This document contains a transcript of tweets from a Twitter chat about healthcare and palliative medicine using the hashtag #hpm. Various participants introduced themselves and their locations and backgrounds. They then discussed definitions of suffering, with suggestions that suffering is subjective and unique to each individual's experience, and is caused by anything that causes distress including diseases, treatments, and impacts on one's life. The importance of determining the source of suffering from the patient's perspective was emphasized.

1. #hpm
Healthcare Hashtag Twitter Transcript
From: Wed May 25 18:00:00 PDT 2011
To: Wed May 25 19:00:00 PDT 2011
Customize transcript dates and layout
Learn more about #hpm at The Healthcare Hashtag Project
Kaviraj2 RT @renee_berry: hey everyone, won't be able to make #hpm tonight, hope you have
a great chat!
Wed May 25 18:00:19 PDT 2011
EOLnavigator We will be tweeting about hospice & palliative care topics relevant to caregivers for
the next hour. #hpm
Wed May 25 18:00:31 PDT 2011
jfclearywisc Jim cleary from Madison WI #hpm
Wed May 25 18:00:45 PDT 2011
aliciabloom MSW, LSW focusing on #palliative care program development & increasing #hospice
access through clinical education at @VITASHospice #hpm
Wed May 25 18:01:43 PDT 2011
MarksPhone Mark from NYC #hpm
Wed May 25 18:01:43 PDT 2011
EOLnavigator Hey there! @jfclearywisc, @Kaviraj2, @MeredithGould #hpm
Wed May 25 18:01:56 PDT 2011
dockj Kevin from Wilmington NC #hpm and family med Ed. Tweets are my own opinion.
Wed May 25 18:02:35 PDT 2011
EOLnavigator Hi! Glad you made it. @aliciabloom, @marksphone #hpm
Wed May 25 18:02:36 PDT 2011
doctatum Paul in Columbia MO (and another day with tornados just cleared out) #hpm
Wed May 25 18:03:07 PDT 2011
MarksPhone it was a real learning experience last week wanted to return and learn more #hpm

2. MarksPhone
Wed May 25 18:03:10 PDT 2011
EOLnavigator Hi Kevin @dockj #hpm
Wed May 25 18:03:13 PDT 2011
dockj Next hour tweets tagged #hpm part of palliative medicine and hospice tweetchat
Wed May 25 18:03:20 PDT 2011
EOLnavigator Topic 1 coming soon.... #hpm
Wed May 25 18:03:30 PDT 2011
EOLnavigator Glad it was! RT @MarksPhone: it was a real learning experience last week wanted to
return and learn more #hpm
Wed May 25 18:03:46 PDT 2011
revdoc Pam Harris, MD w/KC Hospice, ordained minister; joining HPM tweetchat; opinions
are my own #hpm
Wed May 25 18:03:47 PDT 2011
KathyKastner health blogger, with (it seems increasing) interest in all things #hpm (hence recent
post abt dying)http://tinyurl.com/3oqam2v
Wed May 25 18:03:56 PDT 2011
dockj @doctatum glad you are safe. Hope everyone there is OK. #hpm
Wed May 25 18:04:07 PDT 2011
EOLnavigator Hi @doctatum, @revdoc #hpm
Wed May 25 18:04:12 PDT 2011
EOLnavigator T1: As a caregiver, how do you define "suffering" & what influences your beliefs about
suffering? #hpm
Wed May 25 18:04:24 PDT 2011
PracticalWisdom HI Lisa Speaker/Trainer Myers-Briggs/Leadership/Creativity/Presentation/Adult Educ.
Morph the ho-hum into compelling. Curious/Connector #HPM
Wed May 25 18:04:37 PDT 2011
PracticalWisdom Yes, I forgot if you were close. Sorry for Mo folks! RT @dockj: @doctatum glad you are
safe. Hope everyone there is OK. #HPM
Wed May 25 18:05:22 PDT 2011
EOLnavigator @practicalwisdom Glad you made it! #hpm
Wed May 25 18:05:57 PDT 2011
revdoc T1 Suffering is pain/fear/sadness w/o meaning #hpm
Wed May 25 18:05:58 PDT 2011
jfclearywisc Are we talking clinical or family caregivers? #hpm

3. jfclearywisc
Wed May 25 18:06:29 PDT 2011
doctatum @PracticalWisdom @dockj @doctatum Thanks. RedCross doing a good job. More
bad new in Sedalia today. #hpm
Wed May 25 18:06:32 PDT 2011
MarksPhone T1 Do we project what feel and believe, or as observers do we alter what we observe
or do we apply society beliefs? #hpm
Wed May 25 18:06:34 PDT 2011
SheyontheBay Hello all - hospice/palliative nurse NY #hpm
Wed May 25 18:06:43 PDT 2011
aliciabloom suffering is: anything causing distress, multifaceted (physical, emotional, spiritual)
and unique to the individual experiencing it #hpm
Wed May 25 18:06:46 PDT 2011
EOLnavigator Interesting. Why w/o meaning? RT @revdoc: T1 Suffering is pain/fear/sadness w/o
meaning #hpm
Wed May 25 18:06:49 PDT 2011
GailZahtz Trying to participate in #HPM -my first love medical chat- yet it's been hard to show-up
lately. Intro- patient, care-giver, etc
Wed May 25 18:07:04 PDT 2011
PracticalWisdom So Sorry. RT @doctatum: @PracticalWisdom @dockj @doctatum Thanks. RedCross
doing a good job. More bad new in Sedalia today. #HPM
Wed May 25 18:07:19 PDT 2011
EOLnavigator Our thoughts are with our friends affected by the tornado. Anyone here tonight? #hpm
Wed May 25 18:07:20 PDT 2011
PracticalWisdom RT @MarksPhone: T1 Do we project what feel and believe, or as observers do we
alter what we observe or do we apply society beliefs? #HPM
Wed May 25 18:07:30 PDT 2011
SheyontheBay If there's meaning, does it mean there's no suffering? #hpm
Wed May 25 18:07:38 PDT 2011
EOLnavigator @GailZahtz Thanks for coming! #hpm
Wed May 25 18:07:47 PDT 2011
KathyKastner RT @aliciabloom: suffering is: anything causing distress, multifaceted (physical,
emotional, spiritual) and unique to the individual experiencing it #hpm
Wed May 25 18:07:51 PDT 2011
PracticalWisdom @GailZahtz: So Glad you could come. #HPM
Wed May 25 18:08:10 PDT 2011

4. EOLnavigator @SheyontheBay Hey there! #hpm
Wed May 25 18:08:14 PDT 2011
GailZahtz T1- Suffering is only without meaning if we don't look for and find meaning in our pain
and challenges #HPM
Wed May 25 18:08:14 PDT 2011
revdoc Going through pain or other adverse situations can be brave, redemptive, or a growth
experience; w/o meaning, it is just cruel #hpm
Wed May 25 18:08:16 PDT 2011
GailZahtz @PracticalWisdom Thanks! I really miss you and everyone else. #HPM was my first
home. Always in my heart, even if I'm not here!
Wed May 25 18:08:50 PDT 2011
aliciabloom suffering can result not only from a disease, but its treatment and the impact it has on
a person's life #hpm
Wed May 25 18:09:04 PDT 2011
SheyontheBay @revdoc But there'/ still suffering, yes? #hpm
Wed May 25 18:09:11 PDT 2011
GailZahtz @EOLnavigator Thank you for the welcome. are you moderating #HPM
Wed May 25 18:09:12 PDT 2011
EOLnavigator RT @aliciabloom: suffering is: anything causing distress, multifaceted & unique 2 the
individ experiencing it #hpm
Wed May 25 18:09:22 PDT 2011
revdoc Meaning does not erase all pain, but I think it takes things from the realm of suffering
to other experiences #hpm
Wed May 25 18:09:22 PDT 2011
KathyKastner RT @aliciabloom: suffering can result not only from a disease, but its treatment and
the impact it has on a person's life #hpm
Wed May 25 18:09:38 PDT 2011
EOLnavigator @GailZahtz Yes I am! #hpm
Wed May 25 18:09:53 PDT 2011
MeredithGould T1 Isn't suffering totally subjective? And don't we need to go with the definition of the
person who claims to be suffering? #hpm
Wed May 25 18:09:58 PDT 2011
dockj RT @aliciabloom: suffering can result not only from a disease, but its treatment and
the impact it has on a person's life #hpm
Wed May 25 18:10:00 PDT 2011
GailZahtz @revdoc We MUST give the pain and adversity meaning- otherwise it makes life
unbearable. #HPM
Wed May 25 18:10:15 PDT 2011

5. KathyKastner #hpm For a family caregiver, I think suffering includes seeing/perceving loved one
'giving up.'
Wed May 25 18:10:15 PDT 2011
EOLnavigator @GailZahtz Do you find it easy to know the source? #hpm
Wed May 25 18:10:43 PDT 2011
PracticalWisdom RT @MeredithGould: T1 Isnt suffering totally subjective? dont we need 2 go w/the
definition of the person who claims to be suffering? #HPM
Wed May 25 18:10:46 PDT 2011
MeredithGould @SheyontheBay My standard line is "not all suffering is redemptive." #hpm
Wed May 25 18:10:46 PDT 2011
aliciabloom as clinicians, we should always ask patients about the sources of their suffering so
that we can adequately address it & support them #hpm
Wed May 25 18:10:48 PDT 2011
SheyontheBay RT @MeredithGould: T1Isnt suffering totally subjective?dont we need to go with the
definition of the person who claims to be suffering? #hpm
Wed May 25 18:10:57 PDT 2011
MarksPhone @MeredithGould I agree it is the person suffering who defines it but as with all
language etc how is that communicated to the HCP? #hpm
Wed May 25 18:11:00 PDT 2011
EOLnavigator RT @aliciabloom: suffering can result not only from a disease, but its treatment and
the impact it has on a persons life #hpm
Wed May 25 18:11:24 PDT 2011
EOLnavigator RT @revdoc: Meaning does not erase all pain, but I think it takes things from the
realm of suffering to other experiences #hpm
Wed May 25 18:11:40 PDT 2011
GailZahtz @EOLnavigator To know the source for suffering? Some is easy- like a DX. Some
hard, like emotional impact. #HPM
Wed May 25 18:11:41 PDT 2011
MarksPhone @EOLnavigator agree it is multi-deminisonal and each is treated differently #hpm
Wed May 25 18:12:05 PDT 2011
KathyKastner RT @MeredithGould: T1 Isn't suffering totally subjective? And don't we need to go with
the definition of the person who claims to be suffering? #hpm
Wed May 25 18:12:19 PDT 2011
MeredithGould @MarksPhone We need to find out how the pt communicates, what language
system, nonverbal signals, etc. #hpm
Wed May 25 18:12:20 PDT 2011
MarksPhone RT @GailZahtz: @EOLnavigator To know the source for suffering? Some is easy- like
a DX. Some hard, like emotional impact. #HPM

6. Wed May 25 18:12:27 PDT 2011
PracticalWisdom T1: My Tweets are my own. Does anybody else want to Give this information? #HPM
Wed May 25 18:12:29 PDT 2011
EOLnavigator RT @MeredithGould +1: Isnt suffering totally subjective? dont we need 2 go w/the
definition of the person who claims to be suffering? #hpm
Wed May 25 18:12:29 PDT 2011
KathyKastner RT @MeredithGould: @MarksPhone We need to find out how the pt communicates,
what language system, nonverbal signals, etc. #hpm
Wed May 25 18:12:46 PDT 2011
GailZahtz @PracticalWisdom Yes, tweets are my own...trust me, with the fabulous groups I
represent, each have their own very strong opinions! :) #HPM
Wed May 25 18:13:27 PDT 2011
dockj T2 suffering is what the patient experiences when they are in distress they cannot
cope with. Regardless of the source. #hpm
Wed May 25 18:13:30 PDT 2011
EOLnavigator RT @aliciabloom: as clinicians, we always ask pts about the sources of suffering so
that we can adequately address it & support them #hpm
Wed May 25 18:13:31 PDT 2011
KathyKastner @MeredithGould I think I need to tell you I love you (for your mind of course) #hpm
Wed May 25 18:13:42 PDT 2011
aliciabloom asking open ended questions ("what is distressing you?" "tell me what troubles
you?") gives patients an opportunity to speak freely #hpm
Wed May 25 18:13:50 PDT 2011
PracticalWisdom RT @dockj: T2 suffering is what the patient experiences when they are in distress
they cannot cope with. Regardless of the source. #HPM
Wed May 25 18:14:01 PDT 2011
SheyontheBay @EOLnavigator @revdoc It can take things to another realm, but if it doesn't, there's
still suffering-be it physical, spiritual... #hpm
Wed May 25 18:14:03 PDT 2011
GLakesCaring RT @dockj: T2 suffering is what the patient experiences when they are in distress
they cannot cope with. Regardless of the source. #hpm
Wed May 25 18:14:04 PDT 2011
KathyKastner RT @dockj: T2 suffering is what the patient experiences when they are in distress
they cannot cope with. Regardless of the source. #hpm
Wed May 25 18:14:18 PDT 2011
dockj RT @aliciabloom: asking open ended questions ("what is distressing you?" "tell me
what troubles you?") gives patients an opportunity to speak freely #hpm
Wed May 25 18:14:23 PDT 2011

7. EOLnavigator RT @KathyKastner: @MeredithGould I think I need to tell you I love you (for your mind
of course) #hpm
Wed May 25 18:14:30 PDT 2011
MeredithGould Is there a T2? #hpm
Wed May 25 18:14:35 PDT 2011
GailZahtz T2 IMO opinion we need to add in people's cultural perspective to the event and the
relative suffering and communication of it. #HPM
Wed May 25 18:14:41 PDT 2011
PracticalWisdom RT @aliciabloom: asking open ended (?)'s ("what is distressing U?" "tell me what
troubles U?") gives patients an oppor. 2 speak freely #HPM
Wed May 25 18:14:44 PDT 2011
MeredithGould @KathyKastner So does that mean you do NOT love my hair, too? #hpm
Wed May 25 18:15:00 PDT 2011
EOLnavigator Suffering always spurs me to action as a clinician. #hpm
Wed May 25 18:15:16 PDT 2011
dockj Sorry mine was a miss answer. LoL should be T 1. #hpm
Wed May 25 18:15:19 PDT 2011
MarksPhone some patients want to put on a good face for the HCP show they are succeeding in tx
and making progress while outside HC they hurt #hpm
Wed May 25 18:15:20 PDT 2011
KathyKastner I covet your hair. RT @MeredithGould: @KathyKastner So does that mean you do
NOT love my hair, too? #hpm
Wed May 25 18:15:29 PDT 2011
dockj RT @EOLnavigator: Suffering always spurs me to action as a clinician. #hpm
Wed May 25 18:15:43 PDT 2011
EOLnavigator @MeredithGould No T2 yet....still on T1 #hpm
Wed May 25 18:15:54 PDT 2011
PracticalWisdom Yup, Not Blond. RT @KathyKastner: I covet your hair. RT @MeredithGould:
@KathyKastner So does that mean you do NOT love my hair, too? #HPM
Wed May 25 18:16:09 PDT 2011
GailZahtz @dockj T2 I don't think that suffering is distress that someone can't cope with. I think
that you may be coping- but it's hard! #HPM
Wed May 25 18:16:13 PDT 2011
MeredithGould @EOLnavigator Ok, thanks. #hpm
Wed May 25 18:16:21 PDT 2011

8. EOLnavigator Do you think culture or religion influences suffering? #hpm
Wed May 25 18:16:36 PDT 2011
MeredithGould BTW, @bentleystewart has a great post at http://healthfaith.com today re:
communicatng w/pts. #hpm
Wed May 25 18:16:59 PDT 2011
GailZahtz @MarksPhone In my experience, both hcp's and outsiders WANT us to be strong,
stoic, "brave" and that minimizes the reality of the pain #HPM
Wed May 25 18:17:16 PDT 2011
SheyontheBay @EOLnavigator Yes #hpm
Wed May 25 18:17:27 PDT 2011
KathyKastner A big yessrree bob to that RT @EOLnavigator: Do you think culture or religion
influences suffering? #hpm
Wed May 25 18:17:31 PDT 2011
revdoc I think culture and religion can teach us patterns of coping, give us resources to
stand up under adversity #hpm
Wed May 25 18:17:55 PDT 2011
EOLnavigator RT @dockj: T2 suffering is what the patient experiences when they are in distress
they cannot cope with. Regardless of the source. #hpm
Wed May 25 18:18:01 PDT 2011
KathyKastner Nice! RT @revdoc: I think culture and religion can teach us patterns of coping, give us
resources to stand up under adversity #hpm
Wed May 25 18:18:16 PDT 2011
aliciabloom "@EOLnavigator: Do u think culture/religion influences suffering?" yes. patient
perception & values are impacted by culture & religion #hpm
Wed May 25 18:18:36 PDT 2011
hollyby Hello all! At Upaya this week, so only lurking tonight! Have a great chat! #hpm
Wed May 25 18:18:41 PDT 2011
GailZahtz @dockj What is coping? In the face of tragedy- it's just getting up and dong the next
right thing. May not be pretty or clean... #HPM
Wed May 25 18:18:50 PDT 2011
SusanCadell I was very pleased to present research about caregiving parents in peds #palliative
care today @sickkids via @OTNtelemedicine #hpm #growth
Wed May 25 18:19:00 PDT 2011
MeredithGould Culture shapes the ways suffering is perceived and expressed, sure. #hpm
Wed May 25 18:19:03 PDT 2011
EOLnavigator @hollyby Thanks for coming! #hpm
Wed May 25 18:19:04 PDT 2011

9. revdoc Unfortunately, culture and religion can also provide NEGATIVE examples of coping
#hpm
Wed May 25 18:19:23 PDT 2011
jfclearywisc I actually find the question "are you suffering?" to be very powerful and revealing. Or to
ask it of family #hpm
Wed May 25 18:19:45 PDT 2011
GailZahtz @aliciabloom @EOLnavigator Yes, definitely said earlier, culture, religions, belief
system completely impact what and how we suffer #HPM
Wed May 25 18:19:47 PDT 2011
dockj Culture/ religion give us constructs to help us decode suffering in the context of
society, but it is still and individual experience. #hpm
Wed May 25 18:20:02 PDT 2011
PracticalWisdom Hey Meredith,“I’m hoping for a miracle soon. Quote in Blog
RT@MeredithGould.@bentleystewart has a great post at http://healthfaith.com #HPM
Wed May 25 18:20:14 PDT 2011
EOLnavigator RT @GailZahtz +1What is coping? In the face of tragedy- its just getting up & doing
the next right thing. May not be pretty or clean... #hpm
Wed May 25 18:20:28 PDT 2011
EOLnavigator Topic 2 coming in a jiffy..... #hpm
Wed May 25 18:20:41 PDT 2011
GailZahtz The book on the Hunan and their experience with medicine in the U.S. is a beautiful
example of the impact of culture on getting care. #HPM
Wed May 25 18:20:41 PDT 2011
MarksPhone America is death phobic this is the over arching driver of this discussion we do not
accept it therefore we dont want to mitigate it #hpm
Wed May 25 18:20:47 PDT 2011
MeredithGould RT @dockj: Culture/ religion give us constructs to help us decode suffering in the
context of society, #hpm
Wed May 25 18:21:00 PDT 2011
jfclearywisc "What do you mean by a miracle?" #hpm
Wed May 25 18:21:12 PDT 2011
EOLnavigator RT @jfclearywisc: I actually find the question "are you suffering?" to be very powerful
and revealing. Or to ask it of family #hpm
Wed May 25 18:21:20 PDT 2011
doctatum I think it reframes things for the family in conflctRT @jfclearywisc: the question "are
you suffering?" = very powerful and revealing. #hpm
Wed May 25 18:21:29 PDT 2011
culture and religion can be protective factors & sources of strength, but they can also

10. culture and religion can be protective factors & sources of strength, but they can also
aliciabloom create unique challenges and barriers #hpm
Wed May 25 18:21:38 PDT 2011
KathyKastner #hpm Religion caused my best pal great suffering when she felt baby's death was
god's punishment
Wed May 25 18:21:46 PDT 2011
EOLnavigator T2: How does your perspective on suffering affect how you care for someone who is
terminally ill? #hpm
Wed May 25 18:21:53 PDT 2011
revdoc @EOLnavigator @GailZahtz Up and dressed is a fine goal if that is the only place you
can be at the time #hpm
Wed May 25 18:22:08 PDT 2011
dockj RT @MarksPhone: America is death phobic this is the over arching driver of this
discussion we do not accept it therefore we dont want to mitigate it #hpm
Wed May 25 18:22:32 PDT 2011
DrSnit #hpm oh hai! Been watching hockey. Now I'm here!!! How goes cats? Xx missed you!
Wed May 25 18:22:35 PDT 2011
GailZahtz @MeredithGould @dockj @revdoc The real question isn't does culture/religion work-
how does it work for the individual patient and family #HPM
Wed May 25 18:22:43 PDT 2011
DoctorFisher @jfclearywisc Or even better "In what way are you suffering?" gives patient the open
door to talk #hpm
Wed May 25 18:22:45 PDT 2011
PracticalWisdom Sigh, how terrible.RT @KathyKastner: #hpm Religion caused my best pal great
suffering when she felt babys death was gods punishment #HPM
Wed May 25 18:22:51 PDT 2011
EOLnavigator @aliciabloom Irish Catholic (my background) always equate suffering with payment
for sins! #hpm
Wed May 25 18:22:52 PDT 2011
GLakesCaring RT @EOLnavigator: T2: How does your perspective on suffering affect how you care
for someone who is terminally ill? #hpm
Wed May 25 18:22:53 PDT 2011
EOLnavigator @DrSnit Hai there to you too! #hpm
Wed May 25 18:23:12 PDT 2011
PracticalWisdom So Glad you are Here. Like Superman but GirlRT @DrSnit: #hpm oh hai! Been
watching hockey. Now Im here!!! How goes cats? Xx missed you! #HPM
Wed May 25 18:23:20 PDT 2011
MarksPhone T2 my vision or the caregivers vision will effect the patient if the patient allows it and
then the battle of wills begins #hpm
Wed May 25 18:23:24 PDT 2011

11. SheyontheBay RT @GailZahtz: The real question isnt does culture/religion work-how does it work for
the individual patient and family #hpm
Wed May 25 18:23:27 PDT 2011
MeredithGould T2 Takes a lot of consciousness to not project/superimpose one's own stuff onto
patients & caregivers. #hpm
Wed May 25 18:23:47 PDT 2011
GailZahtz @revdoc @EOLnavigator Succeeding 51% of the time- especially during trauma- is
100% success. #HPM
Wed May 25 18:23:55 PDT 2011
DoctorFisher Hi just arrived #hpm
Wed May 25 18:24:00 PDT 2011
EOLnavigator RT @doctorfisher: @jfclearywisc Or even better "In what way are you suffering?" gives
patient the open door to talk #hpm
Wed May 25 18:24:05 PDT 2011
KathyKastner RT @MeredithGould: T2 Takes a lot of consciousness to not project/superimpose
one's own stuff onto patients & caregivers. #hpm
Wed May 25 18:24:16 PDT 2011
aliciabloom @EOLnavigator i'm part italian catholic and part eastern european jew-- i hear you!
#hpm
Wed May 25 18:24:20 PDT 2011
revdoc @GailZahtz @revdoc @EOLnavigator Amen, sister! #hpm
Wed May 25 18:24:30 PDT 2011
EOLnavigator @PracticalWisdom @KathyKastner So sorry! That happens alot. Makes you suffer
too. #hpm
Wed May 25 18:24:44 PDT 2011
MeredithGould @aliciabloom We should talk! #hpm
Wed May 25 18:24:51 PDT 2011
DoctorFisher @MeredithGould agree, try not to project, yet my patients find it comforting when I
share what gives me hope #hpm
Wed May 25 18:25:05 PDT 2011
PracticalWisdom Welcome, so glad you come tonight. RT @doctorfisher: Hi just arrived #HPM
Wed May 25 18:25:12 PDT 2011
SheyontheBay @EOLnavigator @aliciabloom i heard suffering bought time off in purgatory, now
there's no more purgatory->what to do withmy suffering? #hpm
Wed May 25 18:25:20 PDT 2011
KathyKastner Basta. Oy. RT @aliciabloom: @EOLnavigator i'm part italian catholic and part eastern
european jew-- i hear you! #hpm

12. european jew-- i hear you! #hpm
Wed May 25 18:25:32 PDT 2011
revdoc T2 risk that caregivers push pt to find meaning pt is not ready to investigate;
caregivers are successful if pt finds "closure" #hpm
Wed May 25 18:25:46 PDT 2011
MeredithGould @doctorfisher Right and that's not projecting, that's sharing! #hpm
Wed May 25 18:25:51 PDT 2011
DrSnit Belief in punishment or Suffering certainly changes both caregiver & patient EOL /
illness experiences. #hpm
Wed May 25 18:26:01 PDT 2011
GailZahtz Also, neither the outsider nor the person "suffering" knows which even will cause the
most pain. We need to be gentle in judgment. #HPM
Wed May 25 18:26:09 PDT 2011
EOLnavigator @doctorfisher Thanks for making it! #hpm
Wed May 25 18:26:12 PDT 2011
doctorfisher @PracticalWisdom thanks it's always great to 'be' here #hpm
Wed May 25 18:26:30 PDT 2011
EOLnavigator RT @doctorfisher: @MeredithGould agree, try not to project, yet my patients find it
comforting when I share what gives me hope #hpm
Wed May 25 18:26:36 PDT 2011
MeredithGould @aliciabloom Oy vey, Maria...as my mother would say. #hpm
Wed May 25 18:26:51 PDT 2011
aliciabloom @MeredithGould love it! #hpm
Wed May 25 18:27:14 PDT 2011
EOLnavigator I find, when I can identify with pt.'s suffering & they realize we have common
understanding, their suffering decreases. #hpm
Wed May 25 18:27:15 PDT 2011
RossJeanette Hi all I'm joining in late. I'll lurk u til I can figure out what we are talking about #HPM
Wed May 25 18:27:37 PDT 2011
doctorfisher @MeredithGould yes and I think sharing my own views makes me more 'human' plus
if we disagree, it's on the table #hpm
Wed May 25 18:27:38 PDT 2011
EOLnavigator Hope is definitely an important part of relief from suffering. #hpm
Wed May 25 18:27:56 PDT 2011
DrSnit @MeredithGould yes. Also to not be offended or annoyed by seemingly outlandish
beliefs. Oy. "what did you do to make god mad?" #hpm

13. beliefs. Oy. "what did you do to make god mad?" #hpm
Wed May 25 18:28:04 PDT 2011
doctorfisher RT @EOLnavigator: I find, when I can identify with pt.'s suffering & they realize we
have common understanding, their suffering decreases. #hpm
Wed May 25 18:28:07 PDT 2011
EOLnavigator @RossJeanette Glad you made it! #hpm
Wed May 25 18:28:13 PDT 2011
GailZahtz @EOLnavigator I think the key with connecting and identifying with other's suffering is
validating their own perceptions of it. #HPM
Wed May 25 18:28:18 PDT 2011
MeredithGould @RossJeanette We're talking about suffering. LOL. #hpm
Wed May 25 18:28:21 PDT 2011
dockj I think the concept of total pain which accounts for all sources of suffering is a useful
construct. #hpm
Wed May 25 18:28:29 PDT 2011
aliciabloom what we perceive as suffering should be left outside the patient's room, so that we
can fully understand their unique suffering #hpm
Wed May 25 18:28:29 PDT 2011
DoctorFisher RT @EOLnavigator: Hope is definitely an important part of relief from suffering. #hpm
Wed May 25 18:28:34 PDT 2011
EOLnavigator @rossjeanette "Suffering" #hpm
Wed May 25 18:28:37 PDT 2011
MeredithGould RT @dockj: I think the concept of total pain which accounts for all sources of suffering
is a useful construct. #hpm
Wed May 25 18:29:07 PDT 2011
dockj Physical/family dysfunction / relationships/ religious/ cultural. #hpm
Wed May 25 18:29:15 PDT 2011
doctorfisher RT @GailZahtz: @EOLnavigator I think the key with connecting and identifying with
other's suffering is validating their own perceptions of it. #HPM
Wed May 25 18:29:21 PDT 2011
EOLnavigator RT @DrSnit: @MeredithGould yes. Also 2 not be offended or annoyed by outlandish
beliefs. Oy. "what did you do 2 make god mad?" #hpm
Wed May 25 18:29:24 PDT 2011
MeredithGould @dockj Total pain as in physical, mental and spiritual, right? #hpm
Wed May 25 18:29:25 PDT 2011
MeredithGould And, gee, what the heck...also total pain as in familial?1? #hpm

14. MeredithGould And, gee, what the heck...also total pain as in familial?1? #hpm
Wed May 25 18:30:20 PDT 2011
dockj Any or all can be the biggest source of suffering at any one time #hpm
Wed May 25 18:30:22 PDT 2011
KathyKastner #hpm I know this is a serious discussion, but 2nite I'm suffering cuz I have piles of
reading for QA committee meeting in the am.
Wed May 25 18:30:27 PDT 2011
EOLnavigator RT @DrSnit: Belief in punishment or Suffering certainly changes both caregiver &
patient EOL / illness experiences. #hpm
Wed May 25 18:30:32 PDT 2011
aliciabloom hope is important, but often hope = cure, which isn't always reality. sometimes we
need to help patients/families reframe hope. #hpm
Wed May 25 18:30:43 PDT 2011
revdoc Should we question pts about distress we see in them even if they do not report they
are suffering? #hpm
Wed May 25 18:30:54 PDT 2011
GailZahtz No offense, but making fun of other people's belief's (which may seem silly or
destructive to you) is the exact opposite of support #HPM
Wed May 25 18:31:04 PDT 2011
PracticalWisdom MD told Wife/Patient Don't ask a (?) right now if U don't want truth. Arc of Life & Love,
Unbent by Treatment http://nyti.ms/kJ7Sr2 #HPM
Wed May 25 18:31:10 PDT 2011
doctorfisher RT @aliciabloom: hope is important, but often hope = cure, which isn't always reality.
sometimes we need to help patients/families reframe hope. #hpm
Wed May 25 18:31:20 PDT 2011
EOLnavigator @aliciabloom Do you think that you have to have suffered yourself to understand
someone else's suffering? #hpm
Wed May 25 18:31:23 PDT 2011
GailZahtz @revdoc Absolutely, may people suffer the most in silence, and won't discuss or heal
if not directly asked. #HPM
Wed May 25 18:31:54 PDT 2011
PracticalWisdom RT @GailZahtz: Making fun of other peoples beliefs (which may seem silly or
destructive to you) is the exact opposite of support #HPM
Wed May 25 18:31:57 PDT 2011
SheyontheBay @aliciabloom often to facilitate change in what they are hoping for...a peaceful
passing, instead of cure #hpm
Wed May 25 18:31:59 PDT 2011
KathyKastner RT @SheyontheBay: @aliciabloom often to facilitate change in what they are hoping
for...a peaceful passing, instead of cure #hpm
Wed May 25 18:32:17 PDT 2011

15. MeredithGould @EOLnavigator Great question. Probably everyone suffers but some have denial so
thick they don't cop to it. #hpm
Wed May 25 18:32:21 PDT 2011
GailZahtz @PracticalWisdom Thanks Lisa! #HPM
Wed May 25 18:32:41 PDT 2011
MarksPhone I wonder, do HCP have the wear with all to identify all the issues surrounding the
patient and family and navigate a path? #hpm
Wed May 25 18:32:53 PDT 2011
DoctorFisher @aliciabloom Yes, I never let my patients "give up hope", I help them shift their hope
to realistic goals #hpm
Wed May 25 18:32:55 PDT 2011
GailZahtz @DoctorFisher For some reason, we haven't crossed paths. Nice to meet you, and
get to know you, and hope to meet again :) #HPM
Wed May 25 18:33:10 PDT 2011
KathyKastner Yep. My hubRT @MeredithGould: @EOLnavigator Great Q. Probably everyone suffers
but some have denial so thick they don't cop to it. #hpm
Wed May 25 18:33:17 PDT 2011
RossJeanette The physical suffering may be "easier" to identify. #HPM
Wed May 25 18:33:26 PDT 2011
EOLnavigator Sometimes they don't know RT @revdoc: Should we question pts about distress we
C in them even if they do not report they are suffering? #hpm
Wed May 25 18:33:28 PDT 2011
GailZahtz @DoctorFisher @aliciabloom Is there an appropriate time and place when a patient
is entitled to give up hope? Question, not sure. #HPM
Wed May 25 18:33:47 PDT 2011
KathyKastner How wonderful of you RT @DoctorFisher: @aliciabloom I never let my pts "give up
hope", I help them shift their hope 2 realistic goals #hpm
Wed May 25 18:34:00 PDT 2011
aliciabloom @EOLnavigator think suffering is something we all experience in life, regardless of
the source. it's part of being human. #hpm
Wed May 25 18:34:09 PDT 2011
DoctorFisher @GailZahtz You as well! #hpm
Wed May 25 18:34:10 PDT 2011
EldrcareConsult Hey guys so sorry i am late! #hpm
Wed May 25 18:34:10 PDT 2011
revdoc @EOLnavigator @revdoc But is that my deciding the pt is suffering? #hpm
Wed May 25 18:34:25 PDT 2011

16. EOLnavigator @EldrcareConsult Hey there! We are talking about suffering #hpm
Wed May 25 18:34:39 PDT 2011
EOLnavigator RT @doctorfisher: @aliciabloom Yes, I never let my patients "give up hope", I help
them shift their hope to realistic goals #hpm
Wed May 25 18:35:04 PDT 2011
MeredithGould Great post about hope and communicating w/pts: http://bit.ly/lHaS1l #hpm
Wed May 25 18:35:04 PDT 2011
KathyKastner Good Q. RT @revdoc: @EOLnavigator @revdoc But is that my deciding the pt is
suffering? #hpm
Wed May 25 18:35:06 PDT 2011
EOLnavigator RT @RossJeanette: The physical suffering may be "easier" to identify. #hpm
Wed May 25 18:35:10 PDT 2011
DrSnit @GailZahtz have you ever watched a mother ask her daughter what she did to anger
god? It is hard to deal with their needs fully #hpm
Wed May 25 18:35:35 PDT 2011
MeredithGould RT @DrSnit: Belief in punishment or Suffering certainly changes both caregiver &
patient EOL / illness experiences. #hpm
Wed May 25 18:35:40 PDT 2011
EOLnavigator RT @KathyKastner RT @MeredithGould Probably everyone suffers but some have
denial so thick they dont cop to it. #hpm
Wed May 25 18:35:44 PDT 2011
PracticalWisdom Great To See You. RT @EldrcareConsult: Hey guys so sorry i am late! #HPM
Wed May 25 18:35:59 PDT 2011
aliciabloom @GailZahtz- i agree with @DoctorFisher in that we have to help people find hope &
meaning all the time, even if it means reframing it. #hpm
Wed May 25 18:36:13 PDT 2011
doctorfisher @GailZahtz sure, we need to let patients grieve loss. But I don't want to leave them
hopeless so must offer some form of help #hpm
Wed May 25 18:36:47 PDT 2011
whole_patients RT @MeredithGould: Great post about hope and communicating w/pts:
http://bit.ly/lHaS1l #hpm
Wed May 25 18:36:53 PDT 2011
KathyKastner Is it only #hpm-ers who are trained to re-frame?
Wed May 25 18:36:58 PDT 2011
EOLnavigator Never! Hope to die well. RT @GailZahtz: @DoctorFisher @aliciabloom Is there an

17. EOLnavigator Never! Hope to die well. RT @GailZahtz: @DoctorFisher @aliciabloom Is there an
appropriate time & place when a pt can give up hope? #hpm
Wed May 25 18:36:59 PDT 2011
GailZahtz @DrSnit I've been told that either in this life or a former life I did something that I'm
doing "teshuvah" for. (need to go to a 2nd..) #HPM
Wed May 25 18:37:12 PDT 2011
MarksPhone http://bit.ly/jt92nj Jimmie Holland the Human Side of Cancer #hpm
Wed May 25 18:37:15 PDT 2011
MeredithGould RT @KathyKastner: Is it only #hpm-ers who are trained to re-frame?<--my guess is
yes
Wed May 25 18:37:23 PDT 2011
EOLnavigator Ur only frame of reference tho RT @KathyKastner: Good Q. RT @revdoc:
@EOLnavigator @revdoc But is that my deciding the pt is suffering? #hpm
Wed May 25 18:38:05 PDT 2011
GailZahtz @DrSnit On one hand, very hard to hear, process, benefit. On another, my personal
belief system from where it comes, helps me cope. #HPM
Wed May 25 18:38:17 PDT 2011
EOLnavigator Topic 3 is almost upon us.... #hpm
Wed May 25 18:38:19 PDT 2011
revdoc @MeredithGould @KathyKastner Reframing not a big part of my medical education...
#hpm
Wed May 25 18:38:24 PDT 2011
jfclearywisc Said it b4; Tulsky (Hope or Hubris, JPM) Hope=trust. However bad, things will work
out. #hpm
Wed May 25 18:38:32 PDT 2011
DoctorFisher @KathyKastner I was trained to re-frame during #geriatrics fellowship #hpm
Wed May 25 18:38:42 PDT 2011
EOLnavigator Different topic...we've suffered enough! #hpm
Wed May 25 18:38:59 PDT 2011
MeredithGould @revdoc Because it's too "soft" and not "science," right? #hpm
Wed May 25 18:39:01 PDT 2011
MeredithGould @EOLnavigator LOLOL...good one #hpm
Wed May 25 18:39:09 PDT 2011
GailZahtz @DrSnit I want to strangle people who say "it's all for the best" or "we're not given
more than we can handle" others benefit from that #HPM
Wed May 25 18:39:19 PDT 2011
revdoc @MeredithGould @revdoc Yep #hpm

18. revdoc @MeredithGould @revdoc Yep #hpm
Wed May 25 18:39:30 PDT 2011
KathyKastner I have pondered hope and false hope http://tinyurl.com/3yzvexh #hpm
Wed May 25 18:39:35 PDT 2011
KathyKastner Ha! RT @EOLnavigator: Different topic...we've suffered enough! #hpm
Wed May 25 18:39:57 PDT 2011
PracticalWisdom RT @KathyKastner: Ha! RT @EOLnavigator: Different topic...weve suffered enough!
#HPM
Wed May 25 18:40:25 PDT 2011
aliciabloom i often feel like #hospice & #palliative care is as much an art as it is a science #hpm
Wed May 25 18:40:30 PDT 2011
EOLnavigator T3: When you search for information about end of life care online, what kind of
information are you looking for & do you find it? #hpm
Wed May 25 18:40:48 PDT 2011
DrSnit @GailZahtz not the same as watching it as a provider but you get it from an advocacy
perspective. #hpm
Wed May 25 18:40:54 PDT 2011
KathyKastner Hope and aging.Gr8 combo RT @DoctorFisher: @KathyKastner I was trained to re-
frame during #geriatrics fellowship #hpm
Wed May 25 18:41:06 PDT 2011
GailZahtz @aliciabloom @DoctorFisher @EOLnavigator Studies show that outcomes of same
surgeries affected by hope. #HPM
Wed May 25 18:41:07 PDT 2011
PracticalWisdom Great Truth 2 That. Thank you! RT @aliciabloom: i often feel like #hospice &
#palliative care is as much an art as it is a science #HPM
Wed May 25 18:41:11 PDT 2011
revdoc @aliciabloom Absolutely! #hpm
Wed May 25 18:41:12 PDT 2011
dockj RT @aliciabloom: i often feel like #hospice & #palliative care is as much an art as it
is a science #hpm
Wed May 25 18:41:19 PDT 2011
DrSnit RT @EOLnavigator: T3: When you search for information about end of life care
online, what kind of information are you looking for & do you find it? #hpm
Wed May 25 18:41:25 PDT 2011
MarksPhone Finding it is one thing, wanting to know what it says is another there is a gap in
acquiring this knowledge to the problem at hand #hpm
Wed May 25 18:42:00 PDT 2011

19. Wed May 25 18:42:00 PDT 2011
revdoc T3 More research is being done, but too much old literature was anecdotal; I'm
looking for best practices #hpm
Wed May 25 18:42:14 PDT 2011
EOLnavigator It makes me feel defeated when I hear that. RT @GailZahtz: @DrSnit #hpm
Wed May 25 18:42:21 PDT 2011
dockj RT @EOLnavigator: T3: When you search for information about end of life care
online, what kind of information are you looking for & do you find it? #hpm
Wed May 25 18:42:22 PDT 2011
DebErupts RT @aliciabloom I often feel like #hospice & #palliative care is as much an art as it is
a science #hpm | Absolutely
Wed May 25 18:42:34 PDT 2011
MeredithGould @MarksPhone Brilliant...wanted to RT but it was too long. :-( #hpm
Wed May 25 18:42:39 PDT 2011
dockj RT @revdoc: T3 More research is being done, but too much old literature was
anecdotal; I'm looking for best practices #hpm
Wed May 25 18:42:42 PDT 2011
EOLnavigator RT @PracticalWisdom: Great Truth 2 That. RT @aliciabloom: i often feel like
#hospice & #palliative care is as much art as it is science #hpm
Wed May 25 18:43:00 PDT 2011
GLakesCaring RT @EOLnavigator: T3: When you search for info about end of life care online, what
kind of info are you looking for & do you find it? #hpm
Wed May 25 18:43:13 PDT 2011
EOLnavigator RT @dockj: RT @revdoc: T3 More research is being done, but too much old literature
was anecdotal; Im looking for best practices #hpm
Wed May 25 18:43:28 PDT 2011
dockj I spend more time hard searching NLM for #hpm questions than any other clinical
questions I have.
Wed May 25 18:43:50 PDT 2011
GailZahtz @DrSnit @EOLnavigator The juggle is for pt, caregiver, provider, family, allowing
some kind of freedom of perspective allowing dignity #HPM
Wed May 25 18:44:02 PDT 2011
PracticalWisdom RT @MarksPhone: Finding it is 1thing, wanting 2 know what it says is another. A gap
in acquiring this knowledge to the problem at hand #HPM
Wed May 25 18:44:17 PDT 2011
EOLnavigator Best practices in EOL care is pandora's box IMO! #hpm
Wed May 25 18:44:28 PDT 2011

20. dockj RT @EOLnavigator: Best practices in EOL care is pandora's box IMO! #hpm
Wed May 25 18:45:26 PDT 2011
PracticalWisdom @MarksPhone: Sincerely think/Feel you are one of the sharpest Crayons in the Box.
#HPM
Wed May 25 18:45:37 PDT 2011
MarksPhone the real issue is getting the seeking of a this knowledge to want to apply it. In a death
phobic society we want to survial DFS etc #hpm
Wed May 25 18:45:38 PDT 2011
GailZahtz We should be allowed to rage, or find irrational comfort, or even to control our hope if
that empowers us, yes? #HPM @EOLnavigator @DrSnit
Wed May 25 18:45:41 PDT 2011
revdoc @EOLnavigator We can use good information to help find most effective, least toxic,
cost-effective regimens though #hpm
Wed May 25 18:45:42 PDT 2011
DoctorFisher T3 sometimes my search is less about info and more about finding people with
similar mission (like you fine people) #hpm
Wed May 25 18:45:47 PDT 2011
DrSnit There is too much separation between provider, patient, caregiver and "what next" in
palliative and hospice care right now. #hpm
Wed May 25 18:45:47 PDT 2011
MeredithGould RT @DrSnit: There is too much separation between provider, patient, caregiver and
"what next" in palliative and hospice care right now. #hpm
Wed May 25 18:45:56 PDT 2011
KathyKastner Aren't best practices 'situational' in eol care?RT @EOLnavigator: Best practices in
EOL care is pandora's box IMO! #hpm
Wed May 25 18:46:04 PDT 2011
EOLnavigator I've noticed that alot of healthcare sites really shy away from EOL care topics #hpm
Wed May 25 18:46:09 PDT 2011
aliciabloom political discourse about end of life care is frustrating ("death panels" "rationing").
fosters fear & creates barriers for patients #hpm
Wed May 25 18:46:12 PDT 2011
GailZahtz Agree! MT @DrSnit: Too much separation between provider, patient, caregiver and
"what next" in palliative and hospice care right now. #hpm
Wed May 25 18:46:21 PDT 2011
PracticalWisdom RT @doctorfisher: T3 sometimes my search is less about info and more about
finding people with similar mission (like you fine people) #HPM
Wed May 25 18:46:28 PDT 2011
dockj The problems with research in #hpm that good outcomes = bad outcomes for most
medical research.

21. Wed May 25 18:46:38 PDT 2011
KathyKastner RT @GailZahtz: We should be allowed to rage, or find irrational comfort, or even to
control our hope if that empowers us, yes? #HPM @EOL ...
Wed May 25 18:46:54 PDT 2011
MarksPhone The edu issue at hand is changing the learners desire to uptake knowledge and
apply, we dont know what the learners need to know #hpm
Wed May 25 18:46:59 PDT 2011
EOLnavigator RT @revdoc: @EOLnavigator We can use good information to help find most
effective, least toxic, cost-effective regimens though #hpm
Wed May 25 18:47:02 PDT 2011
GLakesCaring T3: Trick is to find info that doesn't "scare" people away from using HPM. #hpm
Wed May 25 18:47:05 PDT 2011
doctatum could you say more?RT @DrSnit: too much separation between provider, patient,
caregiver and "what next" in palliative and hospice care #hpm
Wed May 25 18:47:18 PDT 2011
GailZahtz IMO Palliative physicians, caregivers and providers are the most COURAGEOUS
because they can't cure. #HPM
Wed May 25 18:47:29 PDT 2011
MeredithGould RT @GailZahtz: IMO Palliative physicians, caregivers and providers are the most
COURAGEOUS because they can't cure. #HPM
Wed May 25 18:47:46 PDT 2011
dockj Even in the best of circumstances, there has to be subjectivity in most EOL research.
#hpm
Wed May 25 18:48:03 PDT 2011
EOLnavigator TY. RT @doctorfisher: T3 sometimes my search is less about info & more about
finding people with similar mission (like you fine people) #hpm
Wed May 25 18:48:05 PDT 2011
KathyKastner How about this http://tinyurl.com/4uphd7c @GLakesCaring: T3: Trick is to find info
that doesn't "scare" people away from using HPM. #hpm
Wed May 25 18:48:07 PDT 2011
PracticalWisdom T3: @doctorfisher Do you tell other MD's about finding people with similar mission? I
think so few really understand the beneifts #HPM
Wed May 25 18:48:12 PDT 2011
EOLnavigator Precisely! RT @KathyKastner: Arent best practices situational in eol care? Best
practices in EOL care is pandoras box IMO! #hpm
Wed May 25 18:48:44 PDT 2011
aliciabloom RT @GailZahtz: IMO Palliative physicians, caregivers and providers are the most
COURAGEOUS because they cant cure. #hpm
Wed May 25 18:48:45 PDT 2011

22. DrSnit Yes! RT @GailZahtz: IMO Palliative physicians, caregivers and providers are the most
COURAGEOUS because they can't cure. #HPM
Wed May 25 18:48:47 PDT 2011
MeredithGould @dockj There's subjectivity in all research -- we just pretend there isn't. #hpm
Wed May 25 18:49:03 PDT 2011
MarksPhone @GLakesCaring That's the point what do learners want I believe a need assessment
to understand caregivers and patients is critical #hpm
Wed May 25 18:49:04 PDT 2011
PracticalWisdom RT @DrSnit: Yes! RT @GailZahtz: IMO Palliative physicians, caregivers and providers
are the most COURAGEOUS because they cant cure. #HPM
Wed May 25 18:49:20 PDT 2011
KathyKastner And practice, too, no? RT @dockj: Even in the best of circumstances, there has to be
subjectivity in most EOL research. #hpm
Wed May 25 18:49:24 PDT 2011
EOLnavigator @MarksPhone That's why I asked the Q. I see alot of what we think people want to
know! #hpm
Wed May 25 18:49:32 PDT 2011
GailZahtz T3: Especially in palliative information, it needs to have many formats and messages
so that people can access it within their way. #HPM
Wed May 25 18:49:58 PDT 2011
EOLnavigator RT @GLakesCaring: T3: Trick is to find info that doesnt "scare" people away from
using HPM. #hpm
Wed May 25 18:49:59 PDT 2011
revdoc I don't know about the rest of you...my treatment plans are ALWAYS the best! ;) #hpm
Wed May 25 18:50:09 PDT 2011
SheyontheBay RT @KathyKastner: Arent best practices situational in eol care? Best practices in
EOL care is pandoras box IMO! #hpm
Wed May 25 18:50:21 PDT 2011
dockj @KathyKastner yes. #hpm
Wed May 25 18:50:31 PDT 2011
PracticalWisdom Could you clarify RT @EOLnavigator: @MarksPhone Thats why I asked the Q. I see
alot of what we think people want to know! #HPM
Wed May 25 18:50:37 PDT 2011
MarksPhone EOL research should be paired with a study of knowledge translation How can what
we learn in EOL be up took (LOL) better #hpm
Wed May 25 18:50:49 PDT 2011
EOLnavigator @GailZahtz The value is in the relief of suffering & improvement in QOL without cure.

23. EOLnavigator @GailZahtz The value is in the relief of suffering & improvement in QOL without cure.
#hpm
Wed May 25 18:50:53 PDT 2011
TAFORU RT @DrSnit: There is too much separation between provider, patient, caregiver and
"what next" in palliative and hospice care right now. #hpm
Wed May 25 18:51:02 PDT 2011
MeredithGould Re: research methods & subjectivity, read @SusannahFox post: http://bit.ly/jHrnH4
#HPM
Wed May 25 18:51:13 PDT 2011
Tanrita24 RT @DrSnit: There is too much separation between provider, patient, caregiver and
"what next" in palliative and hospice care right now. #hpm
Wed May 25 18:51:36 PDT 2011
DrSnit p value of what? RT @MeredithGould: @dockj There's subjectivity in all research --
we just pretend there isn't. #hpm
Wed May 25 18:51:46 PDT 2011
MeredithGould @colleen_young Was just recommending folks at the #HPM chapt read that article.
#hcsmca #hcsmeu
Wed May 25 18:51:53 PDT 2011
SheyontheBay VERY cautious about sites I choose 4 research. Like with most "disease-specific"
sites, can b fraught with misinformation #hpm
Wed May 25 18:52:18 PDT 2011
KathyKastner Truth be told..RT @MeredithGould: @dockj There's subjectivity in all research -- we
just pretend there isn't. #hpm
Wed May 25 18:52:27 PDT 2011
doctorfisher T3 lots of 'subjective' research in social sciences and even #psych, can #hpm learn
from them?
Wed May 25 18:53:02 PDT 2011
GailZahtz Palliate: to ease (as a disease) without curing. Webster's Dictionary. I've always loved
that. TO EASE- our goal. #HPM
Wed May 25 18:53:11 PDT 2011
EOLnavigator @PracticalWisdom @marksphone The edu issue is that we dont know what the
learners need to know.asked Q to C if the info found is good #hpm
Wed May 25 18:53:39 PDT 2011
AliveHospice A must-read for #nurses, especially those who work in #pediatrics: http://bit.ly/iCdJC2
#hpm
Wed May 25 18:54:04 PDT 2011
SheyontheBay @GailZahtz And dis-ease = not at ease #hpm
Wed May 25 18:54:23 PDT 2011
doctorfisher @GailZahtz I like that- we take the 'dis' out of 'disease'! #hpm
Wed May 25 18:54:32 PDT 2011

24. EOLnavigator Agree & it's scary! RT @MeredithGould: @dockj Theres subjectivity in all research --
we just pretend there isnt. #hpm
Wed May 25 18:54:38 PDT 2011
dockj RT @doctorfisher: T3 lots of 'subjective' research in social sciences and even
#psych, can #hpm learn from them?
Wed May 25 18:54:51 PDT 2011
MeredithGould @DoctorFisher Subjective research, aka, qualitative research used to be essential
sociology & anthropology #hpm
Wed May 25 18:54:54 PDT 2011
EOLnavigator I can tell! RT @revdoc: I dont know about the rest of you...my treatment plans are
ALWAYS the best! ;) #hpm
Wed May 25 18:55:24 PDT 2011
GailZahtz @DoctorFisher @SheyontheBay Yes, we're easing the pain for others, we aren't
taking it away, can't cure it, shouldn't minimize it. #HPM
Wed May 25 18:55:31 PDT 2011
MarksPhone Knowledge translation is the scientific study of methods for closing the knowledge-
to-practice gap what is gap for pateints and HCP? #hpm
Wed May 25 18:55:55 PDT 2011
MeredithGould Factoid about me: exquisitely well trained in qualitative methods! Can do &
understand quantitative stuff but not under its thrall #hpm
Wed May 25 18:56:20 PDT 2011
SheyontheBay @MeredithGould @DoctorFisher Cant really do controlled studies in EOL care. Not
ethical! #hpm
Wed May 25 18:56:35 PDT 2011
rebeccatrocki RT @MeredithGould: Factoid about me: exquisitely well trained in qualitative
methods! Can do & understand quantitative stuff but not under its thrall #hpm
Wed May 25 18:56:44 PDT 2011
GailZahtz @MarksPhone Gap for patients on HCP? That 10 point "pain scale" Funny, yet true!
#HPM
Wed May 25 18:56:46 PDT 2011
EOLnavigator Thank you all for sharing your thoughts. Any final words of wisdom? #hpm
Wed May 25 18:56:52 PDT 2011
MeredithGould @SheyontheBay @DoctorFisher Even if you could, why would you? Makes NO sense
given the research questions. #hpm
Wed May 25 18:57:14 PDT 2011
revdoc @MarksPhone What do I have? What are my options? What are risks/benefits? Best
and worst case? #hpm
Wed May 25 18:57:14 PDT 2011

25. MarksPhone @EOLnavigator we can apply priciples of adult to identify problems to be solved
#hpm
Wed May 25 18:57:19 PDT 2011
GailZahtz Final thoughts- validate others' pain and suffering, support them how they need, ease
and comfort how individually works. #HPM
Wed May 25 18:57:51 PDT 2011
KathyKastner #hpm we (non hcp) need to know more about dying as well as eol options (hence my
post, she said encouragingly)http://tinyurl.com/26k4kpm
Wed May 25 18:58:40 PDT 2011
GailZahtz Rockin' Thanks to "classic" and new people from #HPM. Congratz and thanks
@EOLnavigator for doing a great job moderating! Love to all :)
Wed May 25 18:58:40 PDT 2011
PracticalWisdom @EOLnavigator @marksphone and I R Adult Educators. We believe in the
importance of a Need Assessment & Androgogy. It's in our Blood. #HPM
Wed May 25 18:58:45 PDT 2011
revdoc "How are you suffering?" is a very powerful tool #hpm
Wed May 25 18:58:52 PDT 2011
EOLnavigator RT @MarksPhone: @EOLnavigator we can apply priciples of adult to identify
problems to be solved #hpm
Wed May 25 18:58:58 PDT 2011
Lux_Seeker RT @KimberlySMoore: Musical Analgesia: Using Music for #Pain http://bit.ly/kFvLSZ
#musictherapy #hpm #cancer
Wed May 25 18:59:04 PDT 2011
pamojamo RT @AliveHospice: A must-read for #nurses, especially those who work in
#pediatrics: http://bit.ly/iCdJC2 #hpm
Wed May 25 18:59:07 PDT 2011
KathyKastner RT @EOLnavigator: RT @MarksPhone: @EOLnavigator we can apply priciples of
adult to identify problems to be solved #hpm
Wed May 25 18:59:15 PDT 2011
DrSnit You cats rock my socks! Thanks for all the amazing insight tonight! Great moderating!
#HPM
Wed May 25 18:59:16 PDT 2011
EOLnavigator RT @GailZahtz: Final thoughts- validate others pain and suffering, support them how
they need, ease and comfort how individually works. #hpm
Wed May 25 18:59:16 PDT 2011
MeredithGould Final thoughts: Listen carefully with care & caring. Be present. Don't get hung up on
the so-called science of care delivery. #hpm
Wed May 25 18:59:25 PDT 2011

26. KathyKastner RT @MeredithGould: Final thoughts: Listen carefully with care & caring. Be present.
Don't get hung up on the so-called science of care delivery. #hpm
Wed May 25 18:59:37 PDT 2011
EOLnavigator RT @KathyKastner: #hpm we (non hcp) need to know more about dying as well as
eol options (hence my post) http://tinyurl.com/26k4kpm #hpm
Wed May 25 18:59:38 PDT 2011
MarksPhone Obviously I am not being clear here this is not about the obvious but the issues that
impede patients family & HPC from knowledge #hpm
Wed May 25 18:59:38 PDT 2011