GeriPal - A Geriatrics and Palliative Medicine Podcast

Have you ever had that moment when talking to a patient, when you realized that the phrase you just uttered, which you've uttered a hundred times before, came out rote and scripted?  Maybe some phrase you learned from a prominent podcast or VitalTalk?  And in response, the family or patient looked at you like you were from another planet?  Yeah, I've been there too. Josh Briscoe, our guests on tod...

Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of valvular heart disease for patients with severe aortic stenosis, a condition that affects one in ten adults older than the age of 80.  The rates of TAVR have also risen dramatically in the last decade. In 2019, the number of TAVRs exceeded surgical aortic valve replacement (SAVR) in the US for the first time.    On t...

Holly Prigerson recalls the moments in which she started investigating prolonged grief disorder.  She recalls being "a social scientist [Holly] in room a full of psychiatrists," who recognized a diagnostic gap in people experiencing profound and potentially harmful grief far after the death of a loved one.  This led her on a remarkable journey.  Holly has accumulated mountains of evidence for the...

In day-to-day practice, It's hard to imagine providing excellent hospice or palliative care services without access to a team social worker.  Social workers augment a team's ability to provide whole-person care, often aiding to identify and meaningfully address the wide variety of challenges and unmet needs faced by individuals and families facing serious illness. But are we really taking full adv...

Two major shifts are transforming the landscape of hospice. First, private equity firms are gobbling up hospices .  As Melissa Aldridge, a health services researcher and former banker explains, we should be very concerned .  Private equity firms try to turn companies as profitable as possible within 3-5 years.  Thus, they have little in the way of long term vision for hospices, instead focused on...

Today we have the honor of interviewing Susan Block, MD, one of the pioneering leaders in the fields of palliative care, particularly psychosocial aspects of palliative care.  Susan led the Project on Death in America's Faculty Scholars program , used her dual training in internal medicine and psychiatry to shine a light on psychosocial aspects of palliative care, and founded the Department of Psy...

A year ago we did our first "Deprescribing Super Special".  Today we are coming back for more (or less given the content), talking about the following articles with their lead authors: First up, we talk with Ariel Green about her article in JAMA Network on preferred phrases a clinician may use to explain why they should reduce or stop the medication .   My take home from this is that while the mos...

We are fortunate today to interview two oncologists whose research has catapulted palliative care forward: Jennifer Temel, author of the landmark NEJM study on early outpatient palliative care for patients with advanced lung cancer; and Areej El-Jawahri, author of the landmark JAMA article on inpatient palliative care for patients with blood cancers undergoing stem cell transplant.   Jennifer's st...

The science of balancing safety and independence of older drivers has come a long way.  Some key points from our podcast today with Emmy Betz (emergency physician-researcher) and Terri Cassidy (occupational therapist and certified driving rehab specialist) include: It's no longer gouache to say "taking away the keys" - which sound punitive and risks infantilizing  Instead the new lingo is "driving...

"Imagine that you are the medical director of a large (>150 bed) nursing home. Two-thirds of the patients in the home now have COVID-19. Seventeen of your patients are dead. The other physicians who previously saw patients in the nursing home are no longer coming to your facility because you have COVID positive patients. You're short on gowns and facemasks. You're short on nurses and nurse aids so...

On today's podcast we welcome back Haider Warraich to talk about pain.  Now this may surprise our frequent listeners as we have had Haider on before to talk about heart failure as well as palliative inotropes , so why are we having him come on to talk about pain?  .   Well, Haider has an intimate relationship with pain, having experienced chronic pain himself and now having dove deep into the late...

You have a patient with dementia severe enough that she cannot recognize relatives.  She falls and breaks her hip.  Should she have an operation, and risk the pain, potential complications, and attendant delirium associated with the operation?  Should she be treated non-operatively, with aggressive symptom management?  A huge part of this decision rests on (1) her previously stated wishes, values,...

Cancer screening is designed to detect slow growing cancers that on average take 10 years to cause harm.  The benefits of mammography breast cancer screening rise with age, peak when women are in their 60s, and decline thereafter. That is why the American College of Physicians recommendation regarding mammography for women over age 75 is:  In average-risk women aged 75 years or older or in women w...

There are a lot of old myths out there about managing urinary tract symptoms and UTI's in older adults.  For example, we once thought that the lower urinary tract was sterile, but we now know it has its own microbiome, which may even provide protection against infections. So giving antibiotics for a positive urine culture or unclear symptoms may actually cause more harm than good.   On today's pod...

In the US, geriatrics "grew up" as an academic profession with a heavy research base.  This was in part due to the tremendous support of the National Institute on Aging.  Clinical growth of geriatrics programs has lagged academic research, despite the rapid aging of the population.  Palliative care, in contrast, saw explosive growth in US hospitals .  In contrast to geriatrics, the evidence base f...

We are two and a half years into the COVID pandemic.  We've lived through lockdowns, toilet paper shortages, mask mandates, hospital surges where ICU's overflowed, a million COVID deaths, prolonged school closures, development and roll out of novel vaccines, an explosion of social isolation and loneliness, and the invention of the "zoom meeting."  But what have we really learned over this seemingl...

It's been a while since we've done a Covid/bioethics podcast (see prior ethics podcasts here , here , here , and here ).  But Covid is not over and this pandemic keeps raising challenging issues that force us to consider competing ethical considerations.   This week, we discuss an article by bioethicists Govind Persad and Emily Largent arguing that the NIH guidance for allocation of Paxlovid durin...

A patient is on morphine and you want to convert it to another opioid like hydromorphone (dilaudid).   How do you do that?  Do you do what I do, pull out a handy-dandy opioid equianalgesic table to give you a guide on how much to convert to?  Well on today's podcast we invited Drew Rosielle on our podcast who published this Pallimed post about why opioid equianalgesic tables are broken and why we...

In today's podcast we talk with Dr. Rajagopal (goes by "Raj"), one of the pioneers of palliative care in India.  Raj is an anesthesiologist turned palliative care doctor.  He is also author of the book, " Walk with the Weary: Lessons in Humanity in Health Care ," and was featured in this Atlantic article .  Raj is the founder of Pallium , an organization dedicated to improving palliative care thro...

Think about the last time you attended a talk on communication skills or goals of care discussions.  Was there any mention about the impact that hearing loss has in communication or what we should do about it in clinical practice?  I'm guessing not.  Now square that with the fact that age-related hearing loss affects about 2/3rd of adults over age 70 years and that self-reported hearing loss incre...

Comics. Cartoons. Graphic Novels. Graphic Medicine.  I'm not sure what to title this podcast but I've been looking forward to it for some time.  Heck, I'm not even sure to call it a podcast, as I think to get the most out of it you should watch it on YouTube. Why, because today we have Nathan Gray joining us.  Nathan is a Palliative Care doctor and an assistant professor of Medicine at Johns Hopki...

In celebration of National Poetry Month , we are delighted to share with you the second podcast in our series on poetry and medicine.  In the first podcast, we talked with Guy Micco and Marilyn MacEntyre about poetry and aging . In this second part in our series, we welcome Mike Rabow and Redwing Keyssar to talk about palliative care and poetry.   As with aging, poetry operates on multiple levels...

Buprenorphine.  It's been around for a long time but is acting like the hot new kid in town.  Just look at this year's AAHPM meeting, where it felt like every other session was talking about how hot buprenorphine is right now.  But does this drug really live up to the hype? On today's podcast we talk with three experts on buprenorphine on why, when, and how to use it in serious illness. Our expert...

In her essay " Why Read a Poem in a Time Like This? ", Marilyn McEntyre writes: All of us need it. We need it because good poems do something prose can't do. They invite and enable us to notice the precarious fissures in what we think is solid ground. They direct us toward the light at the edge of things — the horizon, the fragment of dream before dawn, the feeling that's hard to name, and can onl...

One of my favorite Piece of My Mind essays in JAMA is by Rebecca Sudore, titled, " Can We Agree to Disagree? "  And today our guests agree to disagree.   And yet, and yet… They also agree across a whole range of issues, some of which surprised us. This is the latest in our series of podcasts on concerns about, and potential of advance care planning.  If you're new to this discussion, don't start w...