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Showing posts from April, 2017

Palliative Care in Rural America: An Interview with Michael Fratkin

This weeks GeriPal Podcast is an interview with Michael D. Fratkin, a palliative care clinician and founder of ResolutionCare, a palliative care service for rural and resource poor areas in Northern California.

We discuss the barriers and benefits of providing specialty level palliative care for areas that generally have no access to these services, as well as ways one can fund it.   In addition to discussing traditional house calls visits, we also discuss novel approaches, including in-home video conferencing.




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Transcript of the podcast:

Eric: Welcome to the GeriPal Podcast, this is Eric Widera.

Alex: This is Alex Smith.

Eric: And Alex, who is our guest today?

Alex: Today we have Michael Fratkin, who is a palliative care clinician, and founder, CEO, CMO, chief bottle washer, soup to nuts, everything of ResolutionCare, which is a palliative care service for rural and resource-poor settings in Northern California, …

Using Our Pink Friend (POLST) Appropriately: Please Help!

The National POLST Paradigm Task Force (NPPTF) has just released their updated “Appropriate POLST Paradigm Form Use Policy,” which can be accessed at http://bit.ly/2pJuRmt. So I’ll just start by disclosing that I am very fond of POLST (Physician Orders For Life Saving Treatment).

I believe POLST has made an appreciable and important difference in the lives of many patients and their families. The POLST paradigm is sometimes misunderstood, both by clinicians and members of the public, and I want to share some reminders from the National POLST Paradigm Task Force (NPPTF) about the appropriate use of POLST forms and their kin (MOLST, MOST, POST, COLST, the very catchy T-POPP, and others), now considered endorsed or mature in 24 states, and at varying levels of development in 24 more.

The main point is that, unlike an advance directive, POLSTis not for everyone. And POLST is more than just a form in a chart, it’s a concept that invokes a diligent conversation (or more) between a clinic…

Sean Morrison on the Current State of Palliative Care

Today's GeriPal podcast features Sean Morrison, Geriatrician and Palliative Medicine physician, director of the National Palliative Care Research Center and the Hertzberg Palliative Care Institute at Mount Sinai in New York.

We talk with Sean about a new report titled, "How We Work: Trends and Insights in Hospital Palliative Care." This report was co-produced by the National Palliative Care Research Center and the Center to Advance Palliative Care. The report summarizes the current state of palliative care practice in the US.

Key excerpts the podcast (full transcript below):
Sean: I think the biggest finding is that palliative care teams on average are seeing almost 5% of hospitalized patients, but some teams are seeing up to 15% or 16%. And the right number is probably somewhere between 7.5% to 15% depending upon the makeup of the hospital.

Sean: We've seen really a tremendous growth in the number of advance practice nurses that are in the field. We've…

A Geriatrician Reviews Cicero’s “On Old Age”

by: Jeffrey M. Levine MD, AGSF

As a geriatrician entering the twilight of my career, I look to the philosophers of my field for guidance on how to navigate my own later years. In addition to contemporary texts and journals I turned toward the ancients and discovered a gem in the writings of Cicero, one of the greatest philosophers of the Roman Empire. The work is entitled De Senectute – Latin for “On Old Age.” Cicero wrote this in 44 BC, the year before he was executed at age 63 by Marc Antony’s henchmen for his alliance with Julius Caesar’s assassins and political opposition to the rulers of Rome.

On Old Age is an optimistic discussion of the spirit of man’s declining years, exploring the relationship with nature and outlining strategies to maximize the enjoyment of life. Old age and death are considered natural components of humanity. Unfortunately he does not discuss the point of view of women, a reflection of Roman culture in which the female gender had lower status – unable …

GeriPal Podcast: Laura Hanson on Improving Advanced Dementia Care in Nursing Homes

Today's GeriPal podcast features Laura Hanson, Geriatrician and Palliative Medicine physician at the University of North Carolina, Chapel Hill.  Laura discusses her recent JAMA RCT of a goals of care intervention for nursing home residents with advanced dementia.

Here is a link to the decision aid, including video.

Key excerpts from the podcast:
Laura: That is followed by an in-person discussion. I want to emphasize that, because I think that a video decision aid alone without anchoring to the clinicians who are actually delivering care is not going to be as powerful. We did have a number of family caregivers who said, "I can't choose between function and comfort." That, I think, tells us something about what families want from us and what they're hoping for for the care of somebody with late stage dementia. It allows us to think about the things that we do that might actually cause functional deterioration, like overmedication, or prolonged hospitalization with…

Make April Fools Great Again

In a shocking turn of events, early this morning President Donald Trump posted the following tweet:


In what can only be described as utter chaos inside the beltway right now, what appeared to be an impromptu press briefing (although likely long planned out), the White House Press Secretary, Sean Spicer, elaborated on the joke: “We nailed it!  Period”


Apparently, Paul Ryan was also in on the joke, as he was quoted as saying: “You should see the looks on your faces.  Priceless! Do you really think that we want to repeal the ACA and make millions of people lose their insurance?   For god sakes, we are the party of family values.”

Pundits from across the political spectrum are hailing the impressive stunt.  Sarah Palin was overheard saying “I thought my April Fools’ joke of Death Panels was good, but this.  This was impressive.”