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.
Palliative Care
Specialist palliative care is harder than you think.
Communication Skills
The Work Beneath the Conversation: Articulation Work
There's a word for the part of our job nobody can see. Sociologists have had it since the 1980s. We were never trained in the discipline that keeps it.
Palliative Care
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.
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
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.
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.
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
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.
Communication Skills
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.
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.