Nathan Gray, MD, FACP

What do general pediatrics and outpatient palliative care have in common? (Thoughts from a palliative doc who started medical life thinking he’d be a general pediatrician…)
#hapc

Health, Heartache, and Humor: A Practical Framework for Approaching Humor in Serious Illness | Journal of Palliative Medicine Despite the pain and suffering that often accompany serious illness, humor can play a rich and meaningful role as part of multifaceted patient–clinician interactions. Patients often use humor to commu...

Full article link here: www.liebertpub.com/doi/abs/10.1...

And we close with a “top ten” list of cautions and guidance for those encountering humor in clinical work day to day…

We listed some examples of how this plays out (using my own art)…

In our paper, we suggest the most important thing to consider is the source and the object… who’s making the humor and what is it about?? Some source/object combos are off limits, some high risk, some generally safe.

It may seem obvious, but patients get more leeway than docs!

Patients use humor for coping, to communicate around sensitive topics, to build rapport, or to reassert control in scary times…

clinicians also use humor to cope, build rapport, or even lighten the mood. But when’s the wrong time or the right time!?

How do those caring for folks with serious illness navigate humor?? Patients and family often bring humor to encounters, and many say they appreciate it from providers…

Happy to have paired up w PC SW Melissa Rizzollo to write some fun guidance for @j-palliativemed.bsky.social #hapc

If you get stronger…
#hapc

When none of the discharge options fits…

I never promise we can make all the pain go away, as there are parts of medical suffering we’ll probably never tame, but I love the wins when we’re able to make a difficult day feel a bit more bearable.

Answer data questions with data. Answer emotion and meaning questions with empathy and humility…

Magic in the air ❤️💕 Happy Hospital Valentine’s tomorrow!

Of course! the second of my two posts (as well as the longer explanation on IG) mention those situations… when a discussion/answer is urgent. :)

Some of the times I’ve missed the mark the worst in serious illness conversations over the years have been when I barged into a new topic without specifically asking permission first. #hapc

In situations where a patient says they can’t handle a pressing diagnosis/decision that needs urgent action, I ask if there’s a family member they trust to handle the info and decision, if not, I try to give them some control over details of how info is shared before proceeding. #hapc

When discussing serious health issues with patients, it’s crucial to ask permission each time a new sensitive topic is broached… people may have specific needs, timing, or preferences they’d like to voice before you “go there.”

Oh my, I had almost forgotten about that one. That one puts me in real dad-joke territory…

(Family meeting nemeses...) Reminded of this one rounding on inpatient palliative consults today… the hospital can be a busy, noisy place. ❤️ #hapc

My annual holiday greeting for those working the hospital this season… 🎁

Historically on Twitter and IG, still fairly active on Instagram:
www.instagram.com/inkvessel/

One of my favorite types of cartoon to draw for a break from a heavy day is “medical-term-brought-to-life…”

:) Yes, definitely!! (I think real empathy is often a driver, Just never want the tissues to become a disruption rather than a kindness… have witnessed some very silly situations where the whole moment was railroaded by clinicians like myself jumping around try to find them!)

Thanks so much for the kind words!! Makes me happy to hear the art is useful!

Hooray! You’re here too!!! Thanks for saying “hi!”

2/2 #hapc #grief

In honor of Bluesky migration, I’m going to try to regularly re-post some of my favs from the archives for those here who don’t know me. This one on a valuable lesson I learned about tissues from @vickieleff.bsky.social (1/2)
#hapc #graphicmedicine

For patients and doctors, insurance prior authorization can be a dangerous game | Opinion Doctors trying to get patients necessary drugs and procedures stymied by health insurance prior authorization. It's not a game. It's life and death.

When I see @nathanagray.bsky.social has a new graphic narrative, I click. This collab with @fumikochino.bsky.social tells the important story of pre-auths, denial of care, and how patients suffer as a result.

For patients and doctors, insurance prior authorization can be a dangerous game | Opinion Doctors trying to get patients necessary drugs and procedures stymied by health insurance prior authorization. It's not a game. It's life and death.

Check out this powerful and heartbreaking piece by @fumikochino.bsky.social and @nathanagray.bsky.social on the cruelty of prior authorizations

www.usatoday.com/story/opinio...

#graphicmedicine

For patients and doctors, insurance prior authorization can be a dangerous game | Opinion Doctors trying to get patients necessary drugs and procedures stymied by health insurance prior authorization. It's not a game. It's life and death.

The timing of this story is heated, with health insurance industry in the news, but I was honored to collaborate with @fumikochino.bsky.social and grateful to my patient and his family for the chance to draw/write about the pain of #priorauth for @usatoday.com .

www.usatoday.com/story/opinio...