The Integrative Palliative Podcast

Everyone should have an advanced directive. Full stop. You, your parents, your partner, your adult kids - everyone. Most people know that having an advance directive is important but they feel awkward or anxious about actually making it happen. I've seen patients with stroke have a terrible outcome from a poorly done advance directive. And I've seen family members of people with cancer s...

What have you been avoiding? Is there a courageous conversation you should be having? A boundary you should be setting? A household task that needs to be completed? I wrote Coping Courageously: A Heart-Centered Guide for Navigating a Loved One’s Illness Without Losing Yourself about a year ago and I never recorded the audio book! I meant to. I wanted to. But I just never made it happen - until thi...

Dr. Janet Abrahm is a Fellow of the American Academy of Physicians, Fellow of the American Academy of Hospice and Palliative Medicine, and a Fellow of the American Society of Clinical Oncology. She is a Professor of Medicine at Harvard Medical School, a former practicing oncologist, and an internationally recognized expert in supportive and palliative care for patients with cancer. She has over 20...

Physicians are expert learners, yet many have the feeling that they can't be entrepreneurs. This week, Nneka Unachukwu, MD (affectionately known as "Dr. Una") will convince you that you can learn the skills to become a physician entrepreneur or a physician "intrapreneur" and create the life that you want. If you have a tiny voice inside that dreams of starting a business o...

Talking about advance directives, goals of care, and end-or-life wishes can be scary. Even if the conversation doesn't scare you, finding the right time and the right way to bring it up can be a challenge. This week I share my own recent experience of having a goals of care conversation with a loved one, and give practical guidance for how to get started with your own courageous conversations...

In this episode, Katie Joy Duke (@katiejoyduke) shares her wisdom as a woman and life coach who experienced treatment for stage IV breast cancer. She shares the tough parts and the growth parts, including her decision to pursue an aesthetic flat closure rather than breast reconstruction. She is open and engaging and wise. I know you'll love learning from her. You can find information about he...

We create much of our own suffering, and I suggest that we all cut that out! Life sends us enough stress and challenge - why would we add to our suffering for now good reason? Expectations can add to our suffering.  Learning to modulate your expectations allows you to stay in the moment and enjoy your experiences, your people, and your moments. Holidays are packed with expectations which can turn...

In the serious illness space, regret is rampant.  Caregivers often regret what they did or didn't do when caring for their loved one with cancer, dementia, or other life-limiting illness. Physicians and other clinicians may regret the goals of care conversations that we meant to have but didn't get around to. Regret is terrible and its negative impact can linger long after the ill person...

Emergency Medicine physicians face life and death situations as part of their normal work day. They train for that! But what about when an ailing person with a very advanced cancer comes to the ED without an advanced directive? What if half the family wants aggressive care and half the family wants to let the patient die peacefully at home? This week's guest is Dan Morhaim, MD who is an accom...

Holidays can be joyful times that bring you together with the people that you love. But what if someone is missing?  Maybe your loved one has died, or maybe someone important to you can't join you for the holidays this year. How do you balance grief with expectations of holiday joy? This week I discuss how to cope with the holidays when someone you love won't be with you. In support and...

We've just had a big election and many people have strong feelings about the result. Some people are happy about the outcome, and others are feeling deeply distressed. In palliative care we are experts at helping people cope with highly unwanted outcomes. We can use some of our palliative care skills to help people cope with their feelings right now. What other tips would you suggest? #meded...

Can you define cisgender? Transgender? Intersex? Gender non-conforming? Do you know the difference between sex and gender? Have you heard of a 'dead name?' Do you know why using "Sir" and "Ma'am" can cause you to be inadvertently hurtful to your patients?  Providing gender affirming care is important but you may not have learned this in school. Join us this week...

Sarah Freeman Smith is a blind inspirational speaker and author, former HR/recruiting leader and disability advocate. She went blind in midlife and in this week's episode of The Integrative Palliative Podcast she shares her journey, the tech that she uses to increase her independence, and guidance for physicians and clinicians to help their visually impaired patients. Rayban Meta smart glasse...

Many patients are embalmed or cremated after death, but this isn't the only option. Embalming and cremation have a negative impact on the environment, and other, more eco-friendly, options are becoming popular. Options such as green burials, human composting, and reef balls give people options for how to handle their loved one's body after death. Do you think that accepting, and even fac...

Many physicians, and other clinicians, are wiped out and burned out. They may wonder if they should stay in medicine, or if there is another path that would make them happier. Yet running away from unhappiness isn't a great strategy because sometimes the unhappiness follows you to your next destination. Dr. Heather Fork is a dermatologist and physician career coach who guides physicians to a...

Sometimes patients or family members express their stress with anger. And when the anger is directed your way you may get defensive or annoyed and it can put a pall on your day. Listen to this week's episode for clear guidance about what to do when your patient gets angry so that both of you leave the visit feeling calm. Coping Courageously: A Heart-Centered Guide for Navigating a Loved One’s...

Don't be afraid to talk about dying. We don't learn to talk about dying and so many people are afraid because they don't know what to say. Here are four key topics to bring up with people who have advanced illness such as progressive metastatic cancer. In patients with Alzheimer's disease or other kinds of dementia, it is important to have these conversations early in the disea...

Mental status changes in hospice patients are extremely common. Yet are they always due to disease progression? If a patient suddenly gets confused or sleeps all day, what should you do? Should you counsel the family that this is normal? Order testing? Assess the medication list? Family members sometimes worry that sending their loved one with advanced cancer, dementia, or other serious illness to...

Your patient is in terrible pain from cancer and you have the tools to relieve it. Yet they won't take the oxycontin or morphine that you prescribed.  You can see that they are suffering yet you feel powerless to help. This is a common scenario and it can lead to discord between you and your patients. You may feel like saying, "Well fine then. I can't force you to help yourself...&q...

Ketamine is in the news right now because Matthew Perry died from improper use of ketamine and his physicians just got arrested for making that possible. It is always a bit shocking when physicians get arrested for prescribing medication. It does seem like his physicians were not acting in accordance with their hippocratic oath - if that's true, shame on them. I do wonder, though, will this m...

We live in a soup of uncertainty and so do our patients and clients. Caring for patients with serious illnesses such as cancer or Alzheimers dementia can be extremely stressful because the experience is filled with uncertainty. Having a clear approach to dealing with uncertainty reduces stress and increases joy.  This week we discuss 4 Dos and 4 Don'ts for dealing with uncertainty in health a...

The LovingKindness, or Metta, meditation (not a typo - that's how it is spelled) is one of my favorite meditations. It offers kindness and healing to you, the people in your life and the world. This week I offer you a LovingKindness meditation for your own wellbeing.  You'll notice that there is no intro or ending because I'd like you to hang on to this meditation to use any time yo...

Leave your heirs the gift of organization.  Estate planning is crucial but many people put it off because they aren't sure how to proceed. Adam Zuckerman is an attorney and entrepreneur who created a company, Buried in Work, after losing his father to cancer. Adam is passionate about making estate planning and end of life preparations as easy as possible for families facing serious illness. H...

We've all had challenging patient or client interactions. It can be hard to know how to handle them and it can make us feel lousy or even derail our day. You want to be an empathetic physician, nurse, therapist, PA or other clinician but how do you balance empathy with boundaries when a patient or family is angry or mean? This week join me to reflect on the 8 steps to managing a challenging p...

Dr. Gary Sprouse is the Less Stress Doc. He is a family physician with expertise in stress management and he's the author of Highway to Your Happy Place: A Roadmap to Less Stress. This week Dr. Sprouse shares tools and insights to help you manage stress, banish guilt and regret, and live a happier life.  You can find more information about Dr. Sprouse at www.thelessstressdoc.com Coping Courag...