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Showing posts from March, 2013

Three Things to Put Your Name Behind in Geriatrics and Palliative Care

1. The Palliative Care and Hospice Education and Training Act (PCHETA)

We have written about PCHETA before and we will continue to advocate for it.  You can read more about it in one of our earlier GeriPal posts (here), but in brief PCHETA will greatly expand opportunities for interdisciplinary education and training in palliative care.  We need you to act now to move this bill forward on Capital Hill. Please take 5 minutes to go to the AAHPM Legislative Action Center where you can quickly learn how to ask your representative to sign on as supporters of the bill.

2.Amy Abernethy as one of the "100 Most Influential People in Healthcare"

Let's get our social media machine working to get AAHPM President Amy Abernethy listed as one of 2013’s "100 Most Influential People in Healthcare."  If picked she will be featured among other leaders in health care in Modern Healthcare's August 2013 edition.  Nominate her here.


Nominate AAHPM Pres Amy Abernethy as one of 2013…

Special Mentoring Opportunity at AGS!

“A Longitudinal Senior Faculty and Peer Mentoring Program for Junior Investigators and Educators”
Who: Junior faculty (Assistant Professor/Instructor or equivalent)

What: Symposium to describe practical ways to get the most out of mentoring relationships as an investigator or educator, establish a longitudinal peer mentorship group under the guidance of a senior leader in the field, and develop individual career goals for follow up during conference calls in the year following the symposium.

Why: Mentoring is critical to professional success! Mentors and mentees have a two-way relationship based on feedback, commitment, engagement, balance, self-awareness, and advocacy (Gillespie, 2012). We need many mentors both senior and peer for various aspects of our professional development.

When: Saturday, May 4th 12:30-2pm

Where:American Geriatric Society Annual Meeting in Grapevine, Texas

Speakers include: Louise C. Walter, MD, Sharon Levine, MD, Mary K. Goldstein, MD and Annette Medina-Walpol…

Literature Potpourri

Here are a smattering of interesting articles on my desk I've wanted to blog about, but haven't had time to work into full posts.  Writing about them here briefly doesn't preclude anyone (you?) from posting about these stories in greater detail later!

The February issue of the Journal of General Internal Medicine, or JGIM, should be subtitled "The GeriPal Issue."  Lots of great articles on social media, geriatrics, and palliative care topics, including:An article by Matthew DeCamp on social media and conflicts of interest.  Did you know that 65% of patients trust information about cancer obtained from the internet?  (for comparison, 93% trusted information from a physician).  Lot's of nefarious potential here for big pharma  and docs in their pay to steer patients to their products without adequate disclosure.This study by Amy Kelley on of out-of-pocket costs during the last five years of life.  Amy is on a roll, see this post about her recent Health Affairs …

Why Choosing Wisely Will Have Limited Success

Foreword: The views expressed in this essay are my own and do not reflect the opinions of the GeriPal Blog editors and other GeriPal contributors participating in Choosing Wisely.I support the ultimate goal of Choosing Wisely and have the highest respect for those working on this important endeavor. Choosing Wisely is a campaign led by the American Board of Internal Medicine (ABIM) Foundation with strong collaboration from specialty societies representing nearly all medical disciplines and support from various health and health care organizations.Choosing Wisely seeks to reduce wasteful and unnecessary health care services.The underlying premise is that health care is too expensive due largely to waste and unnecessary utilization.Berwick and Hackbarth (JAMA 2012) demonstrated that 20% to 50% of expenditures are wasteful.Choosing Wisely seeks to address several categories of waste that are particularly expensive for Medicare and the broader health care system (e.g., overtreatment) and t…

#hpmparty New Orleans Thursday 9pm

If you're going to New Orleans for HIPNA/AAHPM I hope you will join for the annual Pallimed/Geripal social media get together.

We won't say right now where the party will start.  This year we will harness the power of social media to make the night even better.  Please tweet suggestions for where to go with the hashtag #hpmparty.  We will tweet the starting location of the party with #hpmparty on Wednesday or Thursday at the latest.  As the evening progresses, we may move locations, so be sure to follow the hashtag if you're joining us after 9pm.

This year is the focus is on music.  My favorite music to come out of New Orleans recently is  Trombone Shorty. I got to see him at Hardly Strictly Bluegrass a couple of years ago with my kids, and we had his album playing daily for weeks after.  Here's a link to a documentary about him on youtube.


And here's one of his newer videos:





Trombone shorty won't be performing in New Orleans when we visit.  Lets hope for some…

The Shortsighted Argument in Limiting Hospice Access

It feels like every passing day brings with it more news of an aggressive campaign to reign in the cost of Medicare hospice spending.  For instance, federal government investigations of hospices that enroll patients who live longer than 6 months have resulted in the death of one of the most important organizations in our field, San Diego Hospice (as covered by Pallimed here). There have also been threats from those like the governor of Louisiana, Bobby Jindal, who attempted to make a case that eliminating Medicaid hospice care would save the state over a million dollars.

Hospice is associated with a host of benefits including reduced symptom distress, improved outcomes for caregivers, and high patient and family satisfaction. The underlying question though with Gov. Jindal’s argument is whether hospice programs cost more than they save for states like Louisiana or the federal government? According to the Louisiana Department of Health and Hospitals the answer to this question is …

Is it better to look good or feel good?

I'm reviewing grants for the National Palliative Care Research Center in New York, and always on the lookout for blog material.  I can't discuss any of the grants themselves, of course, but some interesting items came up at dinner tonight.

Now I love California, but New Yorkers do have a few things on the rest of the country - they walk everywhere, have great fashion sense, and are first to try the latest cool gadgets.

And perhaps there's a lesson here somewhere here about mobility and older adults.

Take shoes.

Most of the shoes I've seen for older adults are utilitarian and plain. What if shoes for older adults were really fashionable - like those modeled by famous palliative care researcher K.S. in the photograph above?  Ooh la la!  Would older adults feel better about walking?

And in this picture we have a cool watch gadget that tracks daily "fuel" expenditure toward a set goal. (This watch belongs to the son of RK from ACS).  Would older adults feel …

Terminal Delirium: Fatalism and Intellectual Laziness?

In 1996, Catherine Sarkisian described the common geriatric diagnosis "failure to thrive" as the result of fatalism and intellectual laziness.  Fatalism, in the sense that there doesn't seem to be anything to be done about the condition (ie throw up your hands). Intellectual laziness, because in fact with some thoughtful clinical sleuthing, the cause of failure to thrive can often be traced to five potentially treatable conditions: impaired functioning, malnutrition, depression, and cognitive impairment.

So is terminal delirium the failure to thrive of palliative care?

Delirium can often be traced to a cause or constellation of causes, such as medication side effects, dehydration, unfamiliar environments, or lack of sleep.  Many of these conditions are treatable, for example by stopping the offending medications, encouraging fluid intake, encouraging family to stay, or improved sleep hygiene.

In palliative care do we too often jump to the diagnosis of terminal delirium?…