GeriPal

by: Olivia Gamboa ( @Liv_g_g ) There is broad consensus in the medical community that lying to patients is unethical.  However, in the care of patients with dementia, the moral clarity of this approach blurs.  In her recent New Yorker article, “The Memory House,”  Larissa MacFarquhar provides an excellent portrait of the common devices of artifice, omission and outright deception that are frequently deployed in the care of patients with dementia.  She furthermore explores the historical and ethical underpinnings of the various approaches used in disclosing (or not) information to patients living with dementia. Ms. MacFarquhar introduces the idea of “compassionate deception,” or the concept that withholding truths, or even promoting outright falsehoods, is a reasonable and even ethical choice for those caring for patients with dementia.  To the extent that it helps a person with dementia feel happier and calmer, allowing them to believe in a gentler reality (one in which, say,

In this week's GeriPal podcast we talk with Guy Micco, MD, a longtime bioethicists, internist, hospice physician, teacher in the UC Berkeley and UCSF Joint Medical Program , mentor, and friend.   Guy and I wrote an article recently for the journal Perspectives in Biology and Medicine about the intersection and issues between the fields of geriatrics, palliative care, and bioethics.  The main thrust of the paper is that we need a workforce that is trained in the principles of all three fields to take the best care of the very sick, the very frail, and the very old.   And for those of you who listen, Guy sings a great rendition of Hello in There, by John Prine: sweet, sad, and sentimental.   Chorus: You know that old trees just grow stronger And old rivers grow wilder every day Old people just grow lonesome Waiting for someone to say, "Hello in there, Hello." Enjoy! Links: Bill Thomas on Reply All Podcast Serving the Very Sick, Very Frail, and Very O

On today's podcast we go deep into the mind of one of the most brilliant and respected palliative care pharmacists, Mary Lynn McPherson, to ask all the questions we've had about opioids but were too afraid to ask.   There isn't really a better person to do this with, as she also just released her second edition of her book:  Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing .  This is the go-to guide for not only learning how to calculate opioid conversions, but also gives great tips for those who have been doing this for a while (I learned a ton from it). In today's podcast we talk about specific aspects of her book including questions about: Whether is is time to update equianalgesic tables The usefulness of opioid conversion calculations Tips and tricks on methadone dosing Fentanyl and cachexia Sublingual morphine - does it work? What to use in liver and renal failure (and why it may not be hydromorphone) Titrating PCAs and drip