Discover and read the best of Twitter Threads about #PedPC
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Day 2 @theNASEM workshop
The highlight from day 1: LaToya, a CNA, gave a moving, honest, courageous account of being a direct care worker. “The ice cream truck should not be a luxury.”
- hours & pay are bad, the work is hard & they love & care their patients & their dignity
The highlight from day 1: LaToya, a CNA, gave a moving, honest, courageous account of being a direct care worker. “The ice cream truck should not be a luxury.”
- hours & pay are bad, the work is hard & they love & care their patients & their dignity
@theNASEM First up- @EspinozaNotes from @PHInational
The intense focus on direct care workers, paying people a living wage, improving working conditions so that we can also improve patient care during this event has given me so much hope
The intense focus on direct care workers, paying people a living wage, improving working conditions so that we can also improve patient care during this event has given me so much hope
“Social determinants of success at work” is one phrase that stuck out to me yesterday.
@mad_sters doing critical work in this area for direct care workers
But I think about it for others who work in our system too.
@mad_sters doing critical work in this area for direct care workers
But I think about it for others who work in our system too.
Good morning from the Keck Center @theNASEM where I am so pleased to be part of their workshop this morning to support and sustain the workforce to care for people with serious illness! #hapc #pedpc #wellness #wellbeing #suffering
The first panel shared experiences from the front lines so vulnerably and beautifully. @MaguirePeggy @PhilRodgersMD @RachelMayAdams
Next up: Fr218A- Agitation and feeding intolerance in children with medical complexity with @StocktonBev and Dr. Katherine Maddox!
Front row is Dr. Julie Hauer. The OG of this topic who wrote the book. If you don’t have it and you do #pedpc here is a link:
bookshop.org/p/books/caring…
bookshop.org/p/books/caring…
Next up: FR201a- An epic step forward- a universal #pedpc navigator in the EHR with @conradw4, Alice Bass & Kat Thomas #hapc23
Actual cartoon of Conrad and Alice at work creating a #pedpc workflow in Epic. #hapc23
“If we could make the EHR better it would make me feel so much more well.” - @conradw4
“If we could make the EHR better it would make me feel so much more well.” - @conradw4
“We thought it would take a year and we were certainly wrong.”
On building the navigator in epic.
#hapc23
On building the navigator in epic.
#hapc23
Dr. Martin Bogetz, a bereaved father, sharing the legacy of his daughter Alyssa:
- an MSW who cared deeply about wellbeing
- the first non-physician associate program director in Peds at Stanford, who focused on supporting trainees
- sister of @jbogetz, #pedpc wonder ❤️ #hapc23
- an MSW who cared deeply about wellbeing
- the first non-physician associate program director in Peds at Stanford, who focused on supporting trainees
- sister of @jbogetz, #pedpc wonder ❤️ #hapc23
The inaugural Alyssa Bogetz lecture: Dr. Susan Block talking about the state of integration of #hapc and #mentalhealth
Alyssa died of AN. The educational fund was started in her honor @AAHPM w the appreciation that our field needs to grow to support people like her. #hapc23
Alyssa died of AN. The educational fund was started in her honor @AAHPM w the appreciation that our field needs to grow to support people like her. #hapc23
Next up! TH110B- A seat at the table: professional competencies define roles and value of psychologists in #pedpc!
@PedsPCTF members @RachelKentor and Amanda Thompson & Sarah McCarthy! #hapc23
@PedsPCTF members @RachelKentor and Amanda Thompson & Sarah McCarthy! #hapc23
Competencies help standardize roles and practice requirements for #psychologists in #pedpc and highlight the important and unique contributions they bring to the interdisciplinary team. #hapc23
PPC Psychology workgroup was formed of 9 peds psychologists, then reviewed by 15 multidisciplinary stakeholders to create competencies. Here's how they did it:
#hapc23
#hapc23
Point 1: Wellbeing of leaders predicts wellbeing of staff. There are indices that are specific to leaders. #hapc23
Point 2. Psychological safety is critical to team wellness. (@AmyCEdmondson)
Defn: If you speak up, there is not a threat that you will be punished.
When people need help, they ask.
People can process mistakes, dissent, name problems even when hard. #hapc23
Defn: If you speak up, there is not a threat that you will be punished.
When people need help, they ask.
People can process mistakes, dissent, name problems even when hard. #hapc23
What is palliative care?
In six studies that examined public awareness about palliative care, all showed that the public is unfamiliar with palliative care. 59% of participants who did feel familiar with palliative care had a perception that was mostly inaccurate-
In six studies that examined public awareness about palliative care, all showed that the public is unfamiliar with palliative care. 59% of participants who did feel familiar with palliative care had a perception that was mostly inaccurate-
-such as thinking it is the same as hospice or end-of-life care. (1, 2)
Negative public attitudes toward palliative care is one of the many barriers to optimal use. Health system leaders report that 60% of patients who could benefit from palliative care do not receive it-
Negative public attitudes toward palliative care is one of the many barriers to optimal use. Health system leaders report that 60% of patients who could benefit from palliative care do not receive it-
-in part, because they decline them. (3)
While we do care for some patients during end-of-life, our main focus is to work with patients and their families at any point in their medical journey. Palliative care supports a patient and their family as a whole-
While we do care for some patients during end-of-life, our main focus is to work with patients and their families at any point in their medical journey. Palliative care supports a patient and their family as a whole-
Speaking of @PalliativeQual - do you do palliative care?
Do you follow the Palliative Care Quality Collaborative? No time like the present! Twitter is still here!
Do you follow the Palliative Care Quality Collaborative? No time like the present! Twitter is still here!
@arifkamalmd on palliative care as a field: "We're kinda badass!"
Wish I felt this way more often! Always good to be reminded! #hapc #pedpc
Wish I felt this way more often! Always good to be reminded! #hapc #pedpc
"Listening is only powerful and effective if it is authentic. And authenticity means you are listening because you are curious and you care- not just because you are supposed to."
@jennilinebarger (quoting "Difficult Conversations" & "Humble Inquiry" books)
#hapc #pedpc
@jennilinebarger (quoting "Difficult Conversations" & "Humble Inquiry" books)
#hapc #pedpc
❤️this chart from "Humble Inquiry"
It's about listening to understand- not to tell.
Not to prepare the next thing you will say.
We are trained that knowing the "right answer" = good doctor. There's much more to it than that.
@jennilinebarger #CincyKidsPGR #pedpc
It's about listening to understand- not to tell.
Not to prepare the next thing you will say.
We are trained that knowing the "right answer" = good doctor. There's much more to it than that.
@jennilinebarger #CincyKidsPGR #pedpc
Beautiful nod to William Carlos Williams poem "The Red Wheelbarrow"
Uncertainty is hard for the medical team.
It is hard for families.
What is the right thing?
"It all depends."- @jennilinebarger #CincyKidsPGR #pedpc #hapc
Uncertainty is hard for the medical team.
It is hard for families.
What is the right thing?
"It all depends."- @jennilinebarger #CincyKidsPGR #pedpc #hapc
In #pedpc we think of Pam Hinds work- parents ask themselves, what would a good parent do?
I think this is the crux of what many of us have struggled with throughout the pandemic.
How we weight risk/benefit often comes down to our personal definition of a good parent.
I think this is the crux of what many of us have struggled with throughout the pandemic.
How we weight risk/benefit often comes down to our personal definition of a good parent.
Last week, my children's school dropped the mask mandate for the 3-6 classes. My husband expected it. I didn't.
We have managed to avoid our children getting COVID for 2 years.
That doesn't make us "better" parents than others.
We have been lucky. And tried hard.
We have managed to avoid our children getting COVID for 2 years.
That doesn't make us "better" parents than others.
We have been lucky. And tried hard.
Academia means attending meetings. I enjoy meetings!
Would a "good parent" travel now?
I traveled yesterday. In a KN95. The majority of other travelers were masked, but many were not. It wasn't heavily enforced, including during flight.
Would a "good parent" travel now?
I traveled yesterday. In a KN95. The majority of other travelers were masked, but many were not. It wasn't heavily enforced, including during flight.
Whew this hits home- @JoShapiro3 talks about how we are "asked to metaphorically debrief on a toxic system" on an individual level.
This is why #organizationalcompassion in #healthcare is necessary!
This is why #organizationalcompassion in #healthcare is necessary!
Ooh there it is! "The best results are organizationally driven...there are factors that are organizational driven that are harming our wellbeing. Often organizations don't know what those factors are."
I really appreciate @JoShapiro3 invoking #shame in medical errors & touching on how systems issues can set us up for medical errors.
We all know the impact of #safety interventions at the system level. The same goes for caring for clinicians.
We all know the impact of #safety interventions at the system level. The same goes for caring for clinicians.
Today I saw a child looking with cerebral palsy like this when I went to see a patient of mine. It's a huge ward with 5 residents looking after children. There is a chance this could be lymphoma. The work up yet to be started. 1/n
He was obviously distressed, posturing, and pulling up his legs. He is spastic and had contractures. Oncology referral sought. What was difficult to watch was nothing was being done for the child. Let me explain. 2/n
#hapc21 "How do we balance our personal goals and values with the benefits,limits of an organizational identity (in social media)?
When you took the job to be a palliative care doc and employed by an org, you take an oath of acting a certain way publicly. Her recs:
When you took the job to be a palliative care doc and employed by an org, you take an oath of acting a certain way publicly. Her recs:
1. Don't be anonymous.
2. Let your org know you are on Twitter and what you are doing so that no one is surprised. Let them follow along.
3. Be your authentic self.
4. Make rules for yourself so as not to diminish your authentic self. (ie don't tweet after a glass of wine)
2. Let your org know you are on Twitter and what you are doing so that no one is surprised. Let them follow along.
3. Be your authentic self.
4. Make rules for yourself so as not to diminish your authentic self. (ie don't tweet after a glass of wine)
Openness, transparency, accountability should always be part of your online footprint.
@wendysueswanson #hapc21 #pedpc #medtwitter
@wendysueswanson #hapc21 #pedpc #medtwitter
Breaking leadership convos down:
1. Empathy- we can be aware w/o responsibility for their emotions. Also- defensive posture blocks empathy.
This is big, I really struggle with this interpersonally at work!
#hapc #pedpc
@KtNeuendorf #Ascend2020
1. Empathy- we can be aware w/o responsibility for their emotions. Also- defensive posture blocks empathy.
This is big, I really struggle with this interpersonally at work!
#hapc #pedpc
@KtNeuendorf #Ascend2020
2. Levels of discomfort.
Using words to not make difficult times worse. Attend to discomfort, acknowledge it, don't heighten it.
Having a crucial conversation as a leader is different than in patient care- colleagues have greater control than patients.
#hapc #pedpc #Ascend2020
Using words to not make difficult times worse. Attend to discomfort, acknowledge it, don't heighten it.
Having a crucial conversation as a leader is different than in patient care- colleagues have greater control than patients.
#hapc #pedpc #Ascend2020
I love this- asking someone to change will probably result in discomfort. "As adults, we need to take ownership...There's something about having discomfort that can lead to change."
As clinicians we want to mitigate discomfort. Not our job as leaders.
@KtNeuendorf, brilliant.
As clinicians we want to mitigate discomfort. Not our job as leaders.
@KtNeuendorf, brilliant.
@DukePallCare SUCCESS! Journal Club Time Machine: Speed Dating with the Classics. Format - everyone in attendance (MS2-Attending) teaches a classic article for 4 minutes, it is put in context by someone old for 1-2 min, and we move on. Here's the list! A #HPC thread:
No 1 - SUPPORT Trial: pubmed.ncbi.nlm.nih.gov/7474243/. 5 AMCs. Docs don't know pt's CPR preference, many DNRs within 2d of death, lots of ICU time and pain. RN led intervention gives docs data. Centers around communication. NO CHANGE IN KEY METRICS.
No 2 - Prognostication: pubmed.ncbi.nlm.nih.gov/10678857/. Docs of pts referred to #hospice asked for assessment of prognosis. Only 20% accurate (+/- 33%) with most over-optimistic. Average miss factor of 5.3! Longer pt/doc relationship = worse prognostication accuracy (#LoveThemTooMuch)
Once again the conversation has started about whether we should change the name “palliative care.”
I appreciate the rationale including points made in a recent @washingtonpost article.
Allow me to present a counterpoint.
A 🧵, with videos:
#hapc #pedpc #MedEd #scicomm
1/
I appreciate the rationale including points made in a recent @washingtonpost article.
Allow me to present a counterpoint.
A 🧵, with videos:
#hapc #pedpc #MedEd #scicomm
1/
Yes, fear of palliative care comes from an association in some people’s minds with death.
As many including @SoniaMKhunkhun @anandiyermd @ctsinclair have pointed out, that is likely a failure of education and due to a cultural fear of death itself, not palliative care.
2/
As many including @SoniaMKhunkhun @anandiyermd @ctsinclair have pointed out, that is likely a failure of education and due to a cultural fear of death itself, not palliative care.
2/
When we conflate the scary thing with something that can help with the scary thing we risk missing a big opportunity for support.
As I’ve said before, it’s like confusing the fire with the fire department:
3/
As I’ve said before, it’s like confusing the fire with the fire department:
3/
📣 Thrilled to share our publication!
Our first case series of Dignity Therapy modified for the pediatric #PalliativeCare population.
Thankful to have had @TXgriefgirl as an amazing partner in this work.
A 🧵 with summary and some reflections
1/x
liebertpub.com/doi/10.1089/pm…
Our first case series of Dignity Therapy modified for the pediatric #PalliativeCare population.
Thankful to have had @TXgriefgirl as an amazing partner in this work.
A 🧵 with summary and some reflections
1/x
liebertpub.com/doi/10.1089/pm…
We attended the Dignity Therapy Training Workshop with @HMChochinov.
It was hands down the most impactful workshop I’ve ever attended and can’t recommend it highly enough.
#hapc #pedpc
2/x
workshops.dignityincare.ca
It was hands down the most impactful workshop I’ve ever attended and can’t recommend it highly enough.
#hapc #pedpc
2/x
workshops.dignityincare.ca
Dignity Therapy is a legacy project in which a facilitated interview is compiled into a narrative document which a dying person can share with loved ones.
3/x
3/x
In the midst of the last week, I lost mindfulness. I was in a reactive state all week. Threat-react. Threat-react. It's impossible to feel like the best version of myself for patients like that. In #pedpc, children are still dying of other things. 1/
Time slows down and stops when a child dies, of anything.
And I have done my best to show up as a #hapc doc, for my patients, their families and my team. But I failed in many ways this week.
2/
And I have done my best to show up as a #hapc doc, for my patients, their families and my team. But I failed in many ways this week.
2/
I was rocking my baby Wednesday night. This is an emotional touchstone for me. This is when I center, when I feel like the best version of myself. My abilities match her needs perfectly. The stress falls away, and we rock. I was able to center for the first time all week.
3/
3/
Can we talk about this for a second?
This is really lovely and exciting and a privilege.
I appreciate the acknowledgment of hard work and energy.
And- I've had a really tough few months.
The burnout is real. 1/
This is really lovely and exciting and a privilege.
I appreciate the acknowledgment of hard work and energy.
And- I've had a really tough few months.
The burnout is real. 1/
I had a hard pregnancy.
Then the baby didn't sleep.
I kept thinking, if I can just sleep, everything will be fixed.
Sleep is better. But everything isn't fixed.
2/
Then the baby didn't sleep.
I kept thinking, if I can just sleep, everything will be fixed.
Sleep is better. But everything isn't fixed.
2/
Apparently an early/mid-career crisis is very developmentally normal at this point. (Reassuring.)
It started to feel like all the decisions I thought were purposeful, were passive.
What of all of this did I actually mean to choose to do and be?
3/
It started to feel like all the decisions I thought were purposeful, were passive.
What of all of this did I actually mean to choose to do and be?
3/
