Got a chance to listen to the new @ama-assn.org podcast today and I think it’s a hit!
Quick, well structured, well produced and taught me a few things about protein-maxxing (as the whippersnappers say).
We talk a lot about prognostic uncertainty at the bedside.
We talk far less about uncertainty at the board table.
Read “Dead Reckoning," rounds-and-rants.ghost.io/the-rise-and...
#PalliativeCare #Hospice #HealthPolicy #HAPC
This is not about villains.
It’s about what organizations owe patients during uncertainty: Not just honesty about risk, but a navigable path through it.
That’s palliative care logic applied to systems.
When the real audit landed years later?
~$10M in overpayments. Negotiable. Survivable.
The organization was already gone.
Sequence killed the mission.
In 2012:
• No audit findings
• No exposure range
• No timeline
• No external fix from CMS
But there was:
• A front-page disclosure
• A $50M estimate treated as fact
• Referrers panicking
• Census collapsing
San Diego Hospice didn’t fail because Medicare wanted money back.
It failed because leaders made irreversible decisions before they had a number.
That distinction matters for palliative care.
Congratulations to Dr. Ian Neel and his co-authors on officially being the first publication in the Proceedings of the @ucsdhealthsci.bsky.social Department of Medicine via @cureusmedical.bsky.social!
First but not the last!
Cc @ucsdggpc.bsky.social #Geriatrics #Dementia
Since today is First Contact Day (the day in Star Trek when humans meet their first aliens, Vulcans) it’s worth talking about that story a bit and how it can inform our analysis of Artemis.
This involves a lot of spoilers from the film Star Trek: First Contact 🖖🏽
en.wikipedia.org/wiki/Star_Tr...
The only thing that has ever made me want to be President is my now-recurring fantasy of personally and manually tearing all of this down.
Despite being assigned a #SadHands photo, I’m thrilled that @statnews.com published my OpEd.
“As a #palliative care physician, I’m nervous about the Medicare infusion of $100 million for ‘functional or lifestyle medicine’”
www.statnews.com/2026/04/09/p...
#HAPC #PalliativeCare
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.
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...
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
