GeriPal

In the latest in our series of talking with front line providers in the midst of the COVID pandemic, we talk with Drs. Craig Blinderman, Shunichi Nakagawa, and Ana Berlin of the palliative care service at Columbia University Irving Medical Center. We cover a host of topics, including the urgent need to conduct advance care planning with our outpatients (including Craig's new Epic dotphrase below, and guide to COVID advance care planning); the need to be flexible to suit shifting demands; to stock up on iPads to engage patients/family members in goals of care discussions from outside the room.  We mention the new JAMA papers on "informed assent" to DNR/I orders by Randy Curtis and colleagues (and Craig's prior JAMA paper), and on rationing scarce resources by Doug White and Bernie Lo (see also our prior podcast on rationing with Doug with links to the practical framework).

I cried after this one.

Maybe it was Ana talking about how hard it was have an agenda when disc…

New York is the current epicenter of the COVID-19 outbreak in the US, with over 30,000 confirmed cases as of March 25th.  Hospitals and ED's are seeing a surge of patients, and geriatrics and palliative care providers, like Cynthia Pan, are doing their best to meet the needs of these patients and their family members.

Today, we talk with Dr. Pan, the Chief of the Division of Geriatrics and Palliative Care Medicine, and the current attending on the palliative care service at NewYork-Presbyterian Queens, located in Flushing, New York. In our discussion we talk about what it is like to be on the front lines right now, lessons learned during this surge, and how she is managing the distress in caring for these patients.

This is our fourth podcast we have published in the last week on COVID. Here are the links to the others:
Covid19: Podcast with Lona Mody and John Mills We also discuss the following resources for communication in this podcastRationing Life Saving Treatments in the …

Many of us with clinical roles are waiting for the other shoe to drop.  Today we hear from Dr. Darrell Owens, DNP, MSN, head of palliative care for the University of Washington's Northwest campus, a community hospital in Seattle.  The UW Northwest hospital has born the brunt of the COVID epidemic in one of our nation's hardest hit areas.

Darrell has stepped up the the plate in remarkable, aspirational ways.

First, he is on call 24/7 to have goals of care conversations with elderly patients in the emergency department under investigation for COVID who do not have an established a code status.  On the podcast Darrell walks us through the language he uses to speak with these patients about the poor outcomes of CPR and ventilation among older adults with COVID.  We note on the podcast that the Center to Advance Palliative Care recently put together Toolkit for COVID including a thoughtful communication guide spearheaded by Tony Back and our friends at VitalTalk.

Second, Darrell h…