Health care bloggers, including Beth Israel Deaconess Medical Center CEO Paul Levy and e-Patient Dave deBronkart, are urging people to talk to friends and family this weekend about their wishes for care at the end of life -- before the time arrives. This year's version warms up the crowd with a few Thanksgiving jokes but the intent is the same.

Some conversations are easier than others

Last Thanksgiving weekend, many of us bloggers participated in the first documented "blog rally" to promote Engage With Grace -– a movement aimed at having all of us understand and communicate our end-of-life wishes.

It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations – our closest friends and family.

Our original mission – to get more and more people talking about their end of life wishes – hasn’t changed. But it’s been quite a year – so we thought this holiday, we’d try something different.

A bit of levity.

At the heart of Engage With Grace are five questions designed to get the conversation started. We’ve included them at the end of this post. They’re not easy questions, but they are important.
To help ease us into these tough questions, and in the spirit of the season, we thought we’d start with five parallel questions that ARE pretty easy to answer:

Silly? Maybe. But it underscores how having a template like this – just five questions in plain, simple language – can deflate some of the complexity, formality, and even misnomers that have sometimes surrounded the end-of-life discussion.

So with that, we’ve included the five questions from Engage With Grace below. Think about them, document them, share them.

Over the past year there’s been a lot of discussion around end of life. And we’ve been fortunate to hear a lot of the more uplifting stories, as folks have used these five questions to initiate the conversation.

One man shared how surprised he was to learn that his wife’s preferences were not what he expected. Befitting this holiday, The One Slide now stands sentry on their fridge.

Wishing you and yours a holiday that’s fulfilling in all the right ways.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team. )

Chronic pain is a common companion of old age. A new Boston study suggests that people who suffer chronic pain may be at higher risk for falls, a serious, sometimes deadly problem for older people.

Writing in tomorrow's Journal of the American Medical Association, a team that included researchers from Beth Israel Deaconess Medical Center, the Institute for Aging Research at Hebrew SeniorLife, and Spaulding Rehabilitation Hospital report on a study that followed more than 700 people over age 70 who were living within five miles of Hebrew SeniorLife in Boston. The participants, who had medical examinations before being enrolled in the trial, noted on a calendar when they felt pain and how it affected their daily life.

After 18 months, the researchers found that people who said they felt pain in two or more joints in one month were 50 percent more likely to fall in the following month than people who did not report joint pain. Back pain was not associated with falls. The increased risk for people with multiple joint pain persisted after the researchers accounted for such factors as a previous history of falls, medication use, illnesses, or trouble with balance.

People with advanced dementia spend their last days suffering the same pain, complications, and poor prognosis as people with other terminal conditions, according to a new study that urges better care focused on providing comfort at the end of their lives.

Dr. Susan Mitchell of Hebrew SeniorLife Institute for Aging Research and Harvard Medical School led a study of 323 patients with end-stage dementia at 22 nursing homes near Boston. Writing in this week's New England Journal of Medicine, they report that the life expectancy for advanced dementia patients was close to what late-stage cancer or congestive heart failure patients might anticipate. Like dying cancer patients, the dementia patients also experienced infections, fever, and eating problems.

"Dementia is a terminal illness," Mitchell said in an interview. "When families understand this is the end stage, most of them will want comfort care as the goal."

Thirteen Massachusetts researchers and clinicians have been elected to the Institute of Medicine, a prestigious national body that makes recommendations on health and health-care policy.

The institute's 65 new members include:

Amy N. Finkelstein, professor of economics, MIT
Alfred L. Goldberg, professor of cell biology, Harvard Medical School
Dr. Sue J. Goldie, professor of public health, and director, Center for Health Decision Science, Harvard School of Public Health
Dr. Daniel A. Haber, professor of medicine, Harvard Medical School, and director, Massachusetts General Hospital Cancer Center
Tyler E. Jacks, professor of biology, and director, David H. Koch Institute for Integrative Cancer Research, MIT
Dr. Ichiro Kawachi, professor and chair, department of society, human development, and health, Harvard School of Public Health
Dr. Isaac S. Kohane, professor of pediatrics and health sciences and technology, Harvard Medical School; and chair, informatics program, Children's Hospital Boston
Dr. Joan Y. Reede, dean for diversity and community partnership and associate professor of medicine, Harvard Medical School
Gary Ruvkun, professor of genetics, Harvard Medical School and Massachusetts General Hospital
Dr. Clifford B. Saper, professor of neurology and neuroscience, Harvard Medical School, and professor and head, department of neurology, Beth Israel Deaconess Medical Center
Dr. Megan Sykes, associate director, Transplantation Biology Research Center, Massachusetts General Hospital, and professor of surgery and professor of medicine, Harvard Medical School
Dr. Bruce D. Walker, director, Ragon Institute of Massachusetts General Hospital, MIT, and Harvard University
Dr. Ralph Weissleder, professor of systems biology and radiology, Harvard Medical School, and director, Center for Systems Biology, Massachusetts General Hospital

Massachusetts has made a strong showing in a $348 million federal grant program that encourages biomedical researchers to engage in high-risk projects with the potential to accelerate the translation of research discoveries into treatments.

Eleven of 42 Transformational R01 grants are flowing to scientists in the state and 12 of 55 New Innovator award winners are based here. One of 18 Pioneer Award recipients is from Massachusetts. All three programs from the National Institutes of Health are designed to spur exploration that may have been deemed too risky in past rounds.

By Elizabeth Cooney
Globe Correspondent

In the face of criticism from a union of health workers, a physicians group has decided to drop its late-night surcharge for patients who come to emergency rooms after 10 p.m. at five Massachusetts hospitals.

Harvard Medical Faculty Physicians said today it would no longer add $30 to bills for emergency care delivered between 10 p.m. and 8 a.m. The fee was attacked earlier this week by a health-care union that is trying to organize workers at Beth Israel Deaconess Medical Center, where the doctors are affiliated. The other affected hospitals are Beth Israel Deaconess-Needham, Nashoba Valley Medical Center in Ayer, Saint Vincent Hospital in Worcester, and Milton Hospital, which dropped the fee earlier this month.

"The general feeling is if it could cause one single patient not to seek emergency care, then we don't want it," Dr. Richard Wolfe, chair of emergency medicine at Harvard Medical Faculty Physicians and Beth Israel Deaconess, said after talking with physicians at the five hospitals. "We've instructed our billing company to no longer bill for that code."

Beth Israel Deaconess Medical Center's board of trustees has elected a new chairman, the hospital said today.

Stephen B. Kay of Chestnut Hill, a senior director of Goldman Sachs & Co., was named the fifth chair of Beth Israel Deaconess at the board's annual meeting yesterday. He succeeds Lois E. Silverman, who was chair for four years. She will become a trustee for life.

Kay has been part of the hospital's history, serving as board chair of Beth Israel Hospital from 1994-96 and founding board chair of CareGroup Health System, the holding company of Beth Israel Deaconess. He has also been a trustee of the Dana-Farber Cancer Institute since 1981.

Kay is also a founding director of Tenacity, a tennis/academic program for inner-city youth, and a vice chairman of the Boston Symphony Orchestra.

A health care union trying to organize workers at Beth Israel Deaconess Medical Center has assailed the hospital's physician group for adding a late-night fee for patients who come to emergency rooms after 10 p.m.

Local 1199 of the Service Employees International Union drew on publicly available Medicare claims data that show patients treated by the Harvard Medical Faculty Physicians at five hospitals in the state were billed a surcharge of $30 if they were seen between 10 p.m. and 8 a.m. Besides Beth Israel Deaconess, the other hospitals are Saint Vincent Hospital in Worcester, Milton Hospital, Nashoba Valley Medical Center in Ayer, and Beth Israel Deaconess Medical Center-Needham.

The doctors' group said the fee was a common practice, comparing it to different pay rates health care providers earn for working overnight.

"Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center – and many physician groups across Massachusetts and the nation – assess a standard after-hours fee for any patient seen between the hours of 10 p.m. and 8 a.m.," Dr. Stuart Rosenberg, head of Harvard Medical Faculty Physicians, and Dr. Richard Wolfe, chair of emergency medicine at Beth Israel Deaconess, said in a statement e-mailed to the Globe today. "This fee is designed to offset the cost of 24-hour, 7-day access to emergency medical services and is compliance with state and federal law and all contracts BIDMC and HMFP have with health care insurers."

The union held a rally this afternoon outside the annual meeting of the Beth Israel Deaconess board at the Four Seasons Hotel, calling for the fees to be rolled back. During its drive to organize employees, the union has criticized the hospital and its chief executive, Paul Levy, about issues beyond employee relations.

"Consumers are seeing more fees everywhere these days, but hitting patients with a fee based on the time of their emergency crosses the line," Mike Fadel, executive vice president of 1199SEIU United Healthcare Workers East. "It’s important for these fees to be refunded before this practice spreads to other hospitals and more patients are taken advantage of in their hour of need.”

Spokesmen for Boston Medical Center, Caritas Christi Health Care, Tufts Medical Center, and Partners HealthCare, the parent of Massachusetts General Hospital and Brigham and Women's Hospital, said their hospitals or hospital-affiliated physician practices do not have such a fee.

Paul Levy, president and CEO of Beth Israel Deaconess Medical Center, was among health care leaders offering first thoughts on a New York Times blog gathering reaction to President Obama's speech before Congress last night.

While the president said widening access to coverage will be paid for by increased efficiency from public and private insurers and health care providers, Levy says that expanded access will cost more.

"I think this gives a false impression that access to insurance, our highest priority, can be delivered at no additional cost to society," Levy says. "If providing access is a national priority, we should pay for it with money and not speculative savings. Eliminating the current tax exemption for employer-sponsored insurance is the most equitable way to do this and would raise over $200 billion per year in a manner consistent with the progressive federal income tax system."

Beth Israel Deaconess Medical Center has appointed a new chief of obstetrics and gynecology to fill a vacancy created when its former chief left to help rebuild healthcare in New Orleans after Hurricane Katrina.

Dr. John Yeh, who was a resident at Beth Israel Hospital in the 1980s, is the new chief. He comes from the University at Buffalo, the State University of New York, where he was chairman of gynecology-obstetrics since 2000. He earned an undergraduate degree at Harvard College and a medical degree at the University of California, San Diego. After n obstetrics and gynecology residency at Beth Israel, he did clinical fellowships at Brigham and Women’s Hospital and Boston’s Children’s Hospital.

Yeh succeeds Dr. Benjamin Sachs, who became dean of Tulane Medical School in 2007. While at Beth Israel Deaconess, he was honored for a team training approach to reduce medical errors.