Is Attending to Clinician Distress Our Job? Sara Johnson, Yael Schenker, & Anne Kelly
GeriPal - A Geriatrics and Palliative Medicine Podcast
Release Date: 12/18/2025
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...
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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...
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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...
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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,...
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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...
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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...
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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...
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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...
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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...
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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_outlineHave 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:
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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).
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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.
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We referenced a prior episode on therapeutic presence and creating a holding space with Kerri Brenner and Dani Chammas, and this article by Kerri.
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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