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Wednesday, July 23, 2014

#hpm Tweetchat 07.23.2014 - The Importance of Language

Language represents symbols and the meaning of those symbols depends on the nature of our interaction. When sitting in a clinic and receiving bad news, patients will cling to every word. Doctors may choose words carefully, avoiding some terms and emphasizing others. Patients and families, listening carefully to each word, walk away from these emotionally charged interactions, often hearing different words, and many times finding different meaning. Vinay Prasad studied the written words used in the Oncology literature, specifically the word “cure”. Defining cure as the chance someone will die of cancer being no greater then that of the age of their peers in general population dying of any cause. However, he found that nearly half the oncology literature uses the word cure to describe diseases that are considered incurable, that do not meet that definition. So, what do is meant by cure?

Another equally confusing term is “fight”. What does it mean to fight cancer? Perhaps even more important, what does it mean to “lose the fight?” Stuart Scott received the Jimmy V award at last weeks ESPYs. Although the language of a battlefield was used throughout the talk, he introduced a new twist when he said, “When you die that does not mean you lose to cancer. You beat cancer by how you live”. Fighting cancer or learning to live with cancer, its a matter of language, its a matter of perspective. Choosing to “fight” or choosing to “live”, we must choose our words carefully.

We will be exploring both of these topics in depth during the #hpm Tweetchat tonight.  We hope you will join in the discussion with us.

-Debra Parker Oliver, MSW, PhD, University of Missouri, Columbia

What: #hpm Tweetchat
When: Wed 7/23/2014 - 9p ET/ 6p PT
Host: Debbie Oliver 
Facebook Event Listing:

T1 What is a "cure?" How does the meaning of the word cure change in different situations? #hpm

T2 @StuartScott gave a moving speech at the @ESPYs this month. Please watch/listen and let's discuss: #hpm

If you are new to Tweetchats, you do not need a Twitter account to follow along.  Try using the search function on Twitter.  If you do have a Twitter account, we recommend using, for ease of following.

We will be posting the transcript and analytics here after the chat takes place.
Chat Transcript and Chat Analytics courtesy of @Symplur

Wednesday, July 23, 2014 by Christian Sinclair ·

Wednesday, July 16, 2014

Hospice and Palliative Medicine Tweetchat reaches 200th chat

When I first began exploring the health care Twittersphere in late 2008, there were not a lot of people there, and explaining it to others and expand the network was pretty challenging. Six years later, the understanding of Twitter as a space to advocate and influence is well understood in the realms of sports, entertainment, politics and news. Well, we too in hospice and palliative care have made a significant impact on Twitter even if it is in the smaller niche of Health Care.

One of the tent poles for people to gather and find each other has been the weekly Hospice and Palliative Medicine Tweetchat. Having seen the success of the Healthcare Social Media (#HCSM) chat hosted by Dana Lewis (@DanaMLewis), I thought we could do something similar with the HPM community. With the assistance of co-founder Renee Berry (@rfberry), we started the chat on July 14th, 2010. Since then, on every Wednesday (barring significant holidays) there has been a chat on Twitter highlighting hospice and palliative medicine issues for four years and tonight we will have our 200th chat. In a social media world where everything seems ephemeral, this is something you can depend on.
The #hpm hashtag (remember when you didn’t understand what that was?) is quite active through the whole week. For stats on the participation in #hpm, you can check out Symplur’s wonderful Healthcare Hashtag site.

Many of the people who participate have mentioned that the weekly chat serves as self-care because of the camaraderie and support. I know many of the people I have met through these chats have become good friends, regardless if I have met them in person yet, although I always look for the opportunity. Thank you to all of the people who have participated and moderated over the past four years. It truly is a community effort.

We invite everyone to come tonight to join in with the celebration of volunteerism, advocacy, communication, shared goals, and communication. If you used to join often but life’s circumstances changed, please come back tonight and say hello. If you are still a little wary, and not sure about it, use to watch the conversation (and maybe join in). If you cannot make it tonight, set a reminder in your calendar until it becomes a good habit! For those of you who will always be Twitter-averse (which is okay!), we will be brainstorming tonight on how to re-purpose the discussions from each weekly chat to reach new audiences.

Looking back at the first post about #HPM Tweetchat, the reasons to participate still resonate:
So why is something like this important?
  • A Tweetchat creates content that might spread
  • A Tweetchat lures other people into the conversation
  • A Tweetchat places you on the map
  • A Tweetchat connects people
  • A Tweetchat increases your sphere of influence
  • A Tweetchat exposes you to new ideas and resources
  • A Tweetchat is a place to get questions answered

(And if you were wondering why we chose #hpm and not the more inclusive #hpc, well Twitter was dominated by tech early adopters and #hpc was primarily used to discuss HP computers. #eol or #eolc were also too restrictive and reinforcing of the common bias that we help only at EOL. #hospice and #palliative are in more common use now as is #hpmglobal.)

Wednesday, July 16, 2014 by Christian Sinclair ·

Wednesday, July 2, 2014

Deadline for Comments on HPM Fellowship Update July 2

Apologies for the late notice, but I only heard yesterday about the deadline today (July 2, 2014) to the ACGME update to the Hospice and Palliative Medicine Fellowship requirements.  These updates do not come around too often and this is the first significant chance for an update since the accreditation became official in the late 2000s.

Here are some of the key files for your reference:
Impact Statement (only 5 pages - summarized below)
Program Requirements (24 fun-filled pages)
Review and Comment Form (you need to complete this and send it to

Whether you agree or disagree it is important to offer feedback either through your official representation from your institution or even as a clinician or advocate for hospice and palliative medicine.  So here is a quick summary of some (not all) of the changes and why I think they may be critical to the future of our specialty.

1) Increasing the hospice experience from 8 weeks to 10 weeks

When I first heard the requirements for hospice experience were placed at only 8 weeks in the first edition of these guidelines I was quite surprised.  My fellowship experience was based out of a community hospice, and the one I helped found in Kansas City was also initially born out of a community hospice.  So a good balance in my eyes, was more around 50/50.  I think this is a step in the right direction.  I wish it was from 8 weeks to 12 weeks, but I'll take what I can get to advance the competencies of HPM clinicians in hospice. Of note a pediatric palliative home care experience can be an adequate substitute for a Medicare or a VA based hospice experience.  I do think all programs should have exposure to pediatric HPM, but not necessarily at the expense of a shortened hospice experience.

2) Changing the fellowship requirement to a total of 12 months instead of a duration of 12 months.
The duration of a fellowship program in hospice and palliative medicine is 12 months. A fellowship program in hospice and palliative medicine must consist of 12 months of education in the subspecialty. 
This change allows the flexibility to include mid-career learners who may not be able to devote an entire 12 months straight to a fellowship program.  And with the current growing HPM workforce shortage, we need flexibility to train HPM specialists.

3) Increasing the protected time for a program director to 20-50%

Original language was vague and left it up to the institution to set the time aside.  If we are to have strong programs across the nation, then we need PDs who are protected to develop great programs, and not just working into the wee hours

4) Faculty to match the program size
In addition to the program director, there must be at least one other hospice and palliative medicine physician faculty member who devotes at least 10 hours per week on average sufficient professional time to the program. For programs with more than two fellows, there must be additional at least three hospice and palliative medicine physician faculty members.
I came from a single faculty program way back in 2003-4.  The teaching was great, but I could see the concern about smaller programs not providing a broader knowledge and skill foundation when you are limited to one faculty member. It would be great to support some of the smaller programs with some of the support found in the PCHETA bill to establish more faculty in HPM.

5) Decrease longitudinal patients across settings from 25 to 10

This is a no-brainer.  This requirement is a good idea in theory, but in reality it is really hard to execute even with the best intentions and frequent reminders.  So 10 seems an achievable number that allows for exposure to the importance of continuity, but it is realistic when factoring in fractured health care delivery systems and a premium on the fellow's time.

If you like all those things then here is something basic you can add to the 'General Comments' section (feel free to personalize/edit:
As a hospice and palliative medicine/care clinician, I reviewed the impact statement to the hospice and palliative medicine fellowship program requirements.  I agree with the changes being proposed, especially the following:
Requirement Int.C. - Flexible scheduling of fellowships for a total of 12 months
Requirement II.A.1.b - Increased protected time for program directors
Requirement II.B.1.a)-b) - Adequate number and dedicated time for faculty
Requirement IV.A.3.e)e).(1) - Increasing the hospice experience from 8 weeks to 10 weeks
Requirement IV.A.3.k) - Decreasing the longitudinal requirement from 25 to 10 patients

Wednesday, July 2, 2014 by Christian Sinclair ·

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