Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF July 17, 2015 | Archived Issues

P & T Approvals, FDA Warnings About Codeine-Containing Meds, NSAIDs, Proglycem

Pharmacy Focus

See highlights of the June meeting of the Pharmacy and Therapeutics Committee. Also, the U.S. Food and Drug Administration has issued warnings about codeine-containing medicines in children, nonsteroidal anti-inflammatory drugs and Proglycem in infants.

» Read more


Meetings and Events


Grand Rounds

Click here to view upcoming grand rounds.


Upcoming CME Conferences

Click below to view a complete list of all scheduled Continuing Medical Education conferences.

CME Newsletter - July 2015 (PDF)


Milestones

Do you know of a significant event in the life of a medical staff member? Please let us know, and we'll post these milestones in Medical Staff Pulse. Also, feel free to submit comments on milestones, and we'll post the comments in the next issue. Click here to email us your milestones and comments.

Share Your News

Won any awards or had an article accepted for publication? Share your news about professional achievements and other items of interest.

Click here to share your news

Physicians Educate About End-of-Life Plans

Cedars-Sinai physicians Jonas Green, MD, MPH, (left) and Daniel J. Stone, MD, MPH, MBA, engaged in some role-playing about end-of-life discussions.

Nearly everyone who dies in the small town of La Crosse, Wisconsin, has an advance directive or similar documentation of their end-of-life wishes. In fact, some 96 percent of La Crosse residents have put their wishes in writing, compared to about 30 percent nationally.

While acknowledging that it's far more difficult to break down the cultural taboo against discussing death in a city of 10 million, Jonas Green, MD, MPH, and Daniel J. Stone, MD, MPH, MBA, are determined to bring about a significant increase in the number of Los Angeles residents who have discussed their end-of-life wishes with their loved ones, physicians and others, and written them down in an Advance Healthcare Directive.

The goal of engaging the community in Cedars-Sinai's effort to make advance care planning a standard part of healthcare brought the two physicians to Temple Isaiah on June 2. After Senior Rabbi Zoë Klein introduced them to about 30 congregants from her synagogue and from nearby Temple Emanuel, Green and Stone led a two-hour discussion on advance care planning and end-of-life conversations.

"This is one area where retrospect doesn't do any good. We have to plan ahead to make sure we and our family members do not go through unnecessary suffering at the end of life," said Stone, medical director of the Cedars-Sinai Medical Group.

"In La Crosse, Wisconsin, they talk about death very openly," said Green, associate medical director for Clinical Effectiveness at the Cedars-Sinai Medical Network. "But in L.A., most of us don't know what our friends, neighbors or even our loved ones are thinking about the end of life. It's not an easy conversation to start — even for physicians. Our purpose today is to make it easier for you to have this conversation with those closest to you, and to give you some tools to help others do the same."

Green and Stone are partnering with Rabbi Laura Geller, senior rabbi of Temple Emanuel (who was joined at the event by Rabbi Jonathan Aaron of Temple Emanuel), and Klein to help train their congregants to serve as lay educators who can assist others in communicating their end-of-life wishes through conversations and advance directives. The two physicians are in the early stages of collaborating with L.A. religious organizations of various faiths to educate the public about advance care planning.

On June 2, they added a bit of drama to their presentation by sitting across from each other and engaging in some role-playing to show how a conversation about the end of life might go. Green initiated the simulated conversation with Stone, who showed the reticence that is so common by saying, "I should tell you up front that this conversation is really my wife's idea. How about having a beer and watching the Dodger game with me instead?"

The audience laughed, and Green kept the conversation on course, saying, "I will make this as comfortable as possible for you, and I'm glad we're having this conversation, because 90 percent of the time, people at the end of life haven't documented their wishes so their family members will know what they want."

Green used Cedars-Sinai's Advance Healthcare Directive booklet as a guide throughout the conversation, and encouraged the audience to do the same.

Andrea Baum is among audience members who left the event with a resolve to start discussing end-of-life issues and completing advance directives with loved ones. The Beverly Hills resident said she has never talked with her 89-year-old father about his values or preferences regarding end-of-life care. What she learned from Green and Stone will help her initiate a conversation she hasn't been able to start.

"My dad doesn't like to talk about personal things, but if he believes I know what I'm talking about, he will trust me," she said. "It helps to know there's a structured way to approach this using the advance directive — and that there's no one right way to have the conversation. It also gives me peace of mind to realize that dealing with death is a part of life."

Previously in Medical Staff Pulse:

Straight Talk About End-of-Life Decisions (May 8, 2015)