was on service last month, the ICU team said to me, "We've just started treating Mr. X's delirium today.  We started him on haloperidol."  In this well-done randomized double blind placebo controlled trial, Girard and his co-investigators detected no difference between the 3 drugs.  Nada.  Zip.

Eric solicited questions in advance via twitter and many are incorporated into the podcast.

Some questions we address:
-But wait, might antipsychotics work for agitated hyperactive delirium?
-…
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