The Work Beneath the Conversation: I Could Do That If I Had Time
Three trials tested whether the conversation is the intervention. Two came back null and one looked inside the machine. None of them supports the sentence — or our answer to it.
Why Palliative Care Works Best When the House Is on Fire
What Specialist Palliative Care has is concentration and repetition—we are in these rooms constantly, so we have gotten fast at reading which belief has seized and where the opening is. Scarcity does a great deal of the work in making that look like something only we possess.
Beyond Mandatory Autonomy: When to Stop Asking
The asking is the easy part. It's the move that lets you leave the room with clean hands, a documented preference, and a man who will get chest compressions he never wanted.
The Question That Ends With a Period
There are two options that are good for you. Both are disagreeable. My job is not to invent a third or to make you pronounce the medical conclusion so I don't have to be the one who said it. My job is to tell you why the boundary exists, in language you can argue with.
Time to Move On From The Buckets
The delivery models our best researchers are building don't use the binary. They use tiers, triggers, defaults, dose-response logic, and precision targeting.
The Taxonomy Is Lagging the Trials
A continuum framework doesn't abandon non-specialist training. It specifies it: which competencies, for which clinicians, at which moments, with what infrastructure.
Palliative Care’s Real Power Skill Is Systems Translation
Palliative care must keep the bullshit filter intact, and stop letting our most consequential work get filed under "support." That is systems translation: converting symptoms, values, family dynamics, prognostic reality, and institutional constraints into care plans the system can actually execute.
The Rise and Fall of San Diego Hospice — Part 3
A nine‑figure proof of claim became the public’s north star—filed months after SDH had already stopped caring for patients—while the Medicare audit later released via FOIA documented > $10M in overpayments. Different artifacts. Different implications.
Shared Decision-Making Is Ours. Don't Let Them Break It.
The distinction between a recommendation and a coercion is the moral architecture of palliative care. When that distinction collapses in the broader culture, we lose the ground we stand on.
The Room You Can't Curate
I have to make an argument, hear a counterargument, lose a vote, and then sit next to the person who beat me at dinner. And then come back the next morning and do it again.
The Peptide Temptation
“Peptide therapy” sounds scientific enough to borrow the prestige of translational medicine and vague enough to hold almost any hope someone wants to pour into it. And that is part of the appeal.
The 2 a.m. Second Opinion
Here's what I think is happening—quietly, unevenly, and faster than our field is tracking: the foundational architecture of serious illness communication is being restructured by a force we didn't design, don't control, and in many cases don't even know is in the room.