Skip to main content

Posts

Showing posts from January, 2011

Disseminating Taxpayer Funded Research: Problems at CMS

When your tax dollars fund research, do you have a right to see the results? Do the federal agencies that fund research have an obligation to taxpayers to see that findings from the research they support are disseminated and easily accessible to the public? And what would you think about a federal agency that takes active steps to obstruct the dissemination of research they support?

There is a very important post by Dr. Chris Langston on the John A. Hartford Foundation health AGEnda blog that addresses some of these issues. Over the years, CMS has spent large amounts of money on research and demonstration projects. Goals of these projects often focus on improving the quality and reducing the cost of care provided to Medicare recipients. These projects are often awarded as grants or contracts to academic researchers or contract research organization.

Dr. Langston tried to learn about the results of a project examining the impact of care management on high cost beneficiaries. Finding in…

Legal Restrictions Compromise Effectiveness of Advance Directives

Imagine that you are caring for Ted, a patient in hospice who would like to go from Los Angeles to Michigan to see his family one last time. His same-sex partner opens up to you that he is worried about what would happen if Ted became sick while in Michigan, as his family there are very religious and don’t necessarily agree with Ted's end-of-life wishes. Not to worry, you say, Ted has a valid advance directive that his same-sex partner is his health care agent. Then you pause and think. Hmmm… Maybe there is something to worry about.

According to a new study in the Annals of Internal Medicine you should be worried. The study, authored by Lesley Castillo, Brie Williams, Sarah Hooper, Charles Sabatino, Lois Weithorn, and GeriPal’s very own Rebecca Sudore, surveys the medical and legal literature from across the United States. There is a lot of great information in the article making it a must read for anyone interested in advance care planning or the confusing intersection of…

Potpourri from Clinical Work IV

I was palliative care attending for a month, from mid-December to mid-January.  Here a few observations from my time on service:

Holding on for the holidays.  In mid-December the hospital was pretty quiet and the hospital half full.  By the time I left in mid-January, the hospital, ICU, nursing home, and hospice unit were all full.  I've heard of people "holding on for the holidays," but this was pretty impressive first hand experience.  Does anyone know if this phenomena has been studied?  Pretty impressive evidence of a mind-body connection.Passing of the greatest generation.  A 95 year old veteran I cared for described serving in General Patton's battalion in Europe.  Patton planned to storm a village at night, and told the troops, "We will take that village tonight!  I don't care how many dog tags we go through, we are going to take that village!"  That was Patton.  These are the last years we will care for these great veterans.  Sad.Vietnam veterans…

What if Mom dies in San Francisco but Dad is buried in Vermont?

I was recently asked by a patient’s family member what they need to prepare for should their loved one pass away and they need to transport the body to their family home. While I have encountered this issue for a patient who died and was cremated (the family carried the urn with them on the flight as a carry-on) I surprised myself in realizing that neither I, nor my informal survey of several geriatric and palliative care colleagues knew the answer. I suspect that, ultimately, most palliative care social workers and, certainly, directors of mortuaries and funeral homes can provide the answer this family member needed. But I decided I needed to learn how to answer this important question myself.

In short, travelling with cremated remains is far easier than travelling with uncremated “human remains” (the term used universally amongst the airline carriers). All remains must be accompanied by the death certificate and, depending on the state of destination, certain legal documents. Shippi…

Understanding Frailty

Frailty is a central concept of Geriatrics. It would only be a slight stretch to claim that the clinical practice of Geriatrics is the management of frailty.

So, if frailty is so important, you would think all Gerontologists would have the same definition on the tip of their tongue. But frailty is surprisingly hard to define. And then is not general agreement on any one definition. The definition remains a matter of debate in the field.

It is certainly a challenge teaching Geriatrics when you can't give a coherent definition for such a central concept. There are many who argue that the Justice Oliver Wendell Holmes definition, "I know it when I see it" is actually the best approach. This is not unreasonable---after all, this accounts for the inordinate amount of stuff that happens with aging that collectively causes frailty. Perhaps clinical judgment is better than any diagnostic algorithm. On the other hand, when a Geriatrician is trying to teach a medical student, who …

Patient-Centered Care: A Perspective by Amy Berman

“For those of you who haven’t yet heard, I have recently been diagnosed with Stage IV inflammatory breast cancer. This rare form of breast cancer is known for its rapid spread. True to form, it has metastasized to my spine. This means my time is limited. As a nurse, I knew it from the moment I saw a reddened spot on my breast and recognized it for what it was.” This is the opening paragraph to a deeply moving and powerful blog post written by Amy Berman at Health AGEnda.  Amy's story is compelling, in part because of her perspective both as a patient and as a leader in nursing and geriatrics (she currently is a senior Program Officer at the John A. Hartford Foundation, and was previously the director of the Hartford Institute for Geriatric Nursing at New York University College of Nursing.)

The post chronicles part of her journey through a health care system that is overwhelmingly fixated on survival, often to the detriment of the patients it attempts to care for. It is a system…

Eric Widera wins Cunniff-Dixon Foundation Award!

Congratulations to GeriPal co-founder Eric Widera for winning an early careerCunniff-Dixon Foundation Award for improving care of patients near the end of life!


Eric was recognized "for his humility, his commitment to his patients and their families, and his leadership in creating forums of communication on geriatric palliative care issues."  This award recognizes what we at GeriPal have known for some time - Eric is an extraordinary palliative medicine physician who leads by example.


“This year’s awardees represent the very best traditions of the humanism of medicine and the best in doctoring,” said selection committee member Richard Payne, MD, Esther Colliflower Director of the Duke Institute on Care at the End of Life. 


Other awardees include:

Ann Allegre, MD, FACP, FAAHPM, director of medical programs at Kansas City Hospice and Palliative Care in Kansas City, Mo (Senior Physician Award)Anthony Nicholas Galanos, MA, MD, medical director of the Duke University Hospital Palliat…

Death Panel Legacy

Yesterday, legislation that would have reimbursed physicians for advance care planning discussions was stripped from Medicare regulations related to the Affordable Care Act (Health Care Reform Bill).

This was the second time such language was removed.  The first time, of course, occurred during debate over the bill in congress.  Sarah Palin said she did not want Obama's "death panels" to decide who was worthy of care.  John Boehner (now house speaker) said the legislation was part of a slippery slope toward government sponsored euthanasia.  Not only was advance care planning legislation stripped from the bill, so were all measures related to palliative and end-of-life care.

What the administration couldn't get through congress it turned to regulation to accomplish.  On Christmas 2010, the New York Times broke the story that the Obama administration and Don Berwick, director of the Centers for Medicare and Medicaid, incorporated language into Medicare regulations rel…

Nip/tuck GeriPal Style: A New Year, A New Look

It has been a little over a year and a half since we started GeriPal.  In that time our little community has expanded quite dramatically.  Just in the last year we have had close to 100,000 views of our website with nearly the same number of views through our feed service.   Who would have thought that there were that many people interested in geriatrics and palliative care???

With all that wear and tear, GeriPal looked like it needed a little freshening up.  So, over the last several weeks we have rolled out a new logo, a new website design, updated our facebook page, and tweaked our twitter page.  I encourage everyone to check out these new redesigned sites:

GeriPal Home Page - www.geripal.orgGeriPal on Facebook - www.facebook.com/GeriPalGeriPal on Twitter - @GeriPalBlog
Don't forget when you are on these sites to either friend us, like us, or follow us.  Also, please give us feedback on the changes.  Did we forget something that you think we should add?  Are you having problems…