Skip to main content

Posts

Showing posts from July, 2014

A Letter to My Geriatric Patients

I would like to send my deepest thanks to every one of you for teaching me so much during my Internal Medicine residency. With every lesson, you touched my heart.

I have been an internal medicine resident the last two years and each day you accepted me into the most vulnerable period of your life. I have been there as you face a scary new cancer diagnosis, when you realize your independence may be lost forever, and when your mind has felt shaky and unstable. I have been there as you navigate the trials of watching your child, your life partner, your sibling or loved one as they face death. I have been there even as you approach the end of your life. In those most challenging times, I marveled at the strength of your generation and the tenacity to overcome the unimaginable.

With my sincerest gratitude, I also extend to your generation several apologies. I am sorry I spend more time looking at a computer screen than looking at you. I am sorry my time on the wards is not spent at yo…

Preparing for the hospice and palliative medicine board certification exam

What do the following three things have in common:
The Paris Air ShowThe World Table Tennis Championships The Hospice and Palliative Medicine Certification Exam
They all happen once every two years! And guess what, this is the year for the Hospice and Palliative Medicine certification exam. Two things to consider to get prepared for the test:

1.  Whether you are preparing to take the hospice and palliative medicine subspecialty board exam or just want to get up to date with the field, then considering joining us at AAHPM’s Intensive Board Review Course. The organizers have created a fast-paced, intensive review of best clinical practices when caring for seriously ill patients and their families.

2. Practice with Blogs to Boards! This is a series of posts from both GeriPal and Pallimed to get physician readers ready for the hospice and palliative medicine boards. We created these for the 2012 exam where every week GeriPal and Pallimed alternated publishing a new question, as wel…

Life and Death After Hip Fractures in Older Nursing Home Residents

Any who has had a loved one who sustains a hip fracture knows that these are life changing if not life-limiting events in the lives of older adults. A recently published article in JAMA Internal Medicine gives further credence to this, as well as giving us evidence to guide our prognostic estimates when caring for someone who sustains a hip fractures in a nursing home setting.

The study by Neuman and colleagues looked at survival and functional outcomes after hip fracture in 60,111 long-term nursing home residents who were hospitalized with an acute hip fracture between July 1, 2005, and June 30, 2009. The primary outcome was death from any cause within 180 days of hospital admission. They also looked at functional outcomes that were based on self-performance for 7 ADLs as recorded in the last available Minimal Data Set (MDS) assessment within 180 days after the index admission.

What Were the Results?

The median survival time after fracture was 377 days (the interquartile rang…

Hospice patients should have access to physical therpay to improve function

by: Alex Smith, @alexsmithMD

I'm going to acknowledge up front that this is a rant. 

One of the skilled nursing facilities I work with has a hospice unit.  We occasionally have patients on the hospice unit who might benefit from physical therapy.  The physical therapists that see patients in the skilled nursing facility say they will talk with the patient about their goals, and if their goals are to maintain their current level of functioning, they will work with the patient.  If the goals are to improve their physical function, they cannot offer that type of support.

This seems ridiculous!

If someone has pain, we don't say, "we will keep your level of pain where it is, but we can't  help you if you want to improve."

If someone has social or spiritual issues, we don't say, "we want to maintain your current level of distress, but can't help you if you want to be less distressed."

Why is this happening?  It may be that a part of the problem has …

Never Stop Dancing: Breaking Stereotypes of Disability in Older Adults One Step at a Time

We have written a lot about disability in older adults here on GeriPal.  Here are just a couple of examples:
Successful Aging Does Not Equal Aging without DisabilityPreventing Disability vs. Improving Quality of Life for Elders Living with Disability: Both are ImportantMany Disabled Seniors Have a Good Quality of LifeThoughts on DisabilityLife Space: Living Well Despite Disability If I had to sum these posts up in a couple words, it would be that successful aging does not equal aging without disability.   If I had to sum these posts in a video, it would be this:



Post by Stanton Warriors.

by: Eric Widera (@ewidera)

Financial Capacity, Alzheimer’s, and the sale of the LA Clippers

More than 5 million Americans currently have Alzheimer disease. One of them happens to be Donald Sterling. There are a lot of directions we can go on a post about this now infamous man and this devastating disease, but the one I would like to highlight is the role that a physician’s determination of financial capacity played in a multibillion dollar sale of a professional sports team.

On May 29, 2014, Sterling was removed as co-trustee of the Sterling Family Trust, which owns the LA Clippers. This removal was based on the certification of two licensed physicians that Mr. Sterling was incapable of carrying out the duties as a Trustee of the trust because of his dementia. Shortly thereafter, his wife, now the sole Trustee of the trust, sold the Clippers to ex-Microsoft CEO Steve Ballmer. Sterling has since claimed that his subsequent revocation of the trust June 9 prevents his wife from completing the Clippers sale, although that appears to be an issue that will be decided by a…

Just "Fix-it"

by: Gretchen Schwarze (Vascular Surgeon)

She seemed awfully angry and at the very least dubious that I couldn’t do more for her father. After 7 hours of surgery trying to salvage her father’s leg, I tried patiently to explain that this new (third) bypass we had just successfully completed was unlikely to provide her dad with a long-term solution. Ultimately, he would lose the leg, if we were lucky he’d have it for another year or two. Accounting for the “unlucky” side of the coin was even more depressing; immediate wound or graft infection, a postoperative heart attack from the liter of blood I had just lost or early graft failure which few surgeons would attempt to reverse given the tenuous nature of the graft to begin with. I didn’t have the heart to mention these things too, she was already upset.

It’s conversations like these that make me feel like there is something intrinsically wrong with the way we conceptualize modern medicine, and by “we” I mean both doctors and patien…

Informed consent in social media research

I’m simultaneously a behavioral researcher, an ethicist, and a hopeless Facebook addict, so I’ve been thinking a lot about last week’s controversial study (Kramer et al, PNAS 2014) in which researchers manipulated the emotional content of 689,003 Facebook users’ News Feeds. In summary, users who saw fewer of their friends’ posts expressing negative emotions went on to express more positive and fewer negative emotions in their own posts, while users who saw fewer posts expressing positive emotions went on to express more negative and fewer positive emotions in their posts.
This provides evidence for “emotional contagion” through online social networks—that we feel better when exposed to other people’s positive emotions, and worse when exposed to negative emotions. This finding isn’t obvious, since some have suggested that seeing other people’s positive posts might make us feel worse if our own lives seem duller or sadder in comparison.
The journal and authors clearly did not anticipate…

Practice Change Leaders for Aging & Health: Jedi Training for Geriatric Professionals

This is your big opportunity!  The C-Suite is giving you 10 minutes to make a business case for your new service line to improve the health and delivery of care for older adults at your institution.  Wow, I've watched Shark Tank on TV and I'm already sweating...(and I wake up from my dream).  But more seriously, one morning before a project presentation, my 6-year old son, now a big fan of Star Wars, shouted out to me with his best Yoda voice, "Use the force, Dad!".  As I begin the transition to mid-career in medicine, I got inspired to seek further Jedi training to grow and cultivate leadership skills.  I have been fortunate to be part of the Practice Change Leaders (PCL) for Aging and Health program for 2014.

The Practice Change Leaders is a national program to develop, support, and expand organizational leaders who are committed to achieving transformative improvements in care for older adults.  The program, founded by Dr. Eric Coleman, is jointly supported by th…