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one question, worked all the way through

Longer pieces on a single question physicians keep asking, argued from the evidence, with what to do about it.

Nov 6, 2026The doctor one screen away
In 2022 one emergency department in thirteen lacked an attending physician around the clock. Every rural one should have an emergency physician on video at all hours, paid for by Medicare rather than grants.
Nov 5, 2026The wrong suspects
Measles cases this year are more than twice last year's. Texas is investigating the pediatricians who vaccinate children, and the children who depend on those doctors will pay.
Nov 4, 2026The patient counts
Theranos is remembered for defrauding investors. For doctors the lesson is what happened to patients. Products that change care still reach them on their makers' word, before the evidence.
Nov 3, 2026Prescribed at checkout
A weight-loss prescription can now take a questionnaire and a card number. Patients deserve a clinician who knows them and a drug the FDA has checked.
Nov 2, 2026Twenty-one days
The Bundibugyo Ebola outbreak has passed 10,000 confirmed cases and reached Kenya and Nigeria. There is no approved vaccine or treatment, and American rules turn on a 21-day window.
Nov 1, 2026Three months, or a chatbot now
More Americans said they would use a therapist three months away than a chatbot available immediately. The wait is the thing to fix, and the handoff to a person is the thing to require.
Oct 30, 2026Wait until you need insulin
A randomized trial found a glucose sensor lowered blood sugar in adults with type 2 diabetes who take no insulin. Medicare's rule still turns mainly on the insulin rather than the evidence.
Oct 28, 2026Who grades the answers
American clinicians asked one AI reference tool 271 million questions in two and a half years. How often such tools get the answer right, on the questions clinicians actually ask, remains largely unmeasured.
Oct 27, 2026The thinking is the job
A new paper says medical training should teach doctors when to defer to a machine. It has the order backwards, and almost nobody is counting what the deferring is worth.
Oct 26, 2026Fifty billion dollars, no scoreboard
Federal money is buying software for small rural hospitals. The program already demands four numbers for every initiative. One of them should be a patient, and it should be published.
Oct 23, 2026Fifty rulebooks, for now
The White House wants one national AI rulebook instead of fifty. Physicians should accept it only if it keeps the states' rules on AI in medicine or protects patients at least as well.
Oct 22, 2026Route, don't write
AI that drafts replies to patients has not reliably saved doctors time. Health systems should first use AI to sort the inbox, and draft clinical replies only where audits show a gain.
Oct 21, 2026Count the cases
Chatbot-linked psychosis appears rare, but hospital counts depend on what clinicians happened to write down. Physicians should ask about chatbots in every new psychosis or mania, and record the answer the same way.
Oct 20, 2026Downtime is a clinical event
When ransomware locked hospitals' computers, more of the Medicare patients already in their beds died. As care depends on more software, AI included, keeping that software safe must come before speed or savings.
Oct 19, 2026The chart leaves the building
When a patient links a medical record to a chatbot, HIPAA stays behind. The protections should go with the record; until Congress acts, physicians should tell patients plainly what they give up.
Oct 18, 2026An alarm needs an answer
Epic's deterioration score has FDA clearance. It belongs only on wards where a staffed team answers its top alerts, the medical staff sets its thresholds and the hospital counts whom it helps and misses.
Oct 17, 2026Wait for the Evidence
Calling it malpractice not to consult AI assumes doing so improves diagnoses, treatment and outcomes. Outside a few tasks the evidence does not yet show that; the standard of care should follow the trials.
Oct 16, 2026Notes before codes
Most studies find that AI scribes raise the bill. They should have to show what they do for patients, starting with the accuracy of their notes.
Oct 15, 2026Nobody wins the bot war
Hospitals and insurers now fight over bills with software, and patients pay. Every algorithm that moves a payment should show a clinician its evidence and be judged by how often it is right.
Oct 14, 2026The surgeon is the benchmark
Surgical robots are inching toward choosing where to clip, cut or sew. Any robot that does should be judged against a good surgeon doing the standard operation, not against other robots.
Oct 13, 2026Yes, doctor
Language models lean toward whatever the request or the chart suggests, so their agreement is weak evidence. Before they reach patients, the FDA should require tests against unsafe orders and loaded wording.
Oct 11, 2026The patient's AI got there first
A chatbot's differential or a smartwatch alert belongs in the history, as a record of what worried the patient; physicians should treat it neither as a diagnosis nor as a threat.
Oct 10, 2026AI for the 25-bed hospital
A small rural hospital should buy the few AI tools that fill a gap in its staffing or clearly pay their way, and leave alone whatever it has no one to check.
Oct 9, 2026When the agent is inside the chart
Software agents now read, draft and send from the medical record; medical staffs should give each one its own identity, limited privileges and an audit trail before it is switched on.
Oct 8, 2026Cleared is not the same as proven
An FDA clearance shows that software met a regulator's floor; physicians should ask for evidence that it works on patients like theirs before they trust it.
Oct 7, 2026The first prescription without a doctor
Utah now lets software choose a patient's first prescription for acne; the terms for withdrawing the doctor's review will outlast the acne, and physicians should write them.
Oct 2, 2026Free advice
AI will soon give clinicians in much of the world a specialist's knowledge for free. Poor and rural patients will gain only if someone supplies the tests, drugs, specialists and money it calls for.
Oct 1, 2026Who gets the time back
Most hospitalists already use AI, and Epic is bringing more of it to the wards. The minutes it saves are few, and they belong to patients and doctors, not to a higher census.
Sept 30, 2026Practicing without a license
Software can do much of an office visit, but the law cannot yet hold it responsible. States should license its operators, with a doctor reviewing its work until trials prove it safe.
Sept 28, 2026Equal pay for equal results
Medicare now pays technology firms for results, and a smart-ring maker will promote one of them to its members. Primary care deserves the same deal, or Medicare will pay twice for fragmented care.
Sept 27, 2026Keep your hand in
AI is taking over the everyday work that kept doctors' skills sharp. The skills it cannot replace will now have to be practiced on purpose.