loader from loading.io

What instead? Alternatives to Beers: Todd Semla and Mike Steinman

GeriPal - A Geriatrics and Palliative Medicine Podcast

Release Date: 08/14/2025

Deprescribing at the End of Life: Jennifer Tjia, Jon Furuno, Simon Mooijaart show art Deprescribing at the End of Life: Jennifer Tjia, Jon Furuno, Simon Mooijaart

GeriPal - A Geriatrics and Palliative Medicine Podcast

Philippe Pinel 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...

info_outline Unilateral DNR? Gina Piscitello, Erin DeMartino, Will Parker show art Unilateral DNR? Gina Piscitello, Erin DeMartino, Will Parker

GeriPal - A Geriatrics and Palliative Medicine Podcast

Do you think your hospital should allow unilateral DNR orders? Under what circumstances? Through what process?  Do you think that when you obtain the assent of a family to not code their loved one, that assent DNR should be counted as a unilateral DNR order? Should we document unilateral DNR and the rationale? Why for DNR, when we don’t document unilateral dialysis not offered, or unilateral no ECMO offered?  Is the assent of a family member to a statement that we will not code their loved one a nudge, and is the assent approach ? Reasonable people will disagree, as we do on this...

info_outline Embedding Care in the ED: Liz Goldberg and Lauren Southerland show art Embedding Care in the ED: Liz Goldberg and Lauren Southerland

GeriPal - A Geriatrics and Palliative Medicine Podcast

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...

info_outline AI and Healthcare: Bob Wachter show art AI and Healthcare: Bob Wachter

GeriPal - A Geriatrics and Palliative Medicine Podcast

Today we interviewed Bob Wachter about his book, “.”  You may recall we , and at that time he was on the fence about AI - more promise or more peril for healthcare?  As his book’s title suggests, he’s come down firmly on the promise side of the equation.  On our podcast we discuss: Why Bob wrote this book, at this time, and concerns about writing a static book about AI and Healthcare, a field that is dynamic and shifting rapidly.  He’s right though - we’ve not had a “ChatGPT”-launch type moment recently. Top 5 or so ways in which Bob uses AI for work,...

info_outline The Role of Specialty Palliative Care in Cancer Surgery: Rebecca Aslakson & Myrick Shinall show art The Role of Specialty Palliative Care in Cancer Surgery: Rebecca Aslakson & Myrick Shinall

GeriPal - A Geriatrics and Palliative Medicine Podcast

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 and trials. Null trials like these often receive less attention in academic and clinical settings, but they can be profoundly practice-changing. Consider the . While some have argued it...

info_outline The Future of Palliative Care? Community-Based Models with Alan Chiu, Mindy Stewart-Coffee, and Ben Thompson show art The Future of Palliative Care? Community-Based Models with Alan Chiu, Mindy Stewart-Coffee, and Ben Thompson

GeriPal - A Geriatrics and Palliative Medicine Podcast

“I just want to say one word to you.  One word.  Plastics… There's a great future in plastics.” This iconic line from the movie The Graduate is at the top of my mind when I think about where we are heading in healthcare. I’ve interpreted “plastics” as symbolizing a dystopian, mass-produced future of medicine—where artificiality and inauthenticity dominate in the pursuit of efficiency and profit margins. After listening to today’s podcast on the growth of community-based palliative care, I find my perspective shifting on this quote. Perhaps the advice given for a...

info_outline Uncertainty In Medicine: Jonathan Ilgen and Gurpreet Dhaliwal show art Uncertainty In Medicine: Jonathan Ilgen and Gurpreet Dhaliwal

GeriPal - A Geriatrics and Palliative Medicine Podcast

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, “.” Together, we explore the nature of uncertainty in clinical practice, its effects on trainees and seasoned clinicians, and strategies...

info_outline Why We Need QI Collaboratives: Guests Steve Pantilat, David Currow, and Arif Kamal show art Why We Need QI Collaboratives: Guests Steve Pantilat, David Currow, and Arif Kamal

GeriPal - A Geriatrics and Palliative Medicine Podcast

In a recent episode of the GeriPal podcast, we explored —and, if so, how to save it—with guests Ira Byock, Kristi Newport, and Brynn Bowman. Today, we shift focus to one actionable way to improve palliative care: through quality improvement (QI) collaboratives, registries, and benchmarking.  To guide this discussion, we’ve invited three leading experts in the field—Drs. Steve Pantilat, David Currow, and Arif Kamal—who bring invaluable experience as pioneers in developing QI collaboratives and registries. Together, they authored a recent paper in JPSM titled “,” which...

info_outline Is Attending to Clinician Distress Our Job? Sara Johnson, Yael Schenker, & Anne Kelly show art Is Attending to Clinician Distress Our Job? Sara Johnson, Yael Schenker, & Anne Kelly

GeriPal - A Geriatrics and Palliative Medicine Podcast

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...

info_outline Rehab and Death in Skilled Nursing Facilities: Sarguni Singh, Christian Furman, and Lynn Flint show art Rehab and Death in Skilled Nursing Facilities: Sarguni Singh, Christian Furman, and Lynn Flint

GeriPal - A Geriatrics and Palliative Medicine Podcast

In this week's podcast, we sit down with Drs. Sarguni Singh, Christian Furman, and Lynn Flint, three authors of the recent   The authors dive into the challenges facing seriously ill older adults discharged to Skilled Nursing Facilities (SNFs), where fragmented care transitions, misaligned Medicare policies, and inadequate access to palliative care often result in burdensome hospitalizations and goal-discordant care.  The discussion highlights key barriers in Medicare’s SNF and hospice benefits, including the inability to access concurrent hospice and SNF care, and explores...

info_outline
 
More Episodes

On a prior podcast we talked with Todd Semla and Mike Steinman about the update to the AGS Beers Criteria of potentially inappropriate medications in older adults (Todd and Mike co-chair the AGS Beers Criteria Panel).  One of the questions that came up was - well if we should probably think twice or avoid that medication, what should we do instead?

Today we talk with Todd and Mike about their new recommendations of alternative treatments to the AGS Beers Criteria, published recently in JAGS, and also presented at the 2025 AGS conference in Chicago (and available on demand online).

We had a lot of fun at the start of the podcast talking about the appropriate analogy for how clinicians should use the AGS Beers Criteria.  In our last podcast, the analogy was a stop sign. You should come to a stop before you prescribe or refill a medication on the Beers list, look around at alternatives, and consider how to proceed.  You might in the end decide to proceed, as there are certainly situations in which it does make sense to start or continue a medication on the Beers list.

Today’s analogy had somewhat higher stakes, involving a driver, a pothole in the road, and a cyclist on the side who you’d hit if you swerved.  Really upping the anti!!!

The podcast is framed around a case Eric crafted of a patient with most of the medications and conditions on the Beers list. We used this as a springboard to discuss the following issues (with links to prior GeriPal podcasts):

And I hope that the prescribing landscape is indeed getting better (thanks to Kai on guitar)!

-Alex Smith