Be the gears, not the gristle.
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.
Spicy
The delivery models our best researchers are building don't use the binary. They use tiers, triggers, defaults, dose-response logic, and precision targeting.
Meaning
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 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.
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.
Health Policy
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
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.
Health Policy
The biggest cancer centers don't get to be biggest because they decided to be. They are accredited. Each of their accreditation regimes carries floor requirements. Some of those floors are clinical. Some of those floors include specialty palliative care.
Changing the World
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.
Hows & Whys
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.