Welcome to the American Family Physician podcast for the March 15th, 2017 issue.

I'm Steve.

I'm Jake.

I'm Kalina.

We are residents and faculty from the University of Arizona

College of Medicine Phoenix Family Medicine residency. On this episode of the pod, we're going to talk

about end-of-life care, latent tuberculosis, preterm labor, antipsychotics in delirium,

multiple myeloma, and we have a special interview with a friend of the pod, Renit Michore, to talk to us about physician advocacy.

The opinions expressed in the podcast are our own and do not represent the opinions of the American

Academy of Family Physicians, the editor of American Family Physician or Banner Health.

Do not use this podcast for medical advice.

Instead, see your own family doctor for medical care.

Okay, let's start with end-of-life care, managing common symptoms.

This article is from Dr. Albert out of Hartford, Connecticut.

The importance of primary care physicians being competent in providing end-of-life care cannot be overstated. At the end of life, care focus turns to symptom

management, and outside of the hospital, this care is often directed by the PCP. There are a few

key points to follow in this case when prescribing medication for symptom management. Right. When it

comes to dosing, start at lower dose, then titrate to the desired effect. Use proactive regimens to prevent symptoms. It's generally easier to prevent than to treat an acute symptom. Always think about medication administration route options, since swallowing function and wakefulness definitely diminish at the end of life.

Sublingual, topical, transdermal, and rectal are all available.

Remember for sublingual administration, mucus membranes must remain moist in order for it to be an effective route of administration.

So with all those things in mind, let's run through what the author calls a hospice comfort kit

to address the most common symptoms requiring management.

...