PC for Patients with Substance Use Disorder: Janet Ho, Sach Kale, Julie Childers
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
51 min
2 speakers
4 chapters
transcribed 9 hours ago
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What makes caring for patients with serious illness and opioid use disorder so challenging?
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Welcome to the Jerry Pal podcast. This is Eric Wadera. This is Alex Smith. And Alex, who do we have on today? We
are delighted to welcome back Janet Ho, who is a palliative care doc and addiction medicine doc and associate professor at UCSF. Janet, welcome back to the Jerry Pal podcast.
Thank you so much.
And we're delighted to welcome Such Calais, who is a palliative care doc at the Ohio State University, Wexner Medical Center. Such, welcome to JerryPal. Thank you very much. And we're delighted to welcome Julie Childers, who's a palliative care doc and addiction medicine specialist and professor of medicine at the University of Pittsburgh. Julie, welcome to the JerryPell Podcast.
Thanks for having me.
So we're gonna be talking about caring for people with serious illness and substance abuse. Um
you mean substance use disorder. Substance use disorder. Oh my god, I
actually have substance use here and my medical training kicked in to say the wrong word. I know
Deeply ingrained. That's what it that's what it was when we were in med school 'cause we were in med school at the same time, same place. Yeah. I think drug use is what we got. We had the wrong terms drilled into us. We just unlearn what we have learned. Like
narcotics. I remember as a fellow, I would come in and our nurse practitioner on our hospice team, I would say the word to Patrice uh narcotics and she would for a half an hour she would just lay into me. Since then I've ever stopped using the word narcotics uh because that so I just need this, Janet. I need you to correct me every time I say the wrong word.
Listeners, I totally did that on purpose. Yeah. Right. Ver well planned. Yeah, role play.
Who has a song request for Alex before we talk about substance use disorder and serious illness?
Uh I do.
What is the song request at?
The song is called The Drugs Don't Work by the Verb.
Other than the title being perfect for this any other reason you picked this song?
Yeah, the the singer initially wrote the song actually to himself, uh, during the depths of an addiction to heroin. And then eventually the song evolved and the lyrics changed and it's supposedly also about his grief with the loss of his father after a long illness. So I just thought it resonated nicely with the issues about addiction and palliative care that we'll be talking about today.
Great choice.
All this talk of getting old It's getting me down my line. Like a cat in a fame. Waiting to drown this time I'm coming down. And I hope you think enough. You lay down by your side. Now the drugs don't work, they just make you worse, but I know I'll see your face again. Now the drugs don't work, they just make you worse. But I know I'll see your face again.
Oh, that was great. Thank you. Thank you.
Great song choice.
Yeah.
I'm gonna open it up to actually all three of you. I guess first one responds gets the the first response. But you know, I've talked to a lot of palliative care providers, a lot of people caring for people with serious illness. Uh myself too. I find this a very hard population to care for, which probably says more about me than than them, this combination of substance use disorder and a serious illness. Why do you think that that is a common feeling amongst those who care for serious illness? Or do do you disagree?
I don't think it's it's only those who care for serious illness. I think it is just about any clinician. Yeah, I see this in the hospital when I'm doing addiction medicine consults. Folks with uncontrolled substance use disorder typically are very impulsive, you know, they're often angry, they often have behavioral issues um stemming from their disorder, their life circumstances all sort of feeding into each other. And so I think, you know, for anybody it is difficult.
Thank you for that question and for how you framed it. I think um Danny Chamas actually just wrote a piece in Annals and that was called Wishing for a No Show, where she talked about examining, you know, counter transference that we bring into a visit.
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Chapters
4 chapters
1
What makes caring for patients with serious illness and opioid use disorder so challenging?
0:00–19:59
2
How does counter‑transference affect clinicians treating this population?
19:59–36:35
3
Why did Sach Kale create an outpatient substance‑use clinic for cancer patients and how is it structured?
36:35–47:59
4
What are the core principles of harm‑reduction that can be applied in palliative care?
47:59–51:25
Speakers
2 identifiedMore from GeriPal - A Geriatrics and Palliative Medicine Podcast
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