I read Farah Stockman’s article in the NYT on why attacks on DEI will cost us all, and thought, “Yes, and ‘everyone’ includes harm to our healthcare workforce, our patients, and their families.”

So we’re delighted that Farah Stockman, pulitzer prize winning journalist, author of American Made: What Happens to People When Work Disappears, and editorial board member at the New York TImes joins us to set the bigger picture for this discussion. Farah provides clear examples from the Biden administration, in which having the most diverse cabinet in history was critical to building bridges, empathy, and inspiring others to feel included.

We are also pleased to welcome Ali Thomas, a hospitalist, member of the Baha'i Faith, leader of anti-racism efforts in the Pacific Northwest, and founder of the BIPOC Health Careers Ecosystem. Ali talks about the history of affirmative action, which started as a program for Whites, the importance of diversity in the healthcare workforce, the history of allyship and cross cultural collaboration, and his own efforts to provide opportunity and support for historically oppressed groups in his own community to obtain healthcare careers.

And Ken Covinsky, avid baseball fanatic, joins us and notes that the day we record (April 15) is Jackie Robinson day. Many may be familiar with the story of Jackie Robinson breaking the color barrier in major league baseball in 1947, but may not be aware of the tremendous adversity Jackie Robinson faced, and persistence he displayed, off the field.

We address many things, including:

• The movement in Corporate America and institutes of higher education to implement DEI programming in the wake of George Floyd

• The general agreement in America of the value of diversity, and disagreement, unpopularity, and backlash about DEI as it was implemented

• How the pursuit of diversity and excellence are not in tension, they are aligned and necessary for each other

• What we can do to build bridges across differences

There was so much we hoped to talk about and didn’t get to, but I will link to now, including: Ali’s mom’s personal history with and study of school desegregation in South Carolina, Farah’s mom’s pioneering work as a speech language pathologist, and Ken’s perspectives on the importance of studying ageism and racism in research.

What a Wonderful World could be sung in irony at this moment. I hope we all take it literally, with the hope this podcast ends with.

-Alex Smith

Early in my research career, I was fascinated by the (then) frontier area of palliative care in the emergency department. I asked emergency medicine clinicians what they thought when a patient who is seriously ill and DNR comes to the ED, and some responded, (paraphrasing), what are they doing here? This is not why I went into emergency medicine. I went into emergency medicine to act. I can’t do the primary thing I’ve been trained to do: ABC, ABC, ABCs. Most emergency providers wanted to do the right thing for seriously ill patients, but they didn’t have the knowledge, skills, or experience to do it.

Today we focus on an intervention, published in JAMA, that gave emergency clinicians basic palliative care knowledge, training, and skills. We talk with Corita Grudzen and Fernanda Bellolio about their cluster stepped wedge randomized trial of a palliative care intervention directed at emergency clinicians. They got training in Vital Talk and ELNEC. They got a decision support tool that identified hospice patients or those who might benefit from a goals of care discussion. They got feedback.

So did it matter? Hmmm….it depends. We are fortunate to have Tammie Quest, emergency and palliative trained and long a leader in this space, to help us unpack and contextualize these findings.

Today we discuss:

• Why the study was negative for the primary (hospitalization) and all secondary outcome (e.g. hospice use).

• Why to emergency clinicians, this study was a wild success because they had the skills they wanted/needed to feel like they could do the right thing (during the onset of Covid no less).

• Why this study was a success due to the sheer size (nearly 100,000 patients in about 30 EDs) of the study, and the fact that, as far as the investigators know, all study sites continue to employ the clinical decision support tool.

• What is a cluster stepped wedge randomized trial?

• Were they surprised by the negative findings?

• How do we situate this study in the context of other negative primary palliative care interventions, outside the ED? E.g. Yael Shenker’s negative study of primary palliative care for cancer, Randy Curtis’s negative study of a Vital Talk-ish intervention, Lieve Van den Block’s negative study of primary PC in nursing homes. Why do so many (most, all??) primary palliative care interventions seem to fail, whereas specialized palliative care interventions have a relatively robust track record of success. Should we give up on primary palliative care? What’s next for primary palliative care interventions in the ED?

And if your Basic Life Support training certification is due, you can practice the correct chest compression rate of 110 beats per minute to Another One Bites the Dust.

-Alex Smith

Whelp, goodbye folks! Eric and I have been DOGE’d.

In a somewhat delayed April Fools, Nancy Lundebjerg and Annie Medina-Walpole have taken over podcast host duties this week.

Their purpose is to interview me, Eric, and Ken Covinsky about your final AGS literature review plenary session taking place at the Annual Meeting in Chicago this May (for those attending, our session is the plenary the morning of May 10). We discuss our favorite articles, parody songs, and memories from AGS meetings past, with a little preview of a song for this year’s meeting.

We covered:

• The first parody song I wrote, for AGS 2018 in Orlando, about this article by Nancy Schoenborn on how to discuss stopping cancer screening.

• Ken’s favorite articles, including

• • The Impact of Rudeness on Medical Team Performance: A Randomized Trial

  • Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization

• Eric’s favorite article on the effect of chair placement on physicians’ behavior and patients’ satisfaction

• Tim Anderson’s study on the intensification of older adults’ outpatient blood pressure treatment at hospital discharge

• Nancy’s favorite topic and parody song, Aducanumab, which won Drug of the Year in 2021.

Enjoy! And maybe, just maybe, Eric and I will be reinstated and return as hosts next week…

-Alex Smith