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Showing posts from May, 2018

Top 5 Resources for Studying for the Hospice and Palliative Medicine Board Exams

We have started to get a lot of questions about how best to study for the 2018 Hospice and Palliative Medicine Board Exam.  Yes, that one that many of us took a little less than 10 years ago and now it’s coming due.  Or the one that you need to take after completing your fellowship this year.  

So, to help answer these question, we at Pallimed and GeriPal have created a quick guide of the top 5 resources we use to prep for the boards:
AAHPM's Intensive Board Review Course: the ultimate live in-person prep that includes a pretty stellar cast of speakers including Mary Lynn McPherson, Kim Curseen, Sandra Sanchez-Reilly, Joe Shega, Drew Rosielle, Michelle Weckman, Scott Schwantes, Janet Bull, Jeff Spiess, and Gregg VandeKieft.   The course takes place this August 9-11, 2018 in Minneapolis, MN, and will include both lecture based content plus lots of exam-type questions to help you pass the test (and brush up on your hospice and palliative care knowledge).  Plus you get to hang out wi…

How do patients decide whether or not to initiate dialysis? An Interview with Keren Ladin

How do patients come to the decision regarding whether or not to initiate dialysis?   Well, that is the question that we talk about with Keren Ladin on this week's podcast.  Keren is a social science researcher, bioethicist, and assistant professor in the department of Occupational Therapy at Tufts.  


What becomes clear when you look at Keren's research is the for many patients, there isn't a decision that is made.  As Keren said in our podcast:
We had asked people all these what we thought were thoughtful questions about, "Can you tell us more about what were the factors that were involved and how did you come to this decision"... and eventually we just got back two different options. One was that it wasn't really a decision at all, that they had felt that they needed to start it or that they would kind of die immediately, or that it wasn't their choice, it was more of their physician's choice, which we thought was also really interesting. To read mo…

Melissa Wachterman Podcast: Dialysis and Hospice

This is the first in a two part series on Geriatrics, Palliative Care, and Chronic Kidney Disease.

One of our most popular GeriPal posts ever is titled, "Dying without Dialysis".  That post discusses an article on the symptomatic experience of persons who decided not initiate dialysis in the setting of advanced kidney disease.

This is obviously a compelling topic, given the high prevalence of kidney disease among older adults.

Medicare policy that poses tremendous barriers to continuing dialysis while enrolling in hospice.  This sets up an either-or dichotomy that leads to low rates of hospice use, and among those who use hospice, lengths of stay that are frequently 3 days or fewer.

This week, Eric and I talked with Melissa Wachterman, a physician researcher from the Dana Farber Cancer Institute and Harvard Medical School.  Melissa used a national dataset of people receiving hemodialysis linked to Medicare claims for older adults who died.  She found:

20% used hospice (compared t…

Rob Buckman, SPIKES, and How We Break Bad News

I still clearly remember the first time I heard the name Rob Buckman.  It was in fellowship when I was led to his book called "How To Break Bad News: A Guide for Healthcare Professionals" and what became the single most important mnemonic in my career as a medical educator: SPIKES.   SPIKES not only gave me the language to break bad news to my patients, but also gave me a way help learners navigate some of the most difficult communication challenges in medicine.

Now, well over a decade later, I still use SPIKES every time I teach about breaking bad news, but I don't think about Dr. Buckman much.  That changed on my car ride home.   I was gearing up to listen to one of my favorite podcasts, 99% Invisible, and up popped the title of the next episode "Breaking Bad News."  I paused for a second, thinking "what is a podcast about architecture and design doing talking about breaking bad news?"

Well, the podcast was absolutely amazing and I highly recomme…

Communicating with Home Health: Podcast with Cynthia Boyd

In this week's GeriPal podcast we talk with Cynthia Boyd, Professor of Medicine and Geriatrician at Johns Hopkins University School of Medicine about how physicians communicate with home health agencies.

Home health plays a critical role in caring for persons residing at home, and in the best of circumstances extend a seamless network of care from the primary care physician's office to the home.  

Sadly, reality is not so rosy.  

The major form of communication between physicians and home health nurses is, well, a form.  CMS Form 485 to be specific.  

In a recent study published in Annals of Internal Medicine, Dr. Boyd revealed that most primary clinicians barely read what the home health nurses write on the form, don't find the form useful, and rarely does it change management.  

It's the 21st century people.  Can we move beyond lame forms and communicate with each other, perhaps using some modern technology?  Or even 20th century technology, such as phones, if not 21st Ce…