GeriPal - Geriatrics and Palliative Care Blog

I wanted to alert the Geripal community about a wonderful and interesting book written by one of our colleagues: Open Wound, The Tragic Obsession of William Beaumontby Jason Karlawish form the University of Pennsylvania.
Most people will enjoy the historical fiction (based solidly on actual events) following a young physician (Beaumont) who saves the life of a French fur trapper (Alexis) in a northern Michigan military outpost in 1822. Alexis suffered a gunshot wound and was going to die until Beaumont intervened and treated his wound. Unfortunately, he was left with a fistula, a hole leading directly into his stomach. This hole provided a window into the world of digestion and over the course of the next several years, Beaumont performed numerous experiments on the gastric juice that he collected. These experiments largely proved that digestion is a chemical process rather than a mechanical one.
I'm not necessarily a history buff, and I might have missed this book if it had not be…

"Zen Mind, Beginner's Mind" is a collection of talks by the late Zen Master Shunryu Suzuki.  The book opens with the words:

"In the beginner's mind there are many possibilities, but in the expert's there are few."
One of the reasons it is fun to attend in July is that the hospital is filled with beginners - medical students starting the wards, interns begining as doctors, and fellows learning their specialty.  July is a time to see the practice of palliative care with fresh eyes and beginners' minds.  New palliative care fellows are experiencing what is routine to experts for the first time: a first call for a consult, a first family meeting, a first death.

In this spirit, I generally go back in July and write about a very basic topic that, though covered before, is well worth covering again with the fresh perspective of a beginner.  Previous posts have covered the topics: how do you explain hospice? and how do you explain palliative care?

This p…

So on the one hand, it seems wierd that residents ask patients about code status when they are admitted to the hospital.  Some patients don't expect it.  I remember a healthy 20 something year old guy admitted for an inflammatory bowel syndome flare saying, "Why are you asking me this?  Am I going to die?"

On the other hand, hospital admission to a medicine service is one of the few times critical advance care planning conversations occur.  This represents a major opportunity to communicate with patients about their goals, values, and preferences for end-of-life care.  Unfortunately, even when these conversations take place, the medical residents sometimes do not document this information in the medical record or discharge summary in a place where it is clearly accessible for future clinicians.

In that context, Josh Lakin and colleagues at UCSF created a remarkable incentive program for residents to document advance directives in the chart.  The study was just published…

Over a year ago, John Newman and Robin Feldman wrote in the New England Journal Of Medicine about a company, PAR, attempting to assert a copyright over the Mini-Mental State Exam (MMSE).  While I found PAR's enforcement of the copyright morally reprehensible, I had little legal knowledge to know whether their copyright claim had any legal standing.   That has all changed thanks to another fine article by Newman and Feldman in the Stanford Technology Law Review (free to download here). I can now gladly say that my moral disgust is now on equal footing with a firm belief that the law is not on PAR's side.

A Little Background on the MMSE Debacle

Let's take a step back though and remind everyone of what we discussed in some previous GeriPal posts about the MMSE copyright debacle.  The MMSE, despite all of it's flaws, is probably the most commonly used cognitive screening test out their in medicine.  Its widespread use can largely be thanked to several factors, most import…