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 framew...

Full argument here:
rounds-and-rants.ghost.io/the-sectaria...

Palliative care should be where we prove something rare:
You can honor mystery without inventing myths.

You can say “I don’t know” without handing the room to sectarian certainty.

That requires rigor, humility, and serious respect for language.

Placebo and nocebo aren’t fake.

They’re psychobiology.

How we frame suffering changes physiology.

Every goals-of-care conversation is also a neurobiological event.

That doesn’t excuse pseudoscience.

It raises the bar for how careful we must be.

High emotion + high uncertainty is where confident but untestable answers thrive.

IV vitamins. “Root cause” detox. Immunity from disproof.
Not abstract harm.

Real patients. Real decisions. Real bodies.

And the pathway runs straight through communication.

#PalliativeCare lives where certainty goes to die.

That’s our strength.

It’s also our greatest vulnerability.

When medicine pretends there’s no mystery, people flee.

When we treat mystery as sacred knowledge, we become a sect.

That tension is reshaping serious illness care right now. 🧵

NASA isn't why the US doesn't have universal healthcare, or a social safety net. The US doesn't have those things because politicians with the power to provide them choose specifically not to (with varying levels of support from voters). Enthusiasm for human spaceflight doesn't drive that choice.

Hospice Was Never Built for Kids 💡No, gentle readers, you're not hallucinating. Those of you subscribed to the newsletter email got a preview of this one last week due to a publication scheduling error. Probably won't be the last tim...

We can stop forcing children into adult frames.

We can build what families actually need.

More here: rounds-and-rants.ghost.io/hospice-was-...

#PedPC #HAPC #PalliativeCare #Palliative #HealthPolicy #Medicaid #CaregiverSupport #RespiteCare #ComplexCare #ChildrensHealth

A new pediatric palliative care framework shows how respite fits under EPSDT without asking permission from Washington.

Stabilizing the caregiver prevents deterioration.
That’s medical work.

Calling it “non‑medical” doesn’t make the downstream admissions disappear.

Adult hospice rules don’t transfer.
✔️Different skills.
✔️Different staffing.
✔️Different reality.

It’s what happens when we build adult systems and ask kids to squeeze into them.

Parents tell us the same thing over and over: They don’t need another admission. They need respite before everything breaks.

If that doesn’t tell us the system is misfiring, I don’t know what does.

Children with medical complexity are <1% of kids and drive >30% of pediatric healthcare spending.

Some children’s hospitals report they account for up to 80% of hospital days.

Yet only ~2% of Medicaid dollars go to home health.

That gap didn’t appear by accident.

Hospice was never built for kids.

And every night, families are absorbing the consequences of that design choice.

🧵

If you've been following Artemis II obsessively, you really need to read the Lady Astronaut books by @maryrobinettekowal.com
You really do. They are amazingly thorough and accurate about space flight (no, really...you will learn so much!) and also super entertaining w/ deep characterizations. 👩‍🚀 🚀

AND the AMA’s policies are both public and only changeable by the House of Delegates (not the comms team or Board Chair). For instance, policysearch.ama-assn.org/policyfinder...

Teams, Not Saviors: Protecting Each Other from Compassion’s Edge States Every team thinks they’re compassionate. Fewer can name the cliffs embedded in compassion—and fewer still can stop one another from going over the edge in the middle of a messy consult.

Compassion isn’t a heroic trait. It’s a coordinated practice. High‑functioning teams keep each other from the cliff—not by caring more, but by caring together.

rounds-and-rants.ghost.io/teams-not-sa...

#Palliative #Hospice #SeriousIllnessCare

My favorite move: a 60‑second G.R.A.C.E. pause before and after the hard conversations. And a teammate with permission to call it when someone’s sliding. It stabilizes the room.

#GRACE #TeamCare

But teams can train for these moments. Shared language helps. So does a predictable structure. Slow the encounter. Realign the group.

#Communication #PalliativeCare

When one clinician tips into distress or saviorism, the whole team adjusts around them. The conversation changes. The family senses it. The work gets heavier.

#ClinicianWellbeing #Burnout

I’ve watched the same patterns in every setting: menu‑dumping, scare tactics, data bunkers, all‑or‑none framing. These aren’t communication quirks. They’re team‑level edge states.

#SeriousIllnessCare #MedEd

Every team has a moment when the encounter starts to tilt—one person gets overwhelmed, another shuts down, someone overfunctions. The slide is quiet but fast.

#PalliativeCare

How Chiropractors Became the Backbone of MAHA Why they love Robert F. Kennedy Jr. — and he loves them.

No exaggeration, I think this is one of the most important stories in US health care. MAHA makes a lot more sense if you see it as a hostile takeover by the quackery industry

Note for #HAPC #Palliative #PalPharm folks: BPC-157 is about to be something you have to know about.

Ms Rachel talking to Deiver Henao, a 9yo in an immigration detention center

www.instagram.com/reel/DVzUzoz...

What a world

Beyond Mandatory Autonomy: Clinician‑Guided Care Without Guilt 💡This is Part 2 of an ongoing series on the concepts and innovations that are challenging decision-making in serious illness. Part 1 laid out why "mandatory autonomy" is failing patients and families,...

Families don’t need menus. They need clinicians who know them, guide them, and leave the door open.
Full post: rounds-and-rants.ghost.io/beyond-manda...

This week’s piece breaks it down: power literacy, default settings, solidarity, trauma-informed choices, and the workflows that make clinician-guided care ethical instead of coercive.
#GoalsOfCare #AdvanceCarePlanning #HealthJustice

Most experienced palliative clinicians already practice maternalism: guided recommendations rooted in relationship, values, and trust. But we rarely name it, and we rarely build the guardrails that keep it safe.
#Hospice #Communication #TraumaInformedCare #RelationalAutonomy

We keep telling families “it’s your choice,” then watch them drown in guilt, fear, and impossible decisions. That isn’t autonomy. It’s abandonment dressed up as respect.

#PalliativeCare #SeriousIllness #EOL #Ethics #HealthEquity #Palliative #Bioethics #MedEd #HAPC

Reverend Jesse Jackson called on each of us to be heralds of change, to be messengers of hope; to step forward and say “Send me” wherever we have a chance to make an impact.

How fortunate we were that Jesse Jackson answered that call. What a great debt we owe to him.

Welcome #HAPC26 to San Diego. We are so glad you're here.

We are ready to talk about our work, learn about yours, and share some excellent places to eat. Think: Lionfish, Seneca, Ironside.

#PalliativeCare w @ucsdhealthsci.bsky.social, @ucsdhealth.bsky.social, & @scrippshealth.bsky.social

#hapc26 attendees! This weekend buy the special edition AAHPM shirt! $5 from every T‑shirt supports the AAHPM Access Fund, helping U.S.-based members attend the 2027 Annual Assembly. Get yours at the AAHPM Resource Center—while supplies last! #wearitforward #hapc26