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The Palliative Lens Andrew Esch MD MBA 3/4/2026 My wife’s uncle Martin is dying. He is here with us in Tampa, he is enrolled in one of our local hospices. The hospice care itself has been a disaster, and that story may come in another blog. Right now it is simply too sad, too emotional, for me to be articulate about it. Today I want to celebrate Martin. Martin is not easy to describe to people who haven’t known him. In many ways, he is an anomaly in today’s world. He is alwa

The Palliative Lens Andrew Esch MD MBA This is written in celebration of the upcoming 2026 AAHPM/HPNA Annual Assembly. There are moments in medicine when you step back and realize that something fundamental has shifted, not with a press release or a dramatic announcement, but quietly, steadily, because a group of people refused to accept the status quo. Palliative medicine is one of those shifts. The first annual assembly was held in 2004 in Phoenix, Arizona and was attended

The Palliative Lens By Andrew Esch, MD Are we approaching the point where health insurance is so expensive that it makes more sense to self-pay? Not “go uninsured and hope for the best.” I mean something more deliberate and more telling: · Pay cash for routine care, imaging, labs, and straightforward procedures · Use a membership model for primary care (DPC or concierge-lite) · Carry catastrophic coverage for the true financial disasters — ICU stays, cancer,

The Palliative Lens By Andrew Esch, MD 2/13/2026 I have a question. What exactly are we doing? The data that made palliative care credible, the trials, the cost savings, the quality outcomes, the patient and family satisfaction, were not built on having just any “palliative care.” They were built on interdisciplinary palliative care teams. Physicians. Nurses. Social workers. Chaplains. Working together, at the same time, around the same patient. That wasn’t a nice bonus fe

The Palliative Lens By Andrew Esch MD It may surprise some (most) people who have worked with me to hear this: I’m a conservative. Not the caricature. Not the stereotype. Not the version people imagine when they hear the word. Just… me. A physician who believes in patient dignity, responsibility, community, and the idea that medicine is fundamentally about showing up for people when they are most vulnerable. For most of my career, I kept my political identity quiet. Not becau

The Palliative Lens By Andrew Esch, MD I love being a physician. I love palliative care. Let me say that first, because everything that follows only makes sense if you understand that. This field has given me the most meaningful professional moments of my life, sitting with families in impossible moments, helping patients reclaim control over their story, and reminding medicine what it is supposed to be about: people. Yet , when my twins, now third-year medical students, ask

The Palliative Lens By Andrew Esch, MD 2/5/2026 There are many hard parts of practicing palliative care. Sitting with grief. Navigating uncertainty. Helping families make impossible decisions. Bearing witness to suffering. But one of the most quietly infuriating parts of my job has nothing to do with medicine at all. It’s the pharmacy. More specifically: trying to get seriously ill patients the medications they’ve already been appropriately prescribed (especially controlled m

THE PALLIATIVE LENS Seeing serious illness care more clearly By Andrew Esch, MD The Palliative Lens 2/3/2026 I want you to try something uncomfortable. Imagine you’re the patient. Not your “patient.” You. Your name. Your body. Your fear. Your spouse trying to keep it together in the passenger seat. Your symptoms are stacking up, your sleep is gone, and the oncologist (or cardiologist, or pulmonologist) says the words we all know: “We can keep treating, but this is getting ha

THE PALLIATIVE LENS Seeing serious illness care more clearly By Andrew Esch, MD The Palliative Lens 2/4/2026 I have spent much of my career believing in hospice. I still do, at least in what hospice was meant to be . But believing in the idea of hospice is not the same as being willing to ignore what it has become. And what it has become, in too many places, is something that no longer earns the trust of the patients and families it claims to serve. That loss of trust did no

THE PALLIATIVE LENS Seeing serious illness care more clearly By Andrew Esch, MD 2/1/2026 The field of hospice and palliative medicine is at a critical inflection point. What once stood as a deeply human, patient-centered approach to care is now at risk of being overshadowed by systemic pressures that threaten quality, accessibility, and the very ethos of why we entered this field in the first place. The Palliative Lens is being launched because we can no longer sit quietly w