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Showing posts from April, 2014

What pushes doctors to talk about withdrawal of life sustaining treatments?

What changes an ICU doctors intention to discuss withdrawal of life support in a family meeting? An interesting study published this month argues that a doctors willingness to discuss withdrawal of life support depends on how sick the patient is, but not necessarily what the patient’s values are in regards to functional recovery.  Interestingly, it also depends on whether doctors are required to record the patient’s most likely 3-month functional outcome before deciding whether to discuss withdrawal of life support.

The Study

The study, by Alison Turnbull (who also on twitter @vitaincerta) and colleagues, was a three-armed randomized control trial of 630 academic intensivists recruited via e-mail invitation. Each of these intensivists reviewed a single hypothetical patient across 10 different scenarios representing a wide range of illness severities that changed the probability of in-hospital mortality (all of which included that the patient was mechanically ventilated for the…

Just for Fun: a Les Misérables parody about hospitalists and ED docs

Two weeks ago, Alex Smith and I gave a talk at the California Compassionate Care Coalition's 6th Annual Conference and Summit.  The topic focused on the top 10 reasons for health care providers to participate in social media (FYI - all the presentations from this meeting can be downloaded for free on the CCCC website).  The last reason we gave attendees to participate online was that it was just downright fun.  To prove out point, we showed some videos we created and uploaded on youtube, which can be found here.

Paul Tatum sent me another video today that further confirmed my belief that the folks online are hilarious.  Enjoy this video by ZDoggMD (as the hospitalist) in an epic "Les Misérables" parody battle with an Emergency Medicine Physician:




by: Eric Widera (@ewidera)

What to do when your patient is racist?

by: Alex Smith, @alexsmithMD

I'd like GeriPal reader's help with an issue that has vexed me since medical school. 

As a third year medical student, I cared for an elderly patient in a residential hospice facility with advanced cancer.  Unable to get up and about without assistance, he complained about feeling "trapped" in his room.  So I got him into the wheelchair and we went outside to enjoy the California sun. 

Several nurses passed by on the other side of the street and my patient made horrible racist remarks about them. 

I froze. 

I didn't know what to do.  I felt terrible that he was saying these things about the nurses.  I was also aware that the nurses could not hear him - we were too far away - and that this man was nearing the end of his life.  Nothing I said was likely to change his perspective or his behavior.  I said nothing.  He died two weeks later.  I've felt bad about that lack of response ever since.

I'd like to write a piece about a…

Medicare hospice payment reform: not seeing eye to eye

By: Alex Smith @alexsmithMD

Eye-popping numbers from the headlines of the New York Times today - 2% of doctors bill for one quarter of all Medicare payments.  At the top of the 2% is a Florida ophthalmologist who billed Medicare for $21 million in a single year.

So what does this have to do with hospice payment reform, you ask?  Those 2% of doctors billed Medicare 14 billion dollars in 2012 for their services (note this doesn't include the cost of medications, but may include the costs of administering medications, like chemotherapy). 

In 2012, Medicare hospice payments totalled $15 billion.  That $15 billion was for ALL the services hospice provides, including medications, durable medical equipment, etc. 

Medpac, the government organization responsible for making recommendations to congress for changes to Medicare payment policy, has been recommending a number of reforms to hospice payment for years.   In the most recent two years the recommendations have been to freeze Medicar…

#Geriatrics and #Palliative Care Consults via #Twitter!

by: @AlexSmithMD

Here at GeriPal, we have really tried to push the envelope with the use of social media in geriatrics and palliative care.  We're announcing here that we have taken things to a whole new level with our recent pilot study of geriatrics and palliative care consults via twitter.

Here we publish our first ever geriatrics consult via twitter.  We have anonymized the identity of the caregiver and patient to protect confidentiality.

Notice how using twitter leverages the strengths of twitter: namely, organizing the creativity and expertise of the whole twitter community to provide optimal care for patients.


Also, you should read this post, including the comments at the bottom.