GeriPal - A Geriatrics and Palliative Medicine Podcast

Do we need an RCT to establish the worth of chaplaincy? Einstein once said, "Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted." A friend of GeriPal, and prior guest, Guy Micco commented today that we need an RCT for chaplaincy is like the idea that the humanities need to justify their value in medical training: "It's like being told to...

Two weeks ago on the GeriPal podcast we talked about why and how to write for the general public .  This week we've invited three guests to share their stories about storytelling that's written for healthcare providers. The first guest is Liz Salmi.  Liz wrote a fabulous perspectives piece in the NEJM titled " Deciding on My Dimples " which talks about her experience as a patient doing shared deci...

In November of 2022, Ava Kofman published a piece in the New Yorker titled "How Hospice Became a For-Profit Hustle."   Some viewed this piece as an affront to the amazing work hospice does for those approaching the end of their lives by cherry picking stories of a few bad actors to paint hospice is a bad light. For others, this piece, while painful to read, gave voice to what they have been feelin...

So you want to write a book. So you want to write a book!  So…you want to write a book?!? Today we talk with two geriatricians:  Rosanne Leipzig , author of Honest Aging: An Insider's Guide to the Second Half of Life; and Louise Aronson , author of Elderhood: Redefining Aging, Transforming Medicine, and Reimagining Life. (You can hear our prior podcast on Louise's book here ).  We talk with them a...

Psychedelics are having a moment.  Enthusiasm is brimming.  Legalization is moving forward in several states , following the lead of Oregon and Colorado.  FDA is considering approval, shifting away from Schedule I restrictions, paving the way for use in clinical practice.  Potential use in palliative care , chronic pain , and for mood disorders is tantalizing. Early data on efficacy in patients wi...

Gabapentin is the 10th most prescribed drug in the United States and use is increasing.  In 2002, 1% of adults were taking gabapentinoids (gabapentin and or pregabalin).  By 2015 that number increased to 4% of US adults. There are a lot of reasons that may explain the massive increase in use of these drugs.  One thing is clear, it is not because people are using it for FDA approved indications.  T...

You know when you walk out of a patient's room and have that sense, "This isn't going to go well." The patient is sick and getting sicker, and refuses to let you talk with family or other members of her inner circle.  Should you stop at "no?"  Today we talk with Anne Rohlfing, Lynn Flint, and Anne Kelly, authors of a JGIM article on the reasons we shouldn't stop at "no."  We owe it to the patient...

Think about the last time a patient yelled at you in anger.  How did you react?  The last time this happened to me I immediately went on the defensive despite years of training in serious illness communication skills.  Afterwards, I thought there must be a better way. Well on today's podcast we invite two of our favorite palliative care psychiatrists, Dani Chammas and Keri Brenner, to teach us abo...

Amber Barnato is an expert in simulation studies.  A health services researcher and palliative care physician, Amber lauds the ability of simulation studies to isolate one variable in a study.  For example, we spend the first half talking about a RCT simulation study of clinician verbal and non-verbal communication with a seriously ill patient with cancer. In one room the physician under study int...

Sometimes you read a book and get a flash of insight - that "ah ha!" moment - about yourself and the ways you interact with others.  That happened to me when reading "Range: Why Generalists Triumph in a Specialized World."  It helped me to understand and justify my interest in (this won't surprise you) EVERYTHING related to geriatrics or palliative care.  Also hat tip to Matthew Growdon for recomm...

The Covid epidemic laid bare two major structural issues.  First, Black and Latinx persons experienced much higher rates of mortality than other groups.  Second, as we discussed in last week's podcast , older adults, particularly those in nursing homes, were far more likely to die than younger individuals.  These are structural issues because the fundamental causes of these issues were not biologi...

In April 2022, the National Academies of Sciences, Engineering and Medicine (NASEM) issued a report on how the United States delivers, regulates, finances, and measures the quality of nursing home care. It's massive with over 600 pages detailing everything from the history of nursing home care in the United States to the latest issues that nursing homes have had to face with COVID-19. On today's p...

Acute Care for Elders (ACE Units) have been around for over a quarter of a century. Randomized trials of ACE units date back to 1996 when Seth Landefeld and colleagues published a study in NEJM showing that they improve basic activities of daily living at discharge and can reduce the frequency of discharge to long-term care institutions.  But if ACE units are so great, why do so few hospitals have...

Today's podcast may be a stretch for our listeners.  Please stick with us.  No matter what your position on medical aid in dying (I'm ambivalent) or abortion (I'm pro-choice), this is a bioethics podcast, and I hope that we can all agree that the ethical issues at stake deserve a critical re-think.  All three of today's guests are well established bioethicists.   Let me start by quote/paraphrasing...

From discussing "taking away the keys to the car" for a cognitively impaired older adult to decisions to limit life sustaining treatments at the end of life, conflict and disagreement permeate everything that we do in medicine.  How well though are we taught to handle conflict and disagreement?  I'd say not well as I don't think I've ever received a formal talk on the issue. On today's podcast we...

We've talked at length on prior podcasts about the failures of aducnumab, Biogen, and the FDA's decision to approve it.   But wait, there's a shiny new anti-amyloid drug, lecanemab!  (No it's not just the French version of Aducanumab).   In an article in the NEJM (a published article this time, wonder of wonders!) lecanemab was shown to slow the rate of cognitive decline by 0.45 points on an 18 po...

Eric and I weren't sure what to call this podcast  - storytelling and medicine? Narrative medicine?  We discussed it with today's guests Heather Coats, palliative care NP-scientist, and Thor Ringler, poet.  It wasn't until the end that the best term emerged - storycatching.  Because that really is what this is about.  Clinicians "catching" patient life stories.    What's in a story?  Well, as we l...

What would it take to transform dementia care?  While a lot of hope and money is being put into new monoclonal amyloid antibodies like lecanemab, the evidence is that while they are great in reducing amyloid in the brain for those with early Alzheimer's disease, the effects are at best modest in slowing down the decline in cognition and function (more to be said on that in an upcoming podcast). In...

Assisted Living Communities (no longer preferable to call them Assisted Living Facilities, as we learned on the podcast) are…what, exactly?  That's the central question on today's podcast.  The problem is the tremendous heterogeneity in services offered and quality of care.  If you've seen one Assisted Living Community you've seen one Assisted Living Community.  To address this question, we talk w...

Health care professionals are human, and as humans we experience loss both in and out of work.  You'd imagine though that our professional expertise and experiences in helping patients and families cope with loss and grief would be helpful in managing our own personal losses.  Turns out, it's maybe not. That was the lesson I learned from reading a new book edited by Matt Loscalzo along with Marsha...

Dr. Faith Fitzgerald once quipped that prognostic modeling is the "punctilious quantification of the amorphous."  She has a point.  Prognosis is inherently uncertain.  As Alex Lee says on our podcast today, all prognostic models will be wrong (in some circumstances and for some patients); our job is to make prognostic models that are clinically useful.  As Sei Lee notes, the argument for developin...

The Department of Health and Human Services helps to guide billions of dollars in investment and direction in research, policy, and health care. The Assistant Secretary for Planning and Evaluation (ASPE), within the HHS, is the principal advisor to the Secretary of HHS on health policy, ranging from legislation to strategic planning to research. How does this relate to aging policy and research? H...

When I'm on service these days there is inevitably a moment when a resident says "Patient so-and-so is on X" - and I have absolutely no idea what X is.  Modern subspecialist practice advances at such a remarkably rapid pace, it can be hard to keep up. In this context, we're excited to hear from infectious disease experts and nephrologists about updates in the care of older adults.  Sonali Advani a...

Earlier this year palliative care was the correct response to the following clue on the game show Jeopardy: From a Latin word for "to cloak", it's the type of care given to seriously ill patients to provide comfort without curing What struck me most was not that palliative care was a question, nor that it made it seem that palliative care isn't provided alongside care directed at curing, nor was i...

Have you had difficulty managing a particular type of cancer pain?  For me it's radiation induced mucositis/esophagitis.  Janet Abrahm is one of the world's experts in pain and symptom management for patients with cancer joins us to talk about (among other things): Ketamine for hyperalgesia and allodynia, how to treat dissociative side effects Lidocaine: worth the hype? Strengths and weaknesses of...