GeriPal - A Geriatrics and Palliative Medicine Podcast

Emergency Podcast! Our guests Sean Morrison, Ken Covinsky, and Stacy Fischer believe that you should care deeply about the proposed shakeup at the National Institutes of Health. Major proposed rules changes at the Office of Management and Budget, would affect a huge range of government grants, from Headstart to Transportation to the National Science Foundation, as well as the National Institutes of Health (NIH), the subject of today's podcast. You dear listeners should all care. You should care because you care for older adults, or you're a researcher who studies palliative care, or you're a chaplain who visited with the family of a patient who died today. You should care because these rule changes are so sweeping that they would remove standard components of the scientific review process and instead put them in the hands of political appointees. You should care because if rules like this were in place in the 1980s, we might not have developed treatments to stop the HIV/AIDS epidemic. You should care because if these rules go into effect we will not be able to work with researchers in other countries studying outbreaks of Ebola or Hauntavirus. You should care because these rules silence federal research into groups of people we care for daily. And if you're not a researcher, your voice is even more important here. As Sean says, researchers who protest these proposed rule changes might come across as self-serving. Clinicians who are not researchers - who can say that these rules will negatively impact the science that improves care of older adults living with chronic conditions and their families - your voices may resonate even more. What can you do? Most of these rule changes are open for public comment here until July 13, 2026. Every comment will be read and requires a response. It's ok to respond anonymously. Personalized stories matter more than form responses. Tips: 1: Say (or just describe to keep anonymous) who you are and why you are qualified to comment. Telling the story of how patients and families you care for or study is enough. Get your partner and parents to respond too. Simply being a concerned citizen is perfectly fine. 2: List the exact provision #s that concern you, and explain what they would do. You do not need to quote the rule directly. Just explain what you understand it to mean in plain terms. Political Appointees Take Control of Grant Awards (§200.205); Peer Review Is No Longer Binding (§200.205(d)); Active Grants Can Be Terminated at Any Time, for Any Reason (§200.340); DEI, Gender Research, and Related Topics Banned as Grant Conditions (§200.300); Prohibition on International Scientific Collaboration (§200.220); Conference Attendance Now Requires Express Agency Pre-Approval (§200.432); Publication Costs and Open Access Fees Presumptively Unallowable (§200.461) 3: Explain the concrete harm. What would happen to your patients and their families if this provision takes effect? 4: Closing: State clearly what you want OMB to do. This can be as simple as: "I urge OMB to withdraw these specific provisions: §200.340, §200.202, §200.205." or "I urge OMB not to finalize this rule." Submit your comment in opposition here: The deadline is July 13, 2026. You can also email your congressperson or senator. Times they are a changin'.

Today we revisit a topic we last discussed in a 2020 podcast with Laura Mosqueda: elder mistreatment. Our guests today are geriatricians Carrie Rubenstein and Julia Hiner, and Tony Rosen, an emergency medicine doctor. They talk about where we are now, in 2026, with elder mistreatment, including: Terminology: elder mistreatment vs. abuse and neglect The need to incorporate prevention and solutions into how we talk about mistreatment This is not rocket science. Studying elder mistreatment is much harder than rocket science. Highlighting the reasons they focus on elder mistreatment, including inspiring words for why this led them to geriatrics and aging research Should we screen for elder mistreatment? The US Preventive Services Task Force doesn't see enough evidence to recommend screening. Our guests may differ… Which clinicians should assess for elder mistreatment? Hospitalists? ED docs? Primary care providers? Tony published a study in JAGS showing older adults who experienced elder mistreatment were as likely to visit primary care as those who did not, also great accompanying editorial by Mara Rosenberg and Lena Makaroun gets a shout out. Early evidence that supporting caregivers can reduce elder mistreatment (in one small study of the COACH intervention, rates of mistreatment were reduced to zero) Borrowing from pediatrics: many/most hospitals and emergency departments can call a Child Protective Services Team. Tony is piloting a parallel team for older adults - the Vulnerable Elders Protection Team (see JAGS paper). We talk about key members of interdisciplinary teams across sites, systems, and counties. Social workers get a big shout out. A one year fellowship in capacity assessment and elder mistreatment at UT Houston, directed by Julia. An Elder Abuse Curriculum for Medical Residents and Geriatric Medicine Fellows https://pmc.ncbi.nlm.nih.gov/articles/PMC10842324/ Kudos to my son Renn for recording 5 overlapping cello parts on Eleanor Rigby! -Alex Smith

Our focus today is on the search for the geriatrician identity, a continuation of the conversation we started with Jerry Gurtwitz on the Future of Geriatrics. Today's conversation is prompted by multiple articles in JAGS: (1) an article by Jerry Gurwitz with a title the same as this podcast; (2) an article by Helen Fernandez on "Med-Geri", a new combined 4 year internal medicine residency and geriatrics fellowship track; and (3) an article by Mary Tinetti titled, "Mainstream or Extinction: Can Defining Who We Are Save Geriatrics?" Of note, Mary's article is a follow up to her 2017 article in JAGS in which she wrote: Those outside the field have difficulty understanding what geriatrics is and what geriatricians do. We contribute to this lack of clarity. We are experts in complexity but are often bad at communicating simply. Our well-intentioned efforts to be inclusive and comprehensive lead to the creation of long, complex descriptions of what we do that further compromises understanding while eroding interest in, and support of, our field. Today we tackle this problem, discussing: A "funny if it wasn't so painful" video and JAGS article in which geriatricians from Johns Hopkins roamed the streets of Baltimore asking lay people "What is a geriatrician?" The responses (something to do with Ben and Jerry's ice cream? Jury-atrician?) will make you laugh and cry at the same time. 4 different types of geriatricians as described by Jerry in his JAGS paper: the complexivist, the healthful longevitist, the syndromist, and the contextualist. As with the 4Ms, Ken couldn't help but add a 5th, the "identityist", arguing that maybe Geriatricians worry too much in public about their identity, and should instead focus in public on what unites them: shared sense of purpose and mission to focus on whole person care and what matters most to older adults. Ken gave a rousing talk on being a Geriatrician at the Society of General Internal Medicine that received a lengthy standing-ovation (and a Cubs Jersey with his name on it). Innovative new programs such as Med-Geri and GeriPal fellowship as ways to bring more people into the profession. How to balance our effort between recruiting specialist geriatricians to the profession and teaching all clinicians geriatrics principles and skills. A paper in JAGS by Richard G. Stefanacci and Ankur Patel in JAGS making the argument that a geriatrician "yields per-patient annual net cost savings of approximately $3495 (specialist consultation avoidance +$1500; ED reduction +$45; hospitalization reduction +$1950)..." and "The reason fee-for-service fails geriatricians is not that their skills are wrong for primary care—it is that the payment model is wrong for their skills. Payvider programs operating under capitation invert every structural disadvantage of fee-for-service. Under capitation, there are no RVUs. There is no penalty for spending 40 min with a complex patient. There is no revenue loss when the patient is dual-eligible rather than commercially insured—the capitated payment is the same regardless of original coverage source. And every unnecessary specialist referral, every avoidable hospitalization, every ED visit that could have been managed in-house represents a cost to the organization rather than a revenue stream." Stay until the end when Mary has one of the best answers yet (in over 400 podcasts!) to Eric's "if you had a magic wand" question. Enjoy! -Alex Smith

While we have previously discussed brain death criteria on the GeriPal Podcast, we have yet to explore the complex landscape families face regarding organ donation. In this episode, we dive into the nuances of Donation after Brain Death (DBD) and Donation after Circulatory Death (DCD), and clarify the essential role of healthcare providers who are not part of an organ procurement organization. In this episode of the GeriPal Podcast, we step into a space in serious illness care that is often misunderstood, overlooked, or reduced to a simple "call the organ donation network" checklist item. Joining us are three experts to help us understand the process and our role in it: Samantha (Sam) Taylor, a Donation Support Specialist and expert trainer on the donation request conversation Dr. Nikole Neidlinger, an abdominal transplant surgeon and medical director for the organ and tissue donation program at the University of Washington Dr. Toby Campbell, palliative care physician and host of the Extraordinary Conversations podcast, which is focused on organ donation for its first season. We'd also like to send a big thank you to Toby as he was the one who recommended doing this podcast, and we'd encourage all of our listeners to check out Extraordinary Conversations. I personally love episodes like this as it opens up a black box that I otherwise dont think about (similar to our Undertaker podcast with Thomas Lynch where we talk about what happens after someone dies).

Eric and I were delighted to be invited to Brazil to give a series of presentations in Sao Paulo at their annual geriatrics meeting. We met people doing important, interesting, and innovative work in Brazil and throughout Latin America. We got the audience to sing along, including (in another talk) the magnificent Brazilian song Sozinho by Caetano Veloso in Portuguese, with my son Renn playing guitar. For our final talk, a podcast in front of a live conference audience, we asked our 3 guests, Eduardo Ferriolli, Marlon Aliberti, & Edison Iglesias to select a recent article to discuss. We talked about: Intrinsic capacity (selected by Eduardo). What is it? What is it used for? How do you measure it? (hint ICOPE). Eduardo emphasized that intrinsic capacity is a positive aspect of aging, focused on potential rather than deficit. We asked him to work intrinsic capacity into George Kushel's famous analogy using the golden gate bridge to describe phenotypic frailty (pillars), deficit accumulation frailty (cable supports), and resilience (withstand stress of wind and cars). Eduardo says intrinsic capacity would be the car, and would vary by type of car and intended purpose. I loved Eduardo's selected article, which percentiles intrinsic capacity, in order to use within individuals to assess how they're tracking over time, and at a public health level, to identify regions or groups of people with lower intrinsic capacity. He draws the analogy to growth curves in pediatrics - if you're consistently at 80% - then drop off - your primary care provider should take notice and investigate/intervene. Geriatric syndromes in hospitalized older adults (selected by Marlon). If intrinsic capacity is for primary care, our guests argue that the comprehensive geriatric assessment, which takes a long time to administer, should be reserved for specialist geriatrics. And yet, this paper finds that a limited shorter version of the comprehensive geriatrics assessment can document geriatric syndromes in hospitalized older adults. Accumulation of multiple geriatric syndromes is associated with increased mortality, and presents an opportunity for risk stratification, goals of care discussions, and intervention. Advance care planning across Latin America (selected by Edison). Back around 2005, when Edison first heard about advance care planning, he says, "it sounded like science fiction." In Brazil, as with Latin America, medicine was highly hierarchical and patriarchal. Doctors knew best. The doctor decided. If there was no patient choice, why would there be a system to protect the decisions of patients made in advance? In the intervening years, Edison and others have worked to incorporate and adapt advance care planning to the Latin American context, which is much more focused on family-centered relational autonomy than individual, and incorporates spirituality to a much greater extent. Edison has been mindful too of not repeating the mis-steps of the advance care planning and advance directive movements in the US. We took questions from our audience and sang "Imagine" in Portuguese together. Enjoy! -Alex Smith

Rural populations in the United States face unique healthcare challenges. These communities tend to be older, have higher mortality rates, and experience higher rates of chronic conditions and physical disabilities compared to urban populations. Despite the increased need for palliative care in rural areas, access remains alarmingly limited. Even in hospital settings, where palliative care programs are more common in urban areas, only 35% of rural hospitals report having such programs, compared to 81% of urban hospitals. In this week's podcast, we explore the challenges and opportunities of delivering palliative care in rural communities with our esteemed guests Karl Bezak, Jeanie Youngwerth, Adie Goldberg, and Gregg Vandekieft. We begin by discussing what inspired each of them to focus on rural palliative care. From there, we dive into what rural palliative care looks like and examine how it differs from care provided in urban settings. Our guests also share insights into the challenges of delivering this care in resource-limited rural environments and explore innovative strategies to ensure patients and families receive the support they need (like providing remote fellowship training for docs living in rural areas!). We also tackle the role of telemedicine in rural palliative care, both the good part, connecting patients in remote areas with specialists who might otherwise be unavailable, and the bad part, the huge digital divide seen in rural areas. Join us for what I thought were some valuable insights our guests brought on how we can better serve rural populations and create a more equitable system for palliative care delivery. And if you want to learn more, check out some of these resources: University of Colorado's Community Hospice and Palliative Medicine (CHPM) Fellowship, which allows mid-career providers to obtain training while continuing to live and work in their community supported through online and distance learning technology Master of Science in Palliative Care Program: Master of Science Degree The Rural Health Information Hub's Rural Hospice and Palliative Care Overview Stratis Health's Rural Community-based Palliative Care resource center The Washington Rural Palliative Care Initiative website CAPC's Safety-Net and Rural Care website The paper validating the AI Algorithm used to identify patient in rural ED for the TeleGOC Pause Model at UPMC (SafeNET) A Google Site where Karl is hosting their most recent data related to the TeleGOC Pause Model

In 2025, the Centers for Medicare and Medicaid Services (CMS) began requiring hospitals participating in the Hospital Inpatient Quality Reporting (IQR) program to report on a new "Age-Friendly Hospital Measure." The hope is that, by attesting to this measure, hospitals will develop evidence-based processes to improve care for older adults in hospital settings. On this week's podcast, we explore this new measure with Sheri Ling, CMS's Deputy Chief Medical Officer serving in the Center for Clinical Standards and Quality (CCSQ). We've also invited some returning guests from our past Age Friendly Health Systems podcast, Julia Adler-Milstein and Stephanie Rogers, to discuss how they are thinking about this new measure and how we should operationalize it. We go over everything you will want to know about the new measure, including: How does this CMS measure differ from both Age-Friendly Health Systems and the 4Ms movement we've been hearing about for years (and that we did the podcast on in 2020 here) Why is CMS finally making "Age-Friendly" a formal, structural requirement for hospitals now? What is an attestation measure vs outcome measure, and why is this one an attestation measure? A deeper dive into the 5 domains to the measure (Eliciting Patient Goals, Medication Management, Frailty Screening, Social Determinants of Health, and Leadership/Governance. Lastly, here are some great resources if you want to help get this started at your hospital: A report by JAHF, Julia and others on how to think about different dimensions of measure performance Health Affairs Scholar paper on related the 4Ms to the 5 domains Two CMS resources with detailed information on how to meet and report on the five domains of this measure: Age-Friendly Hospital Specifications (July 2025) Age-Friendly Hospital Measure Attestation Guide

It's an era of breakthroughs in Alzheimer's research, yet for many clinicians, it's also a time of profound uncertainty. We are currently navigating competing definitions of the disease, multiple new biomarkers coming on market seemingly every week, and the clinical rollout of new amyloid antibodies. How do we translate this rapid-fire science into daily practice? On this week's GeriPal podcast, we sit down with dementia experts Halima Amjad, Barak Gaster, and Heather Whitson. We dive deep into: The evolving definitions of Alzheimer's disease. Does someone have Alzheimer's disease if you have only an abnormal biomarker as defined by the Alzheimer's Association, or is amyloid pathology necessary but not sufficient to define Alzheimer's as per the International Working Group (IWG) recommendations? Where do blood-based biomarkers for Alzheimer's fit into the diagnostic workup, and should they be used at all in primary care? FYI - here is my take on that question in a recent JAMA IM article titled "The Limited Role of Alzheimer's Disease Blood-Based Biomarkers in Primary Care." What's the role of amyloid antibodies in the care of individuals with Alzheimer's disease, including who to use them on? We covered a lot and discussed some of these resources that you can do a deeper dive on: Blood-based biomarker resources JAMA article on Blood-Based Biomarkers for Alzheimer's Disease: Preventing Unintended Consequences Alzheimer's Dementia article on Blood-based biomarkers for detecting Alzheimer's disease pathology in cognitively impaired individuals within specialized care settings: A systematic review and meta-analysis JAMA IM article on The Limited Role of Alzheimer Disease Blood-Based Biomarkers in Primary Care Appropriate use recommendations for amyloid antibodies Donanemab: Appropriate use recommendations Lecanemab: Appropriate Use Recommendations Primary Care Resources Cognition in Primary Care program A JAGS article on "Large Health System Quality Improvement Intervention Providing Training and Tools to Improve Detection of Cognitive Impairment in Primary Care" Other resources AGS's new online curriculum for Alzheimer's Disease By Eric Widera

Philippe Pinel remarked in 1800 that "It is an art of no little importance to administer medicines properly, but it is an art of much greater and more difficult acquisition to know when to suspend or altogether to omit them." This insight remains profoundly relevant today, especially in hospice care, where inappropriate prescribing is a common issue. Studies show that 20%–70% of hospice patients receive at least one unnecessary medication near the end of life, including drugs like antihypertensives, statins, and vitamins. In this episode of the GeriPal Podcast, we tackle the pressing topic of deprescribing at the end of life with expert guests Jennifer Tjia, Jon Furuno, and Simon Mooijaart. The conversation focuses on identifying medications that should almost always be discontinued—such as statins, osteoporosis meds, finasteride, and vitamins, which offer minimal benefit for patients with limited life expectancy. We also delve into more nuanced cases, such as antithrombotics, which present complex decisions that challenge clinicians, particularly when prognosis spans the many weeks to months range. Finally, we explore practical strategies for engaging patients and families in deprescribing conversations. Our guests highlight tools such as the FRAME mnemonic (Focus on the goals of care, Review current medications, Assess each medication's risk/benefit, Minimize the medication burden, and Evaluate regularly) and the Goal Concurrent Prescribing tool, which helps ensure medication decisions align with patients' values and end-of-life priorities. By: Eric Widera Other resources discussed in the podcast Prevalence and Factors Associated With Receiving a Prescription for Antithrombotic Therapy on Hospice Admission," JAGS. 2025 Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease. 2025 Effects of the discontinuation of antihypertensive treatment on neuropsychiatric symptoms and quality of life in nursing home residents with dementia (DANTON): a multicentre, open-label, blinded-outcome, randomised controlled trial. 2024 Perspectives on deprescribing in palliative care. Expert Review of Clinical Pharmacology. 2023 Developing a decision support tool for the continuation or deprescribing of antithrombotic therapy in patients receiving end-of-life care: Results of a European Delphi study. Thrombosis Research. 2025 Human-Centered Design Development and Acceptability Testing of a Goal Concordant Prescribing Program in Hospice. JPM 2025 Reduction of Antihypertensive Treatment in Nursing Home Residents. NEJM 2025

The idea of embedding various forms of non-emergency care in the emergency department makes a WORLD of sense. If an older adult comes into the ED with a fall, the minimum the ED has to do is address the fall injury and send them out. But many emergency providers realize this is often a band aid. They see that patient again the next time they fall. And again. And again. The same could be said for the patient who is malnourished and dehydrated and admitted for "failure to thrive," again. And again. Our two guests today, Liz Goldberg and Lauren Southerland, both emergency medicine physician-researchers, have had enough. On our podcast today they discuss how these sorts of experiences led them to argue that other services that can address the underlying causes that lead to ED visits. Liz Goldberg developed the GAPcare model to address falls, which includes a physical therapist and pharmacist seeing patients on the spot in the ED. Lauren Southerland got Columbus Ohio Office of Aging staff to re-locate from their desks to the emergency department, where they could sign patients up for home delivered meals, medical transportation, adult day services, home modification such as grab bars, and utility assistance for electricity, gas, and water bills. With GAPcare, Liz saw a 66% drop in ED visits for fall over 6 months from her pilot (subsequent fall outcomes of the GAPcare II study will be linked here when published). Remarkable, particularly in the context of the primary care STRIDE intervention, which did not reduce injurious falls (e.g. the type that would result in an ED visit). Maybe the ED is just a better place to intervene? Patients are motivated to change. Get the physical therapist and pharmacist in there! In a study published in JAGS, Lauren found 50% of participants were linked to a new Office of Aging service initiated during the ED visit, with no increase in ED length of stay or hospital admission rate. See also this terrific JAGS editorial on Lauren's paper by Liz. Putting on my JAGS editor hat - both the study and editorial have terrific color figures. A great way to increase your odds of review and acceptance at JAGS is to include one or more high-impact color figures that convey the main findings or points of your manuscript. We talk about the potential downsides, real and perceived in embedding care in the ED. Should everything be embedded? We talk about how these interventions relate to geriatric ED certification. Lauren talks about a remarkable model in Australia that includes a geriatric RN embedded in the ED. Most encouraging is that Liz and Lauren are finding other adopting these interventions. Word is spreading. Other emergency providers have had enough of the endless cycle. Enough. And I got to belt out Gravity, by John Mayer! -Alex

Recent randomized controlled trials have shown that routine perioperative palliative care does not improve outcomes for patients undergoing curative-intent cancer surgery. No, that wasn't a typo. Regardless of how the data were analyzed, the findings remained consistent: perioperative palliative care DID NOT improve outcomes in the only two randomized controlled trials conducted in this area—the SCOPE and PERIOP-PC trials. Null trials like these often receive less attention in academic and clinical settings, but they can be profoundly practice-changing. Consider the Shannon Carson study on palliative care for chronically critically ill patients. While some have argued it "wasn't a palliative care study," I've always regarded it as one of the most significant studies for understanding not what works—but what doesn't—for palliative care in specific patient populations. The same holds true for the SCOPE and PERIOP-PC trials. Both were null, but their findings are deeply relevant to clinical practice. That's why we invited the lead authors, Rebecca Aslakson (PERIOP-PC) and Myrick "Ricky" Shinall (SCOPE), to share insights into what they did in their studies and why they think they got the results that they did. One key takeaway for me from this discussion was the idea that patients undergoing curative-intent surgery might simply be too early in their cancer trajectory to derive meaningful benefits from palliative care, and maybe the focus should be more on geriatrics. I especially appreciated the closing discussion about the future of research in this area: if routine perioperative palliative care doesn't improve outcomes, what should the next generation of studies focus on? Eric Widera Studies we talk about during the podcast Aslakson et al. Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial. JAMA Netw Open. 2023 Shinall et al. Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer: A Randomized Clinical Trial. JAMA Surg. 2023 Carson et al. Effect of Palliative Care–Led Meetings for Families of Patients With Chronic Critical Illness: A Randomized Clinical Trial. JAMA. 2016 Holdsworth et al. Patient Experiences of Specialty Palliative Care in the Perioperative Period for Cancer Surgery. JPSM. 2024 Williams et al. Patient Perceptions of Specialist Palliative Care Intervention in Surgical Oncology Care. Am J Hosp Palliat Care. 2025 Yefimova et al. Palliative Care and End-of-Life Outcomes Following High-risk Surgery. JAMA Surg. 2020

The only certainty in medicine is uncertainty. It touches every aspect of clinical practice, from diagnosis to treatment to prognosis. Despite this, many clinicians view uncertainty as something to tolerate at best or eliminate at worst. But what if we need to rethink and reframe our relationship with uncertainty in medicine? In this episode, we sit down with Jonathan Ilgen and Gurpreet Dhaliwal, co-authors of the New England Journal of Medicine article, "Educational Strategies to Prepare Trainees for Clinical Uncertainty." Together, we explore the nature of uncertainty in clinical practice, its effects on trainees and seasoned clinicians, and strategies to embrace it as a fundamental part of medical reasoning rather than a regrettable byproduct. Jonathan and Gurpreet share insights from research and clinical experience, offering practical methods to help trainees and clinicians recognize, manage, and even embrace uncertainty. Key topics we discuss include: The paradoxical nature of uncertainty: When perceived as a threat, it can provoke anxiety or fear; yet when framed as an opportunity, it can inspire hope and optimism. Why uncertainty is inevitable in medical practice and its impact on clinicians. Is uncertainty a state or a trait? The distinction between epistemic uncertainty (knowledge gaps) and aleatoric uncertainty (randomness in outcomes). How experienced clinicians utilize strategies such as forward planning and monitoring to navigate uncertainty. Communicating uncertainty with patients: how to do it effectively without eroding trust. How to integrate uncertainty into medical education. During the conversation, we explore the emotional responses to uncertainty and how these reactions can influence clinical practice and decision-making. Importantly, Jonathan and Gurpreet emphasize the importance of openly communicating uncertainty with colleagues, supervisors, and patients—a practice that, contrary to common belief, actually strengthens trust, fosters transparency, and encourages collaboration. By normalizing and embracing uncertainty, clinicians can better manage the complexities of medicine and build confidence in their ability to care for patients in the face of the unknown. 👉 We're thrilled that Meg Wallhagen, Professor of Nursing at UCSF, has recorded an intro to this week's podcast. Any listener who contributes $1000+ is invited to record an intro to a GeriPal podcast! You can donate here, any amount is appreciated. Also, Meg is looking for practicing or student clinicians (physicians and nurses) who are willing to participate in a study on how a simulation of hearing loss promotes a greater appreciation of the experience of hearing loss. Participation should take no more than one to one and one half hour and you will receive a gift card in acknowledgement of your time. If interested, please contact her directly at meg.wallhagen@ucsf.edu. For more info, click the following link to open the flyer (PDF format): Information_Flyer_Practitioneer ** NOTE: To claim CME credit for this episode, click here **

Have you had one of those consults in which you're thinking, huh, sounds like the patient's goals are clear, it's really that the clinician consulting us disagrees with those goals? To what extent is it our job as consultants to navigate, manage, or attend to clinician distress? What happens when that clinician distress leads eventually to conflict between the consulting clinician and the palliative care team? Today our guests Sara Johnson, Yael Schenker, & Anne Kelly discuss these issues, including: A recent paper first authored by Yael asking if attending to clinician distress is our job, published in JPSM. See also the wonderful conversation in the response letters from multidisciplinary providers (e.g. of course that's our job! And physicians may not be trained in therapy, but many social workers and chaplains are, and certainly psychologists). A SPACE pneumonic for addressing clinician conflict developed by Sara Johnson, Anne Kelly and others. They presented this at a recent AAHPM/HPNA meeting. See below for what SPACE stands for. We referenced a prior episode on therapeutic presence and creating a holding space with Kerri Brenner and Dani Chammas, and this article by Kerri. We talked about the role of the consultant, including this classic paper on consultation etiquette by Diane Meier and Larry Beresford. Enjoy! -Alex Smith SPACE: Navigating Conflict with Colleagues "Between stimulus and response there is a space. In that space is our power to choose our response." -Viktor E. Frankl SPACE: Conflict Navigation Toolkit Self-awareness: Pause & Notice Before Responding What am I feeling? Take own temperature. Where am I coming from? What do I need? Perspective-Taking: Ask-Tell-Ask Where are they coming from? Check your understanding with them. "Tell me how you're thinking about this?" "I hear you are concerned about…is that right?" Agenda: Yours and theirs, then focus on common ground Where are we going together? "It seems like we both want…" Curiosity: Reframe and explore to understand Am I missing anything? Why is this kind, smart & hard-working colleague thinking differently than I am? "To help me better understand, what is your biggest concern about…?" Empathy: For others: Empathic statements around the situation & silence For self: Your feelings are valid, reflect on it later. You will misstep in tense moments: apologize, learn from it. Eating helps. Authors: Ethan Silverman MD University of Pittsburgh Anne Kelly LCSW San Francisco VA Health Care System Jasmine Hudnall DO Gundersen Health System Cassie Shumway MS, RN, OCN, CHPN UW Health Hospitals & Clinics Andrew O'Donnell RN University of Wisconsin Sara K. Johnson MD University of Wisconsin