GeriPal

Despite being in the field over 15 years, I've never felt so far outside my comfort zone as as palliative care provider as I have felt in the last four months.  A worldwide pandemic of a novel virus had me questioning how I communicate prognostic information when uncertainty was one of the few things I was certain about.  It also pushed me to have these conversations via telemedicine, something I was previously more than happy to leave as a tool for only outpatient providers.  The pandemic and the murder of George Floyd brought to the forefront the systemic racism that permeates our society and my own inadequacies in discussing the trauma that these killings and mistreatment have on black Americans. 

We grow though when we are pushed outside of our comfort zones.  I'm pretty sure Tony Back, the co-founder of VitalTalk, would probably say that I have found my "learning edge".  Lucky for me, we have Tony, along with another VitalTalk guru, Wendy Anderson, on today…

If you looked at the academic literature, you would think that elder abuse and neglect, collectively called elder mistreatment, did not exist before the 1990s.  Of course that's not true at all, it was hidden, covered, and not a major subject of research.  Several pioneers have placed elder mistreatment firmly on the map, including XinQi Dong, Mark Lachs, and today's GeriPal podcast guest, Dean Laura Mosqueda (@MosquedaMD) of the Keck School of Medicine at the University of Southern California and Director of the National Center of Elder Abuse.  Archstone Foundation, who funds our podcast, was a critical early investor in efforts to raise awareness, study, and intervene to prevent elder mistreatment.

Today we learn about what a long term care Ombudsman is, about the impact of Covid19 on elder mistreatment, and ethical issues at the core of elder mistreatment (autonomy vs. safety and public health).  
One major take home point that I'd like to emphasize here are three ques…

This was a remarkable podcast during this moment in which our country is hurting in so many ways.  
Today's topic is the impact of COVID19 on minority communities, but we start with a check in about George Floyd's murder and subsequent protests across the country.  Our guest Monica Peek, Associate Professor of Medicine and Director of Research at the MacLean Center of Clinical Medical Ethics at the University of Chicago, notes right off the bat: COVID19 and the reaction to Floyd are related.  The covid epidemic has created an economic crisis, a heightened level of worry, and a disproportionate number of deaths among the African American community.  When we add COVID on top of the long history of police brutality that has been heightened over the last several years that has been ignored by the federal government - in that context, it's not surprising that we're seeing protesters put their lives on the line to stand up for what they believe in.  These protesters are put…

The question of who should get limited supplies of drugs that treat COVID-19 is not a theoretical question, like what seems to have happened with ventilators in the US.  This is happening now.  Hospitals right now have limited courses of remdesivir.  For example the University of Pittsburgh hospital system has about 50 courses of remdsivir.  They expect it to last to mid-June, enough for about 30% of patients who will present in the next 3 weeks.   Who do you give it to?   The first that present to the hospital (give it all away in the first week)?   Random lottery?  Or something else that also accounts for the greater impact of COVID-19 has on disadvantaged communities ?

On today's Podcast we talk with Colette DeJong, 3rd year medicine resident at UCSF, and Alice Hm Chen, Deputy Secretary for Policy and Planning at the California Health and Human Services Agency, who were two of the authors of a recently published JAMA article titled "An Ethical Framework for Allocatin…