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Showing posts from January, 2016

VitalTalk: Mastering Serious Illness Communication

by: Eric Widera (@ewidera)

It was with some hesitancy I decided last year to take the VitalTalk Faculty Development course. Why the hesitancy? Honestly, I thought to myself that I've been doing palliative care for over a decade. I've taught fellows, residents, medical students, and a whole host of other health care professionals.  I've wrote book chapters on this stuff.  Plus, I've read everything that I could get my hands on from the VitalTalk creators Tony Back, James Tulsky, and Bob Arnold.  What, I thought, am I going to get out of this? As it turned out, a lot.

VitalTalk changed the way I teach communication.  As one example, any of my fellows that I work with can now recite word for word the questions that they know I'll be asking at the end of a family meeting: "What is one thing that went well that you want to continue" and "what one thing do you want to do differently in the future?"   These questions are part of the goal I set for m…

Reaction to JAMA theme issue on Death, Dying, and End of Life

by: Alex Smith, @AlexSmithMD






JAMA just came out with a theme issue subtitled Death, Dying, and End of Life.  Here are some quick thoughts and first reactions.  I got through the viewpoints and stories.  I left a lot on the table for another day, including great work by Atul Gawande, Alexi Wright, Holly Prigerson, Justin Beckelman, Zeke Emanuel, Saul Becker, Leora Horwitz, and Joel Weissman. 




Theme: On the one hand, it's great that JAMA is finally paying attention to these issues. Kudos. On the other hand, we've put in hard work in palliative care to change the frame from "death, dying and end of life" to "living well with serious illness".  Wouldn't it be nice to see a theme issue about promoting quality of life for people with serious illness and their caregivers?






Point and counterpoints on physician assisted death.  On the pro side we have Tim Quill, Tony Back, and Susan Block (I'll call it the Quill piece).  Against is a viewpoint by Tony Yang an…

When Breath Becomes Air: A Review

“And with that, the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.”Paul Kalanithi Nearly twelve months into my residency training, I learned that one of my best friends from medical school died at the age of 28. Through all the grief of losing a close friend, and the sorrow I felt for his family, I couldn't help shake a nagging question that washed over me in waves, particularly in days where I was overwhelmed or burnt-out as a trainee, and one that I felt guilty even having: “was it worth it?” Was it worth it for him to go through years of exhaustive medical training that consumed the majority of his life, only for it to be taken away so close to the ultimate realization of all of his efforts. In hindsight, it was not really a question I was asking of his life, but of mine.  Was it worth striving so hard through residency knowing that at any time, I may meet the same untimely fate?

Reading through Paul Kalanithi’s…

Music & Art on the Cover of The Gerontologist

The current cover of The Gerontologist features a musician at the local Octoberfest, a yearly block party that celebrates the German immigrant heritage of my neighborhood in Manhattan that is now only a memory. TG is the flagship journal of the Gerontological Society of America, the nation's oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging.  Looking back at two decades of covers that I provided to TG, art and music have been a constant theme that captivated me as I visually explored the topic of aging.  I view it as spice that adds meaning and purpose to growing old. In this post I look back and show this side of my portfolio of covers.
Most of my work consists of shots taken on the spur of the moment of people I pass on the street or in my travels.   When asked by the editors to provide a cover for the special issue on Successful Aging, I took a train to Westchester to photograph Tao Porchon, a 90 year old dancer…

Timing of Palliative Care Consultations – Is Earlier Better?

Growth in inpatient palliative care over the last decade has been remarkable. A study published this month showed that in 1998 only 15% of hospitals with more than 50 beds had an inpatient palliative care program. That numbers is now 67% nationally. While this is great news, one can't help to think that the majority of patients facing a serious illness, such as advanced cancer, are not in the hospital. A study published this week in  JPM by Colin Scibetta Colin, Kathleen Kerr, Joseph Mcguire, and Mike Rabow gives us more weight when advocating for improved early access to palliative care through the delivery of outpatient consultations.

What they did

The authors included patients with solid tumors who died between January 2010 and May 2012 and who received care in the final 6 months of life at the UCSF Helen Diller Family Comprehensive Cancer Center. They used claims data to identify patients who had involvement by either the outpatient or inpatient palliative care service.…