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.
Meaning
Wisdom coming at you direct from people in the liminal spaces of the hardest days of their life.
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.
Communication Skills
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.
Changing the World
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.
Hows & Whys
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.
Hospice
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.
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.
Hows & Whys
Why Rounds & Rants Exists
If you want evidence-driven insights, humor, and the occasional rant that makes you rethink how we care for people when it matters most, welcome aboard.