Specialist palliative care is harder than you think.
Hows & Whys
Our predecessors arrived with lancets, basins, and calomel, and families opened the door anyway. Two documents published this August argue about what physicians are for without ever asking why.
Hows & Whys
Operations research has a name for what a palliative care consult does to a system failure. The name explains why the failure keeps happening.
Communication Skills
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
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
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
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 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
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
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
“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
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.