Kyle: Palliative doc, educator, and professional overthinker. Known for turning rounds into rants and rants into teaching points. Writes about medicine, communication, and the evidence-base for the meaning of life.
Communication Skills
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.
Hows & Whys
Kratom becomes clinically relevant because millions of people live in a health system where pain care is uneven and access to thoughtful longitudinal symptom care is thin.
Health Policy
The AI infrastructure that will drive the next decade of cancer care doesn't have a signal for the work specialty palliative care does. As the AI hardens, the field gets quieter — not because anyone decided to silence us, but because the algorithm has no pattern for the patient who needs us.
Hows & Whys
Walk into the website of any cancer center built or rebranded in the last five years and you will find palliative care's vocabulary doing work it didn't sign up for. Symptom management. Whole-person care. Goals of care. Supportive care. The words are everywhere. The specialty is harder to find.
Health Policy
The biggest cancer centers don't get to be biggest because they decided to be. They are accredited. Each of their accreditation regimes carries floor requirements. Some of those floors are clinical. Some of those floors include specialty palliative care.
Changing the World
What if the reason ACP underdelivers isn't that we do too little of it, but that we've misunderstood what it's for? The answer lives in an unlikely place for a clinical field: behavioral economics.
Communication Skills
Honesty and hope aren’t opposing forces. They are a matched set: hope for the best and prepare for the worst—paired with an explicit promise of nonabandonment.
Hows & Whys
The de-skilling threat is real and asymmetric across specialties. Palliative care sits on the protected side of that asymmetry—because the highest-value things we do are the things machines are worst at.
Hospice
This is what happened at San Diego Hospice between November 2012 and February 2013. Leadership made a series of irreversible operational decisions — public disclosure, inpatient closure, live discharges, admission restrictions — while sailing entirely on estimated position.
Health Policy
We work in the places where evidence gets thin, emotions run hot, and the mysteries are real. It is the exact territory where sectarian certainty rushes in with confident answers, unfalsifiable frameworks, and the seductive promise that someone, somewhere, has figured it all out.
💡No, gentle readers, you're not hallucinating. Those of you subscribed to the newsletter email got a preview of this one last week due to a publication scheduling error. Probably won't be the last time that happens! Maybe I'll call it a "subscriber perk.
Communication Skills
Every team thinks they’re compassionate. Fewer can name the cliffs embedded in compassion—and fewer still can stop one another from going over the edge in the middle of a messy consult.