Influence of Hospital Culture on Intensity of Care: Liz Dzeng
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
47 min
5 speakers
7 chapters
transcribed 8 hours ago
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What motivated Liz Dzeng to study hospital culture and end‑of‑life care intensity?
Welcome to the JerryPal Podcast. This is Eric Wadera.
This is Alex Smith.
And Alex, I see two people with us. One in the room with me, too.
One in the room with you. Um joining us by Zoom.
What what's going on in your background? That's not your usual room too. You got a piano there. Oh, I I think we're in for a
lot to talk about. Um I'll do introductions first. So Liz Zhang is a sociologist and hospitalist associate professor of medicine at UCSF, and she's our guest today. Welcome, Liz.
Thanks. I'm really excited to be here.
And joining us as she has many times, and Kelly's a social worker at the San Francisco VA. Welcome back.
I'll take it from here. To be back. Thanks.
Alex is a little off his game because what what happened to your your arm, Alex?
I broke my hand. Yeah. Broke my hand. Yeah. I would say
that that's his podcasting head too. So
I'm not playing guitar. For those of you who are but listening on YouTube, I'm gonna play the piano. For those of you who are listening to the recording only, that's probably most of you, my son Kai is gonna play the guitar part on the song.
Wonderful. Liz, given that we're talking about the song, do you have a song request for Alex?
I do indeed. Um, proud Mary.
Why did you pick Brad Mary?
So this paper is about um uh there well some aspects of this paper around clinical momentum and things around defaults and that sort of thing. And so when I was thinking about the paper, writing it. uh conceptualizing it. I always kept thinking of like whitewater rafting, like we're sort of we we're on this raft and we just go down the river. We can't stop ourselves. Sometimes I think about salmon swimming upstream and some of the uh things as well. And so kind of wanted to go with the river theme. And you know, I think uh this song kind of encapsulates that a bit.
Great. Great. Alex, hit it.
Left a good job in the city. Working for the man every night and day And I never lost one minute seatbelt, worrying about the way things might happen. Big wheel keep on turning. Primary keep on burning. Rollin'. Roll it. Rollin' on the river. Cleaned a lot of plates in Memphis.
How did Liz’s training in the US and UK shape her research perspective?
Funct a lot of pain down in New Orleans. But I never saw the good side of the city Till I hitched a ride on the river boat Queen. Think we'll keep on turning. Primary keep on burning Roll it! Roll it. Rollin' on the river.
Nice job, Alex. Very impressive.
Yeah. And for our listeners, excellent job, Kai. So uh Liz, let's jump into the topic. So uh we're gonna have a link to the article that you published in Jamma IM titled Hospital Culture and Intensity of End of Life Care at Three Academic Hospitals. But before we go into that particular article, how did you get interested in this as a topic around hospital culture, the variations that we see? And why we have those variations?
Yeah, so um I think a lot of this came from my own experiences. Um, as many of us who are trainees in medicine, we go to different uh institutions throughout our training, medical school, residency, fellowship, um, wherever we end up for our careers. So for me, uh I started off at one particular institution for medical school and went to another and noticed quite a few differences and actually That particular institution, um, I also became very interested in what um the the uh interventions that we give near the end of life, and in particular. life sustaining treatments near the end of life that might potentially be um more harmful than beneficial.
What kind of differences did you see?
Um, so well, I I think it's interesting because the ways that we actually, as trainees and residents, provide care near the end of life and the way that we communicate to patients are influenced by the way that we're trained in the hospital, what we see with different attendings. And I think when we're in those environments, we actually don't notice that that's what we're doing, uh, that we're actually very much influenced by what's around us. And it's only when we go to a different institution that we're like, oh, actually things are a bit different. And then you sort of get used to that.
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Chapters
7 chapters
1
What motivated Liz Dzeng to study hospital culture and end‑of‑life care intensity?
0:00–2:40
2
How did Liz’s training in the US and UK shape her research perspective?
2:40–11:27
3
What methods were used to compare the three hospitals in the JAMA Internal Medicine study?
11:27–19:06
4
Which institutional factors create high‑intensity versus low‑intensity end‑of‑life care cultures?
19:06–27:40
5
How does moral distress manifest among clinicians in high‑intensity hospitals?
27:40–36:51
6
What role do palliative‑care teams play in shaping hospital culture and care intensity?
36:51–44:29
7
What practical steps can hospitals take to shift from a high‑intensity to a low‑intensity culture?
44:29–47:10
Speakers
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