Spicy
Time to Move On From The Buckets
The delivery models our best researchers are building don't use the binary. They use tiers, triggers, defaults, dose-response logic, and precision targeting.
Spicy
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.
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
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.
Changing the World
You Will Not Be the Person Who Filled Out That Form
What if the reason ACP underdelivers isn't that we do too little of it, but that we've misunderstood what it's for? The answer lives in an unlikely place for a clinical field: behavioral economics.
Health Policy
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
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
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/