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.
Teaching Pearl
Practical wisdom to the best of my knowledge.
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.
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.
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.
Communication Skills
Beyond Mandatory Autonomy: Truth Without Abandonment
Honesty and hope aren’t opposing forces. They are a matched set: hope for the best and prepare for the worst—paired with an explicit promise of nonabandonment.
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.
Teaching Pearl
Kyle’s Pain Pearls & Pet Peeves
Welcome back to Rounds & Rants, where we tackle the myths, misunderstandings, and maddening habits that make living harder than it needs to be. For today’s topic I thought I'd bring us back from the clouds where I lived for the first few points and talk about
Changing the World
Death, Creativity, and Compassion: What Are We Really Training For?
In specialist palliative care, we talk about “compassion training” as if it’s a discrete skill you can add to a checklist. Joan Halifax’s enactive model challenges that notion: compassion isn’t a module; it emerges when attentional clarity, affective balance, ethical intention, and embodied engagement cohere in context.
Communication Skills
What Kyle Learned Recently
From time-to-time, I will publish articles that have recently crossed my path with my analysis of what they tell us. This will be the first in that series.