The Quiet Revolution We Built Together

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 by about 700 professionals. Today over 3000 generally attend. The 2004 AAHPM Annual Assembly featured nationally recognized leaders such as Diane Meier, Ira Byock, Betty Ferrel, and Christine Cassel, alongside many other early architects of the field. Core topics included advanced pain and symptom management, clinician–patient communication, ethics and goals-of-care decision-making, interdisciplinary team models, and the emerging role of palliative care across hospitals, hospice, and community settings

As the AAHPM–HPNA Annual Assembly approaches, I find myself reflecting not just on where the field is going, but on how profoundly it has already transformed healthcare, often without fully claiming credit for it.

Because whether hospitals, healthcare administrators, or venture capitalists realize it or not, whether policymakers name it or not, whether payment models keep up or lag behind, modern healthcare looks different because palliative care exists.

We Changed What “Good Medicine” Looks Like

There was a time (not that long ago) when good medicine meant doing more. More procedures. More ICU days. More interventions layered on top of one another, often without pausing to ask the most important questions:

• What matters to this person?

• What are we actually trying to achieve?

• At what cost—to the patient, the family, the clinicians?

Palliative care didn’t just introduce better symptom control (though we did that exceptionally well). We introduced clarity. We normalized goals-of-care conversations. We made it acceptable, expected even, for clinicians to talk openly about prognosis, uncertainty, and tradeoffs.

We reframed success:

Sometimes success is pain and symptom  management and comfort.

Sometimes it’s time at home.

Sometimes it’s avoiding one more hospitalization that no longer aligns with a patient’s values.

That shift has changed how medicine is practiced far beyond our consult teams.

We Humanized Complex Care

Serious illness is messy. It doesn’t fit neatly into problem lists or DRGs. It spills into family systems, finances, identity, faith, and fear.  Palliative care showed the healthcare system that complexity isn’t a flaw, it’s the reality.

By insisting on interdisciplinary (or as my friend Connie Dahlin would correct me, interprofessional)  teams - physicians, nurses, social workers, chaplains, pharmacists-we modeled a version of care that treats people, not organs. We proved that emotional distress and spiritual suffering are not “soft issues,” but clinical realities with measurable impact.

Today, when health systems talk about whole-person care, caregiver burden, moral distress, or burnout, they are often using language that palliative care normalized long before it was fashionable.

We Changed Conversations About Value

Long before “value-based care” became a buzzword, palliative care was demonstrating what real value looks like: care that is aligned, intentional, present, and proportionate.

We showed that listening reduces suffering, improves outcomes patients actually care about, and often lowers costs as a byproduct, not the goal.

But more importantly, we challenged a dangerous assumption in healthcare: that cost containment and compassion are at odds.

They’re not.

Thoughtful care is often less expensive precisely because it avoids unwanted, non-beneficial, or harmful interventions. Palliative care didn’t invent this truth but we made it visible.

We Built a Workforce Driven by Vocation

No one stumbles into palliative care by accident.

While we do face real workforce challenges, as I noted in a previous blog, we chose this field knowing the tradeoffs:

• Lower compensation

• Emotional intensity

• Fewer procedural accolades

• More conversations that don’t have tidy ending's

And yet, year after year, people stay.

We stay because palliative care is not just a specialty, it’s a calling. A commitment to bearing witness, to sitting with uncertainty, to showing up when cure is no longer the metric of success.

That moral center matters. In an era when medicine is strained by throughput demands, RVUs, and administrative burden, palliative care has remained a reminder of why many of us went into medicine in the first place.

We Are No Longer “The Future”, We Are The Foundation

For years, palliative care was described as “the future of healthcare.”  The truth is simpler, and more powerful.

We are now part of the foundation.

You see it in oncology pathways that integrate early palliative involvement.

You see it in ICUs where family meetings are no longer optional.

You see it in serious illness conversations happening earlier, more honestly, and with greater skill across specialties.

There is still work to do, around access, workforce shortages, payment reform, and equity. But this moment deserves recognition.

As clinicians, leaders, educators, advocates, and caregivers gather at the Annual Assembly, this is a time to celebrate not just a conference, but a movement that has reshaped how healthcare thinks about suffering, dignity, and care.

Palliative medicine didn’t just add a service line.

It changed the lens.

And healthcare is better because of it.