GeriPal - A Geriatrics and Palliative Medicine Podcast

If you're anything like me, you might find the process of what happens to patients when they visit a radiation oncologist somewhat mysterious. During my training, I didn't receive much education about radiation oncology, and I'm not entirely sure what some of the terms mean (hypofractionated means fewer sessions, right?). Well, today's podcast aims to clear up all these uncertainties. We've invite...

The need for better palliative care in nursing homes is significant. Consider this: the majority of the 1.4 million adults residing in U.S. nursing homes grapple with serious illnesses, and roughly half experience dementia. Many also suffer from distressing symptoms like pain. In addition, about 25% of all deaths in the United States occur within these facilities. Despite these substantial needs,...

Have any of you watched the movie " The Notebook "?  At the end, one of the characters, who has dementia, experiences an episode of lucidity.  When I watched it, between tears (I'm a complete softie) I remember thinking, "Oh no! This will give people false hope!  That their loved one is 'in there.' If only they could find the right key to unlock the lock and let them out." Today we talk about luci...

As you know, dear listeners, I love music. We start each podcast with a song in part to shift the frame, taking people out of their academic selves and into a more informal conversation. Well, today's guests love music at least as much if not more than me, and they each make a strong case for music as medicine. Jenny Chen is a palliative care fellow at Yale who regularly sings for her seriously il...

Our main focus today was on nudging critical care clinicians to consider a more palliative approach to care.  Our guests are all trained in critical care: Kate Courtright, Scott Halpern, and Jaspal Singh.  Kate and Scott have additional training in palliative medicine.   To start. we review: What is a nudge? Also called behavioral interventions, heuristics, and cognitive biases. Prior podcasts on...

We've covered psychedelics on the podcast before—first in 2019 with Ira Byock, where we explored their potential role in medicine , and then again in 2023 with Stacy Fischer, Brian Anderson, and Theora Cimino, focusing on the reasons to approach psychedelic use in patients with caution . In today's episode, we're taking a closer look at the current state of the science around one specific psychede...

Peter Selwyn, one of today's guests, has been caring for people living with HIV for over 40 years.  In that time, care of people with HIV has changed dramatically.  Initially, there was no treatment, then treatments with marginal efficacy, complex schedules, and a tremendous burden of side effects and drug-drug interactions.  The average age at death was in the 30s. Now, more people in the US die...

More and more people are, " doing their own research. "  Self-identified experts and influencers on podcasts (podcasts!) and social media endorse treatments that are potentially harmful and have little to no evidence of benefit, or have only been studied in animals.  An increasing number of federal leaders have a track record of endorsing such products. We and our guests have noticed that in our c...

I read Farah Stockman's article in the NYT on why attacks on DEI will cost us all , and thought, "Yes, and 'everyone' includes harm to our healthcare workforce, our patients, and their families." So we're delighted that Farah Stockman, pulitzer prize winning journalist, author of American Made: What Happens to People When Work Disappears , and editorial board member at the New York TImes joins us...

Early in my research career, I was fascinated by the (then) frontier area of palliative care in the emergency department.  I asked emergency medicine clinicians what they thought when a patient who is seriously ill and DNR comes to the ED, and some responded, (paraphrasing), what are they doing here? This is not why I went into emergency medicine. I went into emergency medicine to act. I can't do...

Whelp, goodbye folks!  Eric and I have been DOGE'd. In a somewhat delayed April Fools, Nancy Lundebjerg and Annie Medina-Walpole have taken over podcast host duties this week. Their purpose is to interview me, Eric, and Ken Covinsky about your final AGS literature review plenary session taking place at the Annual Meeting in Chicago this May (for those attending, our session is the plenary the morn...

A pragmatic trial evaluates the effectiveness of a treatment or intervention in "real-world" clinical practice.  Outcomes are typically assessed from available records.  Eligibility in pragmatic trials are often broad, and don't have the exclusions of efficacy studies, which examine treatment effects under highly controlled conditions in highly select populations. Today we are delighted to welcome...

Eric and Alex have featured discussions about complex bioethical concepts around caring for people at the end of life, including voluntarily stopping eating and drinking ( VSED ), and multiple episodes about the ethical issues surrounding medical aid in dying ( MAID ). Recently, discussion has emerged about how these issues intertwine in caring for patients with advancing dementia who have stated...

As far as we've come in the 50 years since Balfour Mount and Sue Britton opened the first palliative care at the Royal Victoria Hospital in Quebec, have we lost something along the way? In today's podcast we welcome some of the early pioneers in palliative care to talk about the roots of palliative care.  Sue Britton was the first nurse hired on that palliative care unit. Michael Kearney on a tran...

I was very proud to use the word " apotheosis " on today's podcast.  See if you can pick out the moment.  I say something like, "Palliative care for people experiencing homelessness is, in many ways, the apotheosis of great palliative care."  And I believe that to be true.  When you think about the early concepts that shaped the field, you can see how palliative care for persons experiencing homel...

Much like deprescribing , we plan to revisit certain high impact and dynamic topics frequently.  Substance use disorder is one of those complex issues in which clinical practice is changing rapidly.  You can listen to our prior podcasts on substance use disorder here , here , here , and here . Today we talk with experts Janet Ho, Sach Kale, and Julie Childers about opioid use disorder and serious...

Trauma is a universal experience, and our approach as health care providers to trauma should be universal as well. That's my main take-home point after learning from our three guests today when talking about trauma-informed care, an approach that highlights key principles including safety, trustworthiness, peer support, collaboration, empowerment, and cultural sensitivity. With that said, there is...

In today's podcast we were delighted to be joined by the presenters of the top scientific abstracts for the Annual Assembly of the American Academy of  Hospice and Palliative Medicine ( AAHPM ) and the Hospice and Palliative Medicine Nurses Association ( HPNA ).  Eric and I interviewed these presenters at the meeting on Thursday (before the pub crawl, thankfully).  On Saturday, they formally prese...

Things are changing quickly in the Alzheimer's space. We now have biomarkers that can reasonably approximate the degree of amyloid build-up in the brain with a simple blood test.  We have two new FDA-approved medications that reduce that amyloid buildup and modestly slow down the progression of the disease.  So, the question becomes, what, if anything, should we do differently in the primary care...

It is a battle royale on this week's GeriPal podcast. In one corner, weighing in at decades of experience, well known for heavy hits of bedside assessments, strong patient-family relationships, and a knockout punch of interdisciplinary collaboration, we have in-person palliative care consults. But watch out! Travel time can leave this champ vulnerable to fatigue and no-shows.  In the other corner,...

It's another deprescribing super special on today's GeriPal Podcast, where we delve into the latest research on deprescribing medications prescribed to older adults. Today, we explore four fascinating studies highlighting innovative approaches to reducing medication use and improving patient outcomes. In our first segment, we discuss a study led by Constance Fung and her team, which investigated t...

Many older adults lose decision-making capacity during serious illnesses, and a significant percentage lack family or friends to assist with decisions. These individuals may become "unrepresented," meaning they lack the capacity to make a specific medical decision, do not have an advance directive for that decision, and do not have a surrogate to help. In today's podcast, we talk with Joe Dixon, T...

We've talked a lot before about integrating psychiatry into palliative care (see here and here for two examples). Still, we haven't talked about integrating palliative care into psychiatry or in the care of those with severe mental illness. On this week's podcast, we talk with two experts about palliative psychiatry. We invited Dani Chammas , a palliative care physician and psychiatrist at UCSF (a...

Surrogate decision making has some issues.  Surrogates often either don't know what patients would want, or think they know but are wrong, or make choices that align with their own preferences rather than the patients.  After making decisions, many surrogates experience regret, PTSD, and depressive symptoms.  Can we do better? Or, to phrase the question for 2024, "Can AI do better?" Follow that pa...

We've covered stories before.  With Liz Salmi, Anne Kelly, and Preeti Malani we talked about stories written up in the academic literature, such as the JAMA Piece of My Mind series.  We talked with Thor Ringler, who helped found the My Life My Story Project at the VA and beyond, and Heather Coats about the evidence base for capturing patient stories. Today's podcast is both similar and different. ...