Eric Widera posted an article on GeriPal - Feb 7, 2012, 11:36 pm
I didn't know my Grandmother very well as I was growing up. In fact, I'm not sure I even liked her very much when I was younger. I first met my father's mother when my family moved to Taiwan in 1979. I was five and in the middle of kindergarten. My grandparents lived with my uncle, aunt,...
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Eric Widera posted an article on GeriPal - Feb 7, 2012, 6:47 pm
My mother is in her 50’s and currently resides alone. For the past year, she’s depended largely on the Internet to stave off loneliness by visiting entertainment websites and communicating with her busy children via e-mail.  But, while vi...
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Eric Widera posted an article on GeriPal - Feb 1, 2012, 6:22 pm
Palliative care fellow Katherine Aragon (right) and intern Sara Murray displaying their lightweight portable chairs (they have a shoulder strap as well) Just finished another couple of weeks attending on the palliative care service, and wanted to share a couple of thoughts with GeriPal readers....
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Eric Widera posted an article on GeriPal - Jan 31, 2012, 7:38 am
... Brown is currently our colleague in the UCSF Geriatrics Division. The senior author was Harvard Senior Life Geriatrician, Dr. Susan Mitchell. The study was published in the Journal ... This study examined prevalence of Geriatric Syndromes in the homeless elders. Geriatrics syndromes are pro...
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Eric Widera posted an article on GeriPal - Jan 28, 2012, 1:25 pm
***Warning: the below blog includes the direct Emergency Room documentation of an attempt to resuscitate a patient who died*** I understand the value that routine and standard procedure can have in medicine. For example, Quality and Safety endeavors often turn t...
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Eric Widera posted an article on GeriPal - Jan 26, 2012, 2:51 pm
We have learned a lot of lessons in Hospice and Palliative Care about how political discourse can impact our field and the care we give to individuals with serious illnesses.  You only have to go back to January of 2011 to see how the hysteria around death panels led...
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Eric Widera posted an article on GeriPal - Jan 22, 2012, 7:10 am
The MMSE saga has attracted great attention here on GeriPal and elsewhere since the breakthrough NEJM article of Newman and Feldman. As readers Eric Widera's previous posts (here and here) know, the MMSE was one of the most widely used tests in medicine. It was ...
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Eric Widera posted an article on GeriPal - Jan 20, 2012, 6:49 pm
The 2012 recipients of the third annual Hastings Center Cunniff-Dixon Physician Awards were just recently announced. I was honored to be one of the recipients of this award last year, but am humbled by this year’s awardees. Richard Payne said it best in the Hastings Center press release: "Thi...
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Eric Widera posted an article on GeriPal - Jan 19, 2012, 4:09 pm
Eprognosis is barely a week old, and we've already had over 500,000 pageviews (150,000 unique visitors).  For perspective, GeriPal is about 3 years old, and in that time we've had 400,000 pageviews.  We've had loads of press, including 6 stories in the New York Times about prognosis a...
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Eric Widera posted an article on GeriPal - Jan 10, 2012, 4:01 pm
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to do more harm than good. Also, persons who have limited life expectancy may want to plan, discuss their values, and consider palliative care a...
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Eric Widera posted an article on GeriPal - Jan 8, 2012, 2:47 am
This is the third post in a series on copyright in medicine. We started off the series with two posts. The first discussed the importance of a NEJM article advocating for the greater use of copyleft licenses in medicine. The second detailed the dubious copyright infringement cla...
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Eric Widera posted an article on GeriPal - Jan 6, 2012, 12:22 pm
10 year stock price of Gentiva, the nation's fastest growing for-profit hospice provider For-profit hospice has been in the news recently, and the press has not been favorable.  We have this from a recent lengthy article in the Washington Post: "Hospice care, once chiefly a charitable c...
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Eric Widera posted an article on GeriPal - Dec 30, 2011, 8:55 pm
A couple of days ago we covered Dr. John Newman's NEJM perspectives piece that focused attention on how a company, PAR, is trying to charge clinicians everytime they use the MMSE in clinical practice. To make matters worse, PAR is also trying to take down other tests, like the Sweet 16, that ...
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Eric Widera posted an article on GeriPal - Dec 29, 2011, 12:20 am
The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. However, un...
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Eric Widera posted an article on GeriPal - Dec 21, 2011, 10:00 am
It's the most wonderful time of the year. No, not because those damn kids jingle belling and everyone telling you "be of good cheer". And not because of those holiday greetings and gay happy meetings when friends come to call. It's the hap-happiest season of all because I just g...
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Eric Widera posted an article on GeriPal - Dec 11, 2011, 8:40 pm
Sometimes the best ideas are so simple that you both marvel at their eloquence and wonder why you never thought of them. In a perspective in the New England Journal of Medicine, Dr. Dan Wolpaw, a General Internist and Educator at Case Western Reserve University presents a simple an...
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Eric Widera posted an article on GeriPal - Dec 7, 2011, 5:07 pm
I think we all probably agree that health care providers should give patients with a life limiting illness the option to discuss their prognosis. But what about discussing prognosis with those patients who may not have any particular life limiting illness, but have just lived a long lif...
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Eric Widera posted an article on GeriPal - Dec 6, 2011, 12:08 pm
The following observations and questions came up during my recent work as palliative care attending.  Thoughts and responses are welcome: How well do so-called "bridge" programs work?  These are the home-care programs for patients who qualify but whose goals do not align with hospice, ...
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Eric Widera posted an article on GeriPal - Nov 2, 2011, 12:20 pm
Have you heard of the Portal for Online Geriatric Education (POGOe)?  The Portal of Geriatric Online Education (www.POGOe.org) is a free public repository of geriatric and palliative care educational materials (i.e. OSCEs, games, web-based modules, and lectures) developed by leading edu...
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Eric Widera posted an article on GeriPal - Oct 28, 2011, 1:10 am
There are days I hate the POLST form (Physician Orders for Life Sustaining Treatment). In concept, it’s significantly better than the pre-hospital DNR and a generic Advanced Directive. But here in the state of California where I work, the POLST form is misguided, poorly worded, and hig...
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Eric Widera posted an article on GeriPal - Oct 21, 2011, 6:32 pm
Every week we have been posting a lot of questions on GeriPal about some of the biggest issues in geriatrics and palliative care. These range from how to define our professions (both in geriatrics and palliative care), how to communicate with patients and family membe...
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Eric Widera posted an article on GeriPal - Oct 20, 2011, 1:32 am
In the most recent Sunday New York Times, Jane Gross gives a devastating critique of Medicare's Failure to support the needs of the most vulnerable elders. It is must reading for all who care for frail elders, policy makers, and Medicare officials. Ms. Gross brings interesting pers...
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Eric Widera posted an article on GeriPal - Oct 14, 2011, 3:00 pm
Should the word "hospice" be taken out of the professional society names: "American Academy of Hospice and Palliative Medicine," and "Hospice and Palliative Nurses Association?"  AAHPM would become AAPM.  HPNA would become PNA. This idea is completely new to me so I don't feel in...
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Eric Widera posted an article on GeriPal - Oct 13, 2011, 8:47 pm
It's been a while since I posted but I had to share frustration! This week I saw a new patient who has been receiving prescriptions for Librium and Serax (benzodiazepine) from her dentist/oral doctor. That was only one of a long list of issues this woman had which were concerning ...
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Eric Widera posted an article on GeriPal - Oct 11, 2011, 2:26 pm
... of the event means that only seldomly does one get good feedback on your work. Poster sessions can be painful for junior researchers early in their career who may not know many people ... and innovation. The NPCRC approach provides a model for scientific communities that wish to turn th...
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Eric Widera posted an article on GeriPal - Oct 10, 2011, 9:00 am
Here is today’s GeriPal puzzler: what can medicine learn from Click and Clack, the Car Talk guys? Give up? I did after guessing that maybe it's how to fix a patient’s carburetor. Lucky for me though, last weeks JAMA gave me the answer in the first sentence of an editorial by ...
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Eric Widera posted an article on GeriPal - Oct 8, 2011, 2:39 pm
A McMansion in Munster, IN, from Wikimedia CommonsHonolulu, HI, from Wikimedia Commons Following up on our previous post about study that hinted at substantial regional variation in the effectiveness of advance directives, a new study in the Lancet describes considerable regional variation in s...
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Eric Widera posted an article on GeriPal - Oct 4, 2011, 7:22 pm
Image from the Dartmouth Atlas: http://www.dartmouthatlas.org/data/region/ When have advance directives ever been shown to do anything?  They were a complete failure in SUPPORT.  Study after study demonstrates that few people fill them out, rarely are they used, and that health care proxies d...
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Eric Widera posted an article on GeriPal - Oct 1, 2011, 11:34 am
The other day Eric Widera and I were teaching a course to the medical students about writing for social media outlets like Twitter and GeriPal.  One of the students asked us if a patient had ever contacted us online - my answer was no, I think Eric said he discovered a caregiver's blog....
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Eric Widera posted an article on GeriPal - Sep 29, 2011, 3:26 pm
I wanted to get this community's thoughts on a recent article that made some headlines (see ABC news and New York Times for example). In the Sept 26 issue of Archives of Internal Medicine, Brenda Sirovich and colleagues from Dartmouth report a survey of primary care physicians, where they fou...
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Eric Widera posted an article on GeriPal - Sep 24, 2011, 12:05 am
If you see just one YouTube video where a doctor uses his own body to teach, then see Cardiac Arrhythmias.   In this silent movie, a physician does a cardiac dance to teach about arrhythmias.  My favorite: ventricular tachycardia. If, however, you see two YouTube videos where a doctor uses h...
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Eric Widera posted an article on GeriPal - Sep 17, 2011, 11:57 am
We have written several pieces in GeriPal about issues such as isolation and loneliness. One aspect that we haven’t really explored is how there may be communities of elders that may be at increased risk for isolation, especially near the end of life. Luckily, a fellow geriatrician of ours,...
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Eric Widera posted an article on GeriPal - Sep 14, 2011, 3:12 pm
When I was 16 years old, I decided to volunteer in a nursing home. On my first day, I visited with a woman whose son was supposed to come and take her to church. While she sat in her Sunday best, we flipped through a family photo album, looking at pictures of people whose names she had forgotten. Af...
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Eric Widera posted an article on GeriPal - Sep 12, 2011, 10:00 am
Hospitalizations present a host of dangers to an older patient, and perhaps one of the most hazardous parts of hospitalization is the discharge home. All sorts of things can go wrong as health care is transferred from the controlled environment of the hospital to the outpatient setting. Often, healt...
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Eric Widera posted an article on GeriPal - Sep 7, 2011, 12:00 pm
Image from the National Library of Medicine nlm.nih.govI'd like to briefly turn readers attention to two terrific papers published recently in the Annals of Internal Medicine on the timing and outcomes of surgical hip fracture repair. The first, an empirical study by Vidan and colleagues from...
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Eric Widera posted an article on GeriPal - Sep 5, 2011, 11:00 am
Dignity Therapy is a brief form of psychotherapy developed by Harvey Chochinov, MD with a goal of conserving a dying individuals sense of dignity. It attempts to address sources of psychosocial and existential distress, all the while giving individuals a chance to record the meaningful aspects of t...
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Eric Widera posted an article on GeriPal - Sep 2, 2011, 3:06 am
The New York Times just published an excellent piece by Paula Span on a plan by Pfizer to make its cholesterol blockbuster drug Lipitor an over-the-counter (OTC) medication. A couple things caught my eye when reading this piece, not the least of which was the story was picked up by the Times a...
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Eric Widera posted an article on GeriPal - Aug 22, 2011, 9:00 am
There has been a lot of policy discussions about the emergence of the hospitalist movement. A decade ago, when a patient was hospitalized, the doctor managing their care in the hospital was usually their primary care doctor. Increasingly, primary care doctors do not manage their patients in the hosp...
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Eric Widera posted an article on GeriPal - Aug 20, 2011, 6:00 pm
I was taught to give recommendations to seriously ill patients and family members facing tough choices.  This was probably best taught to me via the following analogy.  Let's say you go to Best Buy, and ask to buy a computer, and the store person says, "Do you want SDRAM or GDDDR5 Ram?  Do...
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Eric Widera posted an article on GeriPal - Aug 18, 2011, 5:08 pm
My dog is dying. When he was diagnosed two months ago with brain lesions, we had an open, practical conversation with the veterinarian about quality of life, palliative symptom management and options for a gentle death, including euthanasia, when the time is right. Humans (with rare except...
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Eric Widera posted an article on GeriPal - Aug 16, 2011, 6:42 pm
Last week, I started interviewing clinicians who care for frail elders at On Lok Lifeways as part of a study led by Dr. Alex Smith. (On Lok was one of the first sites to launch the Program of All-inclusive Care for the Elderly (PACE) for nursing home-eligible elders residing in the community)...
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Eric Widera posted an article on GeriPal - Aug 8, 2011, 9:00 am
Research studies often are conducted as if older patient's don't exist. Even when the disease being studied predominantly effects older persons, the study includes patients that bear little resemblence to the typical older patient. This makes providing the best care for older patients difficult beca...
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Eric Widera posted an article on GeriPal - Aug 4, 2011, 11:30 am
Depression is the most common mood disorder in elderly individuals with Alzheimer disease, with prevalence rates somewhere between 15% to 57%. One major difficulty in dealing with this issue is the inherent difficulty in diagnosing depression in dementia, as evident in the huge prevalence ra...
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Eric Widera posted an article on GeriPal - Aug 1, 2011, 3:33 pm
Do you: 1) Make less than £25,000 ($40,926) a year? 2) Rent your home? 3) Fail to eat your vegetables? If you answered yes to all three questions, your telomeres may be shortening at a faster rate than those who answered no (read: are less deprived).. At least that’s what a new study coming ...
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Eric Widera posted an article on GeriPal - Aug 1, 2011, 2:37 pm
Over the last two weeks I have had four different second year residents from several institutions ask me about when they should start thinking about applying for fellowships. Some of these residents were applying for palliative care positions, and some geriatrics positions. The answer I gave t...
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Eric Widera posted an article on GeriPal - Jul 27, 2011, 1:48 pm
Back by popular demand! The Third Annual Interactive Educational Exchangeat the Annual Assembly of the American Academy of Hospice and Palliative Medicine (AAHPM) will be back in 2012!! Don’t miss this great opportunity to share your scholarly work in education …all while enjoying Colorado in M...
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Eric Widera posted an article on GeriPal - Jul 26, 2011, 7:55 pm
It's July, and that means teaching new fellows how to explain palliative care to patients and family members.  For inpatient consults, that means we usually we introduce our names, say we're from palliative care, and then ask if we can sit down.  At that point the patient or family - eyebrows rais...
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Eric Widera posted an article on GeriPal - Jul 20, 2011, 4:01 pm
I was very disappointed with the recent New York Times Article “Concerns About Costs Rise With Hospices’ Use.” The article paints an unbalanced picture of the Medicare Hospice Benefit highlighting “the concerns about excessive costs and misuse” while omitting many of the safeguards in plac...
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Eric Widera posted an article on GeriPal - Jul 18, 2011, 9:30 am
Recently, a group of distinguished neuroscientists commissioned by the Alzheimer’s Association and the National Institute on Aging updated guidelines for the diagnosis of Alzheimer’s disease. The new guidelines view the pathology that leads to Alzheimer’s disease as process that occurs over ma...
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Eric Widera posted an article on GeriPal - Jul 15, 2011, 7:00 am
"Doctor: I am having trouble sleeping." This has got to be one of the most common complaints we here from our older patients. Older patients often feel doctors don't take their sleep problems seriously. And perhaps this criticism that doctors dont take sleep complaints seriously enough ...
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