Discover and read the best of Twitter Threads about #HAPC
Most recents (24)
Day 2 @theNASEM workshop
The highlight from day 1: LaToya, a CNA, gave a moving, honest, courageous account of being a direct care worker. “The ice cream truck should not be a luxury.”
- hours & pay are bad, the work is hard & they love & care their patients & their dignity
The highlight from day 1: LaToya, a CNA, gave a moving, honest, courageous account of being a direct care worker. “The ice cream truck should not be a luxury.”
- hours & pay are bad, the work is hard & they love & care their patients & their dignity
@theNASEM First up- @EspinozaNotes from @PHInational
The intense focus on direct care workers, paying people a living wage, improving working conditions so that we can also improve patient care during this event has given me so much hope
The intense focus on direct care workers, paying people a living wage, improving working conditions so that we can also improve patient care during this event has given me so much hope
“Social determinants of success at work” is one phrase that stuck out to me yesterday.
@mad_sters doing critical work in this area for direct care workers
But I think about it for others who work in our system too.
@mad_sters doing critical work in this area for direct care workers
But I think about it for others who work in our system too.
Good morning from the Keck Center @theNASEM where I am so pleased to be part of their workshop this morning to support and sustain the workforce to care for people with serious illness! #hapc #pedpc #wellness #wellbeing #suffering
The first panel shared experiences from the front lines so vulnerably and beautifully. @MaguirePeggy @PhilRodgersMD @RachelMayAdams
Happy Doctor’s Day❕
Back from Annual Assembly of the @AAHPM @hpna_info 💜😇
Mourning Dove Medical @MourningDoveMed is pleased to present:
“Dr. G’s H.O.S.P.I.C.E. Pocket Guide: 7 Things Hospice Physicians Need to Know to be Ready for Work”
by Dr. Kaishauna Guidry, MD, HMDC
Back from Annual Assembly of the @AAHPM @hpna_info 💜😇
Mourning Dove Medical @MourningDoveMed is pleased to present:
“Dr. G’s H.O.S.P.I.C.E. Pocket Guide: 7 Things Hospice Physicians Need to Know to be Ready for Work”
by Dr. Kaishauna Guidry, MD, HMDC
eBook is available for immediate download on our @MourningDoveMed website 🔗in Bio, @AmazonKindle is LIVE
Paperback will be available on @amazon soon.
Apple Books @AppleBooks also coming soon! #DoctorsDay #NationalDoctorsDay
Paperback will be available on @amazon soon.
Apple Books @AppleBooks also coming soon! #DoctorsDay #NationalDoctorsDay
Dr. G’s H.O.S.P.I.C.E. Pocket Guide: 7 Things Hospice Physicians Need to Know to be Ready for Work a.co/d/hTaUfge #DoctorsDay2023 @MourningDoveMed
Next up: FR201a- An epic step forward- a universal #pedpc navigator in the EHR with @conradw4, Alice Bass & Kat Thomas #hapc23
Actual cartoon of Conrad and Alice at work creating a #pedpc workflow in Epic. #hapc23
“If we could make the EHR better it would make me feel so much more well.” - @conradw4
“If we could make the EHR better it would make me feel so much more well.” - @conradw4
“We thought it would take a year and we were certainly wrong.”
On building the navigator in epic.
#hapc23
On building the navigator in epic.
#hapc23
Dr. Martin Bogetz, a bereaved father, sharing the legacy of his daughter Alyssa:
- an MSW who cared deeply about wellbeing
- the first non-physician associate program director in Peds at Stanford, who focused on supporting trainees
- sister of @jbogetz, #pedpc wonder ❤️ #hapc23
- an MSW who cared deeply about wellbeing
- the first non-physician associate program director in Peds at Stanford, who focused on supporting trainees
- sister of @jbogetz, #pedpc wonder ❤️ #hapc23
The inaugural Alyssa Bogetz lecture: Dr. Susan Block talking about the state of integration of #hapc and #mentalhealth
Alyssa died of AN. The educational fund was started in her honor @AAHPM w the appreciation that our field needs to grow to support people like her. #hapc23
Alyssa died of AN. The educational fund was started in her honor @AAHPM w the appreciation that our field needs to grow to support people like her. #hapc23
Next up: TH109B- Together is better: a combined #hapc and #psychiatry substance use disorder clinic for patients with advanced #cancer
@AmericanCancer take note of this model
#hapc23
@AmericanCancer take note of this model
#hapc23
@lauramakaroff thinking of special populations and your work!
Point 1: Wellbeing of leaders predicts wellbeing of staff. There are indices that are specific to leaders. #hapc23
Point 2. Psychological safety is critical to team wellness. (@AmyCEdmondson)
Defn: If you speak up, there is not a threat that you will be punished.
When people need help, they ask.
People can process mistakes, dissent, name problems even when hard. #hapc23
Defn: If you speak up, there is not a threat that you will be punished.
When people need help, they ask.
People can process mistakes, dissent, name problems even when hard. #hapc23
What is palliative care?
In six studies that examined public awareness about palliative care, all showed that the public is unfamiliar with palliative care. 59% of participants who did feel familiar with palliative care had a perception that was mostly inaccurate-
In six studies that examined public awareness about palliative care, all showed that the public is unfamiliar with palliative care. 59% of participants who did feel familiar with palliative care had a perception that was mostly inaccurate-
-such as thinking it is the same as hospice or end-of-life care. (1, 2)
Negative public attitudes toward palliative care is one of the many barriers to optimal use. Health system leaders report that 60% of patients who could benefit from palliative care do not receive it-
Negative public attitudes toward palliative care is one of the many barriers to optimal use. Health system leaders report that 60% of patients who could benefit from palliative care do not receive it-
-in part, because they decline them. (3)
While we do care for some patients during end-of-life, our main focus is to work with patients and their families at any point in their medical journey. Palliative care supports a patient and their family as a whole-
While we do care for some patients during end-of-life, our main focus is to work with patients and their families at any point in their medical journey. Palliative care supports a patient and their family as a whole-
Speaking of @PalliativeQual - do you do palliative care?
Do you follow the Palliative Care Quality Collaborative? No time like the present! Twitter is still here!
Do you follow the Palliative Care Quality Collaborative? No time like the present! Twitter is still here!
@arifkamalmd on palliative care as a field: "We're kinda badass!"
Wish I felt this way more often! Always good to be reminded! #hapc #pedpc
Wish I felt this way more often! Always good to be reminded! #hapc #pedpc
As doctors, we’re often more comfortable seeing blood than tears… Lacrimation sends us scrambling. (1/3 - thread since Twitter only allows 4 photos per tweet.) #hapc
2/3 These days I’m trying to learn to just sit still and shut up.
For more on tissues and social work specifically, see this video from @DrJRubenstein @VickieLeff and @PalliativClaire …
"Listening is only powerful and effective if it is authentic. And authenticity means you are listening because you are curious and you care- not just because you are supposed to."
@jennilinebarger (quoting "Difficult Conversations" & "Humble Inquiry" books)
#hapc #pedpc
@jennilinebarger (quoting "Difficult Conversations" & "Humble Inquiry" books)
#hapc #pedpc
❤️this chart from "Humble Inquiry"
It's about listening to understand- not to tell.
Not to prepare the next thing you will say.
We are trained that knowing the "right answer" = good doctor. There's much more to it than that.
@jennilinebarger #CincyKidsPGR #pedpc
It's about listening to understand- not to tell.
Not to prepare the next thing you will say.
We are trained that knowing the "right answer" = good doctor. There's much more to it than that.
@jennilinebarger #CincyKidsPGR #pedpc
Beautiful nod to William Carlos Williams poem "The Red Wheelbarrow"
Uncertainty is hard for the medical team.
It is hard for families.
What is the right thing?
"It all depends."- @jennilinebarger #CincyKidsPGR #pedpc #hapc
Uncertainty is hard for the medical team.
It is hard for families.
What is the right thing?
"It all depends."- @jennilinebarger #CincyKidsPGR #pedpc #hapc
DISORDERS OF CONSCIOUSNESS (DoCs)
Join me for another #neuropalliative care Tweetorial about a very broad and complicated topic: @MedTweetorials #NeuroTwitter #NeuroPal #hapc #MedEd
Join me for another #neuropalliative care Tweetorial about a very broad and complicated topic: @MedTweetorials #NeuroTwitter #NeuroPal #hapc #MedEd
My goal for this 🧵 is to define key features of coma, vegetative state (VS), and minimally conscious state (MCS). And why it matters for #PalliativeCare.
This is not a Tweetorial on brain death or prognostication right after brain injury. Stay tuned for those🤓 2/17
This is not a Tweetorial on brain death or prognostication right after brain injury. Stay tuned for those🤓 2/17
To understand differences between disorders of consciousness (DoC) is to separate the ideas of being awake and being aware:
3/17
3/17
🚨Everything you ever WANTED & NEEDED to know about buprenorphine in a single resource.
liebertpub.com/doi/abs/10.108…
Must-read for #hapc #NurseTwitter #socialwork #PharmD #MedTwitter #PA
📒Add to your fellowship required reading
Teaser 🧵on what you will find in the paper/1
liebertpub.com/doi/abs/10.108…
Must-read for #hapc #NurseTwitter #socialwork #PharmD #MedTwitter #PA
📒Add to your fellowship required reading
Teaser 🧵on what you will find in the paper/1
Tip 1: Buprenorphine has Unique Pharmacology & < S/E Compared to Full Agonist Opioids
‘‘partial’’ is based on a comparison of protein activation in vitro studies
🔊does not mean partial analgesic
🔊does not mean partial analgesic
🔊does not mean partial analgesic/2
‘‘partial’’ is based on a comparison of protein activation in vitro studies
🔊does not mean partial analgesic
🔊does not mean partial analgesic
🔊does not mean partial analgesic/2
Tip 2:Buprenorphine may be the preferred opioid analgesic in selected patient populations.
In case you aren't convinced.
Analgesic efficacy is = and maybe > than oxycodone, fentanyl, hydromorphone, hydrocodone, and morphine/3
pubmed.ncbi.nlm.nih.gov/34079354/
In case you aren't convinced.
Analgesic efficacy is = and maybe > than oxycodone, fentanyl, hydromorphone, hydrocodone, and morphine/3
pubmed.ncbi.nlm.nih.gov/34079354/
🥳 Tooting my own horn 🥳
Just got back from a 1-week road trip vacation and learned... 3 papers were published while I was away!
Here's a quick #medthread 🧵about an epic week of publishing w/friends—what we learned, and what we created!
#AcademicTwitter #patientresearchers
Just got back from a 1-week road trip vacation and learned... 3 papers were published while I was away!
Here's a quick #medthread 🧵about an epic week of publishing w/friends—what we learned, and what we created!
#AcademicTwitter #patientresearchers
Have you ever been asked to peer-review a manuscript and wondered if you were "doing it right?"
You are me.
@crblease & I published a template to help organize the thoughts of newbie reviewers (including patients).
informatics.bmj.com/content/28/1/e…
#academictwitter #patientresearchers
You are me.
@crblease & I published a template to help organize the thoughts of newbie reviewers (including patients).
informatics.bmj.com/content/28/1/e…
#academictwitter #patientresearchers
Now that #opennotes are mandatory, will clinician documentation change?
Rahimian et al., analyzed 143,888 notes from 60 #hemonc clinicians from 2012-16, before AND after introduction of open notes.
TL;DR: Notes became longer AND easier to read.🤔
academic.oup.com/jamiaopen/arti…
#hemonc
Rahimian et al., analyzed 143,888 notes from 60 #hemonc clinicians from 2012-16, before AND after introduction of open notes.
TL;DR: Notes became longer AND easier to read.🤔
academic.oup.com/jamiaopen/arti…
#hemonc
Each time my husband deployed, I had a plan for what I would do if he died.
I assumed someone in military dress would find me. At work? At home? Could be anywhere.
I would know when I saw them why they were there.
1/
I assumed someone in military dress would find me. At work? At home? Could be anywhere.
I would know when I saw them why they were there.
1/
In Texas, I had a plan of who I would tell them to call to be with me. These people were different at work versus home.
When I moved to Ohio, I didn't know anyone. So that person became our #hapc #fellowship coordinator.
2/
When I moved to Ohio, I didn't know anyone. So that person became our #hapc #fellowship coordinator.
2/
Once they got the news out, and I had calmed down, I would have to call his mom.
She mostly lived in Thailand. Her home number was best back then. I was afraid someone would answer in Thai and I wouldn't know what to do.
3/
She mostly lived in Thailand. Her home number was best back then. I was afraid someone would answer in Thai and I wouldn't know what to do.
3/
It's not surprising to me that @nytimes would essentially publish an advertisement for physician-assisted suicide. What does surprise me is how advocates fail to see how culturally formative some of these views are 1/ #hapc #hpm #MedTwitter nytimes.com/2021/04/05/wel…
The life of one person who "could no longer stand, feed or toilet himself" was described as "protracted dying." It's difficult to discern when one actually starts to die. It's a conversation worth having. 2/
However, to emphasize that dying begins when one loses independence places an immense burden on some of the most vulnerable people. Surely it's the case that dying eventually entails loss of independence, but the converse can't always be true. 3/
Next talk at #hapc21! Controlling the dyspnea-anxiety cycle.
Remember that dyspnea is very common. Not just in COPD but in other diagnoses, and not just in hospice patients but in the ICU and other settings as well. #hapc21
The complicated and vicious cycle of breathlessness. #hapc21
Breaking leadership convos down:
1. Empathy- we can be aware w/o responsibility for their emotions. Also- defensive posture blocks empathy.
This is big, I really struggle with this interpersonally at work!
#hapc #pedpc
@KtNeuendorf #Ascend2020
1. Empathy- we can be aware w/o responsibility for their emotions. Also- defensive posture blocks empathy.
This is big, I really struggle with this interpersonally at work!
#hapc #pedpc
@KtNeuendorf #Ascend2020
2. Levels of discomfort.
Using words to not make difficult times worse. Attend to discomfort, acknowledge it, don't heighten it.
Having a crucial conversation as a leader is different than in patient care- colleagues have greater control than patients.
#hapc #pedpc #Ascend2020
Using words to not make difficult times worse. Attend to discomfort, acknowledge it, don't heighten it.
Having a crucial conversation as a leader is different than in patient care- colleagues have greater control than patients.
#hapc #pedpc #Ascend2020
I love this- asking someone to change will probably result in discomfort. "As adults, we need to take ownership...There's something about having discomfort that can lead to change."
As clinicians we want to mitigate discomfort. Not our job as leaders.
@KtNeuendorf, brilliant.
As clinicians we want to mitigate discomfort. Not our job as leaders.
@KtNeuendorf, brilliant.
Once again the conversation has started about whether we should change the name “palliative care.”
I appreciate the rationale including points made in a recent @washingtonpost article.
Allow me to present a counterpoint.
A 🧵, with videos:
#hapc #pedpc #MedEd #scicomm
1/
I appreciate the rationale including points made in a recent @washingtonpost article.
Allow me to present a counterpoint.
A 🧵, with videos:
#hapc #pedpc #MedEd #scicomm
1/
Yes, fear of palliative care comes from an association in some people’s minds with death.
As many including @SoniaMKhunkhun @anandiyermd @ctsinclair have pointed out, that is likely a failure of education and due to a cultural fear of death itself, not palliative care.
2/
As many including @SoniaMKhunkhun @anandiyermd @ctsinclair have pointed out, that is likely a failure of education and due to a cultural fear of death itself, not palliative care.
2/
When we conflate the scary thing with something that can help with the scary thing we risk missing a big opportunity for support.
As I’ve said before, it’s like confusing the fire with the fire department:
3/
As I’ve said before, it’s like confusing the fire with the fire department:
3/
📣 Thrilled to share our publication!
Our first case series of Dignity Therapy modified for the pediatric #PalliativeCare population.
Thankful to have had @TXgriefgirl as an amazing partner in this work.
A 🧵 with summary and some reflections
1/x
liebertpub.com/doi/10.1089/pm…
Our first case series of Dignity Therapy modified for the pediatric #PalliativeCare population.
Thankful to have had @TXgriefgirl as an amazing partner in this work.
A 🧵 with summary and some reflections
1/x
liebertpub.com/doi/10.1089/pm…
We attended the Dignity Therapy Training Workshop with @HMChochinov.
It was hands down the most impactful workshop I’ve ever attended and can’t recommend it highly enough.
#hapc #pedpc
2/x
workshops.dignityincare.ca
It was hands down the most impactful workshop I’ve ever attended and can’t recommend it highly enough.
#hapc #pedpc
2/x
workshops.dignityincare.ca
Dignity Therapy is a legacy project in which a facilitated interview is compiled into a narrative document which a dying person can share with loved ones.
3/x
3/x
In the midst of the last week, I lost mindfulness. I was in a reactive state all week. Threat-react. Threat-react. It's impossible to feel like the best version of myself for patients like that. In #pedpc, children are still dying of other things. 1/
Time slows down and stops when a child dies, of anything.
And I have done my best to show up as a #hapc doc, for my patients, their families and my team. But I failed in many ways this week.
2/
And I have done my best to show up as a #hapc doc, for my patients, their families and my team. But I failed in many ways this week.
2/
I was rocking my baby Wednesday night. This is an emotional touchstone for me. This is when I center, when I feel like the best version of myself. My abilities match her needs perfectly. The stress falls away, and we rock. I was able to center for the first time all week.
3/
3/
#hapc call today, 6 new consults:
Avg pt age= 84
Avg # serious dx= 4
Most common dx: ES CHF, no tx option; ES Ca, no tx option; ES COPD, no tx option
Reason for consult: "Need you to talk about goals and EOL"
Me: So, have you started the convo?
Avg response: "Umm, not really"
1/
Avg pt age= 84
Avg # serious dx= 4
Most common dx: ES CHF, no tx option; ES Ca, no tx option; ES COPD, no tx option
Reason for consult: "Need you to talk about goals and EOL"
Me: So, have you started the convo?
Avg response: "Umm, not really"
1/
#medtwitter It's not easy to discuss late stage dx & end of life issues, but it's crucial. Patients & families deserve clear, honest, empathic info. We all need to know how to *at least* start the conversation. #PalliativeCare teams can help coach, or look for other resources
2/
2/
And certainly at a tertiary care or teaching hospital, this should be hard-wired into the training. Make basic communication a required skill, like diagnosing PNA, placing a line, or running a code. #MedEd- we can, and must do better for our learners & our patients.
3/
3/
Some time ago, I saw a pt with severe untreated suffering at #EOL alongside aggressive & unproven life-prolonging interventions. When I asked the medical team, they said they were doing “what the family wanted.”
Sharing some of my thoughts about this below 👇🏾👇🏾👇🏾
Sharing some of my thoughts about this below 👇🏾👇🏾👇🏾
1/ Rejecting paternalism does not imply that we take ourselves out of the decision making process altogether. We should always work together with our pts & families rather than just “doing what they want.”
#hpm #hapc #bioethics
#hpm #hapc #bioethics
2/ We should move towards a “deliberative” rather than an “informative” model of decision making. Pts should share values/expectations & we propose medical treatments. It is crucial for all HCPs to have better training on having #goalsofcare conversations.
#hpm #hapc #bioethics
#hpm #hapc #bioethics
1/ So I got quite a bit of "pushback" when saying that I would probably/most likely/am considering no longer using the joined # of #hpm or #hapc ... when tweeting about #PalliativeCare exclusively...
I also said I would explain myself to those wondering why...
I also said I would explain myself to those wondering why...
2/ Quick disclaimer: I will entertain thoughtful discussion and opinions in this thread...
I won't entertain one sided views that try to shut me down with that "I'm big & your small, I'm smart & your dumb..." talk
I am expressing MY thoughts, keep your gaslighting to yourself
I won't entertain one sided views that try to shut me down with that "I'm big & your small, I'm smart & your dumb..." talk
I am expressing MY thoughts, keep your gaslighting to yourself
3/ One of the #CAPCSeminar19 keynotes was on messaging and how we brand ourselves.
It was a great conversation with Diane Meier and Mark Ganz (intentionally not tagging them) with the sharing of ACTUAL CAPC data but also ACTUAL life stories involving Mark's parents.
It was a great conversation with Diane Meier and Mark Ganz (intentionally not tagging them) with the sharing of ACTUAL CAPC data but also ACTUAL life stories involving Mark's parents.
