Mastodon 11_03 ~ Pallimed

Tuesday, March 29, 2011

The Joint Commission (finally) Accredits Hospital Based Palliative Care Programs

In what has been an on-again off-again story of 5+ years that was beginning to seem like an unattainable holy grail, the Joint Commission has finally issued a press release stating in Fall 2011 they will be recognizing hospitals with exceptional palliative care programs with an emphasis on:
  • A formal, organized palliative care program led by an interdisciplinary team whose members possess the requisite expertise in palliative care,
  • Leadership endorsement and support of the program’s goals for providing care, treatment and services,
  • A special focus on patient and family engagement,
  • Processes which support the coordination of care and communication among all care settings and providers, and
  • The use of evidence-based national guidelines or expert consensus to guide patient care.
This is really important for many reasons.  Many hospitals may claim to have palliative care teams but the members of the team, internal support and integration into hospital culture can vary widely as many who have worked with palliative care programs have seen.  No doubt we have seen large increase in the percentage of hospitals with palliative care with support from organizations like the Center to Advance Palliative Care, but The Joint Commission is the 600lb gorilla and more importantly is a non-palliative care organization to help support quality palliative care programs.

I do like the emphasis on the whole hospital program and not just the team. This may set some higher standards than all teams will be able to accomplish, but then I think that makes all of us strive to do better.  Or we can be like Lake Wobegon where everyone is above average.  I just wonder what percentage of teams will be able to achieve this certification for the hospital as a whole.  This cutoff point will be interesting to watch.

When The Joint Commission comes to your hospital, your palliative care team can get excited because now you may be the people that help the hospital achieve more recognition.  The suits in the C-Suite might find a new interest in what your program is doing and hopefully (fingers crossed) you might get the resources and staffing to achieve it!

One slight irony is the Advanced Certification for Palliative Care is housed in The Joint Commissions "Disease-Specific Programs."  Palliative care is about people, I guess we have to keep on educating.

Tuesday, March 29, 2011 by Christian Sinclair ·

Palliative Care Featured in WaPo, WSJ, NPR, Boston Globe

Quick media round-up from this week:

All of these were making the rounds on Twitter today with lots of clicks and shares from people not in our field which is always nice to see. I am not going to go into detail on any of these articles tonight, but please share them with your team.  I particularly liked the WSJ and Boston Globe one.  The NYT blog deserves its own blog post to discuss the importance of language.

If any Pallimed Reader wants to write up a guest post on the WSJ, Boston Globe or NYT articles, email me your 250-500 word write up (Yes we are open to guest posts, more details to come! See your name in lights, or at least the faint glow of some strangers laptop.)

The NPR and WaPo articles were covering the basics.  Obviously important but not sure you will gain a lot from reading those.  And interestingly those were both written by the same person Michelle Andrews from the Kaiser Health Network.  Not sure why they are covering palliative care issues so much, but keep it up if it gets published.

This convergence doesn't quite rival the 2010 St. Patrick's Day journal smorgasbord of palliative care but is still a pretty impressive grouping of media outlets in just a span of a few days.

by Christian Sinclair ·

Sunday, March 27, 2011

Pallimed Redesign 2011

Pallimed has finally undergone the design redux I have been wanting to do since 2010.  Some of you may have noticed the new look on the Arts and Humanites blog or the Case Conference blog.  With the new design rollout I am focusing on the overall blog functionality, so there may be a few broken links and bugs as I work them out over the next week.

If you do find any please feel free to report them to me at

Here is a listing of the changes made so far across all the Pallimed blogs:


  • Added Disqus plug-in feature for commenting
    • Allows for multiple one click sign-in
    • Still allows for subscribing to comments from individual posts
    • Still allows for anonymous commenting
    • Eliminates Word Captcha Spam protection (the quiggly words)
    • Allows for nested replies (so you can reply to one comment right after that comment)
    • Allows for ‘Likes’ to comments, increasing the validity/importance of your comments
  • Added Print Friendly button to the end of each post
    • Allows for removing images
    • Can select which text to print
    • Can save post as a PDF
    • Can email post 
  • Added automatic text cut off for quick summaries from front page to allow for quick scanning of most recent topics
  • Added related posts at the end of each post to help you find other articles of interest.

  • Added Facebook share and like buttons with counters on each post
  • Added Twitter buttons with counters for each post

  • Enabled Mobile versions of all three websites.
  • Links to Apple and Android Palilmed Apps on top right column

  • Added #HPM Daily - Daily digest of posts on Twitter about Hospice and Palliative Medicine
  • Added 'posts by contributors'
  • Updated disclaimer and privacy visibility
  • Added Popular posts feature highlighting most clicked posts in last 30 days
  • Added widget to see traffic in last 30 days (right column in footer

  • Added clearer navigation to other Pallimed blogs and Palliative Care Grand Rounds

Sunday, March 27, 2011 by Christian Sinclair ·

New Commenting System for All Pallimed Blogs

Hello all, today we have implemented a new commenting plug-in for the main Pallimed blog.  Some of you may have already noticed this at the Arts and Humanities blog or the Case Conference blog.  The new commenting system is called DISQUS, and if that looks confusing just say it out loud and you'll get it.

Read more »

by Christian Sinclair ·

Tuesday, March 22, 2011

Components of Early Outpatient Palliative Care Consultation for Patients with NSCLC

Vancouver 2011
We don't usually comment on stuff from the main palliative care journals, but the Journal of Palliative Medicine published a study that supplements the NEJM trial on early palliative care in metastatic non-small lung cancer.  (See our initial reactions to the NEJM study herehere, and here.)  The present study examines the content and length of time spent during the initial outpatient consultation that took place during the trial. 

Read more »

Tuesday, March 22, 2011 by Lyle Fettig ·

What are my chances, Doctor?: A narrative look at desire for medical prediction and probabilities

Figuring out how much any patient or family member wants to know about the future chances of cure, disability or death is a delicate dance.  Lyle blogged about prognosis disclosure earlier this week and we have covered some of the research articles here before.  But in analyzing the research it is always good to have a narrative to help humanize the story.  The NYT Well Blog is following Dr. Peter Bach, a cancer researcher, as he navigates the medical system with his wife who was recently diagnosed with breast cancer.  The series can be found under the title "The Doctor's Wife."  This week he writes a great piece about his frustration in getting probability and prediction information from his wife's cancer doctor.

Read more »

by Christian Sinclair ·

Is this a first? Surgeon-blogger posts her Five Wishes online

One of my favorite bloggers and a great online supporter of palliative medicine is the Arkansas surgeon RL Bates (@rlbates) who writes at "Suture for a Living." This week she posted her Five Wishes for care near the end of her life on her blog.  Why? Partially as a response to reading about the recent Annals of Internal Medicine on the effect of surrogate decision making on the surrogate,  partially because her husband has difficulty talking about it, and partially because she wants to avoid conflict between any family members over decisions about her care as she discusses in her post.

Please go read her post and offer any comments.  This makes for an interesting ethics case...what would you do if a family member presented you with a blog post like this documenting a patients wishes? It may have already happened to one of you.

PS If I have not convinced you to check out her blog yet, she loves to quilt and posts her creations along with her medical musings for any fans of Americana!)

PPS Do you know it i s less than one month to National Health Care Decisions Day on April 16thIs your organization doing anything for it this year? (Disclaimer: I am helping NHDD organize social media efforts this year)

by Christian Sinclair ·

Sunday, March 20, 2011

Japanese Communication Style: Comparing the Disclosure of a Nuclear Crisis to Disclosure of Cancer Diagnosis/Prognosis

A reporter for the New York Times recently made this statement (see video below):

"I think the Japanese tend to try to maintain a veneer of calm and not breech topics that might be alarming or insulting (emphasis added).  For example, until recently, it was the norm for families not to tell a family member who had cancer (about the cancer) just to save suffering on the part of the family member and we see some of that mentality at play in some of the communications we have seen from Japanese officials who have refused to confirm what turns out now to be a very serious situation at the Fukushima Daiichi plant.  They were very slow in acknowledging some of the dangers."

Read more »

Sunday, March 20, 2011 by Lyle Fettig ·

Looking for people in Japan with stories about palliative care around the Tsunami and Earthquake events

We have covered the role of palliative care in emergencies and in post-disaster medical care before here at Pallimed (Hurricane Ike in Houston 2008, Iowa Floods in 2008, Earthquake in Haiti in 2010) . We are looking for any one in Japan or with connections to health care professionals in Japan to help inform the hospice and palliative medicine communities worldwide about some of the issues faced since the earthquake and tsunami struck.

If you have any stories please email and we will arrange for an interview by email or Skype.

Photo courtesy of The Big Picture

by Christian Sinclair ·

Tuesday, March 15, 2011

Consider the Conversation: A Documentary on a Taboo Subject

I’m not sure how it got there, but an article from the Milwaukee Journal Sentinel landed in my inbox last week. It described the foundations of a new documentary, Consider the Conversation, by two friends who had recently experienced losses; one of them is also affiliated with a hospice. The video examines contemporary dying in America from both personal and cultural/health systems perspectives. The personal approach is achieved through “person on the street” interviews and interviews with people dying of progressive diseases. There are also interviews with well-know palliative care experts such as Ira Byock and James Cleary and journalist/author Stephen Kiernan.

Read more »

Tuesday, March 15, 2011 by Thomas Quinn, APRN ·

"Hi, I'm Here to Place a Pleurx and Provide Palliative Care Consultation": The Interventional Radiologist as HPM Physician

I'll admit I was skeptical of this idea when I first read the abstract, but it's growing on me already.

The American Journal of Roentgenology published a retrospective review of all referrals to an academic interventional radiology service to determine how many of the referrals would be appropriate for a hospice and palliative medicine subspecialist.  In brief, 81% of referrals were deemed appropriate for either hospice or palliative care with about half of patients having a malignancy, 20% having end stage renal disease, and a smaller percentage having end stage liver disease or heart disease and other diagnoses.

Read more »

by Lyle Fettig ·

Official Announcement: Morpheme Conference on New Media for Palliative Professionals

I am very excited to announce the first ever Morpheme Conference May 6-8th, 2011 to help palliative professionals from any discipline work with new media and creative writing. This project got started back in the Fall of 2010 at the AAHPM Board Meeting when Amos Bailey approached me to talk blogging. We began discussing his experiences writing on his blog about gardening and my work with Pallimed. Amos had been thinking about a small workshop hosted in Birmingham, and I eagerly signed on given our aligned values for getting our field proficient in social media and blogs.

Read more »

by Christian Sinclair ·

Join Pallimed Readers in a Some College Basketball Prognostication

Well if you think you are any good at predicting in medicine, try your luck on College Basketball with the 3rd Annual Pallimed Bracket Challenge.  This year we will be giving away prizes, but no worries no entry fees or betting will be going on here just some friendly competition in predicting the future.

Read more »

by Christian Sinclair ·

Sunday, March 13, 2011

Susan Block talks Suffering, Grief, and Peace in the Harvard Business Review

I know, you are probably saying, what, huh? Harvard Business Review you may be thinking to yourself... isn't that for articles about how to best secure venture capital funding and what to do when your lead computer programmer decided to take his intellectual capital to your business rival?  Well sure there are business heavy articles in HBR, but they do highlight innovations across different businesses and frankly I have found numerous articles there that would be relevant in medicine, particularly articles featuring customer service challenges and employee feedback.  Dr. Block's article writes on how to change the medicine culture and approach to illness and death which may improve health care outcomes with aligned goals.

Read more »

Sunday, March 13, 2011 by Christian Sinclair ·

Pallimed Blogs now available on Android Smartphones (FREE!)

Hooray for the sworn enemies of Apple acolytes (of which there seem to be a lot of in medicine),  a new Android App is here and you must get it for your phone.  (Apple fans don't fret! You got your iPhone, iPad app a year ago.)

Pallimed blogs, comments and Twitter feeds are now available in one convenient Pallimed app for FREE.  So for the person who asked me in Vancouver when the Android love attention to the other smartphone OS was coming, You got it now!  And to Joanna S who asked Saturday night when it was coming, your wish has been answered, because we are responsive like that.

Read more »

by Christian Sinclair ·

Tuesday, March 8, 2011

The trauma of surrogacy

The current Annals of Internal Medicine has a provocative systematic review on the effects on surrogates on surrogate decision making. That is - how being a surrogate affects the surrogate (emotionally, effects on grief, trauma, etc.). We've followed the literature about the accuracy (or not) of surrogate decision making, how surrogates make decisions, etc. but this was the first time I'd really paid much attention to this literature. And it ain't pretty - but it also gives us some good guidance to how we can help these individuals who are often as much our 'patient' as the patients themselves. It's a good one for the teaching file - particularly for advanced learners like fellows.

Read more »

Tuesday, March 8, 2011 by Drew Rosielle MD ·

Sunday, March 6, 2011

Dying and Doing Time: Hospice Prison Documentary - "Prison Terminal"

"Each year more than 3000 men and women die in U.S. prisons."

"It is estimated that 20% of the U.S. prison population will be elderly by 2025."

These are the sobering figures presented at the end of one of the trailers of Prison Terminal, a documentary about the prison hospice in the Iowa State Penitentiary, where inmates care for their own terminally ill. The film, directed and edited by Edgar Barens, spans a 6-month time period, and follows the lives of the patients, inmate volunteers, and staff. Here's one of the trailers (it starts after the first 15 seconds).


Prison Terminal is nearing completion, but needs some money to finish the project. Edgar started a fundraising campaign on Kickstarter March 1st, so if you want to see the full length film, consider a donation. By the way, the very cool thing about Kickstarter is that the money doesn't leave your pocket unless the project reaches its fundraising goal in the specified timeframe. So if, you want to be a part of seeing this project through, please do so by clicking here by Friday, April 15th.

This powerful story while being about the experience of dying and caring for the dying in prison, also makes me think of all kinds of important topics for our field and our country, like

- How we will cope with an ever-growing prison population, especially with increased health needs and costs of elderly inmates?

- Compassionate release is not the norm, but even if it becomes more frequent, how will inmates access health care after their release?

- How can we provide compassionate care to those who are dying in the prison system, or support the hospice initiatives that start on the inside?

- How can we help families have increased contact with the dying inmates?

- What are the special psychosocial, emotional, and spiritual needs of dying prisoners and their families?

- What is the best way to train the inmate volunteers, and what kind of bereavement care do they need afterwards?

Or something that I have struggled with in some of my palliative consultations for hospitalized inmates returning to prison...

- How should I change my prescribing practices to fit the correctional facility health care systems? (For example, no PRN doses of pain medications between certain hours at night because of lack of medical staff. Another example, no fentanyl patches allowed, because they could be removed and used by other inmates.)

Inmate Hospice Volunteers: Bertram Berkett, Michael Glover, Michael Williams, Charles Watkins

The Prison Terminal website has links to many interesting essays, and the National Prison Hospice Association has links on their site to articles which address a few of these questions.

One other interesting note, Edgar Barens has made two other films, the first, Angola Prison Hospice: Opening the Door, many Pallimed readers may be familiar with. The second, A Sentence of Their Own, is a documentary about a family impacted by one member's incarceration.

Usually a documentary is not just a story, it is an attempt to instigate cultural and societal change, something us hospice and palliative care types embrace wholeheartedly. So, in the spirit of providing compassionate, patient-centered care for everyone who suffers from serious illness, please visit the website, comment on this post, like or share the Vimeo videos, donate to get the movie finished (and maybe even get your own copy), and discuss it with your colleagues, family, and friends.

The more we spread the word about Hospice and Palliative Medicine, whether inside the walls of a prison or outside, through whatever platform we choose, whether it be social media, movies, radio, TV, print, or old-fashioned conversation, the more the public understands the value of what we do.

You can find Edgar and more on Prison Terminal at the website, Facebook and Twitter (@prisonterminal) and of course Kickstarter (where you can donate to the project).
(Edited: Updateed the video embed 12/21/2013)

Sunday, March 6, 2011 by Holly Yang, MD ·

Vancouver Pictures - Video Montage

Here is a video I made of the pictures sent to me so far from the 2011 Annual Assembly in Vancouver. Thanks to Rick Butin, Holly Yang, Joan Robinson, and Patricia Maani for sending in photos. And if you watch this and say to yourself there are way too many pictures of Christian in it, then you need to send me some of your own! Imagine if you had one of these videos from all the past years you went to the Assembly. I wish I had done this in the past!

You can look at all the pictures sent in and download them from the Facebook Fan Page for Pallimed.

Don't forget to send in your photos to I'll add them to a new version of the video.

Disclaimer: this video is not an official video of the AAHPM nor the HPNA. If you would like any photos removed from this video or Facebook, please contact me.

[minor edits made Mon Mar 7th for grammar and typo; also high res video replaced previous low res version]

by Christian Sinclair ·

"Palliative Medicine: Care versus Cure" on Open Mind

Diane Meier was recently interviewed for the second time (the first being in 2006) by Richard Heffner on his long running PBS show "The Open Mind." To this audience, the interview does not tackle any ground breaking territory, but it is summarizes well hospice and palliative care, the similarities and the differences. To use this as a training tool for some good sound bites which may be helpful when you need to give your elevator pitch on what we do.

Read more »

by Christian Sinclair ·

Tuesday, March 1, 2011

Slidedeck from Social media Session

Here is the slidedeck from the 2011 AAHPM/HPNA Annual Assembly. You can download them, use them, remix them anyway you want. If you are interested in publishing your slides online, feel free to email me ( and I will promote good slidedecks in hospice and palliative care on Pallimed.

Tuesday, March 1, 2011 by Christian Sinclair ·

Pallimed | Blogger Template adapted from Mash2 by Bloggermint