The Schwartz Center for compassionate health care (https://www.theschwartzcenter.org/) is hosting a webinar on communication in the era of COVID-19.
Dear UCSD IM Family,
Please congratulate your friends on their awesome fellowship match results!
One of our Internal Medicine Residency and Palliative Care Fellowship grads wrote an incredible piece for JAMA that you should all read! You can find the article here
Yesterday at Jacobs Medical Center, our fantastic PGY3 and soon to be Chief Resident presented a case he encountered at Jacobs that brought together a group from multiple different specialties! Briefly, we discussed the case of a 23 year old patient with T1DM from a prior pancreatectomy with a long history of depression and medication non-compliance as well as prior suicide attempts. She was admitted with melena and DKA, and over her hospital course developed recurrent bowel intussusception resulting in bowel ischemia and necrosis requiring ICU admission, intubation and multiple urgent surgical procedures. We were fortunate to have representation from Hospital Medicine, Endocrinology and Hospice & Palliative Care which created robust discussion about various nuances of the patient’s case which included: Capacity evaluation – it is important to note that capacity is something that needs to be assessed in a specific clinical period and in answering a specific clinical question. Remember that often orientation questions are not the best way
Today, we learned about dementia, how to disclose the diagnosis, and the challenges around this disease. This is HIGH YIELD stuff. Dementia is like the last frontier, where clinical acumen is necessary. We do not have one test that gives a slam dunk diagnosis. To start if you are thinking about dementia, you need to consider depression and delirium. According to Dr. Sladek, these are the three a”D”go’s! You also should think about the reversible causes. Reversible causes make up <1% of dementia but you can save someone’s life. Alzheimer’s disease is the most common, but there are other types of dementia you need to know. Check out this list:
Today our residents and interns had the opportunity to practice revealing a diagnosis of dementia and their goals of care conversations with standardized patients in our professional development center. Thank you to all of our geriatrics, palliative care, primary care, and pulmonary critical care faculty who helped to facilitate the session! You can find the original article outlining the SPIKES framework to help with patient conversations here. Our residents also got a chance to learn and practice tai chi (outside, so they got some vitamin D also!) with tai chi master, Dr. Jesse Tsao. Remember this has been shown to decrease fall risk and chronic pain! They finished off the afternoon with a session on billing & coding with Dr. Deanna Hill – with a game created by our very own Dr. Joe Meserve!
We continued our geriatrics/general internal medicine Friday school block this week! We started with back-to-back sessions by our AMAZING geriatrician and associate program director, Dr. EB Sladek about healthcare maintenance in the geriatric population and a polypharmacy game. Remember “Bed-to-Bacon” for the activities of daily living! If you can get out of bed (transferring), wash up ( bathing/showering and personal hygiene), get dressed (dressing), and get to the kitchen (functional mobility) to eat bacon (self-feeding, you don’t have to cook it!), you’re able to complete your basic ADL’s! An important geriatric mantra is “fix the can’ts” (ie: can’t read, afford, open, remember, or swallow medications). Even if a patient wants to take the medications they are supposed to, they aren’t able to if they can’t! The interns joined us for sessions about dementia with Dr. Ellen Lee (amazing geriatric psychiatrist) and advanced communication with Chris Onderdonk (invaluable palliative care clinical social worker). Get excited to put these communication skills to
It’s time to switch from viruses, bacteria, and fungi to the HEART! Today, we kicked off our Cardiology Friday School block with some great didactic sessions! Dr. Heather Bruner from the palliative care department gave a talk on palliative heart failure and Dr. Howie Tran discussed how to manage heart failure in the inpatient and oupatient settings. The tagline from this session was: ” You’ve got to warm them up to dry them out.” We then closed out the week by learning about valvular heart disease from Dr. Jia Shen! We learned that a normal aortic valve is like a Mercedes-Benz, but a stenotic valve is more like a Subaru. (Sorry, Subaru drivers.) Stay tuned for more to come next week!