Dr. Harlan Krumholz reflects on the profound impact of experiencing a patient's death for the first time, describing how medical training often leaves clinicians unprepared for the emotional and communicative challenges that follow. Over time, he developed a compassionate framework for speaking with grieving families—honoring the deceased, reassuring them about suffering, releasing them from guilt, and recognizing the love present—to help shape how loss is experienced and remembered. He urges physicians to share their own stories of patient loss, emphasizing that medicine is not only about prolonging life but also about caring deeply and meaningfully when life ends.

In this week's Editor's Page, Dr. Harlan Krumholz introduces Dr. Milton Packer's adipokine hypothesis, which proposes that dysfunctional visceral fat and the adipokines it secretes are central to the development of heart failure with preserved ejection fraction (HFpEF). This framework suggests that the benefits of therapies like GLP-1 receptor agonists and SGLT2 inhibitors may stem partly from restoring balance in adipose–cardiac signaling, offering a biologically grounded model for a condition long marked by therapeutic frustration. While the hypothesis is ambitious and unproven, it provides a coherent structure for future research and exemplifies how bold, integrative thinking can advance medical understanding.

In the Editor's Page for the JACC October 14, 2025 issue, JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, critiques the current physician certification system, arguing it is outdated, misaligned with real-world clinical practice, and contributes to physician burnout without clear evidence of improved patient outcomes. He proposes a modernized, two-tiered framework for certification—distinguishing between essential, instantly recallable knowledge (Type 1) and complex, reasoning-based skills (Type 2)—that emphasizes continuous learning, relevance, and support over high-stakes testing.