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Showing posts from February, 2021

So you want to be a hospice medical director? Podcast with Tommie Farrell and Kai Romero

So what exactly does a hospice medical director do?  Why do some choose to become hospice physicians?  What additional training is needed, if any, beyond Hospice and Palliative Medicine fellowship and boards?  Who should take the new Hospice Medical Director Certification Board Examination ?  A recent study in JAGS found high rates of hospice disenrollment (“live discharge”) for people with dementia - is that a good thing or a bad thing?  Hmmm… We address these and other questions in this week’s podcast with Tommie Farrell, hospice physician in West Texas and Chair of the Hospice Medical Director Certification Board, and Kai Romero, Chief Medical Officer for Hospice By the Bay (that’s San Francisco Bay). And I get a re-do attempt at REM’s “Everybody Hurts!”   Apologies for the first attempt!   -@AlexSmithMD

It's Time We Started Talking Openly About Near-Death Experiences and After Death Communication

  by Scott Janssen "For months as I visited Joe as his hospice social worker, he had remained silent about World War II. Now he was bedbound and dependent on others for help with personal care. The hardest part though was “being stuck in bed with too much time to think.” When I asked what he thought about he started talking about friends killed during the war. These memories, it turned out, had recently begun intruding into his mind and stirring intense feelings of grief and guilt. Talking about combat or other psychologically traumatic events can overwhelm patients, potentially triggering defensive behaviors, intense physiological sensations, or distressing emotions. I was careful not to push too hard, letting Joe decide how much he wanted to unpack. At one point I asked if he had ever thought he was going to die amidst the war’s cataclysmic violence. “All the time,” he said. “Did you ever experience anything unusual? Anything you couldn’t explain?” He asked what I meant. I told

The Problem of Alzheimer's: A Podcast with Jason Karlawish

  Where are we with Alzheimers?  Are we about to see a revolution in how we diagnose and treat it with Amyloid PET scans and the amyloid antibody aducanumab (which is currently on FDA’s desk for approval)?  Or are we still in the same place where there is no meaningfully effective treatment?  Or is it somewhere in between, given the data that we have on comprehensive dementia care? We talk today with Jason Karlawish, a professor of medicine, medical ethics and health policy, and neurology at the University of Pennsylvania Perelman School of Medicine. In addition to being a geriatrician extraordinaire, he is the author of the new book “The Problem of Alzheimer’s: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It.” In addition to talking about PET scans and new drugs like aducanumab, we discuss with Jason about the history of Alzheimers, the history of how we care for and fund caregivers, and where we go from here. So take a listen and che

Pallimed GeriPal virtual party Wed 2/17 6pm PST/9pm EST - RSVP for invite

Short notice, but yes, there will be a Pallimed/GeriPal virtual party this year. Have we planned a lot around this? No. Do we want to see friends and colleagues and meet new people? Yes. Can we do it with minimal expectations? We hope so! We are not sure what to expect, but when we did this in person there was never that much of a plan anyway, except where to go next, and even that was up for improvisation. So what might we do. Probably hang out in different Zoom rooms talking about different subjects, playing games, talking about palliative care things, or maybe not palliative care things. When : Wednesday, Feb 17, 2012 6-8pm PST/9-11pm EST Where : Zoom invite via email sent by email at 5p CT RSVP here so we know how many to expect.   Reserve time on your calendar now! Share this with your friends. Get them registered too.  Keep an eye out on the Twitter accounts of Pallimed and GeriPal just in case this thing goes big and we need to make alternative plans. -Alex, Eric, and friends at

Importance of Function in COVID Prognosis: Podcast with Orestis Panagiotou, Elizabeth White, and Marlon Aliberti

  Nursing home residents have been devastated by COVID.  Somewhere around 40% of deaths from COVID have been among nursing home residents, though they make up just a sliver of the US population. Prognostication among nursing home residents who have COVID is important for a host of reasons - for counseling patients and families about what to expect, for making clinical decisions, and potentially for allocation of scarce resources such as treatments. In today’s podcast, we talk with Orestis Panagiotou and Elizabeth White, the authors of a JAMA IM study that finds that physical and cognitive function are key predictors of mortality prediction for nursing home residents with COVID.  We also talk with Marlon Aliberti, who authored a commentary .   Physical and cognitive function are easy to assess measures that should be routinely captured for older adults, in nursing homes and elsewhere.  Study after study document the importance of function to risk prediction. We also have a brief debate