GeriPal

by: Alex Smith, @AlexSmithMD

In the summer we usually cover a basic topic for the early stage learners, i.e.the new crop of medical students, residents, and fellows.  See prior posts about how to explain palliative care, how to explain palliative care and how to explain hospice.

This year we address: How should we discuss code status?  (And bacon).

Context: New interns around the country are asking patients about code status on the day of admission to the hospital.  Many of them are trying out language and approaches to these conversations for the first time.  New palliative care fellows are trying out their own language.  What are they saying?  What should they be saying?

To address this topic, we talk with Laura Petrillo, MD, a palliative medicine-physician researcher who trained at UCSF and is now faculty at Massachusetts General Hospital.  We additionally have a live studio audience, including Anne Kelly, palliative social worker, Kai Romero, palliative medicine fellow/emergency…

By: Alex Smith, @AlexSmithMD

Symbiosis.  Remember the idea that the fish and the sea turtles live in symbiosis?  The fish eat the algae and parasites off the sea turtles back, and the turtles get a free shell cleaning.  Both are rewarded.  (You're wondering why I'm talking about sea turtles and fish.  OK, I'm in Hawaii and just heard this example from a naturalist/kayak instructor).

The ideal of co-managment is symbiosis: both clinicians contributing symbiotically to make each other better, resulting in better care for patients.

I can't think of a higher example of a symbiotic relationship between clinicians than what Vicki Jackson, Chief of Palliative Care at Massachusetts General Hospital (MGH), and David Ryan, Chief of Oncology at MGH have achieved.

It shines through in this weeks podcast.  We challenged them on a few occasions about their terrific new book "Living with Cancer."  Listen to how they tell the story of learning from each other, working wit…

There's a mismatch between what you read about in the papers and the debates on capitol hill about the VA and the day to day reality of people who work in the VA.  From congress what you here about are wait times to see a doctor.  But from many (not all) veterans, you hear about a system that works, a system that's less physician-centric than the private sector, and a system that outperforms other systems in terms of quality of care.

In this week's GeriPal podcast, we talk with award winning journalist Suzanne Gordon about her new book The Battle for Veterans' Health Care.  Some key excerpts from the podcast/transcript below:

I'm going through some things with some friends whose loved ones are dying in other health care systems. Very good health care systems. I have spent a lot of time with palliative care, in the VA, with some people in this room. I'm not seeing those kinds of conversations happening, that kind of advice. I'm seeing patients, really, bein…