Ashwin Kotwal's guest appearances

Ashwin Kotwal

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

Carla Perissinotto

“Loneliness is different than isolation and solitude.  Loneliness is a subjective feeling where the connections we need are greater than the connections we have.  In the gap, we experience loneliness.  It’s distinct from the objective state of isolation, which is determined by the number of people around you.” - Vivek Murthy, two time (and current) Surgeon General. We have heard a lot about loneliness and social isolation, particularly during the pandemic with enforced social distancing and near imprisonment of older adults in nursing homes.  In this context, we bring in two experts on these topics, Carla Perissinotto and Ashwin Kotwal, to explain:  How loneliness and social isolation overlap and are distinct How common these measures of social well being are in geriatrics and palliative care Why we should care as clinicians How we can ask about them How we should respond to care for patients who are lonely or isolated  Some key references from among the many we discuss on the podcast:   Loneliness in older adults predicts functional decline and death (JAMA IM 2012)  The epidemiology of loneliness and social isolation during the last years of life (JAGS 2021)   Use of high risk medications among lonely older adults (JAMA IM 2021)   Integrating social care into healthcare: GeriPal podcast with Kirsten Bibbens-Domingo   Coalition to end social isolation and loneliness   -@AlexSmithMD

“Loneliness is different than isolation and solitude.  Loneliness is a subjective feeling where the connections we need are greater than the connections we have.  In the gap, we experience loneliness.  It’s distinct from the objective state of isolation, which is determined by the number of people around you.” - Vivek Murthy, two time (and current) Surgeon General. We have heard a lot about loneliness and social isolation, particularly during the pandemic with enforced social distancing and near imprisonment of older adults in nursing homes.  In this context, we bring in two experts on these topics, Carla Perissinotto and Ashwin Kotwal, to explain: <ul> <li>How loneliness and social isolation overlap and are distinct</li> <li>How common these measures of social well being are in geriatrics and palliative care</li> <li>Why we should care as clinicians</li> <li>How we can ask about them</li> <li>How we should respond to care for patients who are lonely or isolated</li> </ul> Some key references from among the many we discuss on the podcast: <ul> <li><a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1188033" rel="nofollow" target="_blank"> Loneliness in older adults predicts functional decline and death (JAMA IM 2012)</a></li> <li><a href="https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17366" rel="nofollow" target="_blank"> The epidemiology of loneliness and social isolation during the last years of life (JAGS 2021) </a></li> <li><a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2782349" rel="nofollow" target="_blank"> Use of high risk medications among lonely older adults (JAMA IM 2021) </a></li> <li><a href="https://www.geripal.org/2019/12/integrating-social-care-into-health.html" rel="nofollow" target="_blank"> Integrating social care into healthcare: GeriPal podcast with Kirsten Bibbens-Domingo </a></li> <li><a href="https://www.social-connection.org/coalition-to-end-social-isolation-loneliness" rel="nofollow" target="_blank"> Coalition to end social isolation and loneliness </a></li> </ul> -@AlexSmithMD

Loneliness and Social Isolation: Podcast with Carla Perissinotto and Ashwin Kotwal

Harm reduction, as so clearly described by our guest Monica Gandhi on this podcast, began as a public health approach that guided management of HIV.  Harm reduction represented an alternative to an abstinence-only approach, which clearly did not work.  In the harm reduction model, you acknowledge that people will take some risks, and that the goal is to decrease risk, not eliminate it.    And yet, here we are with a fear-not-facts approach to the COVID-19 pandemic. Some are advocating for the use of masks in schools, hospitals, and nursing homes in perpetuity.  As in, forever.  Sounds eerily like an abstinence-only approach, right?  Science would dictate that now that we have vaccines, which Monica describes as “the solution,” we don’t need to engage in masking (with a few exceptions). Monica Gandhi, an infectious disease doctor at UCSF, has advocated strongly for a fact-based approach to school opening, early masking and now dropping masking, and global access to vaccinations (and temporarily dropping vaccine patents), among other things. You can and should follow her: @MonicaGandhi9 And from Ashwin Kotwal, geriatrician and palliative care doc-researcher, we hear about experiences caring for patients who are afraid to return to normal after a year of masking and forced isolation, despite the toll these experiences have taken on them (documented in his recent paper in the  Journal of the American Geriatrics Society).   It’s time to get back where we once belonged. (song choice hint) -@AlexSmithMD

Harm reduction, as so clearly described by our guest Monica Gandhi on this podcast, began as a public health approach that guided management of HIV.  Harm reduction represented an alternative to an abstinence-only approach, which clearly did not work.  In the harm reduction model, you acknowledge that people will take some risks, and that the goal is to decrease risk, not eliminate it.    And yet, here we are with a fear-not-facts approach to the COVID-19 pandemic. Some are advocating for the use of masks in schools, hospitals, and nursing homes in perpetuity.  As in, forever.  Sounds eerily like an abstinence-only approach, right?  Science would dictate that now that we have vaccines, which Monica describes as “the solution,” we don’t need to engage in masking (with a few exceptions). Monica Gandhi, an infectious disease doctor at UCSF, has advocated strongly for a fact-based approach to school opening, early masking and now dropping masking, and global access to vaccinations (and temporarily dropping vaccine patents), among other things. You can and should follow her: <a href="https://twitter.com/MonicaGandhi9" rel="nofollow" target="_blank">@MonicaGandhi9</a> And from Ashwin Kotwal, geriatrician and palliative care doc-researcher, we hear about experiences caring for patients who are afraid to return to normal after a year of masking and forced isolation, despite the toll these experiences have taken on them (documented in his recent paper in the <a href="https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16865" rel="nofollow" target="_blank"> Journal of the American Geriatrics Society</a>).   It’s time to get back where we once belonged. (song choice hint) -<a href="https://twitter.com/AlexSmithMD" rel="nofollow" target="_blank">@AlexSmithMD</a>

Return to Normal Hesitancy: Podcast with Monica Gandhi and Ashwin Kotwal

Claire Ankuda

Chris Woodrell

Lynn Flint

As Ashwin Kotwal and Lynn Flint note in the introduction to their Annals of Internal Medicine essay (https://www.acpjournals.org/doi/full/10.7326/M20-1982?journalCode=aim), one year ago people were outraged at the thought of a physician using video to deliver bad news to a seriously ill man in the ICU. And look at where we are today. Video and telephone consults at home, in the ICU, and in the ED are common, accepted, and normal. What a difference a year makes. This week, in addition to Ashwin and Lynn, we talk with Claire Ankuda and Chris Woodrell from Mt Sinai in NYC about their experience with telephone and video palliative care. Claire and Chris recently published a terrific NEJM Catalyst piece about their remarkable ramp up of a telephone based palliative care consult service. Take a look at the figure depicting time trends of health system confirmed/suspected COVID19 cases in their health system and the dramatic rise in tele-palliative care consults (https://catalyst.nejm.org/doi/pdf/10.1056/CAT.20.0204). Their service peaked at 50 consults per day, and as they note, that is likely an undercount. About half of the consults were in the ED. Ashwin and Lynn talk about the nuts and bolts of of how to prepare and conduct video and telephone based serious illness discussions with patients, as described in their Annals essay. Eric and I talk briefly about our experience conducting palliative care consults remotely with patients at New York Presbyterian Columbia, described in our recent JAGS paper. And (bonus!) you get to sing along to "Call Me Maybe." - Alex Smith

As Ashwin Kotwal and Lynn Flint note in the introduction to their Annals of Internal Medicine essay (<a href="https://www.acpjournals.org/doi/full/10.7326/M20-1982?journalCode=aim" rel="nofollow" target="_blank">https://www.acpjournals.org/doi/full/10.7326/M20-1982?journalCode=aim</a>), one year ago people were outraged at the thought of a physician using video to deliver bad news to a seriously ill man in the ICU. And look at where we are today. Video and telephone consults at home, in the ICU, and in the ED are common, accepted, and normal. What a difference a year makes. This week, in addition to Ashwin and Lynn, we talk with Claire Ankuda and Chris Woodrell from Mt Sinai in NYC about their experience with telephone and video palliative care. Claire and Chris recently published a terrific NEJM Catalyst piece about their remarkable ramp up of a telephone based palliative care consult service. Take a look at the figure depicting time trends of health system confirmed/suspected COVID19 cases in their health system and the dramatic rise in tele-palliative care consults (<a href="https://catalyst.nejm.org/doi/pdf/10.1056/CAT.20.0204" rel="nofollow" target="_blank">https://catalyst.nejm.org/doi/pdf/10.1056/CAT.20.0204</a>). Their service peaked at 50 consults per day, and as they note, that is likely an undercount. About half of the consults were in the ED. Ashwin and Lynn talk about the nuts and bolts of of how to prepare and conduct video and telephone based serious illness discussions with patients, as described in their Annals essay. Eric and I talk briefly about our experience conducting palliative care consults remotely with patients at New York Presbyterian Columbia, described in our recent JAGS paper. And (bonus!) you get to sing along to "Call Me Maybe." - Alex Smith

Ramping up Tele-GeriPal in a Pandemic: Claire Ankuda, Chris Woodrell, Ashwin Kotwal, & Lynn Flint