Shunichi Nakagawa @snakagawa_md
Director, Inpatient Palliative Care Services at Columbia University Irving Medical Center. Associate Professor @ColumbiaMed. Clinician-Educator. ncbi.nlm.nih.gov/pubmed/?term=N… New York, NY Joined May 2012-
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4月10日、17日に、かんわとーくオンライン研修会が行われ、12人の医師が参加しました。 参加者の感想をいくつかシェアします。 「事前学習→実践→フィードバックの流れがよかったのと、他の参加者の言葉の使い方なども学べてよかったです。」 続→
We held a @kanwatalk session on 4/10 and 4/17. Trained 12 Japanese physicians.
Bad news is the gap between the patient expectations and reality. Any information could become bad news. As long as you talk to patient and family, it is IMPOSSIBLE to avoid giving bad news. If you say you don’t have to, you are either not talking to patient or lying.
In answering their Q during a family meeting, don't jump on. Take a breath first. Then, answer simply with 1 word or 1 sentence. If you have to talk a lot, you are probably not answering their Q.
It was probably the day I received the most compliments in my life. I received so many compliments that I don't need any more for the rest of my life. Being praised for what you love to do. You cannot ask for more. Appreciate support from my family and colleagues.
In a family meeting, if you are talking more than 50% of the time, you are talking too much. You don't have to. You shouldn't.
When clarifying goals, you should start with open-ended Qs. "What is important?" "What are you most worried about?" But when they are not forthcoming, you can use close-ended Qs appropriately. You should not push them, but you can guide them. Be flexible.
"When your heart stops beating, do you want us to do CPR?" Just asking this is NOT the code status discussion. As a medical professional, we should change how we ask questions depending on the medical condition.
＜6月研修会 キャンセル枠のお知らせ＞ キャンセル枠は1名様分です。 ご希望の方はお早めにお願いいたします！ passmarket.yahoo.co.jp/event/show/det…
In EPIC chat, if you have to exchange messages, which is longer than 3 lines, on your computer screen many times, you should wonder if this is really efficient. Either pick up a phone or try to discuss it in person. That would be much more efficient.
京都の日本集中治療学会@jsicm50_2023、PD06「集中治療室でのwithdraw/withholdにまつわる課題」を聴講し、日本でwithdrawalを進めるのは険しい、と感じた。 発言したかったが時間がなかったので、ここで述べる。 大きな問題は2つある。 1/
a) We don't tell the family that intubation will not help because we assume they won't agree with us (eg, "They are not ready") b) We told them but they don't agree with us. Both are full code, but these are totally different. b) is ok, but a) is not ok.
In a family meeting, if you have to explain the difference between "hospice" and "comfort care" before clarifying the goal, you are probably getting lost. How you call it doesn't matter. Clarify the goal we are trying to achieve first.
人の死亡率は100％です。 今回上手く治したって、どこかで必ず治せない事態に直面します。必ずです。 多くの医療者が治すことに集中しています。勿論それはそれで大切ですが、治せない時にどうするか、はそれ以上に大切です。 専門科にかかわらず、緩和ケアの心得は必要です。 日本では特に。
Before a family meeting, try to get information directly. - If patient has decubitus ulcer, look at it on your own. - If advanced cancer, look at CT scan image (not the report) Hearsay information only will not convince the family.
I keep giving bad news, but the patient and family are so grateful. What matters is not the content we deliver, but the way we deliver it.
Today, we finished SurgTalk (powered by @vitaltalk) for the AY 2023-24. This is year #7 in @ColumbiaSurgery We trained 38 residents (out of 35 gen surg and 12 CT surg) in 8 sessions (81%). "I would recommend this training to others" Score was 4.79/5!!
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𝙳𝚊𝚟𝚒𝚍 .. @CanesDavid
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かんわとーく @kanwatalk
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Pierre Elias, MD @PierreEliasMD
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493 Followers 724 Following Neurointensivist. Canadian living in Pittsburgh. Trying to understand how physicians make decisions about neurologic prognostication. Dog Mom x 2 🐕
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Gen Shinozaki, MD @GenShinozakiMD
2K Followers 191 Following Associate Professor @Stanford| Physician scientist specialized in #epigenetics & device development for #delirium | Love family, sushi, sake & coffee. 日本語でも。
Nimit Agarwal @NimitAgarwalMD
647 Followers 666 Following Geriatrician, Chief of Geriatric Medicine at @UArizona, Researcher , Innovator and Palliator with a passion for advances in Aging. Tweets my own
Kristina Balangue MD .. @kgbalangue
294 Followers 713 Following internist,geriatrician,palliativist:so here for the good&bad&everything in between. pop culture off days,she/her/hers. tweets my own, RTs not endorsement/advice
Seth Trueger @MDaware
62K Followers 13K Following emergency doc @NorthwesternEM | Digital Media Editor @JAMANetworkOpen | opinions ≠ my employers' or med advice | @mdaware.bsky.social
Astrid Grouls, MD @AstridGrouls
282 Followers 276 Following @BCM_GeriPalli #hpm #hapc doc - trained throughout the #TexasMedicalCenter - tweets are my own - Proud Houstonian, cat lover, food enthusiast
Yukio Suzuki @yetii18
2K Followers 977 Following MD, PhD | Gyn Oncologist | Gyn Onc Research Team of Columbia Univ 🇺🇸| KCC & Yokohama City Univ 🇯🇵| 婦人科腫瘍・細胞診・女性医学専門医 | 腹腔鏡技術認定医 | 野球 | 働き方改革・専門医機構など｜研究内容は↓↓
Thanh Neville, MD, MS.. @thanh_neville
23K Followers 8K Following ICU physician & researcher, EOL/pall care; #3WishesProgram Director, #firstgen, #refugee, love to cook, Tweets are MY opinions only & not of my employer
Naoka Murakami @nymurakami
877 Followers 544 Following Transplant nephrologist, researcher, OncoNephrology, @BWHKidney, Assistant Professor @harvardmed, love science and beauty of nature
Rab Razzak @RabRazzakMD
261 Followers 338 Following #hapc doc, teacher, healthcare advocate, amateur comedian, life coach for healthcare professionals. Tweets are my own. Primary acct: @rabrazzak
@snakagawa_md This is great advice. Last week I felt pressured to answer these questions based on prelim path because my patients were persistently asking. Do you think it's helpful to say "it looks like it may be a high grade glioma but we don't know for sure yet"? It sets the expectations?
@snakagawa_md 2/2 Regarding the second question about breaking bad news even if it is my first time meeting the patient, I feel they have the right to have their questions answered, even if it's not the ideal setting. I try to quickly adapt to optimize the setting (take a seat, etc)
4月10日、17日に、かんわとーくオンライン研修会が行われ、12人の医師が参加しました。 参加者の感想をいくつかシェアします。 「事前学習→実践→フィードバックの流れがよかったのと、他の参加者の言葉の使い方なども学べてよかったです。」 続→
@snakagawa_md What do you do when you’re asked a question you’re not prepared to/didn’t plan to answer? For example when a patient asks you for their prognosis before a final diagnosis is made? Or during your first time meeting them and you shouldn’t be the one delivering the news?
@snakagawa_md We're so lucky to have you and I hope this thread leads to even more compliments. You deserve them all!
@snakagawa_md So well deserved honor. Congratulations @snakagawa_md 🎊
We are so proud of you!!! #sinaiproud #geripc @snakagawa_md @MSHSGeriPalCare
It was probably the day I received the most compliments in my life. I received so many compliments that I don't need any more for the rest of my life. Being praised for what you love to do. You cannot ask for more. Appreciate support from my family and colleagues.
Does the Indian setup have a similar award? Consultant/Lecturer of the year @ShreerajT sir?
It was probably the day I received the most compliments in my life. I received so many compliments that I don't need any more for the rest of my life. Being praised for what you love to do. You cannot ask for more. Appreciate support from my family and colleagues.
Well Deserved. Congratulations 👏
It was probably the day I received the most compliments in my life. I received so many compliments that I don't need any more for the rest of my life. Being praised for what you love to do. You cannot ask for more. Appreciate support from my family and colleagues.
@snakagawa_md So well deserved. Thank you for your work and for all of your sharing!
@snakagawa_md Congrats and well deserved!
＜6月研修会 キャンセル枠のお知らせ＞ キャンセル枠は1名様分です。 ご希望の方はお早めにお願いいたします！ passmarket.yahoo.co.jp/event/show/det…
@snakagawa_md どうしても、内容的にsensitiveな側面があると思いますし、うちは、普通にやっているので、今更な感じがあります。
🇯🇵で生命維持装置（人工呼吸器や循環補助装置を含む）を意図的に終了することへの議論
京都の日本集中治療学会@jsicm50_2023、PD06「集中治療室でのwithdraw/withholdにまつわる課題」を聴講し、日本でwithdrawalを進めるのは険しい、と感じた。 発言したかったが時間がなかったので、ここで述べる。 大きな問題は2つある。 1/
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