GeriPal - A Geriatrics and Palliative Medicine Podcast

A geriatrics and palliative medicine podcast for every health care professional. Two UCSF doctors, Eric Widera and Alex Smith, invite the brightest minds in geriatrics, hospice, and palliative care to talk about the topics that you care most about, ranging from recently published research in the field to controversies that keep us up at night. You'll laugh, learn, and maybe sing along. CME and MOC credit available (AMA PRA Category 1 credits) at www.geripal.org

Navigating Organ Donation Discussions: Toby Campbell, Nikole Neidlinger, Samantha Taylor 05/07/2026

Dermatology in Older Adults (GeriDerm): Daniel Butler and Eleni Linos 04/30/2026

GeriPal Live from Sao Paulo! Eduardo Ferriolli, Marlon Aliberti, & Edison Iglesias 04/23/2026

GeriPal Live from Sao Paulo! Eduardo Ferriolli, Marlon Aliberti, & Edison Iglesias Eric and I were delighted to be invited to Brazil to give a series of presentations in Sao Paulo at their annual geriatrics meeting. We met people doing important, interesting, and innovative work in Brazil and throughout Latin America. We got the audience to sing along, including (in another talk) the magnificent Brazilian song . For our final talk, a podcast in front of a live conference audience, we asked our 3 guests, Eduardo Ferriolli, Marlon Aliberti, & Edison Iglesias to select a recent article to discuss. We talked about: (selected by Eduardo). What is it? What is it used for? How do you measure it? (hint ICOPE). Eduardo emphasized that intrinsic capacity is a positive aspect of aging, focused on potential rather than deficit. We asked him to work intrinsic capacity into George Kushel’s famous analogy using the golden gate bridge to describe phenotypic frailty (pillars), deficit accumulation frailty (cable supports), and resilience (withstand stress of wind and cars). Eduardo says intrinsic capacity would be the car, and would vary by type of car and intended purpose. I loved Eduardo’s selected article, which , in order to use within individuals to assess how they’re tracking over time, and at a public health level, to identify regions or groups of people with lower intrinsic capacity. He draws the analogy to growth curves in pediatrics - if you’re consistently at 80% - then drop off - your primary care provider should take notice and investigate/intervene. (selected by Marlon). If intrinsic capacity is for primary care, our guests argue that the comprehensive geriatric assessment, which takes a long time to administer, should be reserved for specialist geriatrics. And yet, this finds that a limited shorter version of the comprehensive geriatrics assessment can document geriatric syndromes in hospitalized older adults. Accumulation of multiple geriatric syndromes is , and presents an opportunity for risk stratification, goals of care discussions, and intervention. (selected by Edison). Back around 2005, when Edison first heard about advance care planning, he says, “it sounded like science fiction.” In Brazil, as with Latin America, medicine was highly hierarchical and patriarchal. Doctors knew best. The doctor decided. If there was no patient choice, why would there be a system to protect the decisions of patients made in advance? In the intervening years, Edison and others have worked to incorporate and adapt advance care planning to the Latin American context, which is much more focused on family-centered than individual, and incorporates spirituality to a much greater extent. Edison has been mindful too of not repeating the mis-steps of the advance care planning and advance directive movements in the US. We took questions from our audience and sang “Imagine” in Portuguese together. Enjoy! -Alex Smith /episode/index/show/geripal/id/40984920

400th Episode Celebration: Ask Us Anything, Hot Ones-style 04/16/2026

Rural Palliative Care: Karl Bezak, Jeanie Youngwerth, Adie Goldberg, and Gregg Vandekieft 04/09/2026

Rural Palliative Care: Karl Bezak, Jeanie Youngwerth, Adie Goldberg, and Gregg Vandekieft Rural populations in the United States face unique healthcare challenges. These communities tend to be older, have higher mortality rates, and experience higher rates of chronic conditions and physical disabilities compared to urban populations. Despite the increased need for palliative care in rural areas, access remains alarmingly limited. Even in hospital settings, where palliative care programs are more common in urban areas, only 35% of rural hospitals report having such programs, compared to 81% of urban hospitals. In this week’s podcast, we explore the challenges and opportunities of delivering palliative care in rural communities with our esteemed guests Karl Bezak, Jeanie Youngwerth, Adie Goldberg, and Gregg Vandekieft. We begin by discussing what inspired each of them to focus on rural palliative care. From there, we dive into what rural palliative care looks like and examine how it differs from care provided in urban settings. Our guests also share insights into the challenges of delivering this care in resource-limited rural environments and explore innovative strategies to ensure patients and families receive the support they need (like providing remote fellowship training for docs living in rural areas!). We also tackle the role of telemedicine in rural palliative care, both the good part, connecting patients in remote areas with specialists who might otherwise be unavailable, and the bad part, the huge digital divide seen in rural areas. Join us for what I thought were some valuable insights our guests brought on how we can better serve rural populations and create a more equitable system for palliative care delivery. And if you want to learn more, check out some of these resources: University of Colorado’s , which allows mid-career providers to obtain training while continuing to live and work in their community supported through online and distance learning technology Master of Science in Palliative Care Program: /episode/index/show/geripal/id/40777340

Pragmatic Trial to Increase Advance Care Planning: Anne Walling, Neil Wenger, & Rebecca Sudore 04/02/2026

Pragmatic Trial to Increase Advance Care Planning: Anne Walling, Neil Wenger, & Rebecca Sudore Today we’re delighted to talk with Anne Walling, Neil Wenger, and Rebecca Sudore about a pragmatic implementation trial aimed at increasing advance care planning for primary care patients with serious illness in University of California clinics, published in . Seriously ill primary care patients were identified using structured data fields (meaning routinely captured without needing to read the chart or use natural language processing). This study focused on patients without a completed advance directive or POLST form. This was a 3 arm trial that tested a nudge in the patient portal and a mailed advanced directive vs. the nudge plus a link to PrepareForYourCare vs. the nudge plus PrepareForYourCare plus a navigator reminding patients to talk with their doctor and bring any completed advance directives or POLST forms to the PCP visit. In brief, the study found that at 2 years there were higher rates of advance directive or POLST in the electronic health record (about 20%) in the arm with the nudge plus PrepareForYourCare plus the navigator compared to the other 2 arms (around 13%). Rates of advance care planning discussions with primary care providers were similarly higher in the 3rd arm. Health care utilization, however, did not differ between arms. Please see links to articles describing the and . I’m going to cut to the pushback to this right up front: The study’s primary outcomes were advanced directives or completion of POLST forms - haven’t we thinking completion of forms should be the primary outcome of advance care planning research? There was no control condition. Observed increases in advance directive or POLST in the electronic health record may have occurred without any intervention. People with serious illness get sicker with time and the sicker they are the more likely they are to engage in advance care planning, without any intervention. This is particularly true as the study occurred during the hight of the Covid pandemic, when there was a global effort to increase advance care planning. How much did these interventions contribute on top of that rise that might have occurred without intervention? Observed documentation - 13-20% - was low. Is it worth the effort of getting buy-in to automate these EHR nudges and spend FTE to hire a navigator? Particularly as health systems, who pushed for focusing on seriously ill patients because they are the most expensive/highest utilizers, did not get what they wanted, i.e. no difference in utilization of acute healthcare services between arms? Our guests provide a strong defense and additional context, which you can and should listen to on the podcast. And I have to point out, setting aside the advance care planning aspect, the method of identifying upstream primary care patients with serious illness is a major contribution to the field in and of itself. Pioneers in the field, led by Amy Kelley, have been working to for over a decade. And a fun fact about All You Need is Love - the verses are in 7/4 time! -Alex Smith /episode/index/show/geripal/id/40684655

CMS's Age-Friendly Hospital Measure: Julia Adler-Milstein, Stephanie Rogers, and Shari Ling 03/26/2026

De-intensify Anti-Hypertensives for Nursing Home Residents? Athanase Benetos and Mike Steinman 03/19/2026

De-intensify Anti-Hypertensives for Nursing Home Residents? Athanase Benetos and Mike Steinman A few weeks ago, I was skimming this paper for UCSF’s Division of Geriatrics Journal club on de-prescribing anti-hypertensive medications for older adults in nursing homes. Seemed to make a world of sense. The found no difference between the deprescribing arm and the usual care arm in mortality, the primary study outcome. I thought, great! So we can deprescribe anti-hypertensives without changing mortality, that must be what the authors concluded. I was shocked, therefore, to read in the first paragraph of the discussion that the deprescribing arm did not achieve the hypothesized 25% reduction in mortality. What?!? Why would deprescribing be associated with reduced mortality? That’s not the main reason or even the first reason I think of for deprescribing. Reducing side effects that impair quality of life, sure. Less pill burden, of course. But prolonged life? Seemed a stretch. Today we hear from the first author of this study, , an esteemed geriatrician-researcher from France. For context, we also interviewed Mike Steinman, co-chair of the and co-lead of the We learned about: Why the hypothesis of reduced mortality in deprescribing was justified, based on natural , and the , an observational study that found higher risks of mortality associated with using multiple anti-hypertensive and low blood pressure. Why mortality was chosen as the primary outcome. Is a negative superiority study the same as what they might have found in a non-inferiority study? (stay with us) Variation in outcome by frailty status How to place this study in context with other research, such as the mentioned on a recent about deprescribing near the end of life. Dantos was a study of deprescribing for nursing home residents with dementia that was stopped early due to safety concerns. Other studies for context include , , and an by Bocheng Jing (UCSF statistician in our group). At the end, we ask our guests to put it together. With all that we know at this point, what’s a clinician to do? To deprescribe or not to deprescribe? And, zoot alors! I get to sing Hymne A L’amour in ! Athanase recounts the moving story of how Edith Piaf sang this song the night she learned the man she loved, Marcel Cerdan, died in a plane crash. -Alex Smith /episode/index/show/geripal/id/40537475

Alzheimer's Definitions, Biomarkers, and Antibodies: Halima Amjad, Barak Gaster, and Heather Whitson 03/12/2026

Leadership, Quality, and the Future of Hospice: Guests Chris Comeaux and Cordt Kassner 03/05/2026

Deprescribing at the End of Life: Jennifer Tjia, Jon Furuno, Simon Mooijaart 02/26/2026

Unilateral DNR? Gina Piscitello, Erin DeMartino, Will Parker 02/19/2026

Embedding Care in the ED: Liz Goldberg and Lauren Southerland 02/12/2026

Embedding Care in the ED: Liz Goldberg and Lauren Southerland 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 emergency medicine physician-researchers, have had enough. On our podcast today they discuss how these sorts of experiences led them to argue that other services that can address the underlying causes that lead to ED visits. Liz Goldberg developed the model to address falls, which includes a physical therapist and pharmacist seeing patients on the spot in the ED. Lauren Southerland got Columbus Ohio Office of Aging staff to re-locate from their desks to the emergency department, where they could sign patients up for home delivered meals, medical transportation, adult day services, home modification such as grab bars, and utility assistance for electricity, gas, and water bills. With GAPcare, Liz saw a over 6 months from her pilot (subsequent fall outcomes of the will be linked here when published). Remarkable, particularly in the context of the primary care intervention, which did not reduce injurious falls (e.g. the type that would result in an ED visit). Maybe the ED is just a better place to intervene? Patients are motivated to change. Get the physical therapist and pharmacist in there! In a , Lauren found 50% of participants were linked to a new Office of Aging service initiated during the ED visit, with no increase in ED length of stay or hospital admission rate. See also this terrific on Lauren’s paper by Liz. Putting on my JAGS editor hat - both the study and editorial have terrific color figures. A great way to increase your odds of review and acceptance at JAGS is to include one or more high-impact color figures that convey the main findings or points of your manuscript. We talk about the potential downsides, real and perceived in embedding care in the ED. Should everything be embedded? We talk about how these interventions relate to Lauren talks about a remarkable model in that includes a geriatric RN embedded in the ED. Most encouraging is that Liz and Lauren are finding other adopting these interventions. Word is spreading. Other emergency providers have had enough of the endless cycle. Enough. And I got to belt out Gravity, by John Mayer! -Alex /episode/index/show/geripal/id/40079230

AI and Healthcare: Bob Wachter 02/05/2026

The Role of Specialty Palliative Care in Cancer Surgery: Rebecca Aslakson & Myrick Shinall 01/29/2026

The Future of Palliative Care? Community-Based Models with Alan Chiu, Mindy Stewart-Coffee, and Ben Thompson 01/22/2026

The Future of Palliative Care? Community-Based Models with Alan Chiu, Mindy Stewart-Coffee, and Ben Thompson “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 future in plastics reflects the past generation’s established worldview, failing to recognize a countercultural revolution seeking transformation and meaningful change, even if it may come across as a little brash. In this thought-provoking episode of the GeriPal podcast, we are joined by Alan Chiu (Chief of Palliative Care at Monogram Health), Mindy Stewart-Coffee (National Vice President of Palliative Care at Optum Home and Community), and Ben Thompson (National Medical Director for Hospice and Palliative Care at Gentiva) to discuss this revolution happening in palliative care. The conversation centers around the rapid growth and investment in community-based palliative care, which has emerged as a key area of innovation and opportunity to meet the largely unmet needs of patients living with serious illnesses. With a focus on expanding access, improving outcomes, and addressing workforce shortages, the guests explore how value-based care models are reshaping palliative care delivery. The discussion highlights the differences between traditional fee-for-service models and newer value-based care approaches, including how they incentivize care. We take a deep dive into the risks and benefits of these models, emphasizing the importance of maintaining high standards of care while fostering innovation. We also delve into the role of for-profit organizations and private equity in driving change, acknowledging concerns about motivations while recognizing that these entities can help spur innovation and improve access when led by clinicians committed to patient-centered care. Ultimately, this podcast serves as a call to action for the palliative care community to help shape not just the “Wild West” of community-based care, but palliative care 3.0 as a whole. Do we sit back and wait for a future dominated by a plastic version of palliative care, or do we help lead this revolution to ensure it maintains the authentic heart of what brought us to this field? As Diane Meier aptly warns, “if you are not at the table, you’re on the menu.” Eric Widera Of Note: the views expressed in this podcast are our guests' own opinions and not representative of their organizations. /episode/index/show/geripal/id/39818080

Uncertainty In Medicine: Jonathan Ilgen and Gurpreet Dhaliwal 01/15/2026

Uncertainty In Medicine: Jonathan Ilgen and Gurpreet Dhaliwal 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 to embrace it as a fundamental part of medical reasoning rather than a regrettable byproduct. Jonathan and Gurpreet share insights from research and clinical experience, offering practical methods to help trainees and clinicians recognize, manage, and even embrace uncertainty. Key topics we discuss include: The paradoxical nature of uncertainty: When perceived as a threat, it can provoke anxiety or fear; yet when framed as an opportunity, it can inspire hope and optimism. Why uncertainty is inevitable in medical practice and its impact on clinicians. Is uncertainty a state or a trait? The distinction between epistemic uncertainty (knowledge gaps) and aleatoric uncertainty (randomness in outcomes). How experienced clinicians utilize strategies such as forward planning and monitoring to navigate uncertainty. Communicating uncertainty with patients: how to do it effectively without eroding trust. How to integrate uncertainty into medical education. During the conversation, we explore the emotional responses to uncertainty and how these reactions can influence clinical practice and decision-making. Importantly, Jonathan and Gurpreet emphasize the importance of openly communicating uncertainty with colleagues, supervisors, and patients—a practice that, contrary to common belief, actually strengthens trust, fosters transparency, and encourages collaboration. By normalizing and embracing uncertainty, clinicians can better manage the complexities of medicine and build confidence in their ability to care for patients in the face of the unknown. 👉 We're thrilled that Meg Wallhagen, Professor of Nursing at UCSF, has recorded an intro to this week's podcast. Any listener who contributes $1000+ is invited to record an intro to a GeriPal podcast! You can donate , any amount is appreciated. Also, Meg is looking for practicing or student clinicians (physicians and nurses) who are willing to participate in a study on how a simulation of hearing loss promotes a greater appreciation of the experience of hearing loss. Participation should take no more than one to one and one half hour and you will receive a gift card in acknowledgement of your time. If interested, please contact her directly at . For more info, click the following link to open the flyer (PDF format): ** NOTE: To claim CME credit for this episode, ** /episode/index/show/geripal/id/39734135

Why We Need QI Collaboratives: Guests Steve Pantilat, David Currow, and Arif Kamal 01/08/2026

Why We Need QI Collaboratives: Guests Steve Pantilat, David Currow, and Arif Kamal 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 underscores the importance of these efforts. In this episode, Dr. David Currow shares lessons from , a national model for standardized data collection and benchmarking that has driven measurable improvements in palliative care. Meanwhile, Drs. Steve Pantilat and Arif Kamal reflect on the history of the Palliative Care Quality Collaborative (PCQC), a U.S.-based initiative formed in 2019 by merging the National Palliative Care Registry (NPCR), the Palliative Care Quality Network (PCQN), and the Global Palliative Care Quality Alliance (GPCQA). Although the PCQC had ambitious goals, it ultimately closed earlier this year. Together, the panelists unpack the reasons behind its closure and discuss the lessons future registries can take away from its challenges. Throughout the conversation, we tackle some of the field’s biggest questions about registries and QI collaboratives: What data should be collected to create meaningful quality indicators? How can we minimize the administrative burden of data collection on clinicians? And how do we balance the risk of becoming narrowly focused “” with the need to maintain holistic, person-centered care? By addressing these questions, the panel highlights the immense potential of QI initiatives to enhance palliative care while remaining true to the field’s core mission: ensuring that patients and their families feel deeply cared for during life’s most vulnerable moments. /episode/index/show/geripal/id/39651750

Is Attending to Clinician Distress Our Job? Sara Johnson, Yael Schenker, & Anne Kelly 12/18/2025

Is Attending to Clinician Distress Our Job? Sara Johnson, Yael Schenker, & Anne Kelly 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 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). 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. We referenced a prior episode on with Kerri Brenner and Dani Chammas, and this article by . We talked about the role of the consultant, including this 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 /episode/index/show/geripal/id/39444175

Rehab and Death in Skilled Nursing Facilities: Sarguni Singh, Christian Furman, and Lynn Flint 12/11/2025

Inflammaging: Brian Andonian, Sara LaHue, Joe Hippensteel 12/04/2025

Inflammaging: Brian Andonian, Sara LaHue, Joe Hippensteel Six years ago we had John Newman on GeriPal to talk about (Song choice Who Wants to Live Forever by Queen, perfect selection). John explained the basics of geroscience, what is it, what are the key theories in geroscience, what is senescence, why people who provide clinical care for older adults should care about geroscience, and potential therapeutics like metformin and rapamycin. Today we bring on three rising stars in Geroscience, Brian Andonian, Sara LaHue, Joe Hippensteel, to talk about one of the key pillars of Geroscience: inflammaging. We use this terrific paper they published in as a springboard. We discuss: What is inflammaging? Chronic progressive low grade inflammation with aging. I try to get one of them to stake a claim that inflammaging should be the organizing principle of geroscience How does inflammaging operate in rheumatologic conditions like rheumatoid arthritis (Brian), neurologic conditions like traumatic brain injury (Sara), and critical illness (Joe). We talk about Post-ICU Syndrome (PICS) and relate inflammaging to our prior podcast with Wes Ely about his book . We also talk about how inflammaging is not just a factor in chronic conditions like diabetes or inflammatory bowel disease, which make intuitive sense, but also in acute conditions, like sepsis or traumatic brain injury in older adults. The state of the science on clinical and research tests for inflammaging - ready for prime time? What is the state of the science for therapeutics? Why should some anti-inflammatory therapeutics make us nervous in frail older adults? Inflammation developed evolutionarily for a reason. E.g. tthink of drugs that wipe out the immune system. The outsized discrepancy between non-FDA products marketed to consumers as anti-inflammaging and the state of academic Geroscience. We announce GeriPal’s new lineup of skin care anti-inflammaging products! We discuss lifestyle interventions such as exercise, meditation, caloric restriction and intermittent fasting, and strength/resistance training. \We recognize the efforts of in bringing together multidisciplinary aging researchers to advance aging research, including our guests. And what a joy to sing Billy Joel! Here’s a link to the I mentioned, which is on my list to see. -Alex Smith /episode/index/show/geripal/id/39260060

The Chaplain and the Doctor: A Podcast with Betty Clark and Jessica Zitter 11/20/2025

The Chaplain and the Doctor: A Podcast with Betty Clark and Jessica Zitter In this week’s episode, we delve into the powerful documentary with two extraordinary guests: Betty Clark, the chaplain at the heart of the film, and Dr. Jessica Zitter, the physician and filmmaker who brought this story to the screen. The film provides a deeply moving look into the ways personal stories and biases shape our interactions in healthcare. Through our conversation with Betty and Jessica, I gained a valuable insight: the narratives we carry within ourselves—whether conscious or unconscious—act as invisible forces that influence how we engage with patients and colleagues. I also learned that recognizing these stories and the biases they may produce, rather than avoiding them, can foster more genuine and empathetic care. They also may lead to deep friendships, as is clearly shown between Betty and Jessica. I love both this podcast episode and the film itself, as they shine a light on the deeply human—and oftentimes flawed—experience of working in healthcare. They remind us of the vital role of storytelling in shaping how we care for patients, and the often-overlooked yet essential contributions of chaplains in healthcare settings. Betty and Jessica’s reflections underscore how chaplains bring compassion and humanity to the medical team, offering emotional and spiritual support to patients and providers alike. If you’re interested in watching The Chaplain and The Doctor during its festival tour, or would like to host a screening at your own institution, I encourage you to visit the film’s website at . This episode of the GeriPal Podcast is sponsored by , an amazing group doing world class palliative care. They are looking for physician faculty to join them in the inpatient and outpatient setting. To learn more about job opportunities, please click here: ** NOTE: To claim CME credit for this episode, ** /episode/index/show/geripal/id/39104010

A Strategic Path Forward for Hospice & Palliative Care: Ira Byock, Kristi Newport, Brynn Bowman 11/13/2025

Palliative Care in Sickle Cell: Craig Blinderman, Stephanie Kiser, Eberechi Nwogu-Onyemkpa 11/06/2025

Medical Billing and Coding in Geriatrics: Peter Hollmann, Ken Koncilja, and Audrey Chun 10/30/2025

Medical Billing and Coding in Geriatrics: Peter Hollmann, Ken Koncilja, and Audrey Chun Last month, the “Billing Boys”—Chris Jones and Phil Rodgers—joined the GeriPal podcast to . This month, we’re back with part two, shifting the focus to geriatrics. While billing and coding may not be the most exciting topic, they’re essential for ensuring fair reimbursement for the complex care we provide and for supporting the work of our interprofessional teams, many of whom can’t bill directly for their services. When we underbill or leave money on the table, we not only shortchange ourselves but also devalue the critical role of geriatrics in the healthcare system. This time, we’re joined by experts , , and to dive into key questions: Why does billing matter, and who does it benefit? What’s the difference between CPT, E&M, and ICD-10 codes (if you need a refresher, check out our chat with the Billing Boys )? We explore how to think about billing for complexity versus time, and unpack new and impactful codes like the Cognitive Assessment and Care Plan Services code (99483), advance care planning (ACP) billing codes, and G2211, which acknowledges the added work of managing patients with chronic conditions. We also highlight the new APCM G-codes for 2025, a set of HCPCS codes that could provide substantial financial support for interdisciplinary teams in geriatrics. Finally, we discuss the advocacy behind these codes. The plays a vital role on the AMA’s RUC committee, helping to improve reimbursement for the complex care of older adults. Tune in to this week’s GeriPal podcast for expert advice, practical strategies, and insights that will help you optimize your billing practices and sustain the future of geriatrics! Here are some of the resources we also talked about: 👉 NOTE: Eric and Alex are giving UCSF Geriatrics Grand Rounds on Wednesday November 5, 4-5pm Pacific Time. The topic is, "What we've learned from nearly 400 GeriPal podcasts." Join us! This will be highly interactive. If you'd like to join via Zoom, you can use this link: . Or join in person, grand rounds are open to all! We will be speaking at the main UCSF Campus, 500 Parnassus Ave, in the Health Sciences West Building, 3rd floor, room 303. You can ask for directions when you arrive at UCSF, or email Alex to arrange for someone to meet you at the front (). /episode/index/show/geripal/id/38826455

Rethinking Slow Codes: Gina Piscitello, Parker Crutchfield, Jason Wasserman 10/23/2025

Rethinking Slow Codes: Gina Piscitello, Parker Crutchfield, Jason Wasserman I’m going to begin with a wonderful quote from a recent editorial in by our guests Parker Crutchfield & Jason Wasserman. This quote illustrates the tension between the widely held view in bioethics that slow codes are unethical, and the complexity of real world hospital practice: “Decisive moral positions are easy to come by when sitting in the cheap seats of academic journals, but a troubling ambivalence is naturally characteristic of live dilemmas.” Gina Piscitello, our third guest, recently surveyed doctors, nurses and others at 2 academic medical centers about slow codes. In a , she found that two thirds had cared for a patient where a slow code was performed. Over half believed that a slow code is ethical if they believed the code is futile. Slow codes are happening. The accepted academic bioethics stance that slow codes are unethical is not making it through to practicing clinicians. Our 3 guests were panelists at a session of the annual meeting last year, and their panel discussion was apparently the talk of the meeting. Today we talk about what constitutes a slow code, short code, show code, and “Hollywood code.” We talk about walk don’t run, shallow compressions, and…injecting the epi into the mattress! We explore the arguments for and against slow codes: harm to families, harm to patients, moral distress for doctors and nurses; deceit, trust, and communication; do outcomes (e.g. family feels code was attempted) matter more than values (e.g. never lie or withhold information from family)? We talk about the classic bioethics “trolley problem” and how it might apply to slow codes (for a longer discussion see this ). We talk about the role of the law, fear of litigation, and legislative overreach (for more see this ). We disagree if slow codes are ever ethical. I argue that Eric’s way out of this is a slow code in disguise. One thing we can all agree about: the ethics of slow codes need a rethink. Stop! In the name of love. Before you break my heart. Think it over… -Alex Smith /episode/index/show/geripal/id/38746785

GeriPal Live! at NPCRC Foley Retreat: Dio Kavalieratos, Prasanna Ananth, Alexi Wright 10/16/2025

GeriPal Live! at NPCRC Foley Retreat: Dio Kavalieratos, Prasanna Ananth, Alexi Wright This is the second GeriPal podcast we’ve recorded live using this format, see this to our prior podcast at the Center to Advance Palliative Care (CAPC) meeting in Philadelphia. Also look for our upcoming podcast recorded live from the . Today we join you from beautiful Banff, Alberta, Canada at the National Palliative Care Research Center () annual Kathleen Foley retreat. This meeting was bittersweet. I’ve been fortunate to attend every meeting in one capacity or another since 2006. The made an enormous impact on the growth and capacity for palliative care research nationally. Personally, NPCRC funding was essential support as I was a new faculty member and had not yet secured longer term career development funding. More than anything, though, I will miss the community. I treasure those meals, hikes, sing-alongs with others dedicated to improving care of people with serious illness through research. On today’s podcast, we invited Dio Kavalieratos, Prasanna Ananth, and Alexi Wright to join us to talk about three articles that spoke to them. For each I leave you with a teaser of a hard question that was raised that we couldn’t really answer. Prasanna chose an article by Abby Rosenberg about . We talked about why palliative care clinicians get fired, with Prasanna, a pediatric oncologist, raising the issue that it’s more problematic when you’re the oncologist providing primary palliative care and you get fired than if the consultant specialty palliative care provider is fired. Dio chose an article about the . We talked about the needs of palliative care internationally, and Alexi raised the question: should the highest standard of palliative care (e.g. in the US) apply to palliative care in every country, a la the Partners in Health model pioneered by the late Paul Farmer? Or should we “settle” for access to affordable opioids? Alexi chose an article about . Alexi used it as a springboard to talk about other populations at compounded risk for poorer care in the current political environment. We hope you enjoy this one as much as we did, dear listeners. We’re always trying to improve, and welcome your suggestions for how to improve upon this new “live” format. So far we’ve heard we need to be better at summarizing the articles for the audience/listeners, and finding ways to involve our live audience to a greater extent than the occasional question. Please let us know if you have other suggestions! Final note - check out the wonderful NPCRC created about their impact on the field of palliative care (Eric and I were filmed recording GeriPal). -Alex Smith This episode of the GeriPal Podcast is sponsored by , an amazing group doing world class palliative care. They are looking for physician faculty to join them in the inpatient and outpatient setting. To learn more about job opportunities, please click here: /episode/index/show/geripal/id/38597290

GeriPal Live! at CAPC: Karen Bullock, Kim Curseen, Matt Gonzales 10/09/2025

Pre-Operative Geri Assessment: Vicky Tang and Houman Javedan 09/25/2025

Pre-Operative Geri Assessment: Vicky Tang and Houman Javedan We love getting requests from listeners for podcast topics. This request came from geriatricians we met at the annual American Geriatrics Society meeting in Chicago. They wanted to know more about what a geriatrician should do in a pre-operative risk assessment. So we invited Vicky Tang and Houman Javedan, two geriatricians and leaders in the pre-operative assessment and prehab space, to talk with us. As is our style, we backed up to some bigger questions, including: -Why do patients need a geriatric assessment pre-operatively?-Why are our surgical colleagues asking us? Is it due to liability concerns? -Why do we do them? Recognizing we may have different motivations than our consultants (hint: stealth geriatrics) -How does the comprehensive geriatric assessment fit int? Do the 4Ms fit into pre-operative assessment if at all? (an entertaining disagreement ensued) -Must a geriatrician do this? -What is the ? -What’s the most important part of Many links from our guests below. And please forgive my Spanish on the song, I tried! Thanks to sons Kai and Renn on Ukulele and Bass for making it sound better. -Alex From Vicky: Systematic review of Prehab Geriatric Surgery Verification Program shared decision making in surgical patients From Houman: Geriatric Surgical Co-management Evidence 1. Trauma survival with geriatric assessment 2022- 2. Hip fracture survival benefit meta-analysis 2014- 3. Elective abdominal surgery benefits POSH program 2018- 4. POSH Program for Spine 2021- 5. Elective orthopedic joints ED readmission decreases 2024 - 6. The need for geriatricians, tools and education models (aka Ms) are not enough - Sub Topics 7. Utility of minicog and where our improved local mortality of 18% and delirium of 11% reported - 8. Geriatrician performed CGA-FI best at predicting mortality in rib fractures 2025 - 9. Geriatrician performed CGA-FI predicting mortality better than age in hip fractures 2024- https://pubmed.ncbi.nlm.nih.gov/39007664/ 10. Multidomain frailty assessment and surgery showing severely frail patients at risk of mortality even with low risk procedures (eg. Cystoscopy) - 11. Different outcomes for hip fracture surgery in the severely frail - 12. Complexity of aging physiology- example of prostaglandin based free water excretion in collecting duct of aging kidney first paragraph on page 360- /episode/index/show/geripal/id/38346270

What Makes a Good Death? Karen Steinhauser, Rasa Mikelyte, Edison Vidal 09/18/2025

GeriPal - A Geriatrics and Palliative Medicine Podcast

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