I’m an engineer, not a physician. For the better part of a year I worked on AI for primary care, and much of that time I spent close to primary care doctors and the people who keep their practices open. I went in assuming the hardest problems would be clinical. They weren’t. The thing I watched wear people down, week after week, was billing.
Not the medicine. The paperwork wrapped around …
Why independent practices sell comes down to billing
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Medicare for All keeps dying in Congress. So what would actually get the major players to agree on universal coverage? Health care journalist Ken Terry returns to lay out a different model, one …
How to fix health care without Medicare for All [PODCAST]
The committee had met six times. The quality data was clear. The care pathway was evidence-based. The physicians in the room nodded. Six months later, nothing had changed.
Not because the initiative was wrong. Not because the physicians were resistant. Because the environment it landed in was never built to hold it.
This is the diagnosis most physician leaders never make, not about their patients, but about their organizations. They identify the …
Why change fails in health care organizations
Needle exchange programs are one of the most well-known, and subsequently most controversial, forms of harm reduction in addiction medicine. These programs provide clean needles and/or syringes for drug users, often in exchange for used needles, in efforts to curb the unsanitary reuse of needles and subsequently decrease the spread of infectious diseases such as hepatitis and HIV. Needle exchange programs, on their own, have been shown to decrease …
Needle exchange programs treat the symptom, not the disease
Owning a proprietary infrastructure layer in AI right now is closer to owning a diamond mine than owning a piece of software, yet most mental health apps still choose to live inside the wrapper pool rather than build their own. That observation comes from years spent building at the intersection of artificial intelligence, behavioral psychology, and neuroscience, evaluating every frontier AI model available, both general-purpose and mental-health-specific, until I could …
Why most AI mental health apps feel like a loop
As physicians, we are taught to diagnose accurately and act quickly. Clinical guidelines assume that if we identify the problem, the health care system will provide the necessary tools to solve it. But what happens when the diagnosis is clear and the treatment simply does not exist?
Recently, while working as an intern physician in South Sudan, I cared for a 9-year-old boy who had traveled from the outskirts of Juba …
What should AI do when the blood bank is empty?
She was seven months old when her parents first noticed it. Not the peaceful stillness of sleep, but something heavier. Her arms, which had once reached for hanging toys, had grown quiet. Her head, once held with the wobbly determination of a healthy infant, began to drift. The milestones that seemed to be arriving suddenly began moving in reverse.
Weeks later, a child neurologist delivered the diagnosis: spinal muscular atrophy type …
We can rewrite DNA but not deliver it in time
When I was in medical school one day the dean stood up in front of my class holding a cheap, plain pen. He just stood there holding it for a minute without uttering a word. He then very slowly and deliberately said, “This, this pen is the most expensive tool you will ever hold. With this you will during your career spend hundreds of thousands of dollars.” He continued to …
The hospital that made us cut my child’s care in half
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For 23 years, an emergency physician stayed calm in the chaos and held the line. Then one night he sat in the hospital parking lot, unable to start his car and drive home. …
Why doctors hide their own depression until it nearly breaks them [PODCAST]
While shadowing a senior colleague during Mental Health Act assessments in the U.K. a few months ago, I noticed something small but instructive. In his documentation for two different patients we had seen together, he referred to me as Dr followed by two different versions of what he assumed to be my surname.
Later that same day, while introducing me to colleagues who were joining us, he hesitated. Unsure which name …
What medicine gets wrong about names
A 78-year-old Black woman with advanced heart failure is admitted with shortness of breath. Her admission order set: full code. The next day, after a brief family conversation, a resident changes the order to DNR/DNI. No note explains the discussion. Two days later, she goes into cardiac arrest. The code team hesitates, then proceeds based on an outdated full code order still visible in the chart. The family later sues, …
When a DNR order becomes a legal liability
The most useful AI data for physicians published this year had nothing to do with medicine.
In early June, Anthropic released a report called “When AI builds itself.” One number matters more than the rest. As of May, more than 80 percent of the code merged into the company’s own codebase was written by the very same AI. A typical Anthropic engineer now produces 5.8 times as much code per …
What software engineering just taught medicine about AI
Everyone is talking about AI in health care, but I bring a somewhat unusual perspective to the discussion. In addition to serving as chief medical officer for NextGen Healthcare, I am a practicing family physician in a practice owned by a local hospital. I also own and operate a small practice with my wife, which gives me firsthand experience with the realities of independent medicine. On top of that, I …
5 hot takes on AI in health care from a physician CMO
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China now has more than 100 JCI-accredited hospitals, the same Joint Commission International standard many U.S. patients recognize from conversations about hospital quality. That number surprises people. It also invites a dangerous shortcut: “JCI-accredited” becomes shorthand for “safe,” “excellent,” or “the best place for my operation.”
Patients deserve a more careful answer.
JCI accreditation matters. I do not dismiss it. But it is not a guarantee of outcomes, technical skill, complication management, …
The question to ask after a hospital says it’s accredited
I have spent the last few weeks watching a popular television drama set in a chaotic urban emergency department. After more than three decades of practicing psychiatry, I did not expect a network drama to affect me this way. It has felt like a strange form of therapy, vividly resurrecting the ghosts of my formative years and bringing back the exhausting, exhilarating days of medical school and my time as …
When a hit medical drama glorifies physician burnout
It was one of the slower nights in December. The ICU PA and I were making small talk, and he handed me an AI-generated Christmas carol composed for ventilated ICU patients. Skimming through, I found the lines mischievously fascinating, if a little macabre. My musings were quickly interrupted by an inner prompt to complete my notes.
The prompt did not indicate a preference for note writing over Christmas cheer, but rather …
Why AI clinical notes will never hold a trembling hand
I spent four years driving into rural Ohio for the developmental-behavioral clinics we built from scratch. The drives ran sixty to eighty miles each way, long enough to settle the mind and short enough to memorize every turn. I drove a white 15-passenger van, the kind no state trooper ever bothers to clock. I usually ran five miles over the limit, steady and unremarkable, blending into the landscape like another …
What rural community medicine really looks like
With three months left of intern year of internal medicine residency, I took the leap and adopted a dog from the Dallas Animal Services shelter. She is my SuperNova.
Nova is a two-year-old Lab-Pitbull mix with big brown eyes that hold your heart and a wagging tail that could power a small town. Her world is simple: following me from room to room, shaking with excitement when I pull out her …
Who is your witness? A question for every patient
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For 15 years, a primary care physician saw more than 22 patients a day and slowly lost herself to exhaustion. It followed her home every night and onto every vacation. In this episode, …
Why the cure for physician burnout is seeing fewer patients [PODCAST]
Each March, the National Resident Matching Program (NRMP) Match offers a snapshot of how the next generation of physicians views the landscape of American medicine. The 2026 Match set records in nearly every category: more applicants, more positions filled, and high overall match rates. But beneath the headline strength, two datapoints tell a more complicated story about the future of primary care.
Family medicine once again posted one of the lowest …
Family medicine match rates signal a workforce problem
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