2011 04 20 hpm tweetchat transcript
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This document is a transcript of a Twitter discussion using the hashtag #hpm. Various healthcare professionals and patients join to discuss the role of marijuana in palliative care. Participants discuss how marijuana can help with nausea, spasms and appetite for patients with life-threatening illnesses. However, some note it is difficult to balance legitimate medical use versus diversion of other controlled substances. The discussion considers research on marijuana and differences from synthetic THC. State laws around medical marijuana are also discussed.
![Wed Apr 20 18:21:48 PDT 2011
equijada @PracticalWisdom @drpippa @AAHPM doesn't have an official stand on marijuana.
Interesting discussion in Vancouver #hpm
Wed Apr 20 18:22:02 PDT 2011
PracticalWisdom Rascal Topic for sure. I knew this would be a good one. RT @drpippa: @equijada
Nice choice of topic for the day! #HPM
Wed Apr 20 18:22:17 PDT 2011
FMDGirl easy to balance legal use, RX from an MD- get from a hospital pharmacy #HPM
Wed Apr 20 18:22:27 PDT 2011
drpippa Still disappointed i missed it! RT @equijada: @AAHPM doesnt have an official stand
on marijuana. Interesting discussion in Vancouver #Hpm
Wed Apr 20 18:23:09 PDT 2011
equijada RT @FMDGirl: easy to balance legal use, RX from an MD- get from a hospital
pharmacy #hpm
Wed Apr 20 18:23:20 PDT 2011
drpippa RT @FMDGirl: easy to balance legal use, RX from an MD- get from a hospital
pharmacy #Hpm
Wed Apr 20 18:23:44 PDT 2011
equijada Moving on to t2 in a min or so #hpm
Wed Apr 20 18:23:52 PDT 2011
PracticalWisdom @equijada @drpippa @AAHPM T1: When I taught Pharmacology (Basic) 100 years
ago Marijuana was complicated Dep/Stim Sometimes Hallacu? #HPM
Wed Apr 20 18:24:01 PDT 2011
revdoc RT @FMDGirl: easy to balance legal use, RX from an MD- get from a hospital
pharmacy [PEOPLE CAN LIE ABOUT SXS USING LEGAL SOURCES] #hpm
Wed Apr 20 18:24:10 PDT 2011
hollyby Hi all! I don't rx it. Still a conflict btwn state & federal law. Not worth my DEA license.
#hpm
Wed Apr 20 18:24:19 PDT 2011
RossJeanette @equijada was the MJ discussion in Vancouver a specific session? I bought the
Audio recording #hpm
Wed Apr 20 18:24:25 PDT 2011
PracticalWisdom @PracticalWisdom: Is this still true? complicated? #HPM
Wed Apr 20 18:24:52 PDT 2011
equijada RT @hollyby: Hi all! I dont rx it. Still a conflict btwn state & federal law. Not worth my
DEA license. #hpm
Wed Apr 20 18:24:53 PDT 2011](https://image.slidesharecdn.com/20110420hpmtweetchattranscript-110630004243-phpapp01/85/2011-04-20-hpm-tweetchat-transcript-6-320.jpg)
![equijada t3: I've learned about my Higher Power #hpm
Wed Apr 20 18:49:24 PDT 2011
PracticalWisdom RT @equijada: DITTO! Its changed my life RT @drpippa: T3 absoultely would not do
what I do if it were not 4 my personal experiences. #HPM
Wed Apr 20 18:49:25 PDT 2011
revdoc I have seen healings, reconciliation, courage, love--I should PAY to do this work. (But
don't tell my boss, I have a mortgage) #hpm
Wed Apr 20 18:50:21 PDT 2011
PracticalWisdom Accept the things I cannot change Keeps me balanced. RT @equijada: t3: Ive learned
about my Higher Power #HPM
Wed Apr 20 18:50:27 PDT 2011
drpippa Sometimes miracles. RT @equijada: t3: Ive seen love in action. It absolutely blows
my mind. #Hpm
Wed Apr 20 18:50:38 PDT 2011
equijada @FMDGirl @revdoc just finished reading Love Wins by Rob Bell re: hell. Religion has
done a disservice #hpm
Wed Apr 20 18:50:43 PDT 2011
mpf2011 #hpm It is the HPM team that has 2 teach how 2 see pt holistically, rather thn the sum
of body systems. LOOK at the pt. not go thru motions.
Wed Apr 20 18:50:43 PDT 2011
revdoc @FMDGirl Not always, but that can be one aspect. People not grounded in anything
besides here and now #hpm
Wed Apr 20 18:50:59 PDT 2011
revdoc RT @equijada: just finished reading Love Wins by Rob Bell re: hell. Religion has
done a disservice [not all of us are like that!] #hpm
Wed Apr 20 18:51:36 PDT 2011
PracticalWisdom T3: Was a clergy Wife for 13 years. Have seen families in their last moments at Re:
worst and best. Learned not to sweat small Stuff #HPM
Wed Apr 20 18:51:39 PDT 2011
AmandaBinDC RT @ctsinclair: Pain-Topics.org News/Research UPDATES: U.S. FDA Releases
Long-Awaited Opioid-REMS http://hpm.md/g2AncC #HPM
Wed Apr 20 18:51:49 PDT 2011
RossJeanette T3 I feel very priviledged in working with people at a difficult time. It makes my
problems seem minor. #hpm
Wed Apr 20 18:51:58 PDT 2011
KathyKastner RT @equijada: @FMDGirl @revdoc just finished reading Love Wins by Rob Bell re:
hell. Religion has done a disservice #hpm
Wed Apr 20 18:52:13 PDT 2011
Book Club? RT @equijada: @FMDGirl @revdoc just finished reading Love Wins by](https://image.slidesharecdn.com/20110420hpmtweetchattranscript-110630004243-phpapp01/85/2011-04-20-hpm-tweetchat-transcript-15-320.jpg)
2011 04 20 hpm tweetchat transcript
- 1. #hpm Healthcare Hashtag Twitter Transcript From: Wed Apr 20 17:55:00 PDT 2011 To: Wed Apr 20 19:05:00 PDT 2011 Customize transcript dates and layout Learn more about #hpm at The Healthcare Hashtag Project PracticalWisdom It's almost that time. 4minute count down to tired fingers, wired brain, and collective Wisdom. I can't wait. #HPM Wed Apr 20 17:56:39 PDT 2011 PracticalWisdom We want others 2 c us competent, not just nice.RT@doclake Powervs.Warmth applies 2 way #hpm prac. interacts @bedsidehttp://is.gd/OI5cqH #HPM Wed Apr 20 18:00:31 PDT 2011 equijada Hi everyone. For the next 6 min, I'll be in #hpm tweetchat. Come join the discussion. #hpm Wed Apr 20 18:01:02 PDT 2011 equijada @PracticalWisdom Hi Lisa, good to see you here #hpm Wed Apr 20 18:01:25 PDT 2011 PracticalWisdom Interested Pt Educ.RT@DianeEMeier:RT @ctsinclairNews/Research UPDATES: U.S. FDA Releases Long-Awaited Opioid-REMS http://hpm.md/g2AncC #HPM Wed Apr 20 18:01:26 PDT 2011 RossJeanette hi @equijada only 6 minutes? #hpm Wed Apr 20 18:01:54 PDT 2011 KathyKastner What about the other 54 minutes :)RT @equijada: Hi everyone. For the next 6 min, I'll be in #hpm tweetchat. Come join the discussion. #hpm Wed Apr 20 18:02:02 PDT 2011 PracticalWisdom My Pleasure. Thanks for being our Host. RT @equijada: @PracticalWisdom Hi Lisa, good to see you here #HPM Wed Apr 20 18:02:28 PDT 2011 equijada @KathyKastner ha, i mean for the next 60 min! #hpm Wed Apr 20 18:02:46 PDT 2011
- 2. PracticalWisdom @KathyKastner @equijada 54 Fun with our Friends. Brain Candy for All #HPM Wed Apr 20 18:03:01 PDT 2011 KathyKastner Wheewh. worried for a mo RT @equijada: @KathyKastner ha, i mean for the next 60 min! #hpm Wed Apr 20 18:03:16 PDT 2011 equijada @RossJeanette Hi Jeanette! 60 min...thinking faster than I type. Welcome. Good to see you here #hpm Wed Apr 20 18:03:26 PDT 2011 FMDGirl Hi everyone- listening in. Kari- RN/pt advocate #HPM Wed Apr 20 18:04:10 PDT 2011 KathyKastner H Lisa ! RT @PracticalWisdom:@equijada 54 Fun with our Friends. Brain Candy for All #HPM Wed Apr 20 18:04:20 PDT 2011 equijada @FMDGirl Hi Kari, welcome. #hpm Wed Apr 20 18:04:54 PDT 2011 PracticalWisdom @equijada: Hoping our Man from Down Under will join us tonight. The Rascal @Hughstephens. #HPM Wed Apr 20 18:05:14 PDT 2011 revdoc Pam Harris MD with Kansas City Hospice; also an ordained minister #hpm Wed Apr 20 18:05:32 PDT 2011 SheyontheBay Hello all, glad to see you #hpm Wed Apr 20 18:06:31 PDT 2011 equijada @PracticalWisdom will start with t1 in a min or so. Join us @hughstephens. Welcome Pam. Good to see you #hpm Wed Apr 20 18:06:35 PDT 2011 revdoc Good to tweet with y'all #hpm Wed Apr 20 18:07:09 PDT 2011 equijada @SheyontheBay hi, good to see you. long time! #hpm Wed Apr 20 18:07:12 PDT 2011 PracticalWisdom @KathyKastner I'm always glad to see you. #HPM Wed Apr 20 18:07:34 PDT 2011 teaminspire Hi everyone--listening in, looking to learn--John Novack, Inspire (online patient support communities) #HPM Wed Apr 20 18:07:45 PDT 2011
- 3. hughstephens @PracticalWisdom @equijada still looking for cat :( might not make #hpm Wed Apr 20 18:08:01 PDT 2011 equijada t1: It's 420! What is the role of marijuana in patients with life threatening illness? #happy420 #hpm Wed Apr 20 18:08:02 PDT 2011 equijada For those not familiar with 420 The True Story Of How April 20 Became 'Weed Day' http://huff.to/hmP832 #hpm Wed Apr 20 18:08:41 PDT 2011 equijada 420 (cannabis culture) - Wikipedia, the free encyclopedia http://bit.ly/f5aOqV #hpm Wed Apr 20 18:08:49 PDT 2011 SheyontheBay @equijada @SheyontheBay yes, sorry about that - lots going on in life!! ;) #hpm Wed Apr 20 18:08:57 PDT 2011 equijada @hughstephens welcome! #hpm Wed Apr 20 18:09:06 PDT 2011 revdoc T1--I am actually not very impressed with Marinol for sx control #hpm Wed Apr 20 18:09:12 PDT 2011 FMDGirl t1- question dear to my heart- close friend passed away from Fredrich ataxia- not legal, but only think that helped #HPM Wed Apr 20 18:09:41 PDT 2011 KathyKastner Clearly I need glasses. I put an 'e' in the middle of sx RT @revdoc: T1--I am actually not very impressed with Marinol for sx control #hpm Wed Apr 20 18:10:19 PDT 2011 revdoc Although Marinol does help for the wasting syndrome associated with AIDS #hpm Wed Apr 20 18:10:21 PDT 2011 SheyontheBay Dating myself: i remember teaching chemo pts how to smoke a joint, circa 1980!!! #hpm Wed Apr 20 18:10:23 PDT 2011 equijada @FMDGirl if you don't mind, can you expand on the experience? what did it help? #hpm Wed Apr 20 18:10:34 PDT 2011 equijada I think that data on marinol and marijuana are actually different. Not sure. #hpm Wed Apr 20 18:11:27 PDT 2011 revdoc Can't speak to the effect of Marinol on sex... #hpm Wed Apr 20 18:11:43 PDT 2011
- 4. equijada @SheyontheBay was it helpful? #hpm Wed Apr 20 18:11:46 PDT 2011 DianeEMeier RT @doclake: Power poses vs. Warmth poses-good research that applies to the way a #hpm practitioner interacts @ the bedside http://is.gd ... Wed Apr 20 18:11:49 PDT 2011 revdoc In Kansas, marijuana is not legal, so we are stuck with Marinol #hpm Wed Apr 20 18:12:13 PDT 2011 equijada Cannabis use in palliative care http://bit.ly/huBHGx A nice review #hpm Wed Apr 20 18:12:56 PDT 2011 FMDGirl Yes, fredrich ataxia causes spasms- traditional meds did not help- up front with docs about using it, pts should be able use medically #HPM Wed Apr 20 18:13:53 PDT 2011 SheyontheBay @equijada@SheyontheBayIf they could get past the 'criminality' it helped, esp w/ nausea.po tabs seemed to get neutralized by gastric jc #hpm Wed Apr 20 18:14:17 PDT 2011 equijada @FMDGirl I hear that a lot from patients taking it. #hpm Wed Apr 20 18:14:40 PDT 2011 SheyontheBay Wasnt legal in Florida either... We ignored the smell of pot wafting down the corridor #hpm Wed Apr 20 18:15:13 PDT 2011 DianeEMeier RT @doclake: The New Old Age: A Mother’s Nighttime Rage http://is.gd/ciHsMe delirium #hpm Wed Apr 20 18:15:24 PDT 2011 equijada It's legal in CA (I'm in CA). There are so many dispensaries. Many times the pts using don't seem legit. Hard to balance. #hpm Wed Apr 20 18:16:14 PDT 2011 RossJeanette thanks for the information on 420. Since marijuana is ilegal in Texas I have no experience w/ this. #hpm Wed Apr 20 18:17:15 PDT 2011 FMDGirl Plus- it increases appetite, Dave- my friend wrote a book:http://amzn.to/hYJGVk #HPM Wed Apr 20 18:17:28 PDT 2011 drpippa Only anecdotal evidence Has been helpful for folks. Hard to balance legit use vs illicit use. Would prob not feel comfortable rxing #Hpm Wed Apr 20 18:17:36 PDT 2011 revdoc SAME ISSUE WITH OTHER PAIN MEDS RT @equijada: Its legal in CA (Im in CA). Many times the pts using dont seem legit. Hard to balance. #hpm Wed Apr 20 18:17:58 PDT 2011
- 5. drpippa @equijada Nice choice of topic for the day! #Hpm Wed Apr 20 18:18:03 PDT 2011 equijada I've let patients use it. I don't have a problem with it. I do get uncomfortable when they are using pot and oxyfast gets lost. #hpm Wed Apr 20 18:18:32 PDT 2011 FMDGirl @equijada How is it different from managing any other chronic patient that is on pain meds? #HPM Wed Apr 20 18:18:40 PDT 2011 equijada @FMDGirl thanks for the link. I'm going to check it out. #hpm Wed Apr 20 18:19:02 PDT 2011 SheyontheBay @equijada Have no idea how it was used or abused in the home. Hospital pts had to provide their own -> no quality control #hpm Wed Apr 20 18:19:04 PDT 2011 revdoc FDA proposing REMS on ALL opiates because of issues of abuse or diversion http://hpm.md/g2AncC #hpm #hpm Wed Apr 20 18:19:07 PDT 2011 PracticalWisdom Sorry had internet problems Kerri great to see you. #HPM Wed Apr 20 18:19:22 PDT 2011 equijada @FMDGirl it's not. I have to risk assess just like opioids. #hpm Wed Apr 20 18:19:35 PDT 2011 BuddhishMD @NYTimeskrugman Language is so important - it sometimes feels like the world of money and business has completely co-opted our lives. #hpm Wed Apr 20 18:20:13 PDT 2011 equijada @FMDGirl I think the main difference is basically legal but in terms of prescribing - same as opoioids #hpm Wed Apr 20 18:20:27 PDT 2011 equijada @drpippa ha! thanks. #hpm Wed Apr 20 18:20:49 PDT 2011 FMDGirl @equijada pt on ms for cancer- it made him confused and he cut his feeding tube in half without realizing it- thought it was a string #HPM Wed Apr 20 18:20:54 PDT 2011 PracticalWisdom RT @drpippa: Only anecdotal evid. Has been helpful 4 folks. Hard 2 balance legi use vsillicit use.Would prob not feel comfortable rxing #HPM Wed Apr 20 18:21:10 PDT 2011 PracticalWisdom RT @FMDGirl: @equijadapton ms 4 cancer- made him confused& he cut his feeding tube in 1/2 without realizing it- thought it was a string #HPM
- 6. Wed Apr 20 18:21:48 PDT 2011 equijada @PracticalWisdom @drpippa @AAHPM doesn't have an official stand on marijuana. Interesting discussion in Vancouver #hpm Wed Apr 20 18:22:02 PDT 2011 PracticalWisdom Rascal Topic for sure. I knew this would be a good one. RT @drpippa: @equijada Nice choice of topic for the day! #HPM Wed Apr 20 18:22:17 PDT 2011 FMDGirl easy to balance legal use, RX from an MD- get from a hospital pharmacy #HPM Wed Apr 20 18:22:27 PDT 2011 drpippa Still disappointed i missed it! RT @equijada: @AAHPM doesnt have an official stand on marijuana. Interesting discussion in Vancouver #Hpm Wed Apr 20 18:23:09 PDT 2011 equijada RT @FMDGirl: easy to balance legal use, RX from an MD- get from a hospital pharmacy #hpm Wed Apr 20 18:23:20 PDT 2011 drpippa RT @FMDGirl: easy to balance legal use, RX from an MD- get from a hospital pharmacy #Hpm Wed Apr 20 18:23:44 PDT 2011 equijada Moving on to t2 in a min or so #hpm Wed Apr 20 18:23:52 PDT 2011 PracticalWisdom @equijada @drpippa @AAHPM T1: When I taught Pharmacology (Basic) 100 years ago Marijuana was complicated Dep/Stim Sometimes Hallacu? #HPM Wed Apr 20 18:24:01 PDT 2011 revdoc RT @FMDGirl: easy to balance legal use, RX from an MD- get from a hospital pharmacy [PEOPLE CAN LIE ABOUT SXS USING LEGAL SOURCES] #hpm Wed Apr 20 18:24:10 PDT 2011 hollyby Hi all! I don't rx it. Still a conflict btwn state & federal law. Not worth my DEA license. #hpm Wed Apr 20 18:24:19 PDT 2011 RossJeanette @equijada was the MJ discussion in Vancouver a specific session? I bought the Audio recording #hpm Wed Apr 20 18:24:25 PDT 2011 PracticalWisdom @PracticalWisdom: Is this still true? complicated? #HPM Wed Apr 20 18:24:52 PDT 2011 equijada RT @hollyby: Hi all! I dont rx it. Still a conflict btwn state & federal law. Not worth my DEA license. #hpm Wed Apr 20 18:24:53 PDT 2011
- 7. FMDGirl I do have a stand I do not use it- I would like to know it is available if I have a terrible stroke, should be MY choice not my states #HPM Wed Apr 20 18:24:57 PDT 2011 hollyby Lurking tonight, but wanted to say hello! Hugs to all! #hpm Wed Apr 20 18:25:07 PDT 2011 mpf2011 @ctsinclair Have fun. #HPM Wed Apr 20 18:25:08 PDT 2011 PracticalWisdom Who wants another Hassle!RT @hollyby: Hi all! I dont rx it. Still a conflict btwn state & federal law. Not worth my DEA license. #HPM Wed Apr 20 18:25:27 PDT 2011 ctsinclair RT @drpippa: Only anecdotal evidence Has been helpful for folks. Hard to balance legit use vs illicit use. Would prob not feel comfortable rxing #Hpm Wed Apr 20 18:25:28 PDT 2011 equijada @RossJeanette yes, I forget the speakers name. Husband/wife team. Totally supported MJ but data equivocal #hpm Wed Apr 20 18:25:31 PDT 2011 KathyKastner RT @FMDGirl: I do have a stand I do not use it- I would like to know it is available if I have a terrible stroke, should be MY choice not my states #HPM Wed Apr 20 18:25:43 PDT 2011 mpf2011 RT @hospice_doctor: Aggressive treatment at the end of life, but where is the patient? New blog post: http://hospicedoctor.blogspot.com #palliative #hpm Wed Apr 20 18:25:46 PDT 2011 revdoc @ctsinclair Thought you were at concert? #hpm Wed Apr 20 18:26:00 PDT 2011 FMDGirl @revdoc @FMDGirl yes-people lie all the time to get narcs- but that should not prevent people who need pain relief from getting it #HPM Wed Apr 20 18:26:46 PDT 2011 PracticalWisdom PT Rights!RT @FMDGirl: I do have a stand I do not use it-I would like know it's ava.if I a stroke, should be MY choice not my states #HPM Wed Apr 20 18:26:47 PDT 2011 PracticalWisdom In the Lobby, Conversation too Good to be left out!RT @revdoc: @ctsinclair Thought you were at concert? #HPM Wed Apr 20 18:27:23 PDT 2011 KathyKastner RT @FMDGirl: @revdoc @FMDGirl yes-people lie all the time to get narcs- but that should not prevent people who need pain relief from getting it #HPM Wed Apr 20 18:27:32 PDT 2011 equijada t2 via @mpf2011 and @practicalwisdom - how do you communicate and advocate AD when what's said isn't what's done http://bit.ly/eU8wq5 #hpm Wed Apr 20 18:27:42 PDT 2011
- 8. revdoc @FMDGirl No argument; but having done chronic pain tx for years, it is not as simple as it seems #hpm Wed Apr 20 18:27:59 PDT 2011 FMDGirl @PracticalWisdom @FMDGirl EXACTLY Lisa- PT RIGHTS! Your better at this tweeting than me ;) #HPM Wed Apr 20 18:28:00 PDT 2011 PracticalWisdom Nope I'm older have more insurance.RT @FMDGirl:@PracticalWisdom@FMDGirl EXACTLY Lisa-PT RIGHTS! Your better at this tweeting than me ;) #HPM Wed Apr 20 18:28:52 PDT 2011 equijada @mpf2011 @practicalwisdom In this story, pt was "DNR" but her goals and wishes weren't exactly known #hpm Wed Apr 20 18:28:53 PDT 2011 joshgriffin RT @FMDGirl: @revdoc @FMDGirl yes-people lie all the time to get narcs- but that should not prevent people who need pain relief from getting it #HPM Wed Apr 20 18:29:02 PDT 2011 FMDGirl @revdoc @FMDGirl yes, understand it is not easy, but either is living with pain- we must go the extra mile to ensure pt safety #HPM Wed Apr 20 18:29:06 PDT 2011 revdoc @FMDGirl Unfortunately, my experience with legislation to promote "safety" is that it makes my life a living hell! #hpm Wed Apr 20 18:30:03 PDT 2011 equijada RT @revdoc: @FMDGirl No argument; but having done chronic pain tx for years, it is not as simple as it seems #hpm Wed Apr 20 18:30:19 PDT 2011 drpippa T2- I try to get family talking about the person, not the disease. Get an idea of what they were like before. Helps inform #Hpm Wed Apr 20 18:30:54 PDT 2011 PracticalWisdom @equijada @mpf2011 @practicalwisdom: Frankly this ink unglued me. Why was her DNR not respected? Where was Clergy/Ethics. #HPM Wed Apr 20 18:30:57 PDT 2011 SheyontheBay T2. In 140 characters?really? #hpm Wed Apr 20 18:31:12 PDT 2011 revdoc T2 Encourage pt conversation with families, not relying on a piece of paper. Make sure your decision makers KNOW what you want #hpm Wed Apr 20 18:31:18 PDT 2011 equijada @SheyontheBay lol #hpm Wed Apr 20 18:31:39 PDT 2011 FMDGirl @revdoc @FMDGirl Agreed!!! That is why you have us nurses to do the paper work-
- 9. FMDGirl @revdoc @FMDGirl Agreed!!! That is why you have us nurses to do the paper work- he he :) #HPM Wed Apr 20 18:31:51 PDT 2011 mpf2011 @equijada How was the pt DNR? She had a signed document?? Noted in Notes? #hpm Wed Apr 20 18:31:59 PDT 2011 PracticalWisdom T2: If a Pt does everything legally & your desire is not respected What (fill in the Blank) is going on. Seems like ego got in the way #HPM Wed Apr 20 18:32:17 PDT 2011 SheyontheBay @equijada ;D #hpm Wed Apr 20 18:32:32 PDT 2011 revdoc T2 Encourage pt conv w/ families, not relying on a piece of paper. Make sure your decision makers KNOW what you want B4 they need info #hpm Wed Apr 20 18:32:38 PDT 2011 equijada @revdoc It seems when healthcare providers are told to #havethetalk it's interpreted as #signthepaper #hpm Wed Apr 20 18:32:41 PDT 2011 drpippa RT @revdoc: Encourage pt conversation with families, not relying on a piece of paper. Make sure decision makers KNOW what you want #Hpm Wed Apr 20 18:32:46 PDT 2011 PracticalWisdom THey Did RT @revdoc: T2 Encourage pt con. w/ families, not relying on a piece of paper. Make sure your decision makers KNOW what Uwant #HPM Wed Apr 20 18:32:56 PDT 2011 FMDGirl t2 question- did not get the link to work- can some one fill me in? #HPM Wed Apr 20 18:33:07 PDT 2011 revdoc @FMDGirl @revdoc Unfortunately, I am the housecall doc, so when I show up I AM the IDT! #hpm Wed Apr 20 18:33:09 PDT 2011 equijada @mpf2011 it was in her advance directive #hpm Wed Apr 20 18:33:15 PDT 2011 PracticalWisdom http://hospicedoctor.blogspot.com/RT @FMDGirl: t2 question- did not get the link to work- can some one fill me in? #HPM Wed Apr 20 18:33:45 PDT 2011 KathyKastner I'd LOL but it's true RT @equijada: @revdoc It seems when healthcare providers are told 2 #havethetalk interpreted as #signthepaper #hpm Wed Apr 20 18:33:46 PDT 2011 SheyontheBay Respectingchoices.org. Worksheet to #havethetalk #hpm Wed Apr 20 18:33:48 PDT 2011
- 10. drpippa So true. RT @equijada: @revdoc It seems when healthcare providers are told to #havethetalk its interpreted as #signthepaper #Hpm Wed Apr 20 18:34:29 PDT 2011 mpf2011 RT @equijada: @mpf2011 it was in her advance directive #hpm | Was the pt conscious? Was family disputing it? Wed Apr 20 18:34:42 PDT 2011 revdoc T2 Not saying it doesn't happen, but I still think there are more problems not naming DPOA than having AD ignored #hpm Wed Apr 20 18:34:53 PDT 2011 RossJeanette T2 bringing the person "in to the room" helps me understand better what makes life meaningful and make care recommendations #hpm Wed Apr 20 18:34:59 PDT 2011 equijada @FMDGirl sorry, try this http://bit.ly/eU8wq5 #hpm Wed Apr 20 18:35:10 PDT 2011 PracticalWisdom Is this a Legal Doc? Could there be Legal Challenges. RT @equijada: @mpf2011 it was in her advance directive #HPM Wed Apr 20 18:35:19 PDT 2011 PracticalWisdom RT @drpippa: So true.RT @equijada: @revdoc It seems when healthcare providers are told to #havethetalk its interpreted as #signthepaper #HPM Wed Apr 20 18:35:37 PDT 2011 equijada @FMDGirl in short - an elderly lady was "DNR" but no mentions of goals, wishes. Received aggressive care dialysis etc that didn't work #hpm Wed Apr 20 18:35:55 PDT 2011 revdoc As DPOA I did have to bully 4 providers into stopping aggressive care for my father despite my telling them his QOL was unacceptable #hpm Wed Apr 20 18:36:26 PDT 2011 equijada @revdoc there is good data that DPOA undergo significant stress and don't follow through thus AD. #hpm Wed Apr 20 18:36:35 PDT 2011 equijada @RossJeanette yes, agree. #hpm Wed Apr 20 18:37:36 PDT 2011 PracticalWisdom T2: Interesting Quote: How the health care system slants inexorably toward aggressive intervention regardless of the context. #HPM Wed Apr 20 18:37:39 PDT 2011 mpf2011 @PracticalWisdom Here is the blog link: http://hospicedoctor.blogspot.com/ #HPM Wed Apr 20 18:37:40 PDT 2011 equijada @revdoc tough. You were able to advocate. Most people aren't as strong. #hpm Wed Apr 20 18:38:13 PDT 2011
- 11. PracticalWisdom RT @revdoc:As DPOA I did have 2 bully 4 providers stopping aggressive care 4 my father despite my telling them his QOL was unacceptable #HPM Wed Apr 20 18:38:15 PDT 2011 revdoc @PracticalWisdom Yes legal provisions for ADs in all states as well as for recognizing ADs legally enacted from others #hpm Wed Apr 20 18:38:23 PDT 2011 FMDGirl @PracticalWisdom @FMDGirl Thanks Lisa! T2- We do take the Humanity out of charting - why don't we include spiritual assessment in chart #HPM Wed Apr 20 18:38:23 PDT 2011 RossJeanette T2 sometimes teams pursue certain care b/cause they want to finish what was started eg "need 2 full weeks on vent for pneumonia Rx" #hpm Wed Apr 20 18:38:35 PDT 2011 PracticalWisdom @mpf2011: Thanks, I read it think FMDGirl Wanted it. #HPM Wed Apr 20 18:38:54 PDT 2011 drpippa Need to address doc side. Why do so many insist that aggressive, curative is only legit model of care? We can model alternatives #Hpm Wed Apr 20 18:38:55 PDT 2011 revdoc @equijada @revdoc It was sheer hell. #hpm Wed Apr 20 18:39:12 PDT 2011 equijada @FMDGirl @PracticalWisdom agree, well said. #hpm Wed Apr 20 18:39:30 PDT 2011 revdoc Stress on DPOA is often because we don't recognize the dying--we need to teach what dying looks like to learners! #hpm Wed Apr 20 18:39:50 PDT 2011 PracticalWisdom RT @drpippa: Need 3 address MD side. Why do so many insist aggressive, curative is only legit model of care? We can model alternatives #HPM Wed Apr 20 18:40:01 PDT 2011 equijada @drpippa modeling is our best model. #hpm Wed Apr 20 18:40:01 PDT 2011 mpf2011 #hpm Unfortunately, even if pts sign an AD, the family hasn't talked to the pt. They don't want to let go despite a "piece of paper." Wed Apr 20 18:40:01 PDT 2011 equijada t3 coming up in a min or so. #hpm Wed Apr 20 18:40:20 PDT 2011 drpippa RT @revdoc: Stress on DPOA is often because we dont recognize the dying--we need to teach what dying looks like to learners! #Hpm
- 12. need to teach what dying looks like to learners! #Hpm Wed Apr 20 18:40:23 PDT 2011 equijada RT @revdoc: Stress on DPOA is often because we dont recognize the dying--we need to teach what dying looks like to learners! #hpm Wed Apr 20 18:41:04 PDT 2011 mpf2011 #hpm So much better if the talk is fully documented (and sometimes taped). Family members present too. Wed Apr 20 18:41:07 PDT 2011 drpippa Deep thoughts for a weds. RT @equijada: @drpippa modeling is our best model. #Hpm Wed Apr 20 18:41:10 PDT 2011 PracticalWisdom T2: I so Strongly Believe we so need you Pal MD's to gather more Power/Recognition/Understanding to help prevent this from happening. #HPM Wed Apr 20 18:41:27 PDT 2011 revdoc Not many families would advocate for aggressive care they can't even spell if docs did not tell them their loved ones needed it #hpm Wed Apr 20 18:41:42 PDT 2011 equijada @drpippa lol! Sincerely, Stuart Handy. #hpm Wed Apr 20 18:41:44 PDT 2011 KathyKastner Gr8 ideas RT @mpf2011: #hpm So much better if the talk is fully documented (and sometimes taped). Family members present too. Wed Apr 20 18:41:58 PDT 2011 KathyKastner RT @revdoc: Stress on DPOA is often because we don't recognize the dying--we need to teach what dying looks like to learners! #hpm Wed Apr 20 18:42:19 PDT 2011 mpf2011 @PracticalWisdom When I was an ICU nurse, before becoming an atty, curative tx was the only option. #HPM Wed Apr 20 18:42:30 PDT 2011 gailliardadults RT @doclake: The New Old Age: A Mother’s Nighttime Rage http://is.gd/ciHsMe delirium #hpm Wed Apr 20 18:42:36 PDT 2011 equijada @KathyKastner @mpf2011 I end up just placing "quotes" in my note and just type out the narrative. #hpm Wed Apr 20 18:42:48 PDT 2011 PracticalWisdom RT@KathyKastner:Gr8 ideas RT @mpf2011: #hpmSo much better if talk is fully documented (and sometimes taped). Family members present 2. #HPM Wed Apr 20 18:42:58 PDT 2011 KathyKastner RT @mpf2011: #hpm So much better if the talk is fully documented (and sometimes taped). Family members present too.#eldercarechat Wed Apr 20 18:43:11 PDT 2011
- 13. PracticalWisdom RT @equijada: @KathyKastner @mpf2011 I end up just placing "quotes" in my note and just type out the narrative. #HPM Wed Apr 20 18:43:29 PDT 2011 mpf2011 @PracticalWisdom I think docs see Palli as "giving up" which is shown by saying "there's nothing more we can do." Should add "to cure." #HPM Wed Apr 20 18:43:46 PDT 2011 equijada t3: How has caring for those in death and dying effected your personal life? I think about this a lot #hpm Wed Apr 20 18:43:56 PDT 2011 PracticalWisdom @PracticalWisdom @KathyKastner @mpf2011: Maybe include a section in a persons Facebook Page. #HPM Wed Apr 20 18:44:09 PDT 2011 FMDGirl health care providers need more education on process of dying, if they are scared of it- they will practice heroic measures #HPM Wed Apr 20 18:44:42 PDT 2011 joshgriffin RT @FMDGirl: health care providers need more education on process of dying, if they are scared of it- they will practice heroic measures #HPM Wed Apr 20 18:45:11 PDT 2011 KathyKastner RT @mpf2011: @PracticalWisdom I think docs see Palli as "giving up" which is shown by saying "there's nothing more we can do." Should add "to cure." #HPM Wed Apr 20 18:45:13 PDT 2011 equijada RT @FMDGirl: health care providers need more education on process of dying, if they are scared of it-they will practice heroic measures #hpm Wed Apr 20 18:45:16 PDT 2011 drpippa T3 - absoultely would not do what I do if it were not for my personal experiences. #Hpm Wed Apr 20 18:45:27 PDT 2011 PracticalWisdom @mpf2011 Yes, the Cure sometimes is Enough is Enough. #HPM Wed Apr 20 18:45:28 PDT 2011 mpf2011 #hpm Our culture is trained by tv commercials to believe there is a cure (pill) for everything. We don't accept death well as part of life. Wed Apr 20 18:45:35 PDT 2011 KathyKastner RT @mpf2011: #hpm Our culture is trained by tv commercials to believe there is a cure (pill) for everything. We don't accept death well as part of life. Wed Apr 20 18:45:52 PDT 2011 equijada DITTO! It's changed my life RT @drpippa: T3 - absoultely would not do what I do if it were not for my personal experiences. #hpm Wed Apr 20 18:46:10 PDT 2011 #HPM There is still a lingering fear of litigation, I think. Despite documentation of pt
- 14. #HPM There is still a lingering fear of litigation, I think. Despite documentation of pt mpf2011 wishes. Wed Apr 20 18:46:20 PDT 2011 FMDGirl t3 I am no longer afraid of death or dying #HPM Wed Apr 20 18:46:37 PDT 2011 hospiceMTBC t3: (Hi, folks!) Working in #hpm helps me enjoy the moment & go with the flow more in my life. Wed Apr 20 18:47:33 PDT 2011 revdoc I elected artificial feed 4 my father s/p ICH, leading to 8.5 yrs of disability, then death from ruptured appy. HPM kept me sane. #hpm Wed Apr 20 18:47:35 PDT 2011 equijada t3: I've seen love in action. It absolutely blows my mind. #hpm Wed Apr 20 18:47:42 PDT 2011 KathyKastner RT @Paulflevy: Palli Care on WIHI: Palli Care = Quali Care 21/4,2:- 3PM Eastern TimeGue... http://bit.ly/ggJqEB #hpm Wed Apr 20 18:47:49 PDT 2011 revdoc RT @FMDGirl: t3 I am no longer afraid of death or dying. THERE ARE A LOT WORSE THINGS THAN DEAD #hpm Wed Apr 20 18:47:55 PDT 2011 FMDGirl Have learned there can be dignity in death #HPM Wed Apr 20 18:47:58 PDT 2011 mpf2011 #hpm Plus docs tend to focus on their "body system" so nephro says to family "kidneys are better today" and they hear "pt is better." Wed Apr 20 18:48:05 PDT 2011 equijada @hospiceMTBC hi, welcome. I love the moment. #hpm Wed Apr 20 18:48:16 PDT 2011 KathyKastner AMEN RT @revdoc: RT @FMDGirl: t3 I am no longer afraid of death or dying. THERE ARE A LOT WORSE THINGS THAN DEAD #hpm Wed Apr 20 18:48:25 PDT 2011 PracticalWisdom Seen this so many times. Courage Too!RT @FMDGirl: Have learned there can be dignity in death #HPM Wed Apr 20 18:48:43 PDT 2011 PracticalWisdom RT @equijada: t3: Ive seen love in action. It absolutely blows my mind. #HPM Wed Apr 20 18:48:54 PDT 2011 FMDGirl @revdoc @FMDGirl you can say that again- why as a society are we so afraid- is because people are afraid of hell? Religion play a part? #HPM Wed Apr 20 18:49:18 PDT 2011
- 15. equijada t3: I've learned about my Higher Power #hpm Wed Apr 20 18:49:24 PDT 2011 PracticalWisdom RT @equijada: DITTO! Its changed my life RT @drpippa: T3 absoultely would not do what I do if it were not 4 my personal experiences. #HPM Wed Apr 20 18:49:25 PDT 2011 revdoc I have seen healings, reconciliation, courage, love--I should PAY to do this work. (But don't tell my boss, I have a mortgage) #hpm Wed Apr 20 18:50:21 PDT 2011 PracticalWisdom Accept the things I cannot change Keeps me balanced. RT @equijada: t3: Ive learned about my Higher Power #HPM Wed Apr 20 18:50:27 PDT 2011 drpippa Sometimes miracles. RT @equijada: t3: Ive seen love in action. It absolutely blows my mind. #Hpm Wed Apr 20 18:50:38 PDT 2011 equijada @FMDGirl @revdoc just finished reading Love Wins by Rob Bell re: hell. Religion has done a disservice #hpm Wed Apr 20 18:50:43 PDT 2011 mpf2011 #hpm It is the HPM team that has 2 teach how 2 see pt holistically, rather thn the sum of body systems. LOOK at the pt. not go thru motions. Wed Apr 20 18:50:43 PDT 2011 revdoc @FMDGirl Not always, but that can be one aspect. People not grounded in anything besides here and now #hpm Wed Apr 20 18:50:59 PDT 2011 revdoc RT @equijada: just finished reading Love Wins by Rob Bell re: hell. Religion has done a disservice [not all of us are like that!] #hpm Wed Apr 20 18:51:36 PDT 2011 PracticalWisdom T3: Was a clergy Wife for 13 years. Have seen families in their last moments at Re: worst and best. Learned not to sweat small Stuff #HPM Wed Apr 20 18:51:39 PDT 2011 AmandaBinDC RT @ctsinclair: Pain-Topics.org News/Research UPDATES: U.S. FDA Releases Long-Awaited Opioid-REMS http://hpm.md/g2AncC #HPM Wed Apr 20 18:51:49 PDT 2011 RossJeanette T3 I feel very priviledged in working with people at a difficult time. It makes my problems seem minor. #hpm Wed Apr 20 18:51:58 PDT 2011 KathyKastner RT @equijada: @FMDGirl @revdoc just finished reading Love Wins by Rob Bell re: hell. Religion has done a disservice #hpm Wed Apr 20 18:52:13 PDT 2011 Book Club? RT @equijada: @FMDGirl @revdoc just finished reading Love Wins by
- 16. Book Club? RT @equijada: @FMDGirl @revdoc just finished reading Love Wins by PracticalWisdom Rob Bell re: hell. Religion has done a disservice #HPM Wed Apr 20 18:52:31 PDT 2011 FMDGirl @revdoc @FMDGirl great point- I brought that up because when I was a child I was so scared of death, sunday school...impressionable #HPM Wed Apr 20 18:52:45 PDT 2011 PracticalWisdom @equijada @FMDGirl @revdoc: What was the main Lesson? #HPM Wed Apr 20 18:53:02 PDT 2011 SheyontheBay @equijada wow.... #hpm Wed Apr 20 18:53:05 PDT 2011 hospiceMTBC T3: Denial=suffering, letting go=peace. #hpm Wed Apr 20 18:53:17 PDT 2011 FMDGirl @KathyKastner @equijada @FMDGirl @revdoc I will have to read it! #HPM Wed Apr 20 18:53:23 PDT 2011 equijada @FMDGirl @revdoc totally. #hpm Wed Apr 20 18:53:41 PDT 2011 phlu RT @doclake: Power poses vs. Warmth poses-good research that applies to the way a #hpm practitioner interacts @ the bedside http://is.gd ... Wed Apr 20 18:53:48 PDT 2011 PracticalWisdom T3: Learned we can be alive but Dead. #HPM Wed Apr 20 18:54:00 PDT 2011 equijada @FMDGirl check it out. History is not tragic, in the end, love wins. #hpm Wed Apr 20 18:54:02 PDT 2011 FMDGirl @hospiceMTBC you said it well #HPM Wed Apr 20 18:54:07 PDT 2011 PracticalWisdom RT @hospiceMTBC: T3: Denial=suffering, letting go=peace. #HPM Wed Apr 20 18:54:21 PDT 2011 revdoc RT @PracticalWisdom: What was the main Lesson? We have only the present: laugh, love, do your best, don't trade today waiting 4 2morro #hpm Wed Apr 20 18:54:52 PDT 2011 PracticalWisdom Idea to read book discuss on #HPM later time? RT @FMDGirl: @KathyKastner @equijada @FMDGirl @revdoc I will have to read it! #HPM Wed Apr 20 18:55:00 PDT 2011 RT @hospiceMTBC: T3: Denial=suffering, letting go=peace. #HPM
- 17. RT @hospiceMTBC: T3: Denial=suffering, letting go=peace. #HPM Wed Apr 20 18:55:02 PDT 2011 FMDGirl RossJeanette got to leave now! goodbye nice tweetchat hosting Earl! #hpm Wed Apr 20 18:55:10 PDT 2011 equijada @equijada @FMDGirl it's this out of this world love I see at the bedside of death (on occasion). #hpm Wed Apr 20 18:55:36 PDT 2011 FMDGirl @PracticalWisdom @FMDGirl @KathyKastner @equijada @FMDGirl @revdoc Iam in! #HPM Wed Apr 20 18:55:47 PDT 2011 PracticalWisdom Thank you! RT @revdoc: RT @PracticalWisdom: We have only the present:laugh/love/do your best, dont trade 2day waiting 4 2morro #HPM Wed Apr 20 18:55:54 PDT 2011 drpippa Love this idea!RT @PracticalWisdom: Idea to read book discuss on #HPM later time? ! #Hpm Wed Apr 20 18:55:57 PDT 2011 mpf2011 #HPM Sadly, ppl don't know how hard it is to take away treatment once started. If u can't breathe, pee or eat on your own, u r dying!! Wed Apr 20 18:55:58 PDT 2011 equijada Final thoughts and parting words of wisdom...Thanks all. #hpm Wed Apr 20 18:56:02 PDT 2011 PracticalWisdom Good Night Thanks RT @RossJeanette: got to leave now! goodbye nice tweetchat hosting Earl! #HPM Wed Apr 20 18:56:07 PDT 2011 equijada @RossJeanette good to see you again. Thanks for coming. #hpm Wed Apr 20 18:56:18 PDT 2011 FMDGirl forgiveness and acceptance and death comes peacefully #HPM Wed Apr 20 18:56:43 PDT 2011 PracticalWisdom @FMDGirl: Lam In? I don't get it? #HPM Wed Apr 20 18:56:46 PDT 2011 KathyKastner Too true! RT @mpf2011: #HPM Sadly, ppl don't know how hard it is to take away treatment once started. #eldercarechat Wed Apr 20 18:56:57 PDT 2011 PracticalWisdom RT @KathyKastner: Too true! RT @mpf2011: #HPM Sadly, ppl dont know how hard it is to take away treatment once started. #eldercarechat #HPM Wed Apr 20 18:57:27 PDT 2011
- 18. PracticalWisdom RT @FMDGirl: forgiveness and acceptance and death comes peacefully #HPM Wed Apr 20 18:57:31 PDT 2011 FMDGirl @PracticalWisdom @FMDGirl opps- I am in- read the book and chat- pick a date :) #HPM Wed Apr 20 18:57:38 PDT 2011 revdoc Thanks for hosting, Earl! #hpm Wed Apr 20 18:57:42 PDT 2011 equijada RT @FMDGirl: forgiveness and acceptance and death comes peacefully #hpm Wed Apr 20 18:57:49 PDT 2011 PracticalWisdom T3: I'm afraid to live in Pain don't think I'm afraid to die. #HPM Wed Apr 20 18:57:53 PDT 2011 hospiceMTBC Thank you, all, for the work you do & the passion you bring to the bedside. #hpm Wed Apr 20 18:57:55 PDT 2011 equijada @revdoc thanks for coming. #hpm Wed Apr 20 18:58:28 PDT 2011 PracticalWisdom @hospiceMTBC: Thank you!!!! #HPM Wed Apr 20 18:58:46 PDT 2011 FMDGirl RT @hospiceMTBC: Thank you, all, for the work you do & the passion you bring to the bedside. #HPM Wed Apr 20 18:58:51 PDT 2011 drpippa @equijada thanks for a night of thought and feeling! Great hosting. #Hpm Wed Apr 20 18:58:55 PDT 2011 KathyKastner Final thoughts: thanks Earl @equijada for gr8 hosting. Thanks to all #hpm-ers for the learning. Wed Apr 20 18:59:13 PDT 2011 mpf2011 #HPM Thanks everyone. Great chat. Wed Apr 20 18:59:15 PDT 2011 equijada @drpippa thanks! hope to catch you next week. happy week to you. #hpm Wed Apr 20 18:59:32 PDT 2011 FMDGirl @PracticalWisdom that is why we need to legalize medical marijuana #HPM Wed Apr 20 18:59:41 PDT 2011 equijada Good night all. Thanks again! #hpm Wed Apr 20 19:00:06 PDT 2011
- 19. Wed Apr 20 19:00:06 PDT 2011 kathydavisku Catrina Lootens and Marilyn Sampilo sentn in great proposal to SDBP on student school reentry for kids with chronic conditions. #pedpc #hpm Wed Apr 20 19:00:13 PDT 2011 KUKidsHP Catrina Lootens and Marilyn Sampilo sent in great proposal to SDBP on student school reentry for kids with chronic conditions. #pedpc #hpm Wed Apr 20 19:00:13 PDT 2011 PracticalWisdom So complicated. I'm neutral on this 1 but not Pt RightsRT @FMDGirl: @PracticalWisdom that is why we need to legalize medical marijuana #HPM Wed Apr 20 19:00:28 PDT 2011 revdoc Goodnight, all! Blessings of Passover and Easter to my Jewish and Christian friends! #hpm Wed Apr 20 19:00:37 PDT 2011 amyrnbsn RT @FMDGirl: health care providers need more education on process of dying, if they are scared of it- they will practice heroic measures #HPM Wed Apr 20 19:00:44 PDT 2011 FMDGirl Wow! That was the fastest tweet hour ever- you picked all my favorite topics! Thank you everyone for your wisdom. #HPM Wed Apr 20 19:00:49 PDT 2011 FMDGirl @revdoc thank you for inspiring words, it was a pleasure to meet you. #HPM Wed Apr 20 19:01:32 PDT 2011 revdoc @FMDGirl @revdoc You too! #hpm Wed Apr 20 19:02:07 PDT 2011 PracticalWisdom @equijada: Thank you for Hosting tonight. You added your own Flavor/Wisdom. Having different Hosts I think adds a great deal! Thanks #HPM Wed Apr 20 19:02:10 PDT 2011 PracticalWisdom AGree 100RT @FMDGirl: Wow! That was the fastest tweet hour ever- you picked all my favorite topics! Thank you everyone for your wisdom. #HPM Wed Apr 20 19:02:23 PDT 2011 PracticalWisdom Agree! RT @FMDGirl: @revdoc thank you for inspiring words, it was a pleasure to meet you. #HPM Wed Apr 20 19:02:33 PDT 2011 PracticalWisdom @FMDGirl Tonight makes me realize how much I've missed you. O.K. enough mushy Gooshy from me. My Amazing Friend. #HPM Wed Apr 20 19:03:17 PDT 2011 PracticalWisdom Quaker Girl Say Keeping in the LIght! RT @revdoc: Goodnight, all! Blessings of Passover and Easter to my Jewish and Christian friends! #HPM Wed Apr 20 19:04:21 PDT 2011
- 20. FMDGirl @PracticalWisdom Miss you too! I was so excited when I saw your tweet about #HPM I so happy I follow you! Your awesome Lisa! Wed Apr 20 19:04:40 PDT 2011