The Palliators
Educating healthcare professionals
one conversation at a time
The Palliators
Educating healthcare professionals
one conversation at a time
Welcome to ThePalliators.com
Starting the Conversations that Matter
About the Palliators
We are board-certified, fellowship-trained Hospice and Palliative Medicine physicians who have backgrounds in Internal Medicine, Family Medicine, and Pediatrics. We have developed a special interest in educating healthcare professionals about the particular needs of those who are facing chronic and terminal illnesses.
We do not mean for this site to replace your own research or professional judgment in caring for your patients, but we hope you can find it to be a resource to provide outstanding care.
Get to Know The Palliators
PeachState Palliator
PeachState Palliator
PeachState Palliator
Dr. Tara Kattine
Internal Medicine
Sometimes you must take care of patients who will never be completely healthy again. You must empathetically give them the horrible news and then help them feel better despite the diagnosis. You take care to support them and their loved ones while not burning out yourself.
We Are Here For You!
Palmetto Palliator
PeachState Palliator
PeachState Palliator
Dr. Nancy Hart Wicker
Family Medicine
It is important to recognize that our patients are more than their diseases and need to be cared for holistically - body, mind, and spirit. Every individual's experience is different, and we need to incorporate their values into their treatment plans. We need to manage ourselves, too, so that we do not burn out.
Pediatric Palliator
PeachState Palliator
Pediatric Palliator
Dr. Katie Mollo
Pediatrics
We should listen to our patients and their families to gain a better understanding of what is important to them in how they live their lives. One of the most important things we can do is advocate for our patients to help them in their struggles to live as well as possible. We also need to tend to patients and their families as a whole.
The Palliators Podcast Show Notes
On Apple and Google Podcasts, Stitcher, Spotify, iHeartRadio, & http://www.buzzsprout.com/333515
Episode #1 Introduction to Palliative Medicine & Hospice: Reviews concepts for practicing clinicians with an important link - Choosing wisely - www.choosingwisely.org
Discussion of The Hospitalist article: 10 Things Hospitalists Need to Know about Palliative Care -
Episode #2 Delivering Important News: Tips From Experience
SPIKES articles:
DOI: 10.1634/theoncologist.5-4-302
Episode #3 Hope: Evolution of hope when it seems hope may be lost.
Discussion of how to help patients face a serious illness without providing false hope.
Article about hope from The Oncologist: Hope
DOI: 10.1634/theoncologist.12-9-1105
Episode #4 Discussion of JPSM article: Addressing a Patent's Hope for a Miracle https://www.ncbi.nlm.nih.gov/m/pubmed/29030208/M
Episode #5 Both Sides of the Stethoscope (Part 1): An interview with Suzanne, a neuro ICU nurse-turned hospice nurse, who faces terminal cancer at home with hospice services. She courageously faces death with thoughtful intention as she focuses on living well.
Episode #6 Both Sides of the Stethoscope (Part 2): The completion of our interview with Suzanne as she shares her experience in hope that we could benefit from her what she has learned.
Episode #7 Futility - Origins, Concepts, Principles, Perspectives, & Policy: An overview and discussion of futility with cases and resources
- https://www.youtube.com/watch?v=cDDWvj_q-o8
- Am J Respir Crit Care Med. 2015 Jan 15;191(2):219-27. https://doi.org/10.1164/rccm.201410-1916ST
Episode #8 Grief (Part 1): Back to the Basics with tips to understand and help your patients and their loved ones who are grieving. Features an interview with Shannon Dunavan, LCSW
https://www.psychologytoday.com/us/blog/supersurvivors/201707/why-the-five-stages-grief-are-wrong
Highlighted Books by Elizabeth Kubler-Ross, MD:
On Death and Dying
Questions and Answers on Death and Dying
Episode #9 Grief (Part 2): Beyond the Basics features Shanon Dunavan, LCSW with more tips on helping people in all stages of grief, but especially through what many think of as the more difficult stages of grief - anger and denial.
Episode #10 Constipation: An Underrated Symptom and Often Undertreated
Get the straight poop on constipation and effective therapies and a discussion about the use of docusate. Drawing from articles in several journals, including JPSM, we discuss the importance of management, eliminating ineffective interventions and providing useful treatment.
Am J Gastroenterol. 2005 Apr;100(4):936-71
https://www.timeofcare.com/the-bristol-stool-chart/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378729/
https://www.jpsmjournal.com/article/S0885-3924(12)00249-7/pdf
J Am Board Fam Med. 2011 Jul-Aug;24(4):436-51. doi: 10.3122/jabfm.2011.04.100272
Am J Med. 2016 Sep;129(9):1001.e1-7. doi: 10.1016/j.amjmed.2016.04.008. Epub 2016 May 3
Episode #11 Empathy, Don't Be an A**hole
Empathy is an important aspect in caring for our patients. It helps our patients and helps us. Learn more about its importance and learn about tools and skills to help with communicating empathy
https://doi.org10.1371/journal.pone.0061526
https://doi.org/10.1046/j.1525-1497.2003.21017.x
https://doi.org/10.1007/s11606-016-3597-2
https://doi.org/10.1001/jamanetworkopen.2018.0351
https://doi.org/10.1371/journal.pone.0061526
https://doi.org/10.1016/j.burn.2017.06.003
https://dx.doi.org/10.2147%2FPRBM.S145810
https://doi.org/10.3389/fpsyg.2016.00763
https://doi.org/10.1371/journal.pone.0177758
https://dx.doi.org/10.5116%2Fijme.4d00.b701
https://www.youtube.com/watch?v=1Evwgu369Jw
Episode #12 Quality of Life: An
Important Concept in the Care of Our Patients
Quality of Life has been key in the care of palliative care and hospice patients. It should help to drive decision-making. Often the determination of quality is not decided by those who should.
http://depts.washington.edu/seaqol/WHOQOL-BREF
https://www.who.int/mental_health/publications/whoqol/en/DOI: 10.18357/ijcyfs94201818637
(JAMA. 1994;272:619-626)
https://doi.org/10.1186/1477-7525-1-60
Kidney International, Vol. 57, Suppl. 74 (2000), pp. S-113–S-120
https://doi.org/10.1016/j.ejca.2019.08.016
https://doi.org/10.1093/jncimonographs/lgm008
Episode #13 Don't Say That!
So much of what we do tell our patients can be confusing, misunderstood, or even insulting. Learn expressions, phrases, and words to enhance your rapport with your patients and ease their anxiety. How we present information is significant. Learn ways that are sensitive and understandable.
Episode #14 PEG Tubes in Advanced Dementia
A discussion and review of studies and decision making about PEG tubes in patients with advanced dementia. Review of the American Geriatric Society Alzheimer's Association position statements
PMID: 25039796 DOI: 10.1111/jgs.12924
https://www.alz.org/media/Documents/feeding-issues-statement.pdf
https://doi.org/10.1007/s12603-014-0517-1doi: 10.3390/nu7042456
https://doi.org/10.1155/2019/7272067doi: 10.1155/2019/7272067
doi: 10.1080/00243639.2016.1211879
Podcast #15 Nausea and Vomiting. Please, no.
https://www.mypcnow.org/fast-fact/the-causes-of-nausea-and-vomiting-v-o-m-i-t/
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6249
From the APM - DOI: 10.3978/j.issn.2224-5820.2012.07.06
From JPSM - DOI: https://doi.org/10.1016/j.jpainsymman.2009.08.010
Podcast #16 Malignant Bowel Obstruction
https://dx.doi.org/10.2147%2FCMAR.S29297
doi: 10.1200/JOP.2017.022210
https://doi.org/10.1016/j.jpainsymman.2005.10.009
http://dx.doi.org/10.1016/j.amsu.2015.07.018
Podcast #17 Don't Say That Again!
This podcast piggybacks off of Podcast #13 (Don't Say That!) to give more communication tidbits to improve communication and understanding in the discussions you have with patients and their loved ones.
Podcast #18 Things That Bug Us!
This podcast takes a look at things that may bother us in our practice of HPM.We discuss ways to approach them so that they do not get the better of us and perhaps have things go better next time.
Am J Med. 2016 Sep;129(9):1001.e1-7. doi: 10.1016/j.amjmed.2016.04.008. Epub 2016
J. Hosp. Med. 2019 February;14(2):110-113 | 10.12788/jhm.3124
https://www.jpsmjournal.com/article/S0885-3924(12)00249-7/pdf
Podcast #19 Are We the Canaries in the Coal Mine?
In this podcast we discuss burnout - how it affects us, our patients, and the healthcare system - and how to help ourselves and work toward change.
JAMA. 2018;319(15):1541-1542. doi:10.1001/jama.2018.1331
N Engl J Med 2020; 382:2485-2487 DOI: 10.1056/NEJMp2003149
Reith T P (December 04, 2018) Burnout in United States Healthcare Professionals: A Narrative Review. Cureus 10(12): e3681. DOI 10.7759/cureus.3681
Journal of Internal Medicine, 2018, 283; 516–529 doi: 10.1111/joim.12752
Patel R S, Sekhri S, Bhimanadham N N, et al. (June 03, 2019) A Review on Strategies to Manage Physician Burnout. Cureus 11(6): e4805. DOI 10.7759/cureus.4805
(http://creativecommons.org/licenses/by-nc-nd/4.0/) https://doi.org/10.1016/j.amjmed.2019.08.034
Behav. Sci. 2018, 8, 98; doi:10.3390/bs8110098
Open Med. 2018; 13: 253-263
Podcast #20 Age Is Not Just a Number
Journal of Medical Ethics 1994; 20 270-271
https://doi.org/10.1136/jme.20.3.188
The Lancet, Volume 4, Issue 4, E200-E208, APRIL 01, 2019
https://doi.org/10.1016/S2468-2667(19)30035-0
The Gerontologist, Volume 60, Issue 1, February 2020, Pages 174–181, https://doi.org/10.1093/geront/gny131
he Gerontologist, Volume 56, Issue 6, 1 December 2016, Pages 997–1006, https://doi.org/10.1093/geront/gnv066
The Gerontologist, Volume 58, Issue 2, April 2018, Pages 226–232, https://doi.org/10.1093/geront/gnw116
https://www.the-rheumatologist.org/article/how-ageism-hurts-physicians-patients/2/?singlepage=1
https://khn.org/news/navigating-aging-a-doctor-speaks-out-about-ageism-in-medicine/
Podcast #21 Everyone Has a Story
The story of how hospice is an important program of care, consequences of not using the services, and how my original plans for finding cures got derailed into becoming something equally as important.
Podcast Reflections
Podcast #21
Vicki Kattine:
There are two things that people love to hear - the sound of their name and the sound of their voice.
Podcast #20
Dr. Robert N. Butler:
Prejudice against age is a prejudice against everyone. We all chance to become its ultimate victims as longevity increases.
Podcast #19
Sam Keen:
Burnout is nature's way of telling you, you've been going through the motions your soul has departed; you're a zombie, a member of the walking dead, a sleepwalker.
Podcast #18
Noel Coward:
I like long walks, especially when they are taken by people who annoy me.
Podcast #17
Benjamin Franklin:
Remember not only to say the right thing in the right place, but far more difficult still, to leave unsaid the wrong thing at the tempting moment.
Podcast # 16
Dane Cook:
People have constipation of the brain but their mouth has the runs.
Podcast # 15
Josh Billings:
A man who wants to vomit never puts on airs.
Podcast #14
Bob Marley:
You never know how strong you are until being strong is your only choice.
Podcast #13
Havelock Ellis:
All the art of living lies in a fine mingling of letting go and holding on.
Podcast #12
Dr. Michael Willoughby from a day we were rounding together:
He told a patient that he wanted to help him have more quantity of life - each of his days to be packed with as much life as possible.
Podcast #11
Brene Brown who has a great 2 and a half minute video on empathy: It is simply listening, holding space, withholding judgement, emotionally connecting and communicating that incredible healing message of “you’re not alone.”
Podcast #10
Robin Williams:
There’s three things in this world that you need: Respect for all kinds of life, a nice bowel movement, and a navy blazer.
Podcast #9
Elizabeth Kubler-Ross & David Kessler:
The reality is that you will grieve forever. You will not get over the loss of aloved ine; you will learn to live with it.
Podcast #8
Melodie Beattie:
Grief is a cleansing process. It’s an acceptance process. It moves us from our past into today and into a better future.
Podcast #7
Wendy Burt, the spokesperson for the Minnesota Hospital Association:
The Policies are helpful road maps for families and caregivers struggling with decisions about end of life care.
Podcast #6
Suzanne Principi:
I found my purpose by trying to have a positive impact on family, friends and coworkers throughout my life. I know all of you have made my life richer in so many ways. Thank you and be good to each other.
Podcast #5
Ira Byock:
The healthiest response to death is to love, honor, and celebrate life.
Podcast #4
Amy Tan :
Hope is the adrenaline of the soul.
Podcast #3
Pope Francis:
Love is the engine that powers our hope.
Podcast #2
J. Cole:
The bad news is nothing lasts forever; the good news is nothing lasts forever.
Podcast #1
Margaret Wheatly:
Be brave enough to start conversations that matter.