“I Want to Learn to Speak Palliative Care”: Reflections from Fellowship Interviews

In the blink of an eye, summer has passed and another fellowship interview season has come and gone. For candidates, the process is a whirlwind of emotions—from excitement to exhaustion—as they carry the weight of their aspirations alongside the pressures of the selection process. For interviewers, it offers a glimpse into the future of palliative care, shaped by the perspectives of those who will soon become its stewards. During this period of reflection and interaction, we are reminded of the profound value palliative care brings to health care.

With pumpkin spice cappuccinos in hand, we reviewed notes from past interviews and marveled at the perspectives shared by palliative care fellowship candidates. Their reflections reveal hope, idealism, and a sense of optimism for the future of health care. As one candidate aptly expressed, “Palliative care is a beautiful thing. [Patients] are counting on us.”

Palliative care brings together medicine, relief of suffering, humility, communication, intentional listening, and self-awareness in a way that few other specialties do. One candidate reflected on the NEJM essay, “The Name of the Dog,” which underscores the importance of building relationships by asking patients about what matters most to them.

The public perception of palliative care has evolved significantly over the years. As one candidate remarked, she went “from Angel of Death to The Most Trusted Doctor” through her work with a patient. This transformation in perception is reflected by Dame Cecily Saunders’ insight: "We will do all we can not only to help you die peacefully, but also to live until you die."

Another applicant reframed palliative care as being rooted in “hope”—hope for celebrating life even in the face of serious illness, hope to become a patient's advocate, and hope to bring human connection back to medicine.

Many candidates saw palliative care as a vital aspect of holistic medicine. One interviewee described it as “medicine with humility.” Another reflected on how sub-specialization in medicine often leads to fragmented care, and palliative care ensures the “big picture” is always considered. As one candidate put it, “We appreciate palliative care always coming, staying calm, and tying up a pretty bow around all the messy situations we encounter.” This ability to remain composed and provide clarity amid the complex storm of illness is what makes palliative care so essential.

Communication is foundational to palliative care, and many fellowship candidates expressed a desire to hone these skills when they join the field. One remarked, “I want to learn to speak palliative.” Another emphasized the power of silence, noting that sometimes saying nothing at all can be the most meaningful response. Effective communication involves more than just words, it requires empathy, therapeutic and appreciative listening, and the ability to navigate difficult conversations with grace and compassion. Palliative care teaches communication skills as a procedure: one that involves preparation, thoughtful planning, execution, and debriefing.

Several candidates shared how their prior experiences shaped their approach to palliative communication. One applicant with a background in journalism described how this experience emphasized the importance of truly listening to and capturing people’s stories. Another summed it up simply: “Palliative care is the ‘make it make sense’ specialty.” At its core, this work involves guiding patients and their loved ones through the complexities of illness and helping them find peace in moments of uncertainty.

An applicant described palliative care as a specialty that “marries medicine with the human experience,” transcending the technicalities of disease treatment and exploring the deeply human needs of those facing serious conditions.

Another interviewee observed, “Palliative care is all about family dynamics. They all presumably grew up under the same roof. How are they all so different?” These differences can create both tension and opportunities for deeper connections and understanding. Palliative care clinicians navigate these dynamics with sensitivity and a goal of healing, ensuring that each family member’s voice is heard and respected.

Serious and terminal illnesses, while often viewed through the lens of tragedy, can also be a time of strength, resilience, and even beauty. As one candidate poignantly remarked, “Dying… can be like a graduation. It’s a process of letting go. It’s a bittersweet time.” This perspective highlights the human side of medicine that palliative care champions, one that honors the full spectrum of emotions and experiences.

Palliative care training hones a deep sense of self-awareness, self-regulation, and emotional intelligence. One candidate shared, “I’m comfortable with being uncomfortable,” reflecting the need to embrace uncertainty and ambiguity in this field. Another noted that palliative care is “more explorative” and inherently team-based, requiring a shift away from task-driven, contingency-focused medicine.

The practice of palliative care is also a life-long process of personal growth. One candidate described striving to “be the little water that drops through the stone,” continuously teaching themselves and others about the principles of palliative care.

Palliative care is a field that brings together the best of medicine with the essential aspects of humanity. It is a discipline rooted in humility, communication, and self-awareness. It seeks to offer validation, comfort, and clarity during life’s most difficult moments. As these future physicians reflect on their experiences and aspirations, we are confident that the future of the field is in capable hands. These rising stars see the beauty and hope in what we do, recognizing palliative care as a practice that not only celebrates life but also honors the human spirit.

As one candidate put it, “Palliative care is about advocating for our patients—advocating for their voices to be heard. Not just churning admissions and discharges.” In a health care system that often prioritizes protocols and results, palliative care reminds us that sometimes, the most important thing we can do is listen and be present. Human beings helping other human beings.

At the end of the day, we stroll through a nearby botanical garden, pausing to smell the roses and appreciate the little things in life that matter most. We find ourselves reflecting on how to live each day better. Carpe diem!