What to Do and Eat in Louisville
Jun 26th
Over 1,200 people will be traveling to Louisville for the AAHPM Intensive Board Review Course, and the burning question on everyone’s mind is … where am I going to eat? Or is it… what am I going to do? Actually, with the packed schedule of educational sessions, food is more likely to be something of an afterthought. There are many dining options available beyond the nearest McDonald’s or room service, however, so be sure to take advantage of the amazing variety of restaurants to experience while in Louisville. With recommendations ranging from casual cafes to fine dining, several AAHPM members who are locals have graciously shared their favorite restaurants and attractions in the area.
So, where are you going to eat? Below are the favorites from our members.
American Cuisine:
The historic Brown and Seelbach hotels downtown have great food. The Hot Brown at the Brown Hotel is legendary and you can have cocktails in the lobby, where there is usually a pianist.
21C Museum Hotel restaurant, Proof
Jack Fry’s on Bardstown Rd is one member’s choice for the best restaurant to represent Louisville.
Hillbilly Tea Restaurant & Tea House
Bluegrass Brewing Company Brewery & Restaurant
Great flavors from around the world:
Havana Rumba- Cuban
Mayan Café- Mayan food from the Yucatán peninsula
Seviche- Latin
el Mundo- Mexican
Sapparo- Sushi
The Irish Rover- Irish pub
La Coop- French Bistro
Majid’s- Middle Eastern
Simply Thai- Thai
Rami’s Café on the World- International Cuisine
Volare- Italian
Procini- Northern Italian
Veranese- Italian
Mozz Restaurant- Italian
Desserts & Sweets:
Homemade Ice Cream & Pie Kitchen
Muth’s- make sure to try the toffee!
Things to do while you are in town:
July 13-15, 2012 is the 10th Anniversary of the Forecastle Festival. This three day Art and Music fest was ranked one of the Top 31 Coolest Tours and Festivals by Rolling Stone.
21C Museum Hotel was voted the #1 hotel in America and it has a contemporary art museum inside of it.
Visit the Louisville Slugger Museum and catch a game at Slugger Field, where the minor league Louisville Bats are playing at home. Then visit Against The Grain Restaurant & Brewery which is located at the Louisville Bats Baseball Stadium.
Tour the Kentucky Derby Museum at Churchill Downs
Stop by the Muhammad Ali Center and Frazier History Museum.
Waterfront Wednesdays are at the riverfront, are free and they feature live music.
The Kentucky Center is showing Circus Circus.
Catch an Indie film at Baxter Ave Theatre.
Take a stroll through the exhibits at the Kentucky Museum of Arts & Crafts.
The Vernon Club offers traditional bowling lanes.
Shopping-
The Bardstown Rd area is vibrant and young.
Frankfort Avenue is more family-oriented with ice cream shops, restaurants, and stores.
Nu Lu is very close to the Convention Center and is a must with eclectic shops and galleries.
Butchertown Market is home to a collection of shops that showcase the incomparable styles and flavors of Louisville.
For more information on all that Louisville has to offer visit the CVB website.
Comfort from a Robot?
Jun 21st
by Jen Bose, AAHPM Coordinator, Marketing & Membership
After reading Last Moment Robot: ‘End of Life Detected’ I was a little torn. I didn’t know if I felt having a robot comfort me during the last hours or minutes of my life was creepy or really forward thinking and almost logical. As long as I can remember technology has been a huge part of my life and the lives of everyone around me. That part of me thought that the idea was pretty rational and that it makes complete sense. That is probably the same part of me that loved Terminator 2 as a child. Robots and computers have been integrated into everyday life and dying is part of that process. It seems like the next natural step.
While there is no replacement for genuine human interaction and compassion, I think the “last moment robot” would be oddly comforting to me. Perhaps my family couldn’t be with me because of timing or distance. I would want someone or something there with me. Is a robot that comforts you really that different from seeking the same comfort from a teddy bear or other stuffed animal? If given the choice between spending my last hours alone or with a robot that has been developed to mimic the comforting effect of another person I would take the robot. Would you?
Educator Resource #1: MedEdPortal
Jun 1st
We will be posting a series of emails/blog posts to highlight educational resources from the Education SIG throughout the year. Comments are welcome.
Dear Colleagues and Education SIG members
Now that we’ve gotten past the excitement of abstract submissions for next year’s Assembly in New Orleans, Lynn and I would like to engage you in sharing education resources with each other and our broader community. The goal is to promote increased scholarship for and dissemination of palliative care education initiatives. This email will be the first in a series to highlight a specific educator resource. All emails will also be posted on the AAHPM blog to engage a larger group of our colleagues. We encourage you to read about these resources, share your personal experiences with them, ask questions about them, pass them along to colleagues, and contribute to the conversation. Please also contact either of us directly if you would like to share a specific resource or have other ideas for pushing the shared vision of our Education SIG community forward.
Cheers, Everyone,
Laura Morrison, Chair lmorriso@bcm.edu
Lynn O’Neill, Chair-Elect lynn.oneill@duke.edu
Education Special Interest Group, AAHPM
Educator Resource #1: MedEdPortal www.mededportal.org
This major resource focuses on academic medical and dental education and is operated by the Association of American Medical Colleges (AAMC). Above all, MedEdPortal is a free, peer reviewed publication service. Because MedEdPortal publishes teaching and faculty development materials and assessment tools, it also serves as a place to find such things. In addition to medical and dental education materials, the website indicates they are now accepting interprofessional educational materials submissions that are relevant to medical or dental education. Those from non-medical disciplines can visit and submit materials.
The 3 main reasons to visit MedEdPortal:
1) Finding Education Materials and Resources for Your Program: One can easily search for curricular and assessment materials by numerous categories (medical specialty, ACGME competency, etc.) Searching under palliative care currently yields 27 items with some authors among our SIG community. You must create an account to log in and actually see the posted materials but summaries are accessible to anyone. Citations are also listed. Go see what resources you can find and avoid re-inventing the wheel.
2) Submitting Your Materials: A clear and rigorous submission and peer review process is described and diagramed on the website. This is much like a journal submission as far a formality, including a waiting period for review and feedback from editors with a decision (acceptance, rejection, and acceptance with revision). All materials accepted are published with a citation. Some institutions with clinician-educator pathways are giving these publications weight nearly equal to journal publications. Many aren’t but are still recognizing these as publications on a CV. As far as the timeline, MedEdPortal went through a major reorganization process last year to increase the efficiency of their system. It is new and improved. You should consider a submission, especially if your initiative will not be published in an article. Also, some materials published in articles are still eligible for publication here.
3) Peer Reviewing for Others: For those health professions educators interested in gaining peer review experience in this arena, MedEdPortal is accepting reviewer nominations. The website has very explicit detail about the review process and guidelines listed on the website. The listed contact is: peerreview@aamc.org
Questions:
Does anyone have experience with MedEdPortal? Have you found helpful materials or had success with a submission? Is anyone a peer reviewer?
Colleagues have indicated to me that the submission process requires attention and effort and that the review process is rigorous and highly repected. If one is successful with a publication, it’s a nice accomplishment and contribution. Comments?
I hope you’ll all consider a visit to the website www.mededportal.org and remember this terrific resource. Obviously, we need to encourage them to have a specific category for our subspecialty, and we need to grow the number of palliative care materials available in the repository.
Cheers, Laura
Common UNIPAC Questions Answered
May 18th
This is the last of three posts by UNIPAC series editor Porter Storey, MD FACP FAAHPM, in which he discusses the new UNIPAC series, including the amplifire™ online confidence-based learning modules, and addresses commonly asked questions.
1. I am mainly interested in coding for hospice services, is this covered?
a. While many hospice regulations are covered, the new AAHPM Hospice Medical Director Manual is the most comprehensive resource for this material.
2. Will the 4th Edition of the UNIPAC Series help me pass the Board Exam in October?
a. While AAHPM has no inside information about the content of the ABIM sponsored exam, we used the published list of topics covered on the exam to inform the development of this edition.
b. The ABIM exam is based on the best practices and current literature in our field, which is what we surveyed and referenced extensively.
c. One of the best ways to study for any exam is to focus on those areas in which your knowledge is weakest. The accompanying amplifire™ confidence-based learning modules will help you identify and focus on these areas.
Porter Storey MD FACP FAAHPM
Executive VP, AAHPM
Colorado Permanente Medical Group
Boulder, CO
UNIPAC 4th edition available for purchase.
More UNIPAC Questions Answered
May 11th
This is the second of three posts by UNIPAC series editor Porter Storey, MD FACP FAAHPM, in which he discusses the new UNIPAC series, including the amplifire™ online confidence-based learning modules, and addresses commonly asked questions.
At the AAHPM Annual Assembly, I was asked several good questions about the new UNIPAC Series 4th edition. Perhaps this information will help inform your purchasing decisions.
- Is there more information in the 4th edition than the 3rd?
a. Older, less-relevant material was replaced with new developments, and while an effort was made to keep them succinct, some books, like the Pediatric UNIPAC grew by nearly 50%.
b. Every effort was made to include systematic reviews and consensus statements to help the reader interpret the vast amount of new material being published in our field. - Has the 4th Edition really been updated? Is it evidence-based?
a. This edition includes 2551 references and over 600 of these are from 2010-2012.
b. You will find material from the NHPCO Facts and Figures 2011 edition and the new American College of Physicians Ethics Manual published in 2012, among many other new sources.
Porter Storey MD FACP FAAHPM
Executive VP, AAHPM
Colorado Permanente Medical Group
Boulder, CO
UNIPAC 4th edition available for purchase.
UNIPAC 4th edition Now Available
May 4th
This is the first of three posts by UNIPAC series editor Porter Storey, MD FACP FAAHPM, in which he discusses the new UNIPAC series, including the amplifire™ online confidence-based learning modules, and addresses commonly asked questions.
At the AAHPM Annual Assembly, I was asked several good questions about the new UNIPAC Series 4th edition. Perhaps this information will help inform your purchasing decisions.
1. Is the 4th Edition of the UNIPAC Series really any different that the 3rd edition?
a. Every UNIPAC was carefully revised and some (like Ethics and Pain) were completely re-written. New and extensively updated topics include:
i. the controversies around opioid contracts,
ii. the latest Catholic Ethical and Religious Directives,
iii. parental requests to withhold information from dying children,
iv. comprehensive assessment of fatigue and anorexia-cachexia,
v. management of co-infection of hepatitis C & HIV,
vi. the importance of legal decisions in the Barber, Saikewics, and Bouvia cases on withdrawing tube-feedings,
vii. treatment of agitation in dementia patients,
viii. the roles of opioids, pulmonary rehabilitation, and non-invasive ventilation in the treatment of dyspnea in patients with end-stage COPD,
ix. and many others.
b. Several of the UNIPACs have new authors who are leaders in our field (e.g. Russell Portenoy) and they were all reviewed by acknowledged experts (e.g. Timothy Quill).
Porter Storey MD FACP FAAHPM
Executive VP, AAHPM
Colorado Permanente Medical Group
Boulder, CO
UNIPAC 4th edition now available for purchase.
AAHPM Quarterly Article Highlights Job Satisfaction in HPM
Apr 2nd
by Larry Beresford
Most hospice and palliative medicine (HPM) professionals have been asked, “How can you do this work? Isn’t it depressing?” Depressing, some folks assume, because so many of the patients die, even though it is often expected. And yet, the experiences of those in the field is, in many cases, just the opposite—many professionals in the field report feeling uplifted, gratified, and hopeful because of the difference they are able to make in the lives of patients and families. An article in the AAHPM Quarterly summarizes data from the Academy’s Physician Compensation and Benefits Survey—2010 Report, other recent research, and the personal experience of HPM physicians to conclude that this work can be extraordinarily satisfying.
As a hospice volunteer over much of the past three decades, I can confirm the personal satisfaction that comes from making a tangible contribution to patients’ quality of life at a critical time of life. But physicians working in HPM may have additional benefits and job satisfaction from the varied opportunities for team leadership, program development, teaching, and research. AAHPM’s survey documents the wide variety of roles, settings, and job titles encompassed by the field of hospice and palliative medicine.
Another resource that has compiled the personal and professional stories of 17 physicians working in hospice and palliative medicine is the HPM Practitioner, an online newsletter published by the DAI Consulting Group. Brought to the field by a wide variety of paths and interests, these committed HPM physicians detail a range of job titles, duties, and responsibilities. But in most cases, they say they can’t imagine doing anything else than their current work in this field.
Larry Beresford is a freelance medical writer from Oakland, CA, who specializes in hospice and palliative care issues.
Dual Diagnosis, aka Substance Abuse, Mental Illness, and Palliative Care
Mar 11th
It seems innocuous, but the term ‘dual diagnosis’ describes a very complicated subset of patients — those who have a substance use disorder as well as a primary psychiatric disorder (anything from depression to schizophrenia). Throw a serious medical illness into the mix, and you have a recipe for one very overwhelmed palliative care physician.
Moving along, I’ve paraphrased key info from the case that was presented –
- Presenters describing patient: “Opiate dependence, stopped methadone maintenance therapy, mood disorder, trauma history, cocaine, family estrangement, new cancer diagnosis.
- Most of room: “This doesn’t sound good…”
Never fear, this patient is manageable! The most important thing is to recognize that a team approach is essential — involve psychiatry, social work, the patient’s outside providers, clinic staff, etc. Try proactive measures like a pain contract (though not infallible), and encourage the patient to bring her sources of support with her to appointments, whether they be friends or family.
- Presenters: “Now she’s your patient and you’ve been noticing she’s missed a lot of appointments with you and her oncologist, she’s had a number of early pain med refills due to lost scripts and stolen meds, and she’s still having a lot of pain despite very high opioid doses. She refuses to switch over to methadone because she doesn’t like the side effects. Now what?”
- Most of room: “Refer patient to someone else!”
Wait! Let’s think about it first and consult with the interdisciplinary team. This is a patient who has had a long history of opioid addiction who is now back on opiates. Of course she’s going to fall back into addictive habits, so let’s figure ways to help the patient change some of those habits. But also don’t forget the phenomenon of pseudoaddiction, which is an iatrogenic syndrome of abnormal behavior that’s a direct consequence of inadequate pain relief.
There are some strategies we can implement – prescribe only small amounts of opioids at a time, do pill counts, and get random urine drug screens (remember that standard UDS dont’t test for oxycodone, so you have to add that separately). Can we combine her psych/substance abuse counseling appointments with her already-scheduled palliative care appointments? And of course, ask the patient about her perception of the obstacles preventing her from full compliance (if you went to the Motivational Interviewing session, this is a perfect time to practice those skills).
Now, say the patient is in remission, but still on high dose opiates due to continuing pain. Keep her on these? Since our ultimate goal is to manage pain while also optimizing function, we should probably wean her off the opioids. She’s wary of methadone, but lets explore those fears and discuss it with her substance abuse counselor. The addiction psychiatrist probably has some other ideas as well.
This is the sort of patient who can be very trying yet ultimately very rewarding to work with. Though keep in mind that It’s especially important to have an outlet to vent the jumble of emotions that these patients stir up, which is another crucial function of the interdisciplinary team.
Erin Zahradnik, MD, Yale University Dept of Psychiatry
Driving Miss Daisy
Mar 10th
You’ve all been there – the elderly couple shuffles into your office, peering through oversize glasses, slightly disoriented but helping each other out. Did you ever stop to think how they got to your office? They almost certainly drove – but should they? Shouldn’t it be their children’s job to tell them to stop?? Focus groups have shown that it’s the physician they look to for guidance (sigh).
Luckily, there are excellent resources to guide you in evaluating driving impairment and to let you know what the laws are in your state. Google “AMA older driver safety” for a wealth of information. It’s free and you don’t have to be an AMA member to access it. There are even disease-specific recommendations from areas as diverse as ophthalmology, cardiology, and neurology. The AMA also has an ethical opinion on impaired drivers and charges the physician with recommending driving restrictions and, if needed, reporting impaired drivers to the Department of Motor Vehicles (DMV).
Dr. Karen Cross recommends a 6-step approach. (1) Identify patients at risk of impaired driving; (2) find out if the patient is still driving; (3) assess their driving skills; (4) make recommendations with referral for a driving evaluation – try www.aded.net for resources; (5) counsel the patient about transportation alternatives; and (6) if all else fails, report the driver to the DMV.
A little more on identifying patients at risk of impaired driving. Driving requires vision, both peripheral and focal. It requires physical activity – from opening the car door to moving one’s foot from the gas to the brake. Reaction time is also important, along with memory and the ability to concentrate, especially when distracted. Many of these skills can be evaluated in the office or home setting. A driving evaluation may be useful when there is conflict over the patient’s abilities. Unfortunately, these are not covered by Medicare or most insurers and can be expensive.
Restricting a patient’s driving can be life altering, resulting in depression, social isolation, and impaired self-esteem. There’s even an increased risk of long-term-care placement if an elderly person can no longer drive to meet their daily needs. On the other hand, there is the risk of injury to themselves or others. It is a physician’s responsibility to make the tough call and recommend driving restrictions when they are needed. Remember to check the AMA website for state-specific tools to support your recommendations.
Safe driving!
The Why, How , What and “So What” of developing Clinical Informatics Tools
Mar 10th
This am has been an interesting juxtaposition of following twitter during the state of the science, and being reminded of the power of a graciously led small group meeting.
I would not qualify myself as a skeptic, but more as a user without training in the multiple areas for which a Clinical informatics system can be adapted to improve our care, And having recently been faced with the common problem of being told the system at my new institution will take months to change, I was hopeful for new quick tools.
Joy Goebel, Kelly Chong, Sangeeta Ahluwalia and Karl Lorenz gave an organized presentation of the issues involved in the why, how what and so what of Clinical info tools.
We were reminded these tools and systems are very early in development and that the technology will progress even as we work to develop tools.
We were reminded of the need to work with stakeholders and end users to develop clinical information tools, and if the application of Implementation Science (a term I had not heard before).
Greater La VA system has a consult tool, but not other notes yet, and is just beginning to generate reports. They seem to have a great and very multidisciplinary development group, and I they may create national VA templates and reports that others can review. It had nice features like embedded tools like the PPS and embedded references which would be great for multiple users to help standardize documents.
There were many good questions asked about limitations, and I realize that the issue still returns to understanding my system and what its benefits and limits are. Any other Cerner users with templates for notes or ideas about how to highlight goals of care info in the large volume of documents generated?
I learned much from blogging, as it caused me to think and listen more critically. Thanks to the academy for the opportunity.
Diane Dietzen, MD Baystate Medical Center
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