1. #hpm
Healthcare Hashtag Twitter Transcript
From: Wed Apr 20 17:55:00 PDT 2011
To: Wed Apr 20 19:05:00 PDT 2011
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PracticalWisdom It's almost that time. 4minute count down to tired fingers, wired brain, and collective
Wisdom. I can't wait. #HPM
Wed Apr 20 17:56:39 PDT 2011
PracticalWisdom We want others 2 c us competent, not just nice.RT@doclake Powervs.Warmth
applies 2 way #hpm prac. interacts @bedsidehttp://is.gd/OI5cqH #HPM
Wed Apr 20 18:00:31 PDT 2011
equijada Hi everyone. For the next 6 min, I'll be in #hpm tweetchat. Come join the discussion.
#hpm
Wed Apr 20 18:01:02 PDT 2011
equijada @PracticalWisdom Hi Lisa, good to see you here #hpm
Wed Apr 20 18:01:25 PDT 2011
PracticalWisdom Interested Pt Educ.RT@DianeEMeier:RT @ctsinclairNews/Research UPDATES: U.S.
FDA Releases Long-Awaited Opioid-REMS http://hpm.md/g2AncC #HPM
Wed Apr 20 18:01:26 PDT 2011
RossJeanette hi @equijada only 6 minutes? #hpm
Wed Apr 20 18:01:54 PDT 2011
KathyKastner What about the other 54 minutes :)RT @equijada: Hi everyone. For the next 6 min, I'll
be in #hpm tweetchat. Come join the discussion. #hpm
Wed Apr 20 18:02:02 PDT 2011
PracticalWisdom My Pleasure. Thanks for being our Host. RT @equijada: @PracticalWisdom Hi Lisa,
good to see you here #HPM
Wed Apr 20 18:02:28 PDT 2011
equijada @KathyKastner ha, i mean for the next 60 min! #hpm
Wed Apr 20 18:02:46 PDT 2011

2. PracticalWisdom @KathyKastner @equijada 54 Fun with our Friends. Brain Candy for All #HPM
Wed Apr 20 18:03:01 PDT 2011
KathyKastner Wheewh. worried for a mo RT @equijada: @KathyKastner ha, i mean for the next 60
min! #hpm
Wed Apr 20 18:03:16 PDT 2011
equijada @RossJeanette Hi Jeanette! 60 min...thinking faster than I type. Welcome. Good to
see you here #hpm
Wed Apr 20 18:03:26 PDT 2011
FMDGirl Hi everyone- listening in. Kari- RN/pt advocate #HPM
Wed Apr 20 18:04:10 PDT 2011
KathyKastner H Lisa ! RT @PracticalWisdom:@equijada 54 Fun with our Friends. Brain Candy for
All #HPM
Wed Apr 20 18:04:20 PDT 2011
equijada @FMDGirl Hi Kari, welcome. #hpm
Wed Apr 20 18:04:54 PDT 2011
PracticalWisdom @equijada: Hoping our Man from Down Under will join us tonight. The Rascal
@Hughstephens. #HPM
Wed Apr 20 18:05:14 PDT 2011
revdoc Pam Harris MD with Kansas City Hospice; also an ordained minister #hpm
Wed Apr 20 18:05:32 PDT 2011
SheyontheBay Hello all, glad to see you #hpm
Wed Apr 20 18:06:31 PDT 2011
equijada @PracticalWisdom will start with t1 in a min or so. Join us @hughstephens.
Welcome Pam. Good to see you #hpm
Wed Apr 20 18:06:35 PDT 2011
revdoc Good to tweet with y'all #hpm
Wed Apr 20 18:07:09 PDT 2011
equijada @SheyontheBay hi, good to see you. long time! #hpm
Wed Apr 20 18:07:12 PDT 2011
PracticalWisdom @KathyKastner I'm always glad to see you. #HPM
Wed Apr 20 18:07:34 PDT 2011
teaminspire Hi everyone--listening in, looking to learn--John Novack, Inspire (online patient
support communities) #HPM
Wed Apr 20 18:07:45 PDT 2011

3. hughstephens @PracticalWisdom @equijada still looking for cat :( might not make #hpm
Wed Apr 20 18:08:01 PDT 2011
equijada t1: It's 420! What is the role of marijuana in patients with life threatening illness?
#happy420 #hpm
Wed Apr 20 18:08:02 PDT 2011
equijada For those not familiar with 420 The True Story Of How April 20 Became 'Weed Day'
http://huff.to/hmP832 #hpm
Wed Apr 20 18:08:41 PDT 2011
equijada 420 (cannabis culture) - Wikipedia, the free encyclopedia http://bit.ly/f5aOqV #hpm
Wed Apr 20 18:08:49 PDT 2011
SheyontheBay @equijada @SheyontheBay yes, sorry about that - lots going on in life!! ;) #hpm
Wed Apr 20 18:08:57 PDT 2011
equijada @hughstephens welcome! #hpm
Wed Apr 20 18:09:06 PDT 2011
revdoc T1--I am actually not very impressed with Marinol for sx control #hpm
Wed Apr 20 18:09:12 PDT 2011
FMDGirl t1- question dear to my heart- close friend passed away from Fredrich ataxia- not
legal, but only think that helped #HPM
Wed Apr 20 18:09:41 PDT 2011
KathyKastner Clearly I need glasses. I put an 'e' in the middle of sx RT @revdoc: T1--I am actually
not very impressed with Marinol for sx control #hpm
Wed Apr 20 18:10:19 PDT 2011
revdoc Although Marinol does help for the wasting syndrome associated with AIDS #hpm
Wed Apr 20 18:10:21 PDT 2011
SheyontheBay Dating myself: i remember teaching chemo pts how to smoke a joint, circa 1980!!!
#hpm
Wed Apr 20 18:10:23 PDT 2011
equijada @FMDGirl if you don't mind, can you expand on the experience? what did it help?
#hpm
Wed Apr 20 18:10:34 PDT 2011
equijada I think that data on marinol and marijuana are actually different. Not sure. #hpm
Wed Apr 20 18:11:27 PDT 2011
revdoc Can't speak to the effect of Marinol on sex... #hpm
Wed Apr 20 18:11:43 PDT 2011

4. equijada @SheyontheBay was it helpful? #hpm
Wed Apr 20 18:11:46 PDT 2011
DianeEMeier RT @doclake: Power poses vs. Warmth poses-good research that applies to the way
a #hpm practitioner interacts @ the bedside http://is.gd ...
Wed Apr 20 18:11:49 PDT 2011
revdoc In Kansas, marijuana is not legal, so we are stuck with Marinol #hpm
Wed Apr 20 18:12:13 PDT 2011
equijada Cannabis use in palliative care http://bit.ly/huBHGx A nice review #hpm
Wed Apr 20 18:12:56 PDT 2011
FMDGirl Yes, fredrich ataxia causes spasms- traditional meds did not help- up front with docs
about using it, pts should be able use medically #HPM
Wed Apr 20 18:13:53 PDT 2011
SheyontheBay @equijada@SheyontheBayIf they could get past the 'criminality' it helped, esp w/
nausea.po tabs seemed to get neutralized by gastric jc #hpm
Wed Apr 20 18:14:17 PDT 2011
equijada @FMDGirl I hear that a lot from patients taking it. #hpm
Wed Apr 20 18:14:40 PDT 2011
SheyontheBay Wasnt legal in Florida either... We ignored the smell of pot wafting down the corridor
#hpm
Wed Apr 20 18:15:13 PDT 2011
DianeEMeier RT @doclake: The New Old Age: A Mother’s Nighttime Rage http://is.gd/ciHsMe
delirium #hpm
Wed Apr 20 18:15:24 PDT 2011
equijada It's legal in CA (I'm in CA). There are so many dispensaries. Many times the pts using
don't seem legit. Hard to balance. #hpm
Wed Apr 20 18:16:14 PDT 2011
RossJeanette thanks for the information on 420. Since marijuana is ilegal in Texas I have no
experience w/ this. #hpm
Wed Apr 20 18:17:15 PDT 2011
FMDGirl Plus- it increases appetite, Dave- my friend wrote a book:http://amzn.to/hYJGVk #HPM
Wed Apr 20 18:17:28 PDT 2011
drpippa Only anecdotal evidence Has been helpful for folks. Hard to balance legit use vs illicit
use. Would prob not feel comfortable rxing #Hpm
Wed Apr 20 18:17:36 PDT 2011
revdoc SAME ISSUE WITH OTHER PAIN MEDS RT @equijada: Its legal in CA (Im in CA).
Many times the pts using dont seem legit. Hard to balance. #hpm
Wed Apr 20 18:17:58 PDT 2011

5. drpippa @equijada Nice choice of topic for the day! #Hpm
Wed Apr 20 18:18:03 PDT 2011
equijada I've let patients use it. I don't have a problem with it. I do get uncomfortable when they
are using pot and oxyfast gets lost. #hpm
Wed Apr 20 18:18:32 PDT 2011
FMDGirl @equijada How is it different from managing any other chronic patient that is on pain
meds? #HPM
Wed Apr 20 18:18:40 PDT 2011
equijada @FMDGirl thanks for the link. I'm going to check it out. #hpm
Wed Apr 20 18:19:02 PDT 2011
SheyontheBay @equijada Have no idea how it was used or abused in the home. Hospital pts had to
provide their own -> no quality control #hpm
Wed Apr 20 18:19:04 PDT 2011
revdoc FDA proposing REMS on ALL opiates because of issues of abuse or diversion
http://hpm.md/g2AncC #hpm #hpm
Wed Apr 20 18:19:07 PDT 2011
PracticalWisdom Sorry had internet problems Kerri great to see you. #HPM
Wed Apr 20 18:19:22 PDT 2011
equijada @FMDGirl it's not. I have to risk assess just like opioids. #hpm
Wed Apr 20 18:19:35 PDT 2011
BuddhishMD @NYTimeskrugman Language is so important - it sometimes feels like the world of
money and business has completely co-opted our lives. #hpm
Wed Apr 20 18:20:13 PDT 2011
equijada @FMDGirl I think the main difference is basically legal but in terms of prescribing -
same as opoioids #hpm
Wed Apr 20 18:20:27 PDT 2011
equijada @drpippa ha! thanks. #hpm
Wed Apr 20 18:20:49 PDT 2011
FMDGirl @equijada pt on ms for cancer- it made him confused and he cut his feeding tube in
half without realizing it- thought it was a string #HPM
Wed Apr 20 18:20:54 PDT 2011
PracticalWisdom RT @drpippa: Only anecdotal evid. Has been helpful 4 folks. Hard 2 balance legi use
vsillicit use.Would prob not feel comfortable rxing #HPM
Wed Apr 20 18:21:10 PDT 2011
PracticalWisdom RT @FMDGirl: @equijadapton ms 4 cancer- made him confused& he cut his feeding
tube in 1/2 without realizing it- thought it was a string #HPM

6. Wed Apr 20 18:21:48 PDT 2011
equijada @PracticalWisdom @drpippa @AAHPM doesn't have an official stand on marijuana.
Interesting discussion in Vancouver #hpm
Wed Apr 20 18:22:02 PDT 2011
PracticalWisdom Rascal Topic for sure. I knew this would be a good one. RT @drpippa: @equijada
Nice choice of topic for the day! #HPM
Wed Apr 20 18:22:17 PDT 2011
FMDGirl easy to balance legal use, RX from an MD- get from a hospital pharmacy #HPM
Wed Apr 20 18:22:27 PDT 2011
drpippa Still disappointed i missed it! RT @equijada: @AAHPM doesnt have an official stand
on marijuana. Interesting discussion in Vancouver #Hpm
Wed Apr 20 18:23:09 PDT 2011
equijada RT @FMDGirl: easy to balance legal use, RX from an MD- get from a hospital
pharmacy #hpm
Wed Apr 20 18:23:20 PDT 2011
drpippa RT @FMDGirl: easy to balance legal use, RX from an MD- get from a hospital
pharmacy #Hpm
Wed Apr 20 18:23:44 PDT 2011
equijada Moving on to t2 in a min or so #hpm
Wed Apr 20 18:23:52 PDT 2011
PracticalWisdom @equijada @drpippa @AAHPM T1: When I taught Pharmacology (Basic) 100 years
ago Marijuana was complicated Dep/Stim Sometimes Hallacu? #HPM
Wed Apr 20 18:24:01 PDT 2011
revdoc RT @FMDGirl: easy to balance legal use, RX from an MD- get from a hospital
pharmacy [PEOPLE CAN LIE ABOUT SXS USING LEGAL SOURCES] #hpm
Wed Apr 20 18:24:10 PDT 2011
hollyby Hi all! I don't rx it. Still a conflict btwn state & federal law. Not worth my DEA license.
#hpm
Wed Apr 20 18:24:19 PDT 2011
RossJeanette @equijada was the MJ discussion in Vancouver a specific session? I bought the
Audio recording #hpm
Wed Apr 20 18:24:25 PDT 2011
PracticalWisdom @PracticalWisdom: Is this still true? complicated? #HPM
Wed Apr 20 18:24:52 PDT 2011
equijada RT @hollyby: Hi all! I dont rx it. Still a conflict btwn state & federal law. Not worth my
DEA license. #hpm
Wed Apr 20 18:24:53 PDT 2011

7. FMDGirl I do have a stand I do not use it- I would like to know it is available if I have a terrible
stroke, should be MY choice not my states #HPM
Wed Apr 20 18:24:57 PDT 2011
hollyby Lurking tonight, but wanted to say hello! Hugs to all! #hpm
Wed Apr 20 18:25:07 PDT 2011
mpf2011 @ctsinclair Have fun. #HPM
Wed Apr 20 18:25:08 PDT 2011
PracticalWisdom Who wants another Hassle!RT @hollyby: Hi all! I dont rx it. Still a conflict btwn state &
federal law. Not worth my DEA license. #HPM
Wed Apr 20 18:25:27 PDT 2011
ctsinclair RT @drpippa: Only anecdotal evidence Has been helpful for folks. Hard to balance
legit use vs illicit use. Would prob not feel comfortable rxing #Hpm
Wed Apr 20 18:25:28 PDT 2011
equijada @RossJeanette yes, I forget the speakers name. Husband/wife team. Totally
supported MJ but data equivocal #hpm
Wed Apr 20 18:25:31 PDT 2011
KathyKastner RT @FMDGirl: I do have a stand I do not use it- I would like to know it is available if I
have a terrible stroke, should be MY choice not my states #HPM
Wed Apr 20 18:25:43 PDT 2011
mpf2011 RT @hospice_doctor: Aggressive treatment at the end of life, but where is the
patient? New blog post: http://hospicedoctor.blogspot.com #palliative #hpm
Wed Apr 20 18:25:46 PDT 2011
revdoc @ctsinclair Thought you were at concert? #hpm
Wed Apr 20 18:26:00 PDT 2011
FMDGirl @revdoc @FMDGirl yes-people lie all the time to get narcs- but that should not
prevent people who need pain relief from getting it #HPM
Wed Apr 20 18:26:46 PDT 2011
PracticalWisdom PT Rights!RT @FMDGirl: I do have a stand I do not use it-I would like know it's ava.if I
a stroke, should be MY choice not my states #HPM
Wed Apr 20 18:26:47 PDT 2011
PracticalWisdom In the Lobby, Conversation too Good to be left out!RT @revdoc: @ctsinclair Thought
you were at concert? #HPM
Wed Apr 20 18:27:23 PDT 2011
KathyKastner RT @FMDGirl: @revdoc @FMDGirl yes-people lie all the time to get narcs- but that
should not prevent people who need pain relief from getting it #HPM
Wed Apr 20 18:27:32 PDT 2011
equijada t2 via @mpf2011 and @practicalwisdom - how do you communicate and advocate
AD when what's said isn't what's done http://bit.ly/eU8wq5 #hpm
Wed Apr 20 18:27:42 PDT 2011

8. revdoc @FMDGirl No argument; but having done chronic pain tx for years, it is not as simple
as it seems #hpm
Wed Apr 20 18:27:59 PDT 2011
FMDGirl @PracticalWisdom @FMDGirl EXACTLY Lisa- PT RIGHTS! Your better at this
tweeting than me ;) #HPM
Wed Apr 20 18:28:00 PDT 2011
PracticalWisdom Nope I'm older have more insurance.RT @FMDGirl:@PracticalWisdom@FMDGirl
EXACTLY Lisa-PT RIGHTS! Your better at this tweeting than me ;) #HPM
Wed Apr 20 18:28:52 PDT 2011
equijada @mpf2011 @practicalwisdom In this story, pt was "DNR" but her goals and wishes
weren't exactly known #hpm
Wed Apr 20 18:28:53 PDT 2011
joshgriffin RT @FMDGirl: @revdoc @FMDGirl yes-people lie all the time to get narcs- but that
should not prevent people who need pain relief from getting it #HPM
Wed Apr 20 18:29:02 PDT 2011
FMDGirl @revdoc @FMDGirl yes, understand it is not easy, but either is living with pain- we
must go the extra mile to ensure pt safety #HPM
Wed Apr 20 18:29:06 PDT 2011
revdoc @FMDGirl Unfortunately, my experience with legislation to promote "safety" is that it
makes my life a living hell! #hpm
Wed Apr 20 18:30:03 PDT 2011
equijada RT @revdoc: @FMDGirl No argument; but having done chronic pain tx for years, it is
not as simple as it seems #hpm
Wed Apr 20 18:30:19 PDT 2011
drpippa T2- I try to get family talking about the person, not the disease. Get an idea of what
they were like before. Helps inform #Hpm
Wed Apr 20 18:30:54 PDT 2011
PracticalWisdom @equijada @mpf2011 @practicalwisdom: Frankly this ink unglued me. Why was her
DNR not respected? Where was Clergy/Ethics. #HPM
Wed Apr 20 18:30:57 PDT 2011
SheyontheBay T2. In 140 characters?really? #hpm
Wed Apr 20 18:31:12 PDT 2011
revdoc T2 Encourage pt conversation with families, not relying on a piece of paper. Make
sure your decision makers KNOW what you want #hpm
Wed Apr 20 18:31:18 PDT 2011
equijada @SheyontheBay lol #hpm
Wed Apr 20 18:31:39 PDT 2011
FMDGirl @revdoc @FMDGirl Agreed!!! That is why you have us nurses to do the paper work-

9. FMDGirl @revdoc @FMDGirl Agreed!!! That is why you have us nurses to do the paper work-
he he :) #HPM
Wed Apr 20 18:31:51 PDT 2011
mpf2011 @equijada How was the pt DNR? She had a signed document?? Noted in Notes?
#hpm
Wed Apr 20 18:31:59 PDT 2011
PracticalWisdom T2: If a Pt does everything legally & your desire is not respected What (fill in the Blank)
is going on. Seems like ego got in the way #HPM
Wed Apr 20 18:32:17 PDT 2011
SheyontheBay @equijada ;D #hpm
Wed Apr 20 18:32:32 PDT 2011
revdoc T2 Encourage pt conv w/ families, not relying on a piece of paper. Make sure your
decision makers KNOW what you want B4 they need info #hpm
Wed Apr 20 18:32:38 PDT 2011
equijada @revdoc It seems when healthcare providers are told to #havethetalk it's interpreted
as #signthepaper #hpm
Wed Apr 20 18:32:41 PDT 2011
drpippa RT @revdoc: Encourage pt conversation with families, not relying on a piece of paper.
Make sure decision makers KNOW what you want #Hpm
Wed Apr 20 18:32:46 PDT 2011
PracticalWisdom THey Did RT @revdoc: T2 Encourage pt con. w/ families, not relying on a piece of
paper. Make sure your decision makers KNOW what Uwant #HPM
Wed Apr 20 18:32:56 PDT 2011
FMDGirl t2 question- did not get the link to work- can some one fill me in? #HPM
Wed Apr 20 18:33:07 PDT 2011
revdoc @FMDGirl @revdoc Unfortunately, I am the housecall doc, so when I show up I AM
the IDT! #hpm
Wed Apr 20 18:33:09 PDT 2011
equijada @mpf2011 it was in her advance directive #hpm
Wed Apr 20 18:33:15 PDT 2011
PracticalWisdom http://hospicedoctor.blogspot.com/RT @FMDGirl: t2 question- did not get the link to
work- can some one fill me in? #HPM
Wed Apr 20 18:33:45 PDT 2011
KathyKastner I'd LOL but it's true RT @equijada: @revdoc It seems when healthcare providers are
told 2 #havethetalk interpreted as #signthepaper #hpm
Wed Apr 20 18:33:46 PDT 2011
SheyontheBay Respectingchoices.org. Worksheet to #havethetalk #hpm
Wed Apr 20 18:33:48 PDT 2011

10. drpippa So true. RT @equijada: @revdoc It seems when healthcare providers are told to
#havethetalk its interpreted as #signthepaper #Hpm
Wed Apr 20 18:34:29 PDT 2011
mpf2011 RT @equijada: @mpf2011 it was in her advance directive #hpm | Was the pt
conscious? Was family disputing it?
Wed Apr 20 18:34:42 PDT 2011
revdoc T2 Not saying it doesn't happen, but I still think there are more problems not naming
DPOA than having AD ignored #hpm
Wed Apr 20 18:34:53 PDT 2011
RossJeanette T2 bringing the person "in to the room" helps me understand better what makes life
meaningful and make care recommendations #hpm
Wed Apr 20 18:34:59 PDT 2011
equijada @FMDGirl sorry, try this http://bit.ly/eU8wq5 #hpm
Wed Apr 20 18:35:10 PDT 2011
PracticalWisdom Is this a Legal Doc? Could there be Legal Challenges. RT @equijada: @mpf2011 it
was in her advance directive #HPM
Wed Apr 20 18:35:19 PDT 2011
PracticalWisdom RT @drpippa: So true.RT @equijada: @revdoc It seems when healthcare providers
are told to #havethetalk its interpreted as #signthepaper #HPM
Wed Apr 20 18:35:37 PDT 2011
equijada @FMDGirl in short - an elderly lady was "DNR" but no mentions of goals, wishes.
Received aggressive care dialysis etc that didn't work #hpm
Wed Apr 20 18:35:55 PDT 2011
revdoc As DPOA I did have to bully 4 providers into stopping aggressive care for my father
despite my telling them his QOL was unacceptable #hpm
Wed Apr 20 18:36:26 PDT 2011
equijada @revdoc there is good data that DPOA undergo significant stress and don't follow
through thus AD. #hpm
Wed Apr 20 18:36:35 PDT 2011
equijada @RossJeanette yes, agree. #hpm
Wed Apr 20 18:37:36 PDT 2011
PracticalWisdom T2: Interesting Quote: How the health care system slants inexorably toward
aggressive intervention regardless of the context. #HPM
Wed Apr 20 18:37:39 PDT 2011
mpf2011 @PracticalWisdom Here is the blog link: http://hospicedoctor.blogspot.com/ #HPM
Wed Apr 20 18:37:40 PDT 2011
equijada @revdoc tough. You were able to advocate. Most people aren't as strong. #hpm
Wed Apr 20 18:38:13 PDT 2011

11. PracticalWisdom RT @revdoc:As DPOA I did have 2 bully 4 providers stopping aggressive care 4 my
father despite my telling them his QOL was unacceptable #HPM
Wed Apr 20 18:38:15 PDT 2011
revdoc @PracticalWisdom Yes legal provisions for ADs in all states as well as for
recognizing ADs legally enacted from others #hpm
Wed Apr 20 18:38:23 PDT 2011
FMDGirl @PracticalWisdom @FMDGirl Thanks Lisa! T2- We do take the Humanity out of
charting - why don't we include spiritual assessment in chart #HPM
Wed Apr 20 18:38:23 PDT 2011
RossJeanette T2 sometimes teams pursue certain care b/cause they want to finish what was
started eg "need 2 full weeks on vent for pneumonia Rx" #hpm
Wed Apr 20 18:38:35 PDT 2011
PracticalWisdom @mpf2011: Thanks, I read it think FMDGirl Wanted it. #HPM
Wed Apr 20 18:38:54 PDT 2011
drpippa Need to address doc side. Why do so many insist that aggressive, curative is only
legit model of care? We can model alternatives #Hpm
Wed Apr 20 18:38:55 PDT 2011
revdoc @equijada @revdoc It was sheer hell. #hpm
Wed Apr 20 18:39:12 PDT 2011
equijada @FMDGirl @PracticalWisdom agree, well said. #hpm
Wed Apr 20 18:39:30 PDT 2011
revdoc Stress on DPOA is often because we don't recognize the dying--we need to teach
what dying looks like to learners! #hpm
Wed Apr 20 18:39:50 PDT 2011
PracticalWisdom RT @drpippa: Need 3 address MD side. Why do so many insist aggressive, curative
is only legit model of care? We can model alternatives #HPM
Wed Apr 20 18:40:01 PDT 2011
equijada @drpippa modeling is our best model. #hpm
Wed Apr 20 18:40:01 PDT 2011
mpf2011 #hpm Unfortunately, even if pts sign an AD, the family hasn't talked to the pt. They
don't want to let go despite a "piece of paper."
Wed Apr 20 18:40:01 PDT 2011
equijada t3 coming up in a min or so. #hpm
Wed Apr 20 18:40:20 PDT 2011
drpippa RT @revdoc: Stress on DPOA is often because we dont recognize the dying--we
need to teach what dying looks like to learners! #Hpm

12. need to teach what dying looks like to learners! #Hpm
Wed Apr 20 18:40:23 PDT 2011
equijada RT @revdoc: Stress on DPOA is often because we dont recognize the dying--we
need to teach what dying looks like to learners! #hpm
Wed Apr 20 18:41:04 PDT 2011
mpf2011 #hpm So much better if the talk is fully documented (and sometimes taped). Family
members present too.
Wed Apr 20 18:41:07 PDT 2011
drpippa Deep thoughts for a weds. RT @equijada: @drpippa modeling is our best model.
#Hpm
Wed Apr 20 18:41:10 PDT 2011
PracticalWisdom T2: I so Strongly Believe we so need you Pal MD's to gather more
Power/Recognition/Understanding to help prevent this from happening. #HPM
Wed Apr 20 18:41:27 PDT 2011
revdoc Not many families would advocate for aggressive care they can't even spell if docs
did not tell them their loved ones needed it #hpm
Wed Apr 20 18:41:42 PDT 2011
equijada @drpippa lol! Sincerely, Stuart Handy. #hpm
Wed Apr 20 18:41:44 PDT 2011
KathyKastner Gr8 ideas RT @mpf2011: #hpm So much better if the talk is fully documented (and
sometimes taped). Family members present too.
Wed Apr 20 18:41:58 PDT 2011
KathyKastner RT @revdoc: Stress on DPOA is often because we don't recognize the dying--we
need to teach what dying looks like to learners! #hpm
Wed Apr 20 18:42:19 PDT 2011
mpf2011 @PracticalWisdom When I was an ICU nurse, before becoming an atty, curative tx
was the only option. #HPM
Wed Apr 20 18:42:30 PDT 2011
gailliardadults RT @doclake: The New Old Age: A Mother’s Nighttime Rage http://is.gd/ciHsMe
delirium #hpm
Wed Apr 20 18:42:36 PDT 2011
equijada @KathyKastner @mpf2011 I end up just placing "quotes" in my note and just type out
the narrative. #hpm
Wed Apr 20 18:42:48 PDT 2011
PracticalWisdom RT@KathyKastner:Gr8 ideas RT @mpf2011: #hpmSo much better if talk is fully
documented (and sometimes taped). Family members present 2. #HPM
Wed Apr 20 18:42:58 PDT 2011
KathyKastner RT @mpf2011: #hpm So much better if the talk is fully documented (and sometimes
taped). Family members present too.#eldercarechat
Wed Apr 20 18:43:11 PDT 2011

13. PracticalWisdom RT @equijada: @KathyKastner @mpf2011 I end up just placing "quotes" in my note
and just type out the narrative. #HPM
Wed Apr 20 18:43:29 PDT 2011
mpf2011 @PracticalWisdom I think docs see Palli as "giving up" which is shown by saying
"there's nothing more we can do." Should add "to cure." #HPM
Wed Apr 20 18:43:46 PDT 2011
equijada t3: How has caring for those in death and dying effected your personal life? I think
about this a lot #hpm
Wed Apr 20 18:43:56 PDT 2011
PracticalWisdom @PracticalWisdom @KathyKastner @mpf2011: Maybe include a section in a
persons Facebook Page. #HPM
Wed Apr 20 18:44:09 PDT 2011
FMDGirl health care providers need more education on process of dying, if they are scared of
it- they will practice heroic measures #HPM
Wed Apr 20 18:44:42 PDT 2011
joshgriffin RT @FMDGirl: health care providers need more education on process of dying, if they
are scared of it- they will practice heroic measures #HPM
Wed Apr 20 18:45:11 PDT 2011
KathyKastner RT @mpf2011: @PracticalWisdom I think docs see Palli as "giving up" which is
shown by saying "there's nothing more we can do." Should add "to cure." #HPM
Wed Apr 20 18:45:13 PDT 2011
equijada RT @FMDGirl: health care providers need more education on process of dying, if they
are scared of it-they will practice heroic measures #hpm
Wed Apr 20 18:45:16 PDT 2011
drpippa T3 - absoultely would not do what I do if it were not for my personal experiences.
#Hpm
Wed Apr 20 18:45:27 PDT 2011
PracticalWisdom @mpf2011 Yes, the Cure sometimes is Enough is Enough. #HPM
Wed Apr 20 18:45:28 PDT 2011
mpf2011 #hpm Our culture is trained by tv commercials to believe there is a cure (pill) for
everything. We don't accept death well as part of life.
Wed Apr 20 18:45:35 PDT 2011
KathyKastner RT @mpf2011: #hpm Our culture is trained by tv commercials to believe there is a
cure (pill) for everything. We don't accept death well as part of life.
Wed Apr 20 18:45:52 PDT 2011
equijada DITTO! It's changed my life RT @drpippa: T3 - absoultely would not do what I do if it
were not for my personal experiences. #hpm
Wed Apr 20 18:46:10 PDT 2011
#HPM There is still a lingering fear of litigation, I think. Despite documentation of pt

14. #HPM There is still a lingering fear of litigation, I think. Despite documentation of pt
mpf2011 wishes.
Wed Apr 20 18:46:20 PDT 2011
FMDGirl t3 I am no longer afraid of death or dying #HPM
Wed Apr 20 18:46:37 PDT 2011
hospiceMTBC t3: (Hi, folks!) Working in #hpm helps me enjoy the moment & go with the flow more
in my life.
Wed Apr 20 18:47:33 PDT 2011
revdoc I elected artificial feed 4 my father s/p ICH, leading to 8.5 yrs of disability, then death
from ruptured appy. HPM kept me sane. #hpm
Wed Apr 20 18:47:35 PDT 2011
equijada t3: I've seen love in action. It absolutely blows my mind. #hpm
Wed Apr 20 18:47:42 PDT 2011
KathyKastner RT @Paulflevy: Palli Care on WIHI: Palli Care = Quali Care 21/4,2:- 3PM Eastern
TimeGue... http://bit.ly/ggJqEB #hpm
Wed Apr 20 18:47:49 PDT 2011
revdoc RT @FMDGirl: t3 I am no longer afraid of death or dying. THERE ARE A LOT WORSE
THINGS THAN DEAD #hpm
Wed Apr 20 18:47:55 PDT 2011
FMDGirl Have learned there can be dignity in death #HPM
Wed Apr 20 18:47:58 PDT 2011
mpf2011 #hpm Plus docs tend to focus on their "body system" so nephro says to family
"kidneys are better today" and they hear "pt is better."
Wed Apr 20 18:48:05 PDT 2011
equijada @hospiceMTBC hi, welcome. I love the moment. #hpm
Wed Apr 20 18:48:16 PDT 2011
KathyKastner AMEN RT @revdoc: RT @FMDGirl: t3 I am no longer afraid of death or dying. THERE
ARE A LOT WORSE THINGS THAN DEAD #hpm
Wed Apr 20 18:48:25 PDT 2011
PracticalWisdom Seen this so many times. Courage Too!RT @FMDGirl: Have learned there can be
dignity in death #HPM
Wed Apr 20 18:48:43 PDT 2011
PracticalWisdom RT @equijada: t3: Ive seen love in action. It absolutely blows my mind. #HPM
Wed Apr 20 18:48:54 PDT 2011
FMDGirl @revdoc @FMDGirl you can say that again- why as a society are we so afraid- is
because people are afraid of hell? Religion play a part? #HPM
Wed Apr 20 18:49:18 PDT 2011

15. equijada t3: I've learned about my Higher Power #hpm
Wed Apr 20 18:49:24 PDT 2011
PracticalWisdom RT @equijada: DITTO! Its changed my life RT @drpippa: T3 absoultely would not do
what I do if it were not 4 my personal experiences. #HPM
Wed Apr 20 18:49:25 PDT 2011
revdoc I have seen healings, reconciliation, courage, love--I should PAY to do this work. (But
don't tell my boss, I have a mortgage) #hpm
Wed Apr 20 18:50:21 PDT 2011
PracticalWisdom Accept the things I cannot change Keeps me balanced. RT @equijada: t3: Ive learned
about my Higher Power #HPM
Wed Apr 20 18:50:27 PDT 2011
drpippa Sometimes miracles. RT @equijada: t3: Ive seen love in action. It absolutely blows
my mind. #Hpm
Wed Apr 20 18:50:38 PDT 2011
equijada @FMDGirl @revdoc just finished reading Love Wins by Rob Bell re: hell. Religion has
done a disservice #hpm
Wed Apr 20 18:50:43 PDT 2011
mpf2011 #hpm It is the HPM team that has 2 teach how 2 see pt holistically, rather thn the sum
of body systems. LOOK at the pt. not go thru motions.
Wed Apr 20 18:50:43 PDT 2011
revdoc @FMDGirl Not always, but that can be one aspect. People not grounded in anything
besides here and now #hpm
Wed Apr 20 18:50:59 PDT 2011
revdoc RT @equijada: just finished reading Love Wins by Rob Bell re: hell. Religion has
done a disservice [not all of us are like that!] #hpm
Wed Apr 20 18:51:36 PDT 2011
PracticalWisdom T3: Was a clergy Wife for 13 years. Have seen families in their last moments at Re:
worst and best. Learned not to sweat small Stuff #HPM
Wed Apr 20 18:51:39 PDT 2011
AmandaBinDC RT @ctsinclair: Pain-Topics.org News/Research UPDATES: U.S. FDA Releases
Long-Awaited Opioid-REMS http://hpm.md/g2AncC #HPM
Wed Apr 20 18:51:49 PDT 2011
RossJeanette T3 I feel very priviledged in working with people at a difficult time. It makes my
problems seem minor. #hpm
Wed Apr 20 18:51:58 PDT 2011
KathyKastner RT @equijada: @FMDGirl @revdoc just finished reading Love Wins by Rob Bell re:
hell. Religion has done a disservice #hpm
Wed Apr 20 18:52:13 PDT 2011
Book Club? RT @equijada: @FMDGirl @revdoc just finished reading Love Wins by

16. Book Club? RT @equijada: @FMDGirl @revdoc just finished reading Love Wins by
PracticalWisdom Rob Bell re: hell. Religion has done a disservice #HPM
Wed Apr 20 18:52:31 PDT 2011
FMDGirl @revdoc @FMDGirl great point- I brought that up because when I was a child I was
so scared of death, sunday school...impressionable #HPM
Wed Apr 20 18:52:45 PDT 2011
PracticalWisdom @equijada @FMDGirl @revdoc: What was the main Lesson? #HPM
Wed Apr 20 18:53:02 PDT 2011
SheyontheBay @equijada wow.... #hpm
Wed Apr 20 18:53:05 PDT 2011
hospiceMTBC T3: Denial=suffering, letting go=peace. #hpm
Wed Apr 20 18:53:17 PDT 2011
FMDGirl @KathyKastner @equijada @FMDGirl @revdoc I will have to read it! #HPM
Wed Apr 20 18:53:23 PDT 2011
equijada @FMDGirl @revdoc totally. #hpm
Wed Apr 20 18:53:41 PDT 2011
phlu RT @doclake: Power poses vs. Warmth poses-good research that applies to the way
a #hpm practitioner interacts @ the bedside http://is.gd ...
Wed Apr 20 18:53:48 PDT 2011
PracticalWisdom T3: Learned we can be alive but Dead. #HPM
Wed Apr 20 18:54:00 PDT 2011
equijada @FMDGirl check it out. History is not tragic, in the end, love wins. #hpm
Wed Apr 20 18:54:02 PDT 2011
FMDGirl @hospiceMTBC you said it well #HPM
Wed Apr 20 18:54:07 PDT 2011
PracticalWisdom RT @hospiceMTBC: T3: Denial=suffering, letting go=peace. #HPM
Wed Apr 20 18:54:21 PDT 2011
revdoc RT @PracticalWisdom: What was the main Lesson? We have only the present:
laugh, love, do your best, don't trade today waiting 4 2morro #hpm
Wed Apr 20 18:54:52 PDT 2011
PracticalWisdom Idea to read book discuss on #HPM later time? RT @FMDGirl: @KathyKastner
@equijada @FMDGirl @revdoc I will have to read it! #HPM
Wed Apr 20 18:55:00 PDT 2011
RT @hospiceMTBC: T3: Denial=suffering, letting go=peace. #HPM

17. RT @hospiceMTBC: T3: Denial=suffering, letting go=peace. #HPM
Wed Apr 20 18:55:02 PDT 2011
FMDGirl
RossJeanette got to leave now! goodbye nice tweetchat hosting Earl! #hpm
Wed Apr 20 18:55:10 PDT 2011
equijada @equijada @FMDGirl it's this out of this world love I see at the bedside of death (on
occasion). #hpm
Wed Apr 20 18:55:36 PDT 2011
FMDGirl @PracticalWisdom @FMDGirl @KathyKastner @equijada @FMDGirl @revdoc Iam
in! #HPM
Wed Apr 20 18:55:47 PDT 2011
PracticalWisdom Thank you! RT @revdoc: RT @PracticalWisdom: We have only the
present:laugh/love/do your best, dont trade 2day waiting 4 2morro #HPM
Wed Apr 20 18:55:54 PDT 2011
drpippa Love this idea!RT @PracticalWisdom: Idea to read book discuss on #HPM later
time? ! #Hpm
Wed Apr 20 18:55:57 PDT 2011
mpf2011 #HPM Sadly, ppl don't know how hard it is to take away treatment once started. If u
can't breathe, pee or eat on your own, u r dying!!
Wed Apr 20 18:55:58 PDT 2011
equijada Final thoughts and parting words of wisdom...Thanks all. #hpm
Wed Apr 20 18:56:02 PDT 2011
PracticalWisdom Good Night Thanks RT @RossJeanette: got to leave now! goodbye nice tweetchat
hosting Earl! #HPM
Wed Apr 20 18:56:07 PDT 2011
equijada @RossJeanette good to see you again. Thanks for coming. #hpm
Wed Apr 20 18:56:18 PDT 2011
FMDGirl forgiveness and acceptance and death comes peacefully #HPM
Wed Apr 20 18:56:43 PDT 2011
PracticalWisdom @FMDGirl: Lam In? I don't get it? #HPM
Wed Apr 20 18:56:46 PDT 2011
KathyKastner Too true! RT @mpf2011: #HPM Sadly, ppl don't know how hard it is to take away
treatment once started. #eldercarechat
Wed Apr 20 18:56:57 PDT 2011
PracticalWisdom RT @KathyKastner: Too true! RT @mpf2011: #HPM Sadly, ppl dont know how hard it
is to take away treatment once started. #eldercarechat #HPM
Wed Apr 20 18:57:27 PDT 2011

18. PracticalWisdom RT @FMDGirl: forgiveness and acceptance and death comes peacefully #HPM
Wed Apr 20 18:57:31 PDT 2011
FMDGirl @PracticalWisdom @FMDGirl opps- I am in- read the book and chat- pick a date :)
#HPM
Wed Apr 20 18:57:38 PDT 2011
revdoc Thanks for hosting, Earl! #hpm
Wed Apr 20 18:57:42 PDT 2011
equijada RT @FMDGirl: forgiveness and acceptance and death comes peacefully #hpm
Wed Apr 20 18:57:49 PDT 2011
PracticalWisdom T3: I'm afraid to live in Pain don't think I'm afraid to die. #HPM
Wed Apr 20 18:57:53 PDT 2011
hospiceMTBC Thank you, all, for the work you do & the passion you bring to the bedside. #hpm
Wed Apr 20 18:57:55 PDT 2011
equijada @revdoc thanks for coming. #hpm
Wed Apr 20 18:58:28 PDT 2011
PracticalWisdom @hospiceMTBC: Thank you!!!! #HPM
Wed Apr 20 18:58:46 PDT 2011
FMDGirl RT @hospiceMTBC: Thank you, all, for the work you do & the passion you bring to the
bedside. #HPM
Wed Apr 20 18:58:51 PDT 2011
drpippa @equijada thanks for a night of thought and feeling! Great hosting. #Hpm
Wed Apr 20 18:58:55 PDT 2011
KathyKastner Final thoughts: thanks Earl @equijada for gr8 hosting. Thanks to all #hpm-ers for the
learning.
Wed Apr 20 18:59:13 PDT 2011
mpf2011 #HPM Thanks everyone. Great chat.
Wed Apr 20 18:59:15 PDT 2011
equijada @drpippa thanks! hope to catch you next week. happy week to you. #hpm
Wed Apr 20 18:59:32 PDT 2011
FMDGirl @PracticalWisdom that is why we need to legalize medical marijuana #HPM
Wed Apr 20 18:59:41 PDT 2011
equijada Good night all. Thanks again! #hpm
Wed Apr 20 19:00:06 PDT 2011

19. Wed Apr 20 19:00:06 PDT 2011
kathydavisku Catrina Lootens and Marilyn Sampilo sentn in great proposal to SDBP on student
school reentry for kids with chronic conditions. #pedpc #hpm
Wed Apr 20 19:00:13 PDT 2011
KUKidsHP Catrina Lootens and Marilyn Sampilo sent in great proposal to SDBP on student
school reentry for kids with chronic conditions. #pedpc #hpm
Wed Apr 20 19:00:13 PDT 2011
PracticalWisdom So complicated. I'm neutral on this 1 but not Pt RightsRT @FMDGirl:
@PracticalWisdom that is why we need to legalize medical marijuana #HPM
Wed Apr 20 19:00:28 PDT 2011
revdoc Goodnight, all! Blessings of Passover and Easter to my Jewish and Christian friends!
#hpm
Wed Apr 20 19:00:37 PDT 2011
amyrnbsn RT @FMDGirl: health care providers need more education on process of dying, if they
are scared of it- they will practice heroic measures #HPM
Wed Apr 20 19:00:44 PDT 2011
FMDGirl Wow! That was the fastest tweet hour ever- you picked all my favorite topics! Thank
you everyone for your wisdom. #HPM
Wed Apr 20 19:00:49 PDT 2011
FMDGirl @revdoc thank you for inspiring words, it was a pleasure to meet you. #HPM
Wed Apr 20 19:01:32 PDT 2011
revdoc @FMDGirl @revdoc You too! #hpm
Wed Apr 20 19:02:07 PDT 2011
PracticalWisdom @equijada: Thank you for Hosting tonight. You added your own Flavor/Wisdom.
Having different Hosts I think adds a great deal! Thanks #HPM
Wed Apr 20 19:02:10 PDT 2011
PracticalWisdom AGree 100RT @FMDGirl: Wow! That was the fastest tweet hour ever- you picked all
my favorite topics! Thank you everyone for your wisdom. #HPM
Wed Apr 20 19:02:23 PDT 2011
PracticalWisdom Agree! RT @FMDGirl: @revdoc thank you for inspiring words, it was a pleasure to
meet you. #HPM
Wed Apr 20 19:02:33 PDT 2011
PracticalWisdom @FMDGirl Tonight makes me realize how much I've missed you. O.K. enough mushy
Gooshy from me. My Amazing Friend. #HPM
Wed Apr 20 19:03:17 PDT 2011
PracticalWisdom Quaker Girl Say Keeping in the LIght! RT @revdoc: Goodnight, all! Blessings of
Passover and Easter to my Jewish and Christian friends! #HPM
Wed Apr 20 19:04:21 PDT 2011

20. FMDGirl @PracticalWisdom Miss you too! I was so excited when I saw your tweet about #HPM
I so happy I follow you! Your awesome Lisa!
Wed Apr 20 19:04:40 PDT 2011