Hows & Whys
The Work Beneath the Conversation: The Workaround
Operations research has a name for what a palliative care consult does to a system failure. The name explains why the failure keeps happening.
Hows & Whys
What's R&R all about anyway?
Systems Thinking
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.
Communication Skills
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.
Communication Skills
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.
Meaning
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.
Changing the World
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.
Hospice
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.
Hows & Whys
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.
Hows & Whys
Kratom In the Chart
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 Disappearing Specialty, Part III
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
The Disappearing Specialty, Part II
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.
Communication Skills
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.