Episodes
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 throughout India.  We are joined by guest-host Tom McNally, a rehab and pediatric palliative care doc at...
Published 05/12/22
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 increases during the last years of life.   Screening for addressing hearing loss should be an...
Published 05/05/22
Published 05/05/22
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 Hopkins. He uses comics and other artwork to share his experiences in palliative care and educate...
Published 04/28/22
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 within the palliative care space.   Poetry puts us in our patient’s shoes. As Redwing’s poem...
Published 04/21/22
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 experts include Katie Fitzgerald Jones (palliative nurse practitioner and doctoral student at Boston...
Published 04/14/22
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 only be accurately captured by metaphor. They take us to the edge of “what can’t be said,” and ambush...
Published 03/31/22
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 with this podcast!  Start by reading this article by Sean Morrison, Diane Meier, and Bob Arnold...
Published 03/24/22
If you develop dementia, odds are you will spend the last months to years of your life in a nursing home or assisted living facility.   While we like to think about how our goals and preferences will influence what that life looks like, including whether you will get potentially burdensome interventions, your fate is probably influenced more by factors like where you live and what nursing home you happen to end up in.  On today’s podcast we dive into drivers of invasive procedures and...
Published 03/10/22
A little over a decade ago, Ken Covinsky wrote a GeriPal post about a Jack Iwashyna JAMA study finding that older adults who survive sepsis are likely to develop new functional and cognitive deficits after they leave the hospital. To this day, Ken’s post is still one of the most searched and viewed posts on GeriPal. This idea that for critically ill patients in the ICU, geriatric conditions like disability, frailty, multimorbidity, and dementia should be viewed through a wider lens of...
Published 03/03/22
There is a lively debate going on in academic circles about the value of Advance Care Planning (ACP).  It’s not a new debate but has gathered steam at least in palliative care circles since Sean Morrisons published a JPM article titled “Advance Directives/Care Planning: Clear, Simple, and Wrong.”  Since then there has been a lot of back and forth, with even a couple of podcasts from us, several JAMA viewpoints, and most recently a series of published replies from leaders in the field on why...
Published 02/24/22
My mom is an Asian woman in her 70s with osteoporosis.  She tried an oral bisphosphonate and had horrible esophagitis.  She said never again, though she eventually tried an IV bisphosphonate.  She had terrible flu-like symptoms.  She said never again.  But based on reports that symptoms are worse the first time, she tried the IV again the next year and fortunately experienced no symptoms.  (Story used with permission, thanks mom!).   I tell this story because these issues don’t typically...
Published 02/17/22
This week many of our listeners will gather for the annual American Academy of Hospice and Palliative Medicine (AAHPM) & Hospice and Palliative Nursing Association (HPNA) annual meeting.  While the majority of this meeting is focused on subspecialty care in the US, the majority of individuals who are in need of palliative care live in low and middle-income countries without even basic access to palliative care.   On this week's podcast, we talk with three leaders in helping improve...
Published 02/10/22
In prior podcasts we talked about racism and COVID, lack of diversity in the palliative care workforce, racial and ethnic differences in end of life care, and implicit bias in geriatrics and palliative care. Today our focus is on structural, institutional, and interpersonal racism, and how these different but related constructs negatively impact the care of older adults and people with serious illness.   We are joined by Deborah Ejem, a medical sociologist and Assistant Professor in the...
Published 02/03/22
Patients with end stage liver disease and decompensated cirrhosis have an average life expectancy of 2 years without transplant.  Outcomes are worse among those who are frail.  Symptoms are common, including pain, ascites, encephalopathy, and pruritus.  Patients with end stage liver disease are often some of the most disadvantaged patients we care for.  Caregiver burden is immense; divorce is common.  Some will go on to receive a transplant, but many will not.  Many are confused about the...
Published 01/27/22
More Health Policy this week! Today, we discuss “SNPs” but this is not a podcast about haircuts during the pandemic. We take a deeper dive into the world of Medicare Advantage and what it means for vulnerable patients facing serious illness and those at the end of life.  We are joined by UCSF geriatrics fellow Alex Kazberouk to talk to Dr. Claire Ankuda (Assistant Professor at Icahn School of Medicine at Mount Sinai and Palliative Care Physician) and Dr. Cheryl Phillips (President and CEO of...
Published 01/20/22
Investor money and venture capital funding is pouring into Medicare Advantage (MA) plans. Enrollment in MA plans has more than doubled from 12 million members in 2011 to 26 million in 2021. What does this mean for us and our patients? Do these plans deliver better care for vulnerable older adults? Or are they a money making machine driving up healthcare costs in the name of profit?  On today’s podcast, we are joined by UCSF geriatrics fellow Alex Kazberouk to talk with Dr. Don Berwick...
Published 01/13/22
Three months ago we did a podcast with Randy Curits about his recent diagnosis of ALS in March and what it was like for someone who studies and cares for people living with serious illness, to now be someone who is living with serious illness.  It was one of our favorite podcasts we’ve done, but also got us to think “wait, how come we’ve never done a podcast on ALS?” We fix that on today’s podcast.  We’ve invited Elizabeth Lindenberger and Kara Bischoff to talk about what every geriatrician...
Published 01/06/22
It’s GeriPal’s 200th episode.  Yup, we started the podcast in 2016 and over the years we have grown from basically podcasting for Alex’s mom to now getting over 25,000 plays per month.    So to celebrate our 200th, and given that the last two years kinda sucked in a lot of ways, we are going to pivot to appreciative inquiry.  We have invited leaders in geriatrics and palliative care to quickly share: One thing that you are grateful for in Geriatrics and Palliative Care (other than...
Published 12/30/21
Geriatric Oncology has arrived. Yes, Louise Walter has been leading the fight to improve cancer screening in older adults for years. But when it came to geriatricizing the way we assess and treat older adults with cancer, the evidence was thin. In our prior podcast with Supriya Mohile and William Dale on geriatric assessment in oncology, we couldn’t say for certain if a geriatric assessment was helpful for patients with cancer. Well now we can.
Published 12/16/21
When older adults experience a hip fracture, there’s a growing consensus that spinal anesthesia offers superior outcomes compared to general anesthesia. It’s surprising therefore, to talk with Mark Neuman about the results of his randomized trial in NEJM, which finds essentially no difference between general anesthesia and spinal.
Published 12/10/21
In today’s podcast, we talk with Janet Bull and Arif Kamal about what we can do to address burnout and increase resiliency, both from an institutional and individual perspective. Janet Bull is the Chief Medical Officer and Chief Innovations officer at Four Seasons Hospice and Arif Kamal is an oncologist, palliative care doctor and researcher at Duke.
Published 12/02/21
On today’s podcast, we break down spiritual care in palliative care with three leaders in the field: Allison Kestenbaum, Katy Hyman, and Paul Galchutt.
Published 11/24/21
We talk with Wes Ely about his book (autobiography) of a critical care doctor’s horror and shame at discovering that his ICU practice of heavily sedating patients for days on end was leading to lifelong physical, cognitive, and psychological harm; and the arc of his redemptive journey to find a better way to care for patients in the ICU. We are joined today by Lekshmi Santhosh, head of UCSF’s post-COVID and post-ICU clinic, to interview Wes about these themes that animate his book.
Published 11/18/21
Anyone who cares for individuals with serious illness must live in a messy space where tough conversations about treatment decisions are common and complicated.   On today’s podcast we talk with James Tulsky about living in this messy space of medical decision making and the challenges that come with communication around advanced treatment decisions.  We talked about James’ path to the work that he has done, including early studies he did that included audio recording DNR discussions...
Published 11/11/21