Making treatment recommendations that meet your patient’s goals requires that they understand their condition. We use the following phrases to assess understanding when discussing a difficult diagnosis or prognosis. “I have been doing a lot of the talking. Could you...
In dementia, when language and logic are failing, behavior communicates comfort and distress. Yelling in the middle of the night might be communicating many things: “Where am I?” “My hips hurt.” “I’m afraid.” “I’m cold.” Behavior is a two-way street. Keep it slow....
Access to Medical Aid in Dying improved The Washington State legislature made these changes, effective July 23, 2023: Physicians Assistants and Advanced Registered Nurse Practitioners may now serve as the consulting OR prescribing provider for a patient. The waiting...
Wishing yourself and others well is better than counting sheep . . . . . . and safer than a sedative. Try this beautiful meditation for sleep. Repeat twice for each person. Start with yourself, then slowly move outward, starting with those you hold most dear, then...
Parkinson’s disease has a variable trajectory and patients can be quite disabled months and years before they are hospice eligible. Here are cues that it may be time to transition to a palliative approach: Functional loss Orthostatic hypotension that persists with...
Olanzapine has “broad spectrum” activity for treating nausea. Recent studies confirm olanzapine’s effectiveness for difficult-to-treat nausea in cancer patients whether or not the nausea is related to chemotherapy. Olanzapine acts through multiple receptors, and we...
When rescue efforts don’t work well, consider hospice referral for in-home CHF management. Prognosis in heart failure is tricky. These pieces of history indicate poor prognosis. Brittle fluid management, including use of metolazone, Spending more than 50% of time in...
This month our Palliative Pearls reviews comfort medication dosing. You will find guides for assessment and effective dosing recommendations to enhance a patient's comfort. Comfort Medication Dosing For more information, contact Dr. Leslie Estep, Dr. Anita Meyer, or...
Choosing a health care agent is an important place to start advance care planning. Decision making can get messy if this choice isn’t made before a crisis. This graphic below shows the hierarchy for surrogate decision making under Washington state law if otherwise...
As we enter a new year, this is a worthy time to remember to practice self-care, to take care of ourselves as providers for others. We shared this years ago and feel it is worth revisiting. Double-booked patients, charts, emails, curbsides, phone calls, meetings. . ....
