Tweet

What started off as a simple idea to play up the friendly rivalries between cities, was not only really fun but also enlightening.

First off, it was nice to talk about something besides just our work. Just like personal self-care, it is nice to take a break from only focusing on pain, suffering, illness, and death, instead having a little bit of fun.

In addition to the fun, it was nice to see some of the HPC world play along.  We both had a few notable defections to the other side and some trash-talking gamesmanship from people across social media.

Lastly, it was an important lesson in tying our work to things that are important to the public-at-large. Maybe in the future we will see some of our larger palliative care and hospice organizations jump on the friendly sports wager bandwagon bringing more public attention to the good work that all of us do each day.

Imagine if the Kansas City Hospice and Palliative Care and the Zen Hospice Project of San Francisco volunteers offered some of their unique projects in a charitable side bet.  Or maybe, the palliative care departments of UCSF and the University of Kansas (*the Royals do play in Kansas City, Missouri FYI) put a grand rounds guest speaker on the line, in addition to local wares and treats. You don't have to have a blog to do this. So when the NFL, NHL, MLS, NBA, MLB championships are on the line, let's get creative and spread our good work to new audiences that doesn't always have to focus on our expertise. If you do make one of these fun wagers, please let us know.  We will be happy to feature it!

Don't forget to look for our three guest posts coming from GeriPal to Pallimed in November and December and four of our writers sharing their work with GeriPal.

Now that the series is complete, here is what the Alex Smith, Eric Widera and the rest of the SF-based Geripal crew will be receiving from Kansas City in the next few weeks:

• Christopher Elbow Chocolates - 16 piece assortment 
• Fiorella's Jack Stack BBQ - BBQ Super Sampler
• Lost Trail Root Beer - 12 pack
• The Roasterie Coffee - Sporting Champions Blend

Here you go Geripal, I believe this is yours!

In closing, here is a quote sent to me by Earl Quijada towards the end of the game last night.  He rightfully pointed out there is plenty in this quote to align with our work in hospice and palliative care.

“[Baseball] breaks your heart. It is designed to break your heart. The game begins in the spring, when everything else begins again, and it blossoms in the summer, filling the afternoons and evenings, and then as soon as the chill rains come, it stops and leaves you to face the fall all alone. You count on it, rely on it to buffer the passage of time, to keep the memory of sunshine and high skies alive, and then just when the days are all twilight, when you need it most, it stops.” - Bart Giamatti

Tweet

Just in case you thought Pallimed and GeriPal were the only two hospice and palliative medicine blogs out there, I wanted to let you know I have finally gone back and refreshed our ongoing *UPDATED Hospice and Palliative Medicine Blog List*. It had been over a year since I updated it, and I sadly realized a lot of blogs went dormant in that time (19!), but I also found 13 blogs previously not recorded!

So why does this matter? Many have said that blogs are dead, taken over by the fast paced world of Twitter, the ever disappearing Snapchat, and the infinity time-suck of Facebook. Jason Kottke summed it up nicely:

Sometime in the past few years, the blog died. In 2014, people will finally notice. Sure, blogs still exist, many of them are excellent, and they will go on existing and being excellent for many years to come. But the function of the blog, the nebulous informational task we all agreed the blog was fulfilling for the past decade, is increasingly being handled by a growing number of disparate media forms that are blog-like but also decidedly not blogs. Instead of blogging, people are posting to Tumblr, tweeting, pinning things to their board, posting to Reddit, Snapchatting, updating Facebook statuses, Instagramming, and publishing on Medium. In 1997, wired teens created online diaries, and in 2004 the blog was king. Today, teens are about as likely to start a blog (over Instagramming or Snapchatting) as they are to buy a music CD. Blogs are for 40-somethings with kids.

Ha, while I do have kids, I'm not a 40-something (yet), and I think people in health care and especially in hospice and palliative medicine still have a lot to say.  And a tweet, picture or Facebook post just doesn't capture it.  We have to write more AND read more to get at real change. In the past we had things like Palliative Care Grand Rounds to feature great blog writing every month. But that round-up of powerful prose dropped off, because it takes time to sustain those things and everyone always seems to be running out of time. Twitter, Facebook, and even LinkedIN are all so ephemeral. Yet blogs have a sense of permanence and search-ability, those other social networks really do not have.

Except not all blogs are permanent. My favorite blog of years past was Hospice Blog by Hospice Guy. He was an anonymous hospice doctor in Oklahoma and he wrote honestly and passionately about his work. But he stopped writing, and the blog eventually disappeared*. Either taken down intentionally or just lost to the maintenance of the internet. I don't want that to happen to other HPM writers.

So I will make a promise to you as editor of Pallimed to highlight great writing when we see it.  It may come in a summary of links, a feature piece about a single blog, or even reposted content (with permission). And when you read it, you can share it, tweet it, or most valuable of all - leave a comment.

And I hope you will make a commitment to all of us, your peers. If you are an aspiring creative type...wait, scratch that...some of you may underestimate your aspirations and creativity.  If you have something you want to say about hospice and palliative medicine, drop me a line. Let me know what your skill set and ambitions are and I will help you find other like-minded people or projects that are achievable and then we will really begin to have an impact.

*I've downloaded as much as I could find from the Internet Archive of The Hospice Blog by Hospice Guy. If anyone knows who he might be, tell him to drop me a line, I would love to preserve his writings.

Tweet

As longtime readers will know, we here at Pallimed have advocated for social media being an effective change agent for issues relevant to hospice and palliative care for many years. With a thriving blog community (43! But we could always use more blogs!*), a strong Twitter presence of senior leaders and new leaders, a weekly Tweetchat since 2010 and several quality Facebook pages, the specialty which emphasizes communication skills at the bedside has done a good job communicating to the world as well.

Paul Bisceglio (@PaulBisceglio) from The Atlantic featured some of these efforts and the newer trend of being very open about end-of-life issues online and in the public view in his article, "How Social Media is Changing the Way We Approach Death."  The article is nearing over 1000 likes on Facebook in just over 24 hours, which is really impressive for what some might consider taboo.  But what the article and the social media stats on this article tells us, as a field, is that people want to engage on this topic. What a call to us to make sure we are available not only online, but to our communities offline as well.  We as professionals and advocates for quality care for those facing serious illness need to realize the power in sharing the stories and research that we find online.

Sharing is the first and easiest step.  The next is commenting and adding to a fruitful discussion, whether on a blog, Facebook, or every Wednesday night (9p ET) at the #hpm tweetchat.  Even though there are some uncivil places in the comment sections of some sites (not ours!) a smart and genuine comment can really add a lot to an article, so please ignore the loud barks from those impolite faux-raconteurs. And lastly you can contribute by adding original thought and content.  I know there are some brilliant minds out there with great ideas to share.  There are platforms to deliver your message, you just have to try.

* If you know any blogs not on the list, please share.
Photo Credit: Unknown

Tweet

Back in March, the contributors of Pallimed got together for a hard conversation. We were only missing a few people but it was still a sizable gathering at a restaurant late one evening in New Orleans. We have met at Academy meetings before, really to check in with each other and how all of us were doing in our professional and personal lives.  But this was a little different.  None of us were posting with much regularity for the previous 18 months.   Compared to where we were in 2008, 2009, and 2010 we all recognized we had many more responsibilities and working on Pallimed really didn't always fit into our schedule despite the best of our intentions.

But there was a different spark that night, different from years past.  This spark was probably brighter because of the darkness from being dormant for much of 2011 and 2012. We challenged each other to not let this great opportunity to fall by the wayside.  With the knowledge and wisdom from our schooling and clinical experiences, we recognize there is also a responsibility to share information, to engage in a conversation which can change the world before any one person becomes our patient.  Pallimed is a strong platform for sharing and we realized we did not want to just keep it to ourselves, so we are now reaching out to many new voices, including yours.

I'm asking you, whoever you may be, reading this post to join me in walking down the road that leads to awesome.

Do you want your patients to have doctors and nurses who understand good symptom control?
Do you want your community to think differently about how they approach end of life?
Do you have conversations about pain medicine portrayal on TV and film?
Do you wish your parents understood what you do for a living?

See your wishes for the world and the pain you want to relieve through this platform and together we can make a tremendous difference.  This site is not about one person alone late at night writing on the website.  It is about ten, one hundred, one thousand people alone late at night writing on the website joining in a cacophonous conversation that spreads across the globe to support the good work you do.  Supporting Pallimed and other hospice and palliative blogs is about investing in yourself.


2006 - 1st Anniversary
2007 - 2nd Anniversary
2008 - 3rd Anniversary
2009 - 4th Anniversary
2010 - 5th Anniversary 
2011 - 6th Anniversary
2012 - 7th Anniversary

Photo Credit: Adapted from 8 by chrisinplymouth under CC By-NC-ND 3.0

Tweet

Are you drowning in information about hospice and palliative care?  It seems like every day there is a new aggregator of articles, highlights and tweets.

The criteria to the list below is:
1) The information must be primarily related to the clinical practice of hospice and/or palliative care,
2) The information must be able to land in one's inbox via email subscription,
3) The information must be available without paying for it directly or indirectly (membership), AND
3) The information should be posted with a regular frequency.

And here is the list in alphabetical order:

Blogs
Hospice and Palliative Care Blog List

Palliative Care Journals (all issues/articles open access)
Supportive Oncology
BMC Palliative Care

Palliative Care Journals/Collections (Table of Contents/Article Alerts)
Current Opinion in Supportive and Palliative Care (TOC)
European Journal of Palliative Care (TOC)
JAMA Network - Palliative Care/End of Life Care (Article Alerts/Partial Open Access)
JAMA Network - Pain (Article Alerts/Partial Open Access)
Journal of Pain and Symptom Management (TOC)
Journal of Palliative Medicine (TOC/Partial Open Access)
Journal of Social Work in End of Life and Palliative Care (TOC/Partial Open Access)
Omega - Journal of Death and Dying (TOC)
Palliative and Supportive Care (TOC)
Palliative Medicine (TOC)
Supportive Care in Cancer (TOC)

Research Summaries
HospiLink by Hospiscript
Palliative Medicine Matters by Hospice Pharmacia

Aggregators
All Thing Palliative by Dr. Steven Prior
AAHPM Smart Briefs (open to non-members)
Media Watch by Barry Ashpole

Newsletters
ChiPPS (Children's Project on Palliative/Hospice Services) by NHPCO (open to non-members)
CAPC eNews

Photo Credit
Margot Trudell - "Drown" (via Flickr) -  Some rights reserved

I may have missed some that meet all four criteria above, so if you have others please email me tip@pallimed.org

Tweet

Hi remember us?  Just your friendly neighborhood hospice and palliative medicine blog.  Yes we have been quiet for almost three months.  And even before that we were slowing down in our posts.  But I think that needs to change. And it will start to change now.

Pallimed has been a labor of love since its inception.  No ad revenue, no grants, no donations, just some after hours writing on topics which we the writers thought were interesting.  We were part of a very early growth in specialty medicine blogs and became a pretty strong voice.  But then the time to write posts seemed to disappear, it was easier to just tweet a link, and many other good informational sources started appearing.  We have heard many stories from all of you about how seeing these posts made you feel more comfortable to start your own blog, or start to tweet and share information about hospice and palliative care far beyond the walls of your organization.

Many times over the past few months I have written drafts to post, only to save them, and feeling they were not up to par.  A severe case of writer's block is what I finally self-diagnosed. The block is a vicious beast.  But today is a new day.

This new day is inspired by a sign I saw while driving down the street in Chicago on a recent visit.  Now if any of you know me, I am not one to think much of superstition or amazing coincidences, but I would describe my understanding of the human mind as a meaning making machine. So when I saw this sign I was overcome with a rush of meaning.

Yes, that is the 'P' of Pallimed in the serif font known as Algerian. I had never seen it in other locations, (even though apparently it can be seen in many places, and inspires a deep loathing.)  What I see with this sign is not the classic 'No Parking Any Time' but rather 'No Pallimed Any Time.'

And I did not like the feeling when I saw it.  So now in this new day, you will start to see more posts from me, and I will start to spur the old motley crew of bloggers who have written some fantastic posts in the past.  I have thoughts for a redesign but hiring a professional coder to do the work so it has a much cleaner and intuitive feel, maybe even a new logo to get rid of that loathsome Algerian.  So if you want to be part of the new day, keep reading, commenting, sharing, and if you really want to contribute (no blogging experience necessary) email me now at ctsinclair@gmail.com

More to come on the new day...

Tweet

While we are a bit quieter than we used to be when we started we are still here and blogging. At nearly 1200 posts, this past week marked the 7th Anniversary of Pallimed (Jun 8, 2012). No need to recount the beginnings since you can read that in other anniversary posts (linked below). But I just wanted to take a moment to mark the passage of time. Thanks for being here with us readers and sharing these posts.

As the current editor I still have grand plans for what Pallimed can be, but little things add up and it makes it hard to keep pushing for a vision when so many other priorities come first. We always love to hear feedback from readers so please share with us your thoughts in a comment or by email to christian@pallimed.org.

2006 - 1st Anniversary
2007 - 2nd Anniversary
2008 - 3rd Anniversary
2009 - 4th Anniversary
2010 - 5th Anniversary
2011 - 6th Anniversary

Tweet

[Ed. note: This post is a reimagining of a post at Geripal. Same facts - some simliar sentences - wholly different approach.]

This week the American Geriatric Society is holding their annual meeting and they announced they will now do a fellowship match starting with the 2014 academic year. This is huge news for geriatrics since they have been without a match since they were first officially recognized by the ACGME in 1988. It also serves as an important benchmark for palliative medicine fellowships.

Why is this important news? Both fellowships have a lot in common and hopefully directors at geriatrics programs can work with their HPM colleagues to accelerate working through the complexities of getting a HPM match. We have seen posts on GeriPal and Pallimed about the frustrations caused by not having a match.

With Geriatrics now having a match, hopefully our field will be inspired to do the same in a rapid manner. This should be easier because we have gotten past the toddler years as a subspecialty. Can you believe it was only 6 short years since ACGME officially recognized HPM? We now have over 70 HPM fellowships and a few score that have been existence under voluntary guidelines for more than a decade.

The match offers many benefits to future fellows: more opportunity to see other programs besides their home program, and more clarity on the timelines on when programs will take applications, interview, and make offers. With all these benefits it is surprising to me that out of nearly 150 recognized specialties only 50 or so participate in a match.  Thankfully our field is marching towards a match, but it is not as easy as one might think. 

I have been in discussions at meetings with over 40 fellowship directors in the room who are all desiring great candidates in a fairly small pool.  When the match comes up, the tension in the room can rival a challenging family meeting when you start talking about what dates work, and how soon to implement a program.  One thing nearly everyone agreed on is the importance of a match for fairness to programs and applicants.  The challenge is more in taking a good idea and making it reality.
If you may not understand why this is important, I again encourage you to read Brian McMichael’s post on what it is like to be an applicant in the current system:

“My [application] process was cut short by a spoils-to-the-swift ethic. Because of the asynchronous timelines, I had to decline interview offers from programs I was very interested in. Given the inherent power disparity in the roles and the dynamics involved, I did not believe I had the latitude to walk away from offers from great programs in order to "explore my options" further. Perhaps my issue, but I doubt mine alone."

It is sad that this is the first impression that we give applicants coming to the field. I am happy that Geriatrics has accomplished this and that we now realize we do not have to wait 24 years for palliative medicine to do the same.  We will do better.

[Ed. note:  I appreciate what GeriPal and Eric Widera have accomplished and their ongoing contributions to the field.  I enjoy working with him and the writers at Geripal.  These words represent no one but myself.  This is not a war between us, so please  don't make it out as such.  This is more of a creative writing exercise because after reading his post I felt insulted.  Not as a board member, or as a blogger, but as a member of this field.  We have studious people accomplishing great things in palliative medicine and hospice organizations.  We are not perfect and it is good to encourage us to do better, but language matters.  Our work makes this clear. - Christian Sinclair]

Tweet

We welcome comments about any aspects of the questions or the answers/discussions.  The feedback that we hope to get in the comment sections of the post will help us all learn important aspects for the boards. We also welcome an interdisciplinary viewpoint when answering these questions, so even if you are not taking the medical boards, your input is still very much welcome.



Discussion:Show/hide Discussion

Tweet

There are many simple ways you can participate and the NHDD website is a great resource.  If you haven't planned anything for the public you could just focus your efforts on your friends and family.  Or maybe your whole hospice office could make sure everyone has completed their advanced care planning.  Or you can participate in the blog rally on Monday and use your social media platforms to spread the message. And you can have fun with it like these medical students did in their Star Wars themed Advanced Care Planning Video.

Most of all don't be hypocritical.  If you are going to encourage everyone to complete it, take the first step and do it yourself.  If you can't convince yourself to complete your advance care plan then how well will you be able to advocate for others.

Tweet

We welcome comments about any aspects of the questions or the answers/discussions.  The feedback that we hope to get in the comment sections of the post will help us all learn important aspects for the boards. We also welcome an interdisciplinary viewpoint when answering these questions, so even if you are not taking the medical boards, your input is still very much welcome.

You visit a patient at home receiving hospice care for cancer. Her pain has been well controlled with long acting morphine 60mg BID and occasional PRN doses of short acting liquid morphine (10mg) over the past few weeks: she had been tolerating this well. She has had recent progressive functional decline and is currently at a PPS of 20%. In the last 24 hours the patient has vomited and has been more lethargic and having difficulty swallowing pills. She appears uncomfortable. In your examination you see a very thin patient who appears to be dying with a prognosis in the few days to a week range.

The patient’s son is a respiratory therapist at a hospital and is insisting you change the patient’s opioid to a fentanyl patch because “it is less sedating than morphine.”

The best response is:

a) Because the patient is cachectic, you tell the family that fentanyl transdermal patches are not indicated because the medication will not be absorbed.

b) Agree with the son and convert the patient to a 37.5mcg/hr fentanyl patch with oral morphine liquid 10mg q1 hour PRN

c) Because the fentanyl will not be effective for over 24 hours, continue the long acting morphine sulfate 60mg BID but give it rectally instead of by mouth

d) Suggest starting a morphine infusion via her port at 1.7mg/hr basal with a 3mg q30min bolus PRN after talking with the son about his concerns about sedation.


Discussion:Show/hide Discussion

Tweet

We welcome comments about any aspects of the questions or the answers/discussions.  The feedback that we hope to get in the comment sections of the post will help us all learn important aspects for the boards. We also welcome an interdisciplinary viewpoint when answering these questions, so even if you are not taking the medical boards, your input is still very much welcome.

Mrs Dole, a 68 year old with 20 year history of Diabetes Mellitus Type II is referred to Palliative Care from Oncology with Stage III Nasopharyngeal carcinoma. Nausea is the key concern. For last 3 years she has had early satiety but maintained weight. Since initiating chemotherapy, she has had nausea for the first 2 days of her chemotherapy cycle, which then resolves.

1 week after the last round of chemotherapy she required intravenous fluids for dehydration. Now 2 weeks later is having intermittent severe nausea. It can be provoked by sudden changes in body position. She fell once because she lost her balance. Usually she does not vomit, but occasionally does. She describes a feeling of the room spinning associated with the nausea.

Of the following options, which drug is most targeted to this patient’s specific nausea type:
a) Ondansetron
b) Prochlorperazine
c) Metoclopramide
d) Diazepam
e) Meclizine

Discussion:Show/hide Discussion

Tweet

For those who attended our blogs to boards session - here is the link to the PDF's posted on Slideshare (Questions + Answers; Questions Only)






If you didn't get the chance to attend, don't fret.  We plan to post a question a week on both GeriPal and Pallimed to get everyone ready of the 2012 palliative care boards.

Tweet

For the past few years at Thanksgiving, Pallimed donates a blog post to Engage With Grace, a movement to encourage a new tradition of using the family time during this American fall tradition to get families talking about what is important to them.  This is a movement you can easily get behind in person if you are an advocate for good patient centered health care, which you likely are if you are reading this blog.  So donate your blog, Facebook update, Twitter account (#EWG) to Engage With Grace this holiday weekend.  And then put your money where your mouth is and bring it up yourself while your family is together.

Tweet

by  adaphobic

A 50 -year-old woman calls the palliative care office requesting an outpatient evaluation. She says that she was diagnosed with rheumatoid arthritis approximately one year ago. She has gained benefit from initiation of disease modifying anti-rheumatic drugs yet she is still left with residual pain that has caused her to cut back on her work schedule. She reports over the phone that she has stopped going to church because she has a hard time sitting through long early morning church services and she's also developed depression. She read about palliative care on a website and decided to give the clinic a call to request an evaluation.

Is this a scenario which you have been encountered previously ?

I ran across a blog post the other day ("Palliative Care: The Pal for Every RA Patient") from an enthusiastic advocate for patients with rhematoid arthritis who suggested that palliative care might have a role in this type of patient.

Let's review some generally accepted "criteria" for "early" involvement of palliative care:

• Does the patient have a serious illness? No one can argue the fact that rheumatoid arthritis is very serious.
• Does the patient have  a burden of symptoms? It certainly seems so. Check.
• Does the patient had significant psychosocial and spiritual concerns? Yes indeed.

I think it is flattering that palliative care would be considered an option in this type of scenario. It means that our field's message is truly getting across to a wider audience and that our philosophy is resonating with that audience.  The biopsychosocial model which underpins palliative care also applies very well to care of patients with rheumatoid arthritis.  If an expert palliative care inter-disciplinary team is to see patients as described above, though, we are going to need to bring our sleeping bags into work.

The recent CAPC Public Opinion Survey suggested that we should say that we see patients who have "serious" illness rather than "advanced," "life-limiting," or "terminal" diseases (see Christian's post about the survey here).  I have found this to be helpful as I describe our services to new patients/families.  If we want to see patients at an appropriate point in their illness course, create appropriate demand amongst patients/families, and ensure they will embrace us from the start, then using "serious illness" does seem to be a more sensitive approach (for finding cases which may be appropriate for palliative care). 
      
We'll likely never find an ideal 1-2 word adjective to describe the type of patients we think we can benefit most.  Most of the terms above represent general statements regarding prognosis but still leave a lot for interpretation (eg when in the does one become "terminally ill"?)  "Serious" tells you even less regarding prognosis- it's only a vague conception of how a patient or family perceives their illness. We  need to accept that while "serious illness" is more sensitive than other terms , it probably isn't as specific.  As we try to maximize the number of appropriate early referrals, we'll continue to be challenged to determine what our role is for patients as described above.
 
Intersections between palliative care and rheumatology do definitely exist, though.  The author of the blog post does refer to a journal article which describes some cases where palliative care is most certainly appropriate. This article is worth a glance and I have encountered some similar issues in my clinical work.

Certainly I do not discourage this type of advocacy. I remember from my residency being exposed to several rheumatologists who practiced medicine using a biopsychosocial philosophy. I'm sure that many of them would welcome greater interdisciplinary involvement.   Perhaps palliative care's greatest benefit for these patients would be more indirect than seeing every patient.  System-wide educational and quality improvement palliative care initiatives may be where the value is for these patients.

How would you recommend that a palliative care team handle this type of request for an evaluation?  Here are some possible options:

• I would schedule the patient for an appointment with a plan to provide a single evaluation, sending recommendations back to the rheumatologist and primary care physician.
• I would be open to the possibility of comanaging this patient over time alongside the patients rheumatologist and primary care physician.
• I would consider taking over this patient's primary care as the palliative care clinician.
• I would not schedule an evaluation of the patient.
• Outpatient palliative care clinic?  We're barely keeping our heads above water seeing patients in the hospital!
• Other.

Tweet

The Happy Hospitalist, a long time blogger and purveyor of fine absurdist humor with the creation of multiple 'animated bear' videos (aka Xtranormal videos) has created a video focused on the dying patient in the intensive care unit...but not really.  Not really in the fact the video is not patient-centered at all, and that is the point.  HH skewers the system that so readily places orders for tests, scans and procedures before even talking or touching the patient.  For anyone in hospital based palliative care I am sure there are many witnessed experiences in the self-declared hyperbole of the video.


Here is the video (link to original post):


Below are some of my favorite lines/segments because they emphasize the frustrating weaknesses of our current approach to care of the critically ill:

"His functional score is -2, which means death within minutes."
'The cardiologist who orders a stat echo, EKG Q1 hour, and a iTunes enhanced pacemaker so he can bill for music therapy.'
"'Everyone deserves to die with a normal BMP."

There are other little gems I don't want to spoil that will make sense to anyone who has worked in the hospital, and for the non health care professionals reading this post I think anyone who has had a loved one critically ill will recognize some of these absurd situations that divorce the care of the numbers from the care of the patient.  This point is highlighted in my favorite line of the video which is repeated over and over again from both the hospitalist and the ICU nurse:

Listen all the way to the end to get a sense of what HH really thinks about palliative care in the hospital.  He has been a big supporter of palliative care and he gets the fact that palliative care should be far upstream from just dying patients in the ICU.  For examples see some of his other posts:
Barriers to Palliative and Hospice Care: Denied by the Nursing Home
End of Life Care Discussion Should Occur Before Death
The Power of Love: Going to Dialysis Hell and Back

Leave your thoughts here but also go to Happy Hospitalist's blog and leave comments there because it is pretty popular and our thoughts might get to people outside our normal blogging circles

Tweet

A hearty congratulations to Eric Widera and Alex Smith and the rest of the GeriPal team for reaching their two year milestone.  They have created a wonderful site where geriatrics and palliative care are discussed passionately and their reach is extending the field.  GeriPal has become a major influence in just two short years because of hard work and their dedication. 

And if you are thinking, "Gee GeriPal and Pallimed do a great job of independently covering hospice and palliative medicine issues, so there is no other need for a new blog"...you would be selling yourself short.  We need more writers out there.  Be the next Pallimed, or GeriPal!  And when you start your blog come tell me, and we will help spotlight your best writing. And remember there are plenty of other great blogs out there too, check the list. (If you are blogging and not on it tell me!)

Kudos to GeriPal!  Find them wherever you like to live on the web: Facebook, Twitter or their blog.

Tweet

Today is the 6th anniversary of Pallimed and while we had a great beginning of the year you may have noticed that it has been pretty quiet around here lately. You do not have to worry, we are not going away, but I think all of us here were keeping busy in so many other parts of our lives that Pallimed took a bit of a back seat to other priorities. Finding balance is something we try to help our patients and families acheive and of course self-care is something we stress to our peers and trainees as well.

The good news: in the month off, the hospice and palliative medicine world of blogs and social media did just fine. So we are glad to be in a cultural ecosystem that allows for these breaks every once in a while. In fact now that we are back from our unannounced hiatus, I want to challenge you to fire up that old blog or Twitter account and get back on the horse. You might have taken a break too, but now you can get back in the game, because we need you, your field needs you.

The more we talk openly in public about the complexities faced by our patients, the quality research advancing care, and the humanity within our everyday tasks, the stronger our field will become.

• Keep the comments coming to all the great blogs out there.
• If you know how to Tweet teach someone else to do it. 
• Look out for an announcement from Pallimed next week on a new initiative.

"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has." - Margaret Mead

For stats and history peruse some of the past anniversary posts:

2006 - 1st Anniversary
2007 - 2nd Anniversary
2008 - 3rd Anniversary
2009 - 4th Anniversary
2010 - 5th Anniversary

Tweet

Palliative Care Grand Rounds is back after a brief hiatus.  Thanks to last month's host Tim Cousounis for restarting PCGR with a bang.  Let's jump right into the best of the blogs featuring hospice and palliative care from the last month.

• Melissa Sweet from Australia blogs for Croakey (the health care blog of the site Crikey).  She recently featured  Palliative Care Australia and their efforts to develop a national consensus statement on palliative care. From the first post a larger discussion on the use of social media to help palliative care grow in Australia led to a second post.  (Found via @GroundSwellAus)

• Blog posts written from personal experience are so helpful in understanding how health care is experienced from the other side of the Electronic Medical Record.  Nora O'Brien-Suric, a geriatric social worker, writes about delirium in her father after bypass surgery on "health AGEnda" the John A Hartford Foundation blog. She writes:

So my family members asked physicians they knew the same question and reported back to me that a cardiologist, a neurologist, and an internist had said that my father should not be experiencing any confusion after surgery and therefore he must have dementia. This came as a complete surprise to me, as I just assumed that all health care professionals, especially those who work with older people, would know what I knew.

• From this post I found out there is a brand new group looking at this issue in more detail, the American Delirium Society.  Can you believe it?  This is one symptom that needs more attention and I am so glad to hear this. They just finished up their first conference this week.

• Tara Parker-Pope at the blog "Well" (NY Times) features the great multimedia mini site from the New York Times on Childhood Cancer.  It features pictures and audio recordings of 6 children (via Krista Renenger at the HFA's Hospice and Caregiving blog)

• GeriPal was on fire in may with some great posts.  Alex Smith with 'Your Tax Dollars Are Being Wasted by Medicare' makes a compelling argument why talking about the role of money in our health care system needs to be part of a larger discussion.  I also enjoyed Eric Widera's post on choosing between two different specialties, in his case Geriatrics and Palliative Care.  Well at least we know what happens when those two get together, you get GeriPal and we all like that!

• Empathy is a common theme in communication training for any palliative care trainee, but Dr. Shock emphasizes that etiquette and not empathy might be the more appropriate 'e' word:

Empathy or the ability to appreciate someone else’s emotions and express this emotional awareness is a capacity that differs amongst individuals. It’s clear that doctors who can communicate well with patients will be more effective. Communication is an important competence educated during med school. This is mostly about etiquette instead of empathy.

• And here is a bonus from Dr Shock: the video 'Beards and Bow Ties.'  I'm thinking we might need something like this for hospice and palliative care.  Reading the comments you can see even something like this is controversial.

• Garr Reynolds is well-known in speaking and presentation circles for his books like Presentation Zen.  (NB: all people who present at conferences can benefit from reading his books.  Please. No more boring slides. Please.) He recently wrote about the importance of Grandmothers in his post "The Eternal Power of Relationships"  There is much in this post any palliative care advocate would like and probably find something to take away with them. And one of them has to do with a Japanese song called "Toilet Goddess." You should read the English lyrics. 

• Fresh Widow blogs about the integration of LGBT families into grief support groups.  The civil rights of the LGBT community have very real consequences when it comes to health care but also in the aftermath of an illness and death.  She challenges organizations who care for grieving people: 

Civil rights IS an issue for organizations that support the grieving. Gay families are families. I challenge organizations that support grieving people to accept love and families of all stripes and to STATE their non-discrimination policies up front. Because sad as it is, you can lose a partner and STILL get turned away from free, peer-based support, and you can make that call without ANY idea how you'll be received.

• Now here is a post that should spark your imagination for some research studies and maybe feedback to trainees. The Talk-o-Meter iPhone app that measures how much each person in a two-person conversation is talking.(via GOOD magazine) I'm thinking it could be helpful in IDT if it could track multiple voices. Speak up chaplain!

• What is the role of scientist in explaining research to the public?
• What are the barriers to communicating this well?
• How does one read a scientific paper?
• And why should we all understand statistics a little bit better?
• Why don't professional media outlets rarely cite the author or journal or title of articles they quote?
• Why should you never draw your conclusions solely from the tables and figures of a paper? 

I love this quote from Freed:

Now listen: most non-scientists see a table like this and freak out. They take around 3 seconds to decide they can’t understand it, get scared of feeling stupid in the face of all those numbers, and so they calm down by skipping over it and back to the words. Scientists have a huge advantage over their non-scientist friends on this front: they don’t expect to understand this table in three seconds. Or even three minutes. They look at it the way a piano player might look at a Bach score, or an art lover might look at the Mona Lisa.

Thanks for tuning into to another edition of Palliative Care Grand Rounds. Look for us in July on another great hospice and palliative care blog.  For updated schedules and past PCGR see http://www.palliativecaregrandrounds.org/