Beyond Mandatory Autonomy: Truth Without Abandonment
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.
Latest
AI Won't De-Skill Palliative Care
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.
The Rise and Fall of San Diego Hospice — Part 2
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.
The Sectarian Temptation
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.
Hospice Was Never Built for Kids
💡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.
Teams, Not Saviors: Protecting Each Other from Compassion’s Edge States
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.
The Rise and Fall of San Diego Hospice — Part 1
How a “Mother Ship” Was Built: Ethos, Scale, and Blind Spots I trained at San Diego Hospice. In fact I was part of the last class of fellows. That sentence carries weight I've been unpacking ever since. SDH shaped how I think about dying, how I talk to
Beyond Mandatory Autonomy: Clinician‑Guided Care Without Guilt
💡This is Part 2 of an ongoing series on the concepts and innovations that are challenging decision-making in serious illness. Part 1 laid out why "mandatory autonomy" is failing patients and families, and introduced Kon's shared decision-making continuum as a practical alternative. The Word We Don&
Hospice ROI Lives in Relationships, Not Throughput & Widgets
If you want real returns, invest in earlier hospice enrollment, stable teams, and time to do the relational work—then use tech to buy clinicians that time. I read the Hospice News piece celebrating AI’s promise in hospice—faster admissions, smarter documentation, and “efficiency” to stretch scarce clinicians. The
A Near‑future Worth Building For Community Specialty Palliative Care
A pediatrics team in Queensland just did something our field talks about but rarely executes. Gold Coast Health launched DevPaed Connect—a shared-care model that lets PCPs (we'll use the US lingo here, but "GP" if you're Down Under) submit a clinical question to
Beyond Mandatory Autonomy: Rethinking Decision-Making in Serious Illness
💡This is the first in a four (?) part series on the concepts and innovations that are challenging decision-making. The Autonomy Myth and Why It’s Failing Us Truth bomb: “Do you want us to shock his heart if it stops?” is not a neutral question. It’s a transfer of
What Physicians Are (Actually) For On Specialist Palliative Care Teams
If you think the physician on a Specialist Palliative Care team is the captain, you’ve already missed the plot. Our role is counter‑cultural: we make space, translate, and selectively intervene—then get out of the way. That’s how teams deliver the outcomes the literature promises. Why teams,
Health Policy
Hospice Is Buckling Under Structural Choices We Made
Hospice isn’t failing because clinicians forgot how to care. It’s failing because we built a structure that funds poorly, measures the wrong things, and aims enforcement in ways that often miss the mark.
Palliative Care 3.0: What We Should Build Now That We Find Ourselves In The Wild West
While this topic is important and topical (and I'm really trying to keep my commentary on current events elsewhere), I couldn't in good conscience not take a moment to acknowledge what's going on around us. These past days have been heavy. The slaying of
Health Policy
Hospice Caregiver Burden and the Systematic Delegitimization of Care
💡Start with Rachel Cohen Booth's excellent article in Vox, What happens when a city takes women’s unpaid work seriously? It catalyzed my thoughts below. Hospice prides itself on dignity at the end of life. But what about dignity for those doing the hardest work—unpaid caregivers? If
Opinion
Did Palliative Care Spend a Decade on the Wrong Problem?
I think this might be true, but I invite your commentary and reactions: The move toward “everyone with serious illness needs specialist palliative care” consumed a decade of oxygen and money while the harder, more consequential work—how to pay for specialist, team-based palliative care as defined by NQF/NCP
Teaching Pearl
Kyle’s Pain Pearls & Pet Peeves
Welcome back to Rounds & Rants, where we tackle the myths, misunderstandings, and maddening habits that make living harder than it needs to be. For today’s topic I thought I'd bring us back from the clouds where I lived for the first few points and talk about
Changing the World
Death, Creativity, and Compassion: What Are We Really Training For?
In specialist palliative care, we talk about “compassion training” as if it’s a discrete skill you can add to a checklist. Joan Halifax’s enactive model challenges that notion: compassion isn’t a module; it emerges when attentional clarity, affective balance, ethical intention, and embodied engagement cohere in context.
Changing the World
Augmented Intelligence in Palliative Care—Redesigning Care Delivery
Dr. Whyte's right—and in palliative care, the stakes are even higher.
Changing the World
Compassion on Clearance: Why Palliative Values Always Seem to End Up Out of Stock
If you’ve ever wondered why working in healthcare, especially in Specialist Palliative Care, feels like its being pulverized by grinding gears, this essay is for you.
Changing the World
The Monster We Built—and How Palliative Care Can Slay It
Let’s stop pretending that our health system is anything other than a Frankenstein’s monster stitched together from billing codes, productivity metrics, and cultural myths about heroism in medicine.
Communication Skills
What Kyle Learned Recently
From time-to-time, I will publish articles that have recently crossed my path with my analysis of what they tell us. This will be the first in that series.
Precision Symptom Management: Why Palliative Care Is Poised for a Genomic Revolution
The News That Sparked This Post Tempus AI’s acquisition of OneOme’s pharmacogenomics (PGx) assets is making headlines in precision medicine circles. Most observers see this as an oncology play. They’re not wrong—Tempus has built its reputation on molecular oncology and AI-driven insights. But here’s the
Hows & Whys
Why in the World Would Anyone Listen to Me?
Why listen to me? Because I’m not here to sell platitudes. I’m here to share the soapboxes I stand on every day, bust the myths that make care worse, and offer the kind of practical wisdom you only get when you’ve sat at the bedside for thousands of hours.