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

Why you should care about the shakeup at NIH: Sean Morrison, Ken Covinsky, Stacy Fischer 06/18/2026

Why you should care about the shakeup at NIH: Sean Morrison, Ken Covinsky, Stacy Fischer Emergency Podcast! Our guests Sean Morrison, Ken Covinsky, and Stacy Fischer believe that you should care deeply about the proposed shakeup at the National Institutes of Health. Major at the would affect a huge range of government grants, from Headstart to Transportation to the National Science Foundation, as well as the National Institutes of Health (NIH), the subject of today’s podcast. You dear listeners should all care. You should care because you care for older adults, or you’re a researcher who studies palliative care, or you're a chaplain who visited with the family of a patient who died today. You should care because these rule changes are so sweeping that they would remove standard components of the scientific review process and instead put them in the hands of political appointees. You should care because if rules like this were in place in the 1980s, we might not have developed treatments to stop the HIV/AIDS epidemic. You should care because if these rules go into effect we will not be able to work with researchers in other countries studying outbreaks of Ebola or Hauntavirus. You should care because these rules silence federal research into groups of people we care for daily. And if you’re not a researcher, your voice is even more important here. As Sean says, researchers who protest these proposed rule changes might come across as self-serving. Clinicians who are not researchers - who can say that these rules will negatively impact the science that improves care of older adults living with chronic conditions and their families - your voices may resonate even more. What can you do? Most of these rule changes are until July 13, 2026. Every comment will be read and requires a response. It’s ok to respond anonymously. Personalized stories matter more than form responses. Tips: 1: Say (or just describe to keep anonymous) who you are and why you are qualified to comment. Telling the story of how patients and families you care for or study is enough. Get your partner and parents to respond too. Simply being a concerned citizen is perfectly fine. 2: List the exact provision #s that concern you, and explain what they would do. You do not need to quote the rule directly. Just explain what you understand it to mean in plain terms. Political Appointees Take Control of Grant Awards (§200.205); Peer Review Is No Longer Binding (§200.205(d)); Active Grants Can Be Terminated at Any Time, for Any Reason (§200.340); DEI, Gender Research, and Related Topics Banned as Grant Conditions (§200.300); Prohibition on International Scientific Collaboration (§200.220); Conference Attendance Now Requires Express Agency Pre-Approval (§200.432); Publication Costs and Open Access Fees Presumptively Unallowable (§200.461) 3: Explain the concrete harm. What would happen to your patients and their families if this provision takes effect? 4: Closing: State clearly what you want OMB to do. This can be as simple as: “I urge OMB to withdraw these specific provisions: §200.340, §200.202, §200.205.” or “I urge OMB not to finalize this rule.” Submit your comment in opposition : The deadline is July 13, 2026. You can also email your congressperson or senator. Times they are a changin’. /episode/index/show/geripal/id/41680240

How We Limit Non-beneficial Life Sustaining Treatments: Jason Batten, Liz Dzeng, Teva Brender 06/11/2026

How We Limit Non-beneficial Life Sustaining Treatments: Jason Batten, Liz Dzeng, Teva Brender Today’s podcast is a natural follow up to our podcasts on and .Today we talk about a new study about how clinicians , published in JAMA Network Open. Do they adhere to society guidelines, which allow as permissible approaches only shared decision-making and following institutional policy. Or do they take alternative approaches, like not offering interventions, not mentioning interventions, or simply stating a plan to limit interventions? Turns out doctors are using these alternative approaches frequently. Our guests are Jason Batten, Liz Dzeng, and Teva Brender, all clinicians, all of whom have been thinking about and wrestling with the ethical reasoning behind these approaches. We all admit to using these approaches. Are the alternative approaches wicked games (song hint), and our response should be to stop these behaviors, beginning with ourselves? After all, if you ask patients or surrogates, they’re likely to say they want all the options and may not . Or, as with slow codes, does the fact that these alternative approaches are in common use suggest that the guidelines should be revised? You listen and decide! -Alex Smith Additional links: Dzeng 2023 JAMA IM: The larger ethnographic study from which data was drawn with data drawn from high- medium- and low-intensity hospitals. Brender 2025 JAMA NO: Factors that exacerbate or mitigate moral distress related to potentially non-beneficial treatments. Dzeng 2015 JAMA IM: Study illustrating that more senior physicians feel more comfortable not offering or recommending against futile CPR. Relevant quote: "Experienced physicians at all sites generally were comfortable engaging in best interest decision making and, when clinically appropriate, not offering or making explicit recommendations against offering resuscitation." Weiss Goitiandia AJOB 2025: Reasons why some clinicians would hesitate to go to the ethics committee / futility process for these discussions: Axelrod AJOB 2025: Discusses some of the systemic consequences of using physiologic futility as a standard and how it might contribute to a healthcare system that imposes aggressive treatments on vulnerable patients. /episode/index/show/geripal/id/41604520

Elder Mistreatment Prevention and Solutions: Carrie Rubenstein, Julia Hiner, & Tony Rosen 06/04/2026

CCRCs, ALFs, and Private Equity: John Burton, Bill Applegate, & Melissa Aldridge 05/28/2026

CCRCs, ALFs, and Private Equity: John Burton, Bill Applegate, & Melissa Aldridge Two retired luminaries in geriatrics join us today to share their personal experiences. First, John Burton, a geriatrician and Director of the Division of Geriatric Medicine at Johns Hopkins for some 35 years, shares his journey moving into a Continuing Care Retirement Community (CCRC) during Covid. You can read about John’s early experiences in his JAGS commentary titled, The tone is bleak. John’s experience since Covid, as you’ll hear, is very positive. Many of the concerns he raised about isolation have been addressed. Second, we hear from Bill Applegate, Geriatrician, retired faculty at Wake Forest, and former Editor in Chief of JAGS (Bill recruited Eric and me to join JAGS as editors about 10 years ago). Bill had a distinctly negative experience in two assisted living facilities (ALFs), which you can read about in his JAGS essay, titled, “.” Bill is seriously concerned about the lack of national oversight, poor staffing, and financial motivations behind for-profit and private-equity owned ALFs. Finally, we hear from Melissa Aldridge, a former banker turned health services researcher, about the nationally. This is a follow up to our prior podcast on with Melissa, Lauren Hunt, and Krista Harrison. Melissa is concerned that private equity has a very short time frame to turn acquisitions profitable, and cutting staff is often their first move. Further, private equity is financing these acquisitions with debt that is increasingly hard to trace and regulate. We talk about how private equity moving from purchasing fast food chains, toy stores, and hotels into CCRC, ALF, nursing home, and hospice ownership is a major concern. This is not the same as and turning a profit. These institutions provide healthcare, daily care needs, and community for a huge swath of older adults. These concerns should trigger a higher level of scrutiny, oversight, and regulation than other industries. What can you do about this, dear listeners? Listen to the end to find out! Thanks to Jerry Gurwitz for suggesting this podcast. We appreciate your suggestions. Keep ‘em coming. -Alex Smith /episode/index/show/geripal/id/41443790

Search for Geriatrician Identity: Mary Tinetti, Helen Fernandez, Jerry Gurwitz, Ken Covinsky 05/21/2026

Search for Geriatrician Identity: Mary Tinetti, Helen Fernandez, Jerry Gurwitz, Ken Covinsky Our focus today is on the search for the geriatrician identity, a continuation of the conversation we started with Jerry Gurtwitz on the . Today’s conversation is prompted by multiple articles in JAGS: (1) an article with a title the same as this podcast; (2) an article by Helen Fernandez on “”, a new combined 4 year internal medicine residency and geriatrics fellowship track; and (3) an article by Mary Tinetti titled, “?” Of note, Mary’s article is a follow up to her 2017 in which she wrote: Those outside the field have difficulty understanding what geriatrics is and what geriatricians do. We contribute to this lack of clarity. We are experts in complexity but are often bad at communicating simply. Our well-intentioned efforts to be inclusive and comprehensive lead to the creation of long, complex descriptions of what we do that further compromises understanding while eroding interest in, and support of, our field. Today we tackle this problem, discussing: A “funny if it wasn’t so painful” and in which geriatricians from Johns Hopkins roamed the streets of Baltimore asking lay people “What is a geriatrician?” The responses (something to do with Ben and Jerry’s ice cream? Jury-atrician?) will make you laugh and cry at the same time. 4 different types of geriatricians as described by Jerry in his JAGS paper: the complexivist, the healthful longevitist, the syndromist, and the contextualist. As with the 4Ms, Ken couldn’t help but add a 5th, the “identityist”, arguing that maybe Geriatricians worry too much in public about their identity, and should instead focus in public on what unites them: shared sense of purpose and mission to focus on whole person care and what matters most to older adults. Ken gave a rousing talk on being a Geriatrician at the Society of General Internal Medicine that received a lengthy standing-ovation (). Innovative new programs such as and GeriPal fellowship as ways to bring more people into the profession. How to balance our effort between recruiting specialist geriatricians to the profession and teaching all clinicians geriatrics principles and skills. A paper in by Richard G. Stefanacci and Ankur Patel in JAGS making the argument that a geriatrician “yields per-patient annual net cost savings of approximately $3495 (specialist consultation avoidance +$1500; ED reduction +$45; hospitalization reduction +$1950)...” and “The reason fee-for-service fails geriatricians is not that their skills are wrong for primary care—it is that the payment model is wrong for their skills. Payvider programs operating under capitation invert every structural disadvantage of fee-for-service. Under capitation, there are no RVUs. There is no penalty for spending 40 min with a complex patient. There is no revenue loss when the patient is dual-eligible rather than commercially insured—the capitated payment is the same regardless of original coverage source. And every unnecessary specialist referral, every avoidable hospitalization, every ED visit that could have been managed in-house represents a cost to the organization rather than a revenue stream.” Stay until the end when Mary has one of the best answers yet (in over 400 podcasts!) to Eric’s “if you had a magic wand” question. Enjoy! -Alex Smith /episode/index/show/geripal/id/41368100

The Interior Experience of Prescribing Medical Aid in Dying: Carly Zapata and Dani Chammas 05/14/2026

The Interior Experience of Prescribing Medical Aid in Dying: Carly Zapata and Dani Chammas I had the privilege of learning from fellow Lisa Harris about a term she termed, “.” As an ob/gyn and abortion provider, Lisa found the debate around the legality of abortion so polarizing that it created a false dichotomy: you’re either for or against. Any talk about misgivings, uncertainty, ambiguity, or ambivalence was silenced. Talking about these issues in the face of polarization was deemed dangerous and undermining to one side or another. “How could you?” For Lisa’s work in finding common ground and embracing nuance she was awarded the for forging connections across divisions. In today’s podcast we focus on the equivalent experience of moral uncertainty, distress, and residue among prescribers of medical aid in dying. We are joined by Carly Zapata and Dani Chammas, prescribers of medical aid in dying in California. We discuss: Their journey prescribing medical aid in dying, and reasons for choosing to prescribe The legality of prescribing in California. We compare California to Canada, as we have . We discuss suggesting that legal barriers may not explain the remarkable 20 fold differences in use of medical aid in dying between California and Canada; rather, Canada has 6x the number of providers per capita as California, and much greater awareness of the legality of medical aid in dying. We talk about cases that are not as clear - e.g. people who have . Moral issues, including ambiguity and ambivalence, distress and residue. For example the moral distress created when a patient requests medical aid in dying due to what is clearly a systems failure (see this for clear examples from Canada). We ask if they sometimes feel frustrated that more people who are in favor of medical aid in dying are not prescribing, instead leaving prescribing responsibility to a relatively small group of clinicians. How core ethical ideas might lead to very different conclusions about medical aid in dying, and ways Dani teaches ethics to trainees. Psychological models that can help navigate this complex terrain with patients and families, including and . And I can’t believe I haven’t played, “I will follow you into the dark” previously - but google couldn’t find it - really? In 400+ GeriPal podcasts? Great song. So fitting. My son Renn plays guitar on the audio only version. -Alex Smith Additionally, some take home points, sent by Dani after recording: (1) Holding the dialectic: On one hand, people deserve the highest level of attention to their personhood and their suffering—an effort that, at times, can soften or even resolve a desire for hastened death. And on the other hand, some people will authentically experience this as the most values-aligned way of dying, given their circumstances. (2) Learning to accept that while laws create the safety rails, within those boundaries, morality is pluralistic. Both patients and clinicians bring deeply held moral frameworks to these decisions—and those frameworks deserve to be acknowledged and respected. (3) We have to be willing to ask the hard questions—and to show up for one another as we do. Because this work, more than almost any other, has taught us the profound impact of not feeling alone when navigating grey terrain. I view the discussion as an invitation for our field to not necessarily to become more certain, but to be willing to wrestle with the hard questions—while still showing up with rigor and compassion. And to remember that our patients are people before they are cases. If we can stay close enough to truly know them, we’re much more likely to respond in ways that honor both their suffering and their dignity—whatever path that ultimately leads to. /episode/index/show/geripal/id/41284715

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

GeriPal - A Geriatrics and Palliative Medicine Podcast

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