GeriPal - A Geriatrics and Palliative Medicine Podcast

In this week's podcast we talk with Lew Cohen, MD, about his new book "A Dignified Ending: Taking Control Over How We Die." Eric and I approached reading this book with trepidation. We feared it would be a polemic defending physician aid in dying. It is not. Dr. Cohen does not hide his beliefs and opinions. He also does not shy away from the complexity of the issue - he interviews leading disability rights activists and challenges leaders of the aid in dying movement. His book is filled with stories of the people and family, doctors and activist who have defined this movement. As Eric says, he takes the controversy meter up to 11 with notions of approving aid in dying and euthanasia for progressive neurological conditions such as dementia (with thoughtful safeguards). We challenge Lew, somewhat forcefully at times. Personally, I disagree with many of his stances (as you will hear/read), but I can respect how thoughtfully he's gone about putting together his study of the issue. As Dr. Cohen notes, no issue seems to activate the strong emotion centers of our brain like aid in dying. In this time of extreme polarization, it's critical that we engage in thoughtful and respectful communication about aid in dying. - Alex Smith, MD

In this week's GeriPal podcast we talk with Stacy Fischer, MD and Regina Fink, RN, PhD, both from the University of Colorado, about a lay health navigator intervention to improve advance care planning with Latinos with advanced cancer. The issue of lay health navigators raises several issues that we discuss, including: - What is a lay health navigator? - What do they do? How are they trained? - What do lay health navigators offer that specialized palliative care doesn't? Are they replacing us? - What makes the health navigator intervention particularly appropriate for Latinos and rural individuals? For advance care planning? Eric and I had fun singing in French (yes French, not Spanish, listen to the podcast to learn why). Enjoy! Alex Smith, MD

This week we talk with BJ Miller, hospice and palliative care physician, public speaker, and now author with Shoshana Berger of the book "A Beginner's Guide to the End." As we note on the podcast, BJ is about as close as we get to a celebrity in Hospice and Palliative Care. His TED Talk "What Really Matters at the End of Life" has been viewed more than 9 million times. As we discuss on the Podcast, this has changed BJ's life, and he spends most of his working time engaged in public speaking, being the public "face" of the hospice and palliative care movement. The book he and Berger wrote is filled to the brim with practical advice. I mean, nuts and bolts practical advice. Things like: - How to clean out not only your emotional house but your physical house (turns out there are services for that!) - Posting about your illness on social media (should you post to Facebook) - What is the difference between a funeral home and mortuary - Can I afford to die? How much will it cost? We focus our discussion with BJ on his reasons for writing the book, sexuality and serious illness, and priming people to check the instincts of a medical system that favors aggressive/intensive/invasive care and crappy deaths. And BJ came up with some nice harmonies to "Tonight, You Belong to Me." Enjoy! AlexSmithMD

This weeks podcast is all about the intersection of geriatrics, palliative care, advanced care planning and surgery with our guest Dr. Vicky Tang. Vicky is an assistant professor and researcher here at UCSF. We talk about her local and national efforts focused on this intersection, including: * Her JAMA Surgery article that showed 3 out of 4 older adults undergoing high risk surgery had no advance care planning (ACP) documentation. * Prehab clinics and how ACP fits into these clinics * The Geriatric Surgery Verification Quality Improvement Program whose goal is to set the standards for geriatric surgical care including ACP discussions prior to surgery * How frailty fits in and how to assess it (including this paper from JAGS on the value of the chair raise test) So take a listen and enjoy this informative podcast. You can also check out associated links that can be found in this podcast on our website at: https://www.geripal.org/2019/06/advance-care-planning-before-major-surgery.html

There are few names more closely associated with palliative care than Diane Meier. She is an international leader of palliative care, a MacArthur "genius" awardee, and amongst many other leadership roles, the CEO of the Center to Advance Palliative Care (CAPC). We were lucky enough to snag Diane for our podcast to talk about everything we always wanted to ask her, including: * What keeps her up at night? * Does palliative care need a national strategy and if so why and what would it look like? * The history of CAPC and the leadership centers * Advice that she has for graduating fellows who want to continue to move palliative care forward as they start their new careers * What she imagines palliative care will look like in 10 or 15 years? * What is the biggest threat facing palliative care? We hope you join us for this great podcast!

In this week's podcast, we talk with Dr. Ira Byock, a leading palliative care physician, author, and public advocate for improving care through the end of life. Ira Byock wrote a provocative and compelling paper in the Journal of Pain and Symptom Management titled, "Taking Psychedelics Seriously." In this podcast we challenge Ira Byock about the use of psychedelics for patients with serious and life-limiting illness. Guest host Josh Biddle (UCSF Palliative care fellow) asks, "Should clinicians who prescribe psychedelics try them first to understand what their patient's are going through?" The answer is "yes" -- read or listen on for more!

Louise Aronson, a Professor of Geriatrics at UCSF and author of 'Elderhood,' discusses her rich experiences in the field of aging. She explains the significance of the term 'Elder' versus 'older adult' and critiques its impact on societal views. Louise passionately addresses ageism, challenging narratives that diminish the value of older adults. She advocates for a broader understanding of geriatrics, emphasizing healthy aging for all and not just the frail. The conversation also touches on historical perspectives and celebrates the wisdom of elderhood.

In this week's GeriPal podcast we discuss the research into delirium with a focus on prevention. We are joined by internationally acclaimed delirium researcher Sharon Inouye, MD, MPH. Dr Inouye is Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center in the Institute for Aging Research at Hebrew SeniorLife.

Estimating prognosis is hard and clinicians get very little training on how to do it. Maybe that is one of the reasons that clinicians are more likely to be optimistic and tend to overestimate patient survival by a factor of between 3 and 5. The question is, aren't we better as palliative care clinicians than others in estimating prognosis? This is part of our training and we do it daily. We got to be better, right?

On today's podcast we talk with one of the national experts on multimorbidity, Melissa Wei. Dr. Wei is an Assistant Professor and physician researcher at the University of Michigan. In addition to destroying the lyrics to Bohemian rhapsody, we talk to Dr. Wei about how we should conceptualize multi morbidity, it's impact on older adults, and about her recent JAGS publication titled "Multimorbidity and Mental Health-Related Quality of Life and Risk of Completed Suicide."