iiinova — where your digital self keeps evolving

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Emily Moin @emilymoin.com · 25/09/2026

I regret that these technologies – which are powerful and could certainly be incredibly useful – have entered medicine in the way they have: unexamined, without rigorous patient-centered evaluation, mired in proprietary claims, regulatory capture, and credulous adopters.

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Keith Plummer @xianmind.bsky.social · 04/07/2026

This article about the potential impacts of AI scribes on medical students, practicing medical professionals, and the physician-patient relationship reminded me of observations Postman made about the stethoscope. The author raises important questions. www.nytimes.com/2026/07/01/m...

nytimes.com

How A.I. Might Change the Way Doctors Think

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Shannon Vallor @shannonvallor.bsky.social · 25/06/2026

Ask how many more shifts they’d let a surgeon work after a week in which they severely harmed 12-15% of their patients

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Shannon Vallor @shannonvallor.bsky.social · 30/05/2026

Spent a plane ride reading Pope Leo's Encyclical on AI. Many thoughts to share later, but this will stick with me: "The quality of a civilization is measured not by the power of its means, but by the care it is able to offer, by its ability to recognize the other as a face not merely as a function."

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Ryan Marino, MD @ryanmarino.bsky.social · 02/05/2026

One thing people don’t realize is that even if you don’t use Medicaid—even if you never would use Medicaid—your ability to access care, and your ability to access healthcare providers like me, will be affected in some way or another by every cut or barrier to Medicaid. Nobody will be unaffected.

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Carl T. Bergstrom @carlbergstrom.com · 30/04/2026

This is a fascinating example because it's exactly what a bullshitter does and what gives him away. He leans into the little cues you give them, and riffs on those cues ,making stuff up. "It's a real, verifiable peer-reviewed publication" (To be clear: there is no "Swedish magpie" paper.)

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Yahia Lababidi @ysl.bsky.social · 18/04/2026

Celeste Roberge’s sculpture “The Weight of Grief” #art

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Josh Briscoe @jbriscoe.bsky.social · 16/04/2026

My body is not my own. What does that mean for intractable, hot button bioethical debates? open.substack.com/pub/familyme...

open.substack.com

Stewarding the Body

How can we hold health in common?

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Josh Briscoe @jbriscoe.bsky.social · 14/04/2026

jamanetwork-com.proxy.lib.duke.edu/journals/jam... from @jama.com If AI were a medication, we'd be putting it through far more rigorous testing before wide deployment...

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Josh Briscoe @jbriscoe.bsky.social · 12/04/2026

Hope springs eternal... familymeetingnotes.substack.com/p/a-machine-...

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Josh Briscoe @jbriscoe.bsky.social · 05/02/2026

We had no way of anticipating how the car would revolutionize the landscape. With it came highways, streets, drunk driving, day trips to the sea, road rage, etc etc. We weren't intentional in how we adopted the car nor how we adopted the EMR. What culture do we intend to create with AI? 10/10

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Josh Briscoe @jbriscoe.bsky.social · 05/02/2026

(It is both more mundane and more laborious to double-check the output of someone/something else than to just do it yourself, as any attending earnestly reading over a trainee's notes can testify) 9/10

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Josh Briscoe @jbriscoe.bsky.social · 05/02/2026

So, too, with the rest of medicine: all standardized technique. What we want is to make the red numbers black; the dispel the shadows on the CT scan. Humans are in the loop - for now, and practicing a form of medicine that is itself a shadow of what once was. 8/10

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Josh Briscoe @jbriscoe.bsky.social · 05/02/2026

We're prepared for it because the practice of medicine is already a desiccated technical endeavor. A healthcare leader can discuss doing away with medical interpreters as if they're parts in a machine and offer no human value to the encounter itself. Translation is all technique and no culture. 7/10

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Josh Briscoe @jbriscoe.bsky.social · 05/02/2026

I would suggest that we both are and are not prepared for this. We're prepared for it in the same way a turkey is prepared for Thanksgiving; the culture of medicine has fashioned the clinical encounter into one that is ripe for harvesting by various stakeholders. 6/10

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Josh Briscoe @jbriscoe.bsky.social · 05/02/2026

There's also growing interest in AI surrogate decision-makers. For years this was a theoretical and nuanced debate relegated to ethics journals. Now proof-of-concept trials have been published in NEJM AI. Are we prepared for this? familymeetingnotes.substack.com/p/a-machine-... 5/10

familymeetingnotes.substack.com

A Machine Better Than Family

Artificial Surrogate Decision-Makers (i.e., the Patient Preference Predictor)

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Josh Briscoe @jbriscoe.bsky.social · 05/02/2026

What I didn't hear discussed in this convo was how AI scribes will almost certainly increase the degree of surveillance within the clinical encounter. Nothing from recent decades would suggest otherwise: the EMR was used by various stakeholders to pry into that space, why not AI scribes? 4/10

familymeetingnotes.substack.com

Where The Walls Listen

Artificial Intelligence and Clinical Scribes

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Josh Briscoe @jbriscoe.bsky.social · 05/02/2026

But saddled with the burdens of modern technopoly - the challenges and admin oversight of the EMR, the "always on" access of inbasket messages, etc. - have driven clinicians to embrace the promises of AI. 3/10

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Josh Briscoe @jbriscoe.bsky.social · 05/02/2026

Clinicians are desperate for "faster horses" - a phrase that reflects early 20th century expectations of what the next advance after the horse-drawn carriage might offer. The automobile wasn't a faster horse; it was something altogether different. 2/10

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Josh Briscoe @jbriscoe.bsky.social · 05/02/2026

It probably shouldn't be surprising to me anymore that clinicians are absolutely enamored with AI, just as they're usually enamored with technology more broadly (as evidenced by, e.g., allure of interventionalist specialities over primary care). 1/10

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Matthew Loftus 🧻 @matthewloftus.bsky.social · 05/02/2026

My book has a cover! I wish I could share it with you right now, but unfortunately you'll have to wait until August 18, 2026. But you can preorder it now if you want. www.amazon.com/Resisting-Th...

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Josh Briscoe @jbriscoe.bsky.social · 03/02/2026

Clinicians talking with admin in several years: “What would you say you do here?” “I told you! I take the clinical recommendations from the AI so the patient doesn’t have to. I have people skills! I HAVE PEOPLE SKILLS!”

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Matthew Sparks @nephrosparks.bsky.social · 22/01/2026

Really troubled by this question in a popular surgical critical care study book… Surgical Critical Care and Emergency Surgery Topic is early v late dialysis and so much on this topic is know and just disappointing to this question…. The keyed answer was….

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Steve Joffe @stevejoffe.bsky.social · 20/01/2026

The consent form Louis Waskansky signed before undergoing the first-ever human heart transplant, in 1967.

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Christian Sinclair @ctsinclair.bsky.social · 02/01/2026

Media outlets sharpened their pens by telling us that cars and trucks hit pedestrians and cyclists instead of drivers. Now they rinse and repeat with AI.

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Josh Briscoe @jbriscoe.bsky.social · 22/12/2025

I think Derek Thompson is right to claim Alasdair MacIntyre was only half right when he argued our society had lost moral cohesion. We're still bound by a moral framework: the market. www.derekthompson.org/p/the-26-mos...

derekthompson.org

The 26 Most Important Ideas For 2026

Modern trends and history lessons—across culture, politics, AI, economics, science, and the long story of progress. But first: an announcement!

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Jed Brown @jedbrown.org · 18/08/2025

It is not "attribution and sourcing" to generate post-hoc citations that have not been read and did not inform the student's writing. Those should be regarded as fraudulent: artifacts testifying to human actions and thought that did not occur. www.theverge.com/news/760508/...

For help with attribution and sourcing, Grammarly is releasing a citation finder agent that automatically generates correctly formatted citations backing up claims in a piece of writing, and an expert review agent that provides personalized, topic-specific feedback.

Screenshot from Grammarly's demo of inserting a post-hoc citation.
https://www.grammarly.com/ai-agents/citation-finder

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Kevin M. Kruse @kevinmkruse.bsky.social · 20/12/2025

Coming back to this, I'm still struck by the implication that academics should care if the AI pushers "trust" all our work that's done without AI. I don't know, man, you all seemed to trust our work enough to steal it from us wholesale.

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GeriPal Podcast @geripal.bsky.social · 18/12/2025

To what extent is it our job as consultants to manage or attend to clinician distress? What happens when that clinician distress leads to conflict? #medsky Guests Sara Johnson, Yael Schenker, & Anne Kelly. 👉 Post: bit.ly/GeriPalEp385 😀 Hosts: @alexsmithmd.bsky.social | @ewidera.bsky.social

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Josh Briscoe @jbriscoe.bsky.social · 18/12/2025

familymeetingnotes.substack.com/p/where-the-...

Dr. Paisley’s brow furrowed. “I will say, it looks like you’re spending about an average of three minutes per encounter on non-clinical chatter. Hmm. The weather, patient vacations. Of course, of course we want our patients to feel welcome, but…” A pie chart grew on the wall. “If you reduce that to just one minute, you’ll be able to see seven more patients in a day! Goodness, look at that. Three minutes of non-clinical puts you in the bottom 10th percentile. Friendly, but inefficient!”

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Josh Briscoe @jbriscoe.bsky.social · 18/12/2025

It will maximize the oversight and intrusiveness of the EMR by placing admin ears in every clinical encounter.

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Josh Briscoe @jbriscoe.bsky.social · 18/12/2025

They wonder what’s driving hospital investment in ambient AI for charting, as evidence for improved productivity isn’t there. Maybe it’s earnest care for clinician well-being? I have another suggestion: surveillance.

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.chantal//RYAN @thoughtrise.bsky.social · 15/12/2025

this field biologist does a great job highlighting the insidiousness of AI editing these one-click AI edit buttons are incredibly appealing to many photographers, amateurs and professionals alike, and are framed as innocuous this is worth sharing and educating people about

screenshot of a post on facebook from Alex Lamoreaux, depicting two versions of the "same" photograph of a bobcat in front of a pine plantation, one labeled original game cam photo, one labeling AI processed

the markings have been altered on the AI photo, and the head changed and resized

text says:

Oh! A neat goose hybrid posted to ‘What’s this Bird?’ but when you zoom in on the photos the bill details have been too manipulated by AI photo editing to be accurately assessed for which species may be involved.
Scroll on… A cool-looking Red-tailed Hawk that someone is wondering which subspecies it might be - right up my alley! But when you zoom in on the photos literally every feather group has been so heavily manipulated and altered by AI editing that it’s impossible to determine subspecies because the photo is essentially fake now; just a mashup of whatever AI thinks parts of a Red-tail should look like.
Scroll on… WOW! That’s a remarkable trail cam photo of a Bobcat! It almost looks like a painting!… but the head looks oddly small…. hmmmm. After some prodding the original photo is produced and sure enough it had been so heavily altered by AI ‘post processing’ that the photo posted was essentially a digital mock-up with totally different proportions and fur markings. No longer the photo off the trail cam; it may as well have just been ‘created’ by AI from scratch.
This stuff is killing me. My days on social media are becoming very limited. We can’t even trust simple, everyday photos of animals to be real. The wildlife community needs to quit editing with AI, and we need to start calling out photographers that are using it. Our reality is being destroyed all around us.

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Seth Trueger @mdaware.org · 09/12/2025

I didn’t really get how much “health care contact days” is a meaningful patient outcome until I got sick thank you @ishaniganguli.bsky.social @dusetzinas.bsky.social @jamanetworkopen.com

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Josh Briscoe @jbriscoe.bsky.social · 06/12/2025

Introducing ambient #AI scribes into a world in which clinicians write notes is very different from the future world in which no one has written notes. familymeetingnotes.substack.com/p/where-the-...

familymeetingnotes.substack.com

Where The Walls Listen

Artificial Intelligence and Clinical Scribes

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Josh Briscoe @jbriscoe.bsky.social · 05/12/2025

My final installment in a series of essays on medical authority. I worry we won't find a path forward by yelling at each other, but I see hope in a few places. familymeetingnotes.substack.com/p/a-power-gr... #medsky

familymeetingnotes.substack.com

A Power Great and Terrible

Medical Authority in Human Life (Part 3)

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Awais Aftab @awaisaftab.bsky.social · 29/11/2025

Meaning, Medications, and Psychodynamic Psychopharmacology: Discussion with David Mintz Exploring medication effects mediated symbolically www.psychiatrymargins.com/p/meaning-me...

psychiatrymargins.com

Meaning, Medications, and Psychodynamic Psychopharmacology: Discussion with David Mintz

Exploring medication effects mediated symbolically

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Josh Briscoe @jbriscoe.bsky.social · 30/11/2025

It isn‘t clear to me that the machine is that good. Human clinicians have been degraded by years of laboring under forces that are making them machines (eg, engagement with electronic medical records and utilization management). ironic.

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Marc Watkins @marcwatkins.bsky.social · 24/11/2025

This is the 3rd time Google has offered a Gemini trial for college students since May. They're clearly tying trials around the academic calendar. It is no wonder college instructors are hostile toward AI companies pushing free premium AI for college students during finals.

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Josh Briscoe @jbriscoe.bsky.social · 27/11/2025

Next up: medical authority and intervention. I approach a controversial case with the hope that this could provide a context for a more productive disagreement. familymeetingnotes.substack.com/p/here-to-he... #medsky

familymeetingnotes.substack.com

Here to Help: Clinicians and their Tools

Medical Authority in Human Life (Part 2)

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