Burdensome Transitions: Harry Potter and Health Care Reform: by Joan Teno, MD, MPH
September 29, 2011 | 
Author
Based on research and my clinical experience, my concern is the financial incentives of Medicare and Medicaid result in some health care providers hospitalizing NH residents to qualify them for SNF Medicare benefits. My fear is what you pay for is driving force in these health care transitions. Often this is not an explicit decision, but the middle-of-the-night reflex act of sending a frail, older patient to the ER. Read the rest of this entry »
Decision Science meets Decision Fatigue
When do we typically conduct family meetings?
Are you, and the families/patients hydrated, fed, or hungry and fatigued?
In this issue of JPM, Bakitas, Kryworuchko, Matlock, and Volandes present an framework for how the emerging field of Decision Science and Palliative Care have complementary and perhaps synergistic roles in enhancing the decisions about patient preferences at the end-of-life. Read the rest of this entry »
Posted in Communication, Patient Centered Care, Psycho-social | 
Tags: decision making | 
7 Comments »
Decision Fatigue
An article in the August 17th New York Times Sunday Magazine by John Tierney Do You Suffer From Decision Fatigue? seems pertinent to palliative care patients and families.
The article reviews recent data that confirm that the complexity of making choices or decisions can be very fatiguing. This can result in Read the rest of this entry »
Posted in Communication, Patient Centered Care, Reflective practice | Tags: decision fatigue, decision making, palliative care | 3 Comments »
Call to Action for JPM Readers
Your favorite Journal is looking to engage you in our JPM Social Community. Stay connected and engaged with your favorite Journal (of Palliative Medicine) . Email us and get involved immediately with your JPM community Read the rest of this entry »
August 2011 posts: Thanks Dr. Cadell, Dr. Dellinger and Dr. Nagpal!
Check out some excellent posts by Drs. Cadell, Dillinger and Nagpal Read the rest of this entry »
“How do you do this?”
We had just spent the better of two hours with a newly diagnosed cancer patient.
A patient young, certainly by the standard of my own 60 years.
She herself still absorbing the news that she, no one, ever hopes to hear. Her husband, at more remove, fathoming, all at once, the unfathomable. The visit itself emotional, more so than any of us in that room might ever have expected.
With me, this visit, one of the Family Medicine residents with whom I work as faculty. She, the entire time, quiet, but attentive, paged once from the room—and long then in returning. Read the rest of this entry »
Ondansetron associated with fatal arrythmias
The FDA has issued a warning that Ondansetron may increase the risk of developing prolongation of the QT interval, which can lead to an abnormal and potentially fatal heart rhythm, including Torsade de Pointes. Read the rest of this entry »
Regarding Great News
Dr. Dillinger,
Thank you for posting. I believe I have read some articles saying that patients covered under Medicare use more than 33% and some use up to 40% of their total care usage/cost to Medicare during their last 6-12 of life. I do not recall the source, but you have sparked my interest and I’ll work on finding current data. First I’ll look to Centers for Medicare and Medicaid Services data, unless you wish to guide me elsewere. Thanks again
Off-service reflections: Where is the weakest link in our health care system?
I am just coming off a very busy palliative care service. A multi-disciplinary team of us have been caring for a diverse cohort of patients in a dedicated palliative care unit, a busy palliative care consult service as well as an out-patient clinic.
Here is a smörgåsbord sample of encounters in the past few days Read the rest of this entry »
Going Postal
An 86 year old patient with advanced malignancy is seen by palliative care for anemia, dyspnea, fatigue and pain. Patient is a very meticulous person and maintains pristine personal financial records and documentation. His fatigue has been getting worse. On questioning, Read the rest of this entry »
Surrogate Decision Making
A complex case:
JD, an octogenarian was admitted for pain control for a terminal cancer with an anticipated life span of several days. Patient was decisional on admission and continued to remain lucid and was able to report symptom status and intensity as well as report on the effectiveness of the pain medicines. Patient had two spells of confusion which were thought to be secondary to Read the rest of this entry »
Labor of Love
Today is Labor Day. The U.S. has been celebrating the American worker since 1882. It’s a day where we picnic, barbecue, get together with family and friends, and say goodbye to another summer. Many of us don’t get to enjoy Read the rest of this entry »
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