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Showing posts from August, 2014

Debate: should palliative medicine physicians be required to certify in their primary specialty?

by: Alex Smith, @AlexSmithMD

It's been 10 years since I became certified in Internal Medicine, and that means it's time for me to re-certify.  My clinical practice is small, as I'm mostly a researcher.  The entire focus of my clinical practice is palliative care.  I used to attend on the wards, but I don't anymore.

Can I just say how much I hate studying for the boards...again?  MKSAP again?  Really?  Why am I reading about some obscure disease that I have no interest in remembering as a palliative medicine physician?

Hospice and Palliative Medicine is one of the few sub-specialties to require board ongoing maintenance of certification in the clinician's primary area of specialization - be it internal medicine, family medicine, pediatrics, radiation-oncology - whatever it may be (medicine subspecialties count - you could be certified in Oncology and Palliative Medicine, without maintaining your internal medicine certification).  Cardiologists, gastroenterologist…

What books inspired you to go into #geriatrics or #palliative care?

by: Alex Smith @AlexSmithMD

I just read a wonderful categorization of books about aging on Lousie Aronson's blog.  She categorizes books about aging into five types: informational, memoirs, wellness and longevity books, general non-fiction, and literary works.  My favorite category are the wellness and longevity books, you know the ones, about how if you eat enough "blueberries and kale" you will not "have to age or die."  Louise graciously declines to state the names of such books, only noting that the authors initials are often followed by the letters "M" and "D".  To that I would simply add that the author's name often contains the letters "O" and "z". 

In any case, I have been planning for some time to start a thread about books that inspired us to go into the fields of geriatrics, gerontology, palliative, hospice, and end-of-life care. 

Was there a particular book that pushed you along on your path to your cur…

Surgical decision-making for elders: GeriBoards, prehab, and other great ideas

by: Alex Smith, @alexsmithMD

A while back people realized that outcomes of surgery in older people were probably better than previously believed. This led to a widespread perception that we were being ageist by not being aggressive enough in offering surgery to older adults.  We started operating on more older adults. We identified new ways to operate on increasingly elderly and frail patients.  If you look into geriatric surgery now, you will mostly find a bunch of stuff about how to optimize surgery for elders.  (Example - I was recently asked to review the orthopedic surgeon society's new guidelines on management of hip fracture.  It was all about this surgical approach or that approach, this screw or that piece of hardware, with almost nothing about the decision to have surgery or not.)

However, there is a new group of physicians researchers who are concerned that the pendulum has swung too far.  They are concerned that we are performing too many surgeries on high risk older …

Potpourri from clinical work VII

by: Alex Smith, @alexsmithMD

The following are some reflections from being on service recently.  Not enough time to develop these into full posts.  If these issues tickle you, please respond in the comments!  To see previous potpourri's from clinical work follow the links to I, II, III, IV, V, and VI.
David Reuben wrote a terrific perspective describing "The Hospital Dependent Patient."  These are patients who, usually elderly, who have chronic illness exacerbations that frequently land them in the hospital.  In the hospital they have a high quality of life, when surrounded by nurses and treatments that can only be delivered in the hospital.  I cared for one such patient.  He had frequent episodes of low blood pressure following dialysis, landing in him in the hospital over and over again.  He also had early dementia.  He could remember enough to think that he should be in dialysis most days, even when it wasn't his usual day.  Normally tired and sleepy, in the dialy…