iiinova — where your digital self keeps evolving

I wrote about why I think the future of clinical decision support is actually 𝘀𝗶𝗹𝗲𝗻𝗰𝗲: AI actually doing far MORE in the background, while having the judgment (and restraint) to interrupt us far LESS.

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And now we’re building AI that can generate a warning, recommendation, caveat, differential, or “helpful” suggestion about basically... everything. Ruh-roh, Scooby.

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For 20+ years, clinical decision support has taught us a pretty important lesson: 𝗶𝗳 𝘆𝗼𝘂 𝗶𝗻𝘁𝗲𝗿𝗿𝘂𝗽𝘁 𝗰𝗹𝗶𝗻𝗶𝗰𝗶𝗮𝗻𝘀 𝗼𝗳𝘁𝗲𝗻 𝗲𝗻𝗼𝘂𝗴𝗵 𝘄𝗶𝘁𝗵 𝘁𝗵𝗶𝗻𝗴𝘀 𝘁𝗵𝗮𝘁 𝗱𝗼𝗻’𝘁 𝗺𝗮𝘁𝘁𝗲𝗿, 𝘁𝗵𝗲𝘆 𝘄𝗶𝗹𝗹 𝗹𝗲𝗮𝗿𝗻 𝘁𝗼 𝘀𝘁𝗼𝗽 𝗹𝗶𝘀𝘁𝗲𝗻𝗶𝗻𝗴.

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Somehow this trauma has become my philosophy of clinical AI.

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For years, the jingle was the song our ER bed alarms played whenever a high risk patient tried to climb out of bed. At 3am, hearing it for the 700th time that night, you start to wonder how many marbles you're going to have left when the sun comes up.

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Back to Where I Started... 21 Years Later

I want to help shape which future we get. I'll do a series of articles over the next few months about what's changed, before ending with what I think medicine needs to become. But, first up: What I'm gonna do with MDCalc! Click to read the article below. www.linkedin.com/pulse/back-...

linkedin.com

Soooo, ha, um, I have a secret I’ve been keeping from you: I’m joining MDCalc full-time as its Head of AI. I wish I could say that I rage-quit medicine or that I’ve got some incredibly juicy story to tell, but alas.

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I think medicine is at one of those rare moments when a lot of what comes next genuinely hasn’t been decided yet. AI could make medicine dramatically better to practice. It could also become the most powerful technology we’ve ever invented for asking fewer people to do even more work.

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So here's my LinkedIn post with that cringe "I'm starting a new job!" energy! There are things about emergency medicine that changed. There are things about medicine that changed. There are things about me that changed, too. And then there’s AI.

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Instead, after 18 years in emergency medicine, I’m stepping away from clinical practice for now, leaving the incredible Permanente Medicine — and joining @mdcalc full-time, the lil' ol' website I started as a medical student 21 years ago.

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anymore. See you in Philly tomorrow! Come argue with me about it. 🙃

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I'm joining Justin Freid (CMI Media Group), CP McBee (Microsoft AI), and Zoe Lazarre (Genentech) to talk about what happens when personalization, speed, and emotional intelligence all get automated at once — and what we all owe patients when the thing shaping their care decisions isn't a clinician

And it's exactly the tension I'll be on stage to argue about — 𝗧𝗵𝗲 𝗦𝗵𝗶𝗳𝘁 𝗶𝗻 𝗛𝘂𝗺𝗔𝗜𝗻 𝗕𝗲𝗵𝗮𝘃𝗶𝗼𝗿, at CMI Agility in Philadelphia.

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3️⃣ Certain enough that by the time they're in front of me, I'm not indepently trying to assess them as their licensed, legally-responsible-for-them doctor. I'm at best a double check, and at worst, an obstacle to the tests and answers that they are 𝗰𝗲𝗿𝘁𝗮𝗶𝗻 they need.

That's the part that's actually changing behavior — not that patients are more informed, but that they're more certain. (These are not the same thing.) They are: 1️⃣ Certain they're fine and it can wait. 2️⃣ Certain they're dying and it's an emergency.

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Instead of a list of possibilities, GenAI often offers people a conclusion, delivered with total confidence. Even in a tone that sounds like a doctor.

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See, Dr. Google gave people a list of possibilities and left them to sit with the uncertainty that everything could 𝘵𝘦𝘤𝘩𝘯𝘪𝘤𝘢𝘭𝘭𝘺 be cancer. Or HIV.

Physicians try to meet patients where they are, and increasingly, that means they're no longer asking "Dr. Google," they're asking Dr. Claude. Sometimes he's a friend, and other times, he's foe.

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Practicing in SF (HQs for OpenAI and Anthropic), sometimes it's easier to start off with this question: Okay patient, what did ChatGPT tell you?

All Men Are Mortal — All We Have Is Now

(I have no relationship to the actual mortals.com, I'm just being sarcastic around Johnson's immortals.com)

mortals.com

Mortals 🐁

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/s because this is the internet, and yes i realize that doctors could stand to follow this advice just as well as anyone else

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All Men Are Mortal — All We Have Is Now

They're just considered one of the incredible benefits of living in a wealthy country. (Unfortunately, this makes Mortals.com even harder to monetize. But we have plenty of spots open.)

mortals.com

Mortals 🐁

Of course we each have some responsibility for our own health. Eat better. Move more. Go to bed. But we should also build a society where doing those things doesn’t require extraordinary amounts of time, money, and control over your life.

Meanwhile, millions of people are working multiple jobs, commuting long distances, sleeping too little, eating whatever is affordable and convenient, and trying to squeeze exercise, relationships, and preventive healthcare into whatever time is left.

You can afford healthy food. A gym and a trainer. You probably have more control over your schedule. You can pay other people to do things that buy you back time. You can live somewhere safe to exercise. You can take vacations. You can afford excellent medical care.

The good news: If you didn't even blink at spending $1 million a year trying not to die, congratulations: socioeconomic status has already enrolled you in one of the most effective longevity programs we have!

Our revolutionary insight: 𝘆𝗼𝘂 𝗮𝗿𝗲 𝗴𝗼𝗶𝗻𝗴 𝘁𝗼 𝗱𝗶𝗲. This is 100% proven! But there are a bunch of extremely boring, extremely effective things you can do to improve your odds of making it happen later.

All Men Are Mortal — All We Have Is Now

At Mortals.com, we’ll give you 90% of the value — for free! All we ask is that you tell a friend. Or your Senator. Word of mouth is the most effective form of advertising, and public policy is our growth strategy.

mortals.com

Mortals 🐁

→ Maintain meaningful relationships with other humans → Reduce chronic stress and spend time outdoors → Find purpose and meaning in your life → Don’t smoke → Avoid drugs → Drink little or no alcohol Don’t have $75,000–$1 million per year? No problem. Like I said, I have no business plan.

Today I’m launching Mortals -dot- com. I have no business plan. Here’s what I’m offering in exchange for 10% of my company, Sharks🦈: → Eat a healthy, low UPF diet → Exercise regularly, including cardio and lifting heavy things → Sleep 7–9 hours a night

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But if we believe physicians matter, then creating a profession people actually want to remain part of should be an outcome of the healthcare system, too.

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None of this means preserving medicine exactly as it is; quite the opposite. Some things 𝘴𝘩𝘰𝘶𝘭𝘥 disappear. Some 𝘴𝘩𝘰𝘶𝘭𝘥 be automated. And perhaps we need a much broader definition of what it means to “stay” in medicine in the first place.

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But after the conversations I’ve had here — and the ones I hear constantly back home — I think this sentiment is real, and we should take it seriously.

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I don’t mean this rhetorically — I think there is a growing sense of betrayal and resentment amongst physicians that we don't talk about. Look, medical culture teaches us to put our heads down and keep going because our patients need us.

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𝗠𝗮𝘆𝗯𝗲 𝘄𝗲 𝘀𝗵𝗼𝘂𝗹𝗱 𝘀𝗽𝗲𝗻𝗱 𝗺𝗼𝗿𝗲 𝘁𝗶𝗺𝗲 𝗮𝘀𝗸𝗶𝗻𝗴 𝗵𝗼𝘄 𝘁𝗵𝗲 𝗵𝗲𝗮𝗹𝘁𝗵𝗰𝗮𝗿𝗲 𝘀𝘆𝘀𝘁𝗲𝗺 𝗻𝗲𝗲𝗱𝘀 𝘁𝗼 𝗰𝗵𝗮𝗻𝗴𝗲 𝗶𝗳 𝗶𝘁 𝘄𝗮𝗻𝘁𝘀 𝗶𝘁𝘀 𝗽𝗵𝘆𝘀𝗶𝗰𝗶𝗮𝗻𝘀 𝘁𝗼 𝘀𝘁𝗮𝘆.

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We spend enormous effort asking how physicians need to change to meet the needs of the healthcare system.

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Because physicians everywhere are feeling squeezed: more complex patients, less time, greater expectations, pressure to do more for less, new professions taking on work we once considered ours, and now AI potentially doing the same.

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We need you and your voice. We want you to stay. And I think both CCIM and the Australian Medical Association are asking similar questions: What is the value of a physician? What bargain have we made with society? And are society and our healthcare systems still holding up their end of it?

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At CCIM, the message from Dr Amandeep Hansra is simple: "Hey there, physician. You belong." The House of Medicine has space for you. If you want to write books, or work in pharma, or create a company — or if you're not a cookie cutter version of what a "physician looks like," you're welcome here.

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I just wrapped up my keynote at Creative Careers in Medicine, asking what we should hold onto in medicine, and what we should let go of, particularly as AI starts to successfully perform 𝘀𝗼𝗺𝗲 of the 𝘁𝗮𝘀𝗸𝘀 that we physicians perform. (Note: this is a far cry from AI 𝗱𝗼𝗶𝗻𝗴 our 𝗷𝗼𝗯𝘀.)

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This is the question that I'm left with after two weeks in Australia, meeting many of those talented people. I'm reflecting on how similarly physicians feel despite an ocean away, in another hemisphere, in an entirely different healthcare system.

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Graham Walker, MD @drgrahamwalker.com · 30/08/2026

Will medicine remain a profession that talented people are willing to devote their lives to?

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Anyway, here's me at dinner in Australia eating a giant plate of salad, not once wondering whether the lettuce was going to give me explosive diarrhea. It's the little things.

Graham Walker, MD @drgrahamwalker.com · 30/08/2026

America increasingly feels like we're holding the canoe paddles up to the light, wondering whether the plastic they're made from is secretly causing diabetes or trans kids, while our boat rapidly drifts toward a waterfall.

Graham Walker, MD @drgrahamwalker.com · 30/08/2026

Australia isn't rowing perfectly. There are real problems here, and real fights over how to solve them, that I barely understand as an outsider looking in. 𝘉𝘶𝘵 𝘢𝘵 𝘭𝘦𝘢𝘴𝘵 𝘵𝘩𝘦𝘺'𝘳𝘦 𝘳𝘰𝘸𝘪𝘯𝘨.