Kai Romero's guest appearances

Kai Romero

GeriPal

John Newman

Scott Bauer

BJ Miller

Andy Cohen

Aaron Kesselheim

Louise Aronson

Haider Warraich

Lewis Cohen

Stephanie Rogers

Tim Anderson

Jessica Zitter

Susan Block

John Mills

Katie Fitzgerald

John Nelson

OwlTail

Tommie Farrell

So what exactly does a hospice medical director do?  Why do some choose to become hospice physicians?  What additional training is needed, if any, beyond Hospice and Palliative Medicine fellowship and boards?  Who should take the new Hospice Medical Director Certification Board Examination?  A recent study in JAGS found high rates of  hospice disenrollment (“live discharge”) for people with dementia - is that a good thing or a bad thing?  Hmmm… We address these and other questions in this week’s podcast with Tommie Farrell, hospice physician in West Texas and Chair of the Hospice Medical Director Certification Board, and Kai Romero, Chief Medical Officer for Hospice By the Bay (that’s San Francisco Bay). And I get a re-do attempt at REM’s “Everybody Hurts!”. Apologies for the first attempt!   -@AlexSmithMD

So what exactly does a hospice medical director do?  Why do some choose to become hospice physicians?  What additional training is needed, if any, beyond Hospice and Palliative Medicine fellowship and boards?  Who should take the new <a href="https://hmdcb.org" rel="nofollow" target="_blank">Hospice Medical Director Certification Board Examination</a>?  A recent study in JAGS found high rates of <a href="https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17066" rel="nofollow" target="_blank"> hospice disenrollment</a> (“live discharge”) for people with dementia - is that a good thing or a bad thing?  Hmmm… We address these and other questions in this week’s podcast with Tommie Farrell, hospice physician in West Texas and Chair of the Hospice Medical Director Certification Board, and Kai Romero, Chief Medical Officer for Hospice By the Bay (that’s San Francisco Bay). And I get a re-do attempt at REM’s “Everybody Hurts!”. Apologies for the first attempt!   -@AlexSmithMD

So you want to be a hospice medical director? Podcast with Tommie Farrell and Kai Romero

Naomi George

The Emergency Department (ED) is a hard place to have serious illness discussions, whether it be goals of care or code status discussions, or whether or not to consider intubation for a seriously ill patient.  Emergency physicians often don't have the time for in-depth discussions, nor have been trained on how to do so.  There often is limited information about the patient, their functional status, or their prognosis.  These are some of the most challenging and some of the most important conversations in medicine, as 75% of older adults visit the ED during the last 6 months of life (data thanks to this Alex Smith publication in Health Affairs!)   So how do we have these urgent conversations in a time of crisis to ensure that patients receive care that aligns with their goals?  We have Naomi George, researcher and ED physician extraordinaire from the University of New Mexico, and Kai Romero from UCSF and Hospice by the Bay to help answer this question. Naomi discuss her practical approach to crises communication that she published along with others (including previous GeriPal guest Kei Ouchi) in this Annals of Emergency Medicine publication titled "Managing Code Status Conversations for Seriously Ill Older Adults in Respiratory Failure."  We also talk with Kai Romero about her Academic Life In Emergency Medicine blog post on "Work Grief: A Practical Primer for Emergency Medicine Providers". 

The Emergency Department (ED) is a hard place to have serious illness discussions, whether it be goals of care or code status discussions, or whether or not to consider intubation for a seriously ill patient.  Emergency physicians often don't have the time for in-depth discussions, nor have been trained on how to do so.  There often is limited information about the patient, their functional status, or their prognosis.  These are some of the most challenging and some of the most important conversations in medicine, as 75% of older adults visit the ED during the last 6 months of life (<a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2011.0922" rel="nofollow" target="_blank">data thanks to this Alex Smith publication in Health Affairs!</a>)   So how do we have these urgent conversations in a time of crisis to ensure that patients receive care that aligns with their goals?  We have Naomi George, researcher and ED physician extraordinaire from the University of New Mexico, and Kai Romero from UCSF and Hospice by the Bay to help answer this question. Naomi discuss her practical approach to crises communication that she published along with others (including previous <a href="https://www.geripal.org/2018/03/third-die-after-ED-intubation.html" rel="nofollow" target="_blank">GeriPal guest Kei Ouchi</a>) in this Annals of Emergency Medicine publication titled "<a href="https://www.annemergmed.com/article/S0196-0644(20)30410-8/fulltext" rel="nofollow" target="_blank">Managing Code Status Conversations for Seriously Ill Older Adults in Respiratory Failure</a>."  We also talk with Kai Romero about her Academic Life In Emergency Medicine blog post on "<a href="https://www.aliem.com/work-grief-primer/" rel="nofollow" target="_blank">Work Grief: A Practical Primer for Emergency Medicine Providers</a>".

Crisis Communication and Grief in the Emergency Department: Podcast with Naomi George and Kai Romero

Todd Cote

The vast majority of hospice services are delivered in patient's homes or other places of residence like nursing homes. This makes the traditional model of hospice care vulnerable in this coronavirus pandemic, especially in the era of social distancing and limited personal protective equipment (PPE). So how are hospice's responding to the COVID-19 pandemic? On this weeks podcast, we talk to two leaders of two large hospice agencies, Drs. Kai Romero and Todd Cote, to get their views on this question. Kai is the Chief Medical Office of Hospice by the Bay in California. Todd is the Chief Medical Officer at Bluegrass Care Navigators in Kentucky. It's inspiring to hear how these hospices and others are stepping up to the challenge of caring for both COVID positive and non-COVID positive patients during this time. Among subjects we talk about include: - The variability how this pandemic is affecting hospices in how they are responding to COVID (even if they take COVID positive patients) - Supply limitations (PPE, medications, etc) - The role of telemedicine in hospice visits and the challenges with trying to do some hospice visits virtually - How COVID influences prognostic eligibility to hospice - Special issues in vulnerable populations like homeless and rural populations Check out our new COVID page at https://www.geripal.org/p/covid.html for important links we talk about in this podcast as well as previous COVID podcasts.

The vast majority of hospice services are delivered in patient's homes or other places of residence like nursing homes. This makes the traditional model of hospice care vulnerable in this coronavirus pandemic, especially in the era of social distancing and limited personal protective equipment (PPE). So how are hospice's responding to the COVID-19 pandemic? On this weeks podcast, we talk to two leaders of two large hospice agencies, Drs. Kai Romero and Todd Cote, to get their views on this question. Kai is the Chief Medical Office of Hospice by the Bay in California. Todd is the Chief Medical Officer at Bluegrass Care Navigators in Kentucky. It's inspiring to hear how these hospices and others are stepping up to the challenge of caring for both COVID positive and non-COVID positive patients during this time. Among subjects we talk about include: - The variability how this pandemic is affecting hospices in how they are responding to COVID (even if they take COVID positive patients) - Supply limitations (PPE, medications, etc) - The role of telemedicine in hospice visits and the challenges with trying to do some hospice visits virtually - How COVID influences prognostic eligibility to hospice - Special issues in vulnerable populations like homeless and rural populations Check out our new COVID page at <a href="https://www.geripal.org/p/covid.html" rel="nofollow" target="_blank">https://www.geripal.org/p/covid.html</a> for important links we talk about in this podcast as well as previous COVID podcasts.

How are hospices responding to the COVID pandemic?  Podcast with Kai Romero and Todd Cote