GeriPal

by: Sei Lee

I wanted to alert folks to a wonderful "Piece of My Mind" article in JAMA (Mar 17, 2015) by a pediatrician about difficult conversations. As I was reading it, there were numerous phrases and sentences that poignantly rang true.

The manuscript revolves around the author and his wife’s experiences following a spontaneous abortion. Providers didn’t want to tell him the bad news, despite the fact that the ultrasound was strongly suggestive of bad news. Providers used strategies that sounded all too familiar to me.

"Uncertainty can be a 'get out of jail free' card for providers, momentarily allaying fears while punting the difficult conversation down the road."

"Hope is a powerful tool that physicians have wielded incautiously throughout the history of medicine."
As a palliative care provider, I’ve witnessed many clinicians use hope and uncertainty to avoid hard discussions. Instead of talking about what’s most likely (which is of…

by: Stan Terman, PhD, MD


Beneficiaries of Medicare, and their families and surrogates, may soon have more opportunity to obtain an “explanation and discussion of advance directives such as standard forms” with physicians and other health care providers for one or more half-hour, face-to-face sessions. But first, CMS must review the approximately 240 comments that were submitted before September 8, 2015.

Several comments strongly objected to the proposal. Many objections seemed derived from the same boiler plate, but one by the Association of American Physicians and Surgeons (AAPS) is both strong and unique. This non-profit, 5000-member organization, which describes itself as “defending the patient-physician relationship and the practice of ethical medicine,” characterized payments to physicians as: “financial incentives,” “inducement,” “unethical conflict of interest,” similar to other “unethical bonuses,” and a “commission-like reward system.” It criticized the option for additio…

Across the globe, more than half the world’s population lives in cities, and there is a growing recognition that urban environments need to be more age-friendly.   With its rich cultural offerings and easy access to stores, New York City looks like a great place to grow old.  In this post I present photos of elders getting around the city.   


Go downtown in the early morning hours and you can see Chinese elders strolling and exercising in the parks and public spaces.  This is the Manhattan Bridge that spans the East River. 

Most of these shots were taken with my iPhone going back and forth to the hospital.  The Bloomberg administration installed bike lanes all over the City, and these are favorite places for people speeding around on motorized wheelchairs, often in the wrong direction.  

This is a well dressed trio.  The lady in the middle was photographed going to church on 125th Street in Harlem, while the lady on the right was waiting for her ride.  

Uptown, midtown, and downtown …

by: Amy Getter, RN, MS


Death scenarios, debates about assisted suicide, hospice and end of life commentaries, “Death cafes” and “death dinners” have been in magazines, the subject of special reports on television, newspaper articles and in various other media sources. It seems that a new popularity has risen among the press to highlight the “taboo” subject of death. Naturally, as a hospice nurse, I am pleased to see an increasing interest from the public in things surrounding dying (since, after all, it is what I talk about every day!). More recently, palliative care has joined hospice and dying in the media’s scrutiny and discussion.

Palliative care is now a recognized medical specialty. Over half of the nation’s hospitals offer a palliative care team: a group of experts that usually consists of physicians, social workers, chaplains and nurses. One of their goals is to help a patient and their family members navigate through the maze of hospitalizations and different treatment…

Dying is in serious need of a redesign. This is the point of BJ Miller's TED talk that was given several months ago and is now available to watch at the TED talk website. If you haven’t seen it yet, I highlight encourage you to watch it.

BJ, the Executive Director of the Zen Hospice Project and a true leader in palliative care, gives an inspirational talk about the certainty of death, the current approach our health care system takes to care for the dying, and various “design cues” we can take including our need to lift our sights to making life more wonderful rather than less horrible as death approaches.

This talk is a great reminder that as a community we can use our natural creativity to rethink dying.  Not to go against it, but as BJ says in his talk:
"We can design towards it. Parts of me died early on, and that's something we can all say one way or another. I got to redesign my life around this fact, and I tell you it has been a liberation to realize you c…