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Addressing The Range of Patient Beliefs About COVID-19
by Lyle Fettig (@FettigLyle)I ’ve been thinking about my role as a physician in responding to skepticism about a range of COVID topics, especially as we approach the holidays and all the tension about difficult recommendations to forgo traditional Thanksgiving dinners. As I think about our current situation, I can’t help but recall an encounter I had with a patient many years ago.In winter 2008 after President Obama was first elected, I saw a woman in clinic who said she was disappointed by the election result. She cited a jaw dropping falsehood about what she thought his election would mean for healthcare, and especia...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 21, 2020 Category: Palliative Care Tags: communication covid fettig Source Type: blogs

Chlorpromazine in Delirium FTW!
by Drew Rosielle (@drosielle)David Hui, Eduardo Bruera, and colleagues havepublished another important delirium trial out of MD Anderson which I thought was worth blogging about in detail.In some ways it ' s related to thesame group ' s RCT a few years ago of lorazepam added to haloperidol for agitation in hospitalized advanced cancer patients with delirium (showing the lorazepam quite effectively reduced agitation via presumably a sedating effect). As I pointed out in the Palllimed post about that trial, while they labeled their patient group as ' agitated delirium in advanced cancer ' , in essence it was really a sedatio...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 23, 2020 Category: Palliative Care Source Type: blogs

Patient Access to Notes is Coming! Is Palliative Care Ready?
by Christian Sinclair (@ctsinclair)Patients and families across the US are about to get a close look under the hood of electronic health records in just a few weeks. Starting in November, the21st Century CURES Act is putting in place the rules for patient access to their health records including the clinical notes of the clinicians. Your organization is possibly planning for this new access to be flicked on like a light switch in the inky dark of night. Some of you may be shocked and seeing this for the first time, some of you have seen glimmers, some of you are well prepared, and some have had your eyes long adjusted and ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 19, 2020 Category: Palliative Care Tags: opennotes sinclair Source Type: blogs

Obstetrics and Gynecology Needs Palliative Care
by Nathan Riley " Can you all, please, just leave us alone? "One particular experience with the death of a newborn stands out in my mind. Moments after birth the baby was breathless, and the neonatology team could not intubate. All of the kingdom ’s pediatric surgeons and other specialists rushed to labor and delivery to no avail. The baby was born with a four centimeter gap in his trachea, an irreparable condition. The mother sat there, holding her dying baby as he took his last breaths while physicians, nurses, and residents were busy as usual. Click-clacking away on computers. Adjusting blankets. Asking questions...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 24, 2020 Category: Palliative Care Tags: gynecology obstetrics palliative care pediatrics prenatal riley Source Type: blogs

Why Writing Down the Good Stuff Can Keep Out the Bad
by Michala Ritz and colleaguesIn today ’s current world of social isolation and virtual EVERYTHING, it is easy to get sucked down an endless rabbit hole of negativity, sad stories of sickness and death, and scary projections of the future. It is now normal to wake up, wonder about family and friends near and abroad, and monitor the vol atile stock market – all while sipping our morning coffee worrying what bad news tomorrow may bring.Those lingering questions keep us up at night, like monsters under our beds.“What if I lose my job?”“What if my parents contract COVID?”“How will my patients do with all of this?...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 21, 2020 Category: Palliative Care Tags: covid friedman gratitude kamal nicolla ritz shin The profession Source Type: blogs

Moral Distress and COVID-19: Worlds Collide
by Vickie Leff (@VickieLeff)As a clinical social worker, I am often approached by my medical colleagues asking for support and a listening ear around difficult cases, understanding their own reactions, team dysfunction, and moral distress. In the middle of this COVID pandemic, Social Workers, Chaplains, Nurses, Physicians, Respiratory Therapists, Child Life Specialists, etc. are all likely experiencing an increase in moral distress. This is due to the necessary change of focus from “patient-centered” to “community -based” approach, and resource allocation issues such as PPE shortage, health inequities, visitation l...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 14, 2020 Category: Palliative Care Tags: covid hapc hpm leff moral distress social work social worker Source Type: blogs

Book Review: " From Here To Eternity: Traveling the World to Find the Good Death " by Caitlin Doughty
by Jared Rubenstein (@DrJRubenstein)Caitlin Doughty is a mortician, funeral home owner, author, and activist who strives to instill more death positivity into our classically death-avoidant culture. Through her writing, websitecaitlindoughty.com,podcast andnumerous YouTube videos she utilizes her signature voice and style to both educate and entertain. In her book,From Here To Eternity: Traveling the World to Find the Good Death, Ms. Doughty treats the author to a whirlwind tour of different cultural practices around death throughout the world. In equal parts travelogue and ethnography, the reader gets to experience eight ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 31, 2020 Category: Palliative Care Tags: book review Source Type: blogs

Prioritizing in Palliative Medicine: Why Quality of Life Suffers with Racism
by Michelle Christopher and Sonia Malhotra (@SoniaMKhunkhun)The silence was palpable. Two of us continued to speak about our concerns about the way Black lives were treated and how important it was to address these concerns among us for the betterment of our patients. If we couldn ’t understand this among colleagues, how would we ever understand what our patients, a predominantly Black population at a safety net hospital, went through?- - - - - - - - - - - - -As the COVID pandemic started and we saw the first surge of patients flood our hospitals, we watched our patients, colleagues and broader community come together to...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 13, 2020 Category: Palliative Care Tags: christopher malhotra race The profession Source Type: blogs

I see you. I'm grateful.
by Holly Yang (@hollyby)Thoughts as I drove to work at the hospital today:For people and families who stay 6 feet away and wear a mask, buff, or bandana when they work out near others, enjoy busy outdoor spaces, or walk their dog, I see you. I ’m grateful.For grocery, retail, postal, delivery, restaurant and all other essential workers who take care of us with careful hygiene, clean spaces, and by showing up and being professional despite encountering lots of stressed out people, I see you. I ’m grateful.For good citizens who are kind and respectful to grocery, retail, postal, delivery, restaurant and all other essenti...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 30, 2020 Category: Palliative Care Tags: covid yang Source Type: blogs

National Healthcare Decisions Day in the Era of COVID
by Emily Riegel (@emriegel)“Why did I keep stressing what was and was not normal, when nothing ... was?” -- Joan Didion,The Year of Magical Thinking“Certainty? In this world nothing is certain but death and taxes.” -- Benjamin FranklinIn normal times, under non-pandemic circumstances, yesterday being April 15 would have marked the United States ’ traditional Tax Day. With one certainty, taxes, already rescheduled, we know that we are not in certain or normal times. This year, the novel coronavirus pandemic elevates the immediacy of that other certainty: death.Since 2008, April 16 is designated as National Healthc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 17, 2020 Category: Palliative Care Tags: advance care planning covid nhdd riegel Source Type: blogs

Delivery of Effective Telehealth
Palliative Care Colleagues,At MGH, we have been learning a great deal about the delivery of effective telehealth in the palliative care setting through our multi-center PCORI REACH PC trial of standard in person palliative care vs telehealth palliative care. We are happy to share with you some of what we have learned in case it may be useful to you and your teams who may be asked to conduct virtual visits in the context of mitigation related to COVID-19. We have found that telehealth can lend itself well to the important work that we do. Below you will find some of the resources we have used to train and support clinicians...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 18, 2020 Category: Palliative Care Tags: greer jackson telehealth temel Source Type: blogs

14th Annual Pallimed Party (aka Un-Meeting)
by Christian SinclairWell, I know we all wish we were in San Diego learning from each other, seeing old friends, and making new ones, but the fact is we are not doing that. I still want to honor the spirit of the annual Pallimed Party, even though throwing a party does not feel like the right optics. So let ' s call it an un-meeting.So how will this work? I ' m not quite sure, so bear with me. It is going to be kind of experimental so if being an early adopter is your thing, I totally get it if you are out. But a small group of us are going to try to do something virtually. It will primarily consist of the online platform ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 18, 2020 Category: Palliative Care Tags: party sinclair Source Type: blogs

The Voice and Role of Palliative Care in the Era of COVID-19
by Suzana Makowski (@suzanakm)Theguidelines outlined in the recent letter co-sponsored by Pallimed and Geripal serve as important reminders of key messages for clinicians: social distancing, handwashing, use of personal protective equipment to help flatten the curve of viral spread, adhering to protocols about screening, testing and even triaging.I would advocate for another layer of engagement in this effort. Palliative care as a specialty is uniquely positioned to address the people who are likely to be disproportionately affected by the disease: the chronically ill and the aged. After all, this population is the demogra...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 17, 2020 Category: Palliative Care Tags: covid emergency preparedness makowski Source Type: blogs

The Dizzying Experience of Healthcare in the Time of a Pandemic
By Lyle Fettig@fettiglyleCheck out the Pallimed COVID-19 Resource page here. - Ed.I love theletter co-published by Pallimed and Geripal about COVID,and you should read that too. As an erstwhile (for now) Pallimed contributor, I thought I ' d toss in my two cents with some additional thoughts/reflections based on week 1 of preparing for the COVID pandemic as a palliative care physician.Over the last week, I ' ve operated mentally in most of these lanes:1. Primary prevention and public health:Through extensive advocacy for social distancing and widespread testing. I have talked about it with my patients and my own family and...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 17, 2020 Category: Palliative Care Tags: covid emergency preparedness fettig Source Type: blogs

A Letter of Support For You and Thoughts About COVID-19
Co-published March 13th onGeriPal andPallimedDear Hospice and Palliative Care community,We are sad we cannot be together this year at the Annual Assembly and deeply concerned about the growing risk of the novel coronavirus. We want to send you a bit of encouragement, and some thoughts on how we can take care of ourselves, our teams, and our community in the setting of this new pandemic.We have always “punched above our weight” as a field, and the secret to that has been hard work, community, and being smart.We don ’t have to tell you to work hard. You and your teams know how to do this.1) Start social distancing from...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 13, 2020 Category: Palliative Care Tags: covid emergency preparedness pandemic rosielle sinclair smith tatum Widera yang Source Type: blogs