July 2019 - Helping families understand a timeline for elders with dementia can relieve suffering and help with planning. Dementia Mitchell Mortality Risk Index Score Points/Risk factor 1.9 Complete dependence with ADLs 1.9 Male gender 1.7 Cancer 1.6 Congestive heart...
June 2019 - We find “Futility” is not a useful term when discussing treatment options. It is not well defined and tends to be inflammatory. It can mask value judgments by clinicians. It can pit clinicians against each other and against the patient and family, making...
May 2019 - Another new study showed inhaled isopropyl alcohol significantly reduced nausea, this time in patients in the ED. Several studies have shown that inhaled isopropyl alcohol can provide rapid relief of nausea. It may perform well enough to avoid systemic...
April 2019 - When you would not be surprised if your patient died in the next year, it is time to take action to provide care that makes medical sense and is aligned with realistic patient goals. 1. Try to improve prognostic awareness. “In my experience, patients with...
March 2019 - Many patients in your practice may be interested in a palliative approach to care. Patients living with a serious or a life-threatening illness may be more interested in the quality of life than quantity of life. They need our help to match care to their...
February 2019 - Treating dyspnea improves function in late stage COPD and CHF. Consider using a low-dose opioid 30 – 60 minutes before planned exertion to improve activity tolerance. Patients with palliative goals are excluded from opioid prescribing...
January 2019 - That pit in your stomach means you need to talk to a team member or colleague about a patient’s care. Moral distress occurs when you think you know the right thing to do, but you feel constrained from doing it. It is an important contributor to burnout...
December 2018 - Many dying patients are unable to ask for comfort medicines. More patients are dying in senior facilities without 24-hour staff able to assess nonverbal pain and dyspnea or use “as needed” medications. We find scheduling low-dose, short-acting opioids...
November 2018 -There is a big difference between AICD deactivation and pacemaker deactivation. More patients (or their surrogates) are requesting the deactivation of cardiac devices at end of life. Some want a more natural death. Others hope for an easier or earlier...
October 2018 - Double-booked patients, charts, emails, curbsides, phone calls, meetings. . . Work late and start again the next day. It is important to find a way to rest in the middle of things. Stopping, even briefly, allows us to step out of our suffering and see...
