Healthcare is Stupid

Health policy strategist Ezekiel Emanuel, billionaire Vinod Khosla, and two others just published a viral JAMA article claiming autonomous AI will soon replace human doctors. The result—probably due to the prominence of the authors and the prestige of the journal—created a disturbance in the Force of the medical world, and broke the healthcare internet for a couple of weeks. Despite that, we aren’...

This is a special mini-episode. It's about the events of 9/11, but not the ones you you're thinking of.  Rahul shares a story of what he was doing on that day, 25 years ago. 

That "smart" thing on your wrist, your finger, or wrapped around your bicep—can you actually trust what it's telling you? Is it doing real medicine, or just guessing? It may say in the fine print that it's not a medical device, but let's face it a lot of people use it like it is. This episode: Apple Watches, Oura rings, Whoop bands, and the regulatory loophole that lets de...

You booked an appointment with a doctor. You saw a nurse practitioner instead. Was that a downgrade — or the only reason you got in at all? This week we sort out what actually separates the roles. NPs and PAs handle a huge share of routine care well: the sore throat, the med refill, the blood pressure check, the stable chronic condition on a stable plan. But are they always the right team member f...

Every time you see a doctor, somebody has already decided how they get paid for it — and that decision can shape what happens next. Fee-for-service rewards doing more and capitation rewards doing less, but the incentives get more complex, with payors, healthcare delivery organizations, and regulators trying to enforce standards. Sitting in the exam room, naked under a gown, you want what’s best fo...

Last episode, we sat down with Dr. TR Levin — the gastroenterologist who built one of the most effective colon cancer screening programs in the country — and worked through why screening is so much harder to understand than it looks. Some tests find things that would never have hurt you. A simple test sent to your home may work better as a screening program than a more invasive procedure, mostly b...

Cancer screening saves lives, and it has been thoughtfully constructed to do so. But the version of cancer screening that some of us experience is one where nobody explains the odds, nobody mentions the alternatives, and a positive result sends you into a cascade of procedures that may or may not have been necessary. That version feels stupid. And there’s another version of screening, where someon...

“Will AI replace doctors?” makes for a great headline, a great dinner party argument, and a great way to stress out a podcast co-host. It’s also, unfortunately, the wrong question. In a follow up to our last episode, we respond to our listeners’ feedback. We put co-host and radiologist Jonathan Mates on the spot and use radiology as our test case — the specialty that’s been at the center of this c...

One in four ChatGPT users — roughly 200 million people a week — use it for health questions. About a third of them end up changing their medications or requesting referrals based on what it tells them. Is that brilliant, terrifying, or both? In this episode, we dig into the question everyone is asking themselves, whether they want to or not: How should my doctor be using AI? And how should I? We b...

People are sharing medical results from their online portals, just like they do with college acceptances and baby gender reveals. How did we get to this point? And what are the real effects on how patients understand their medical records and how doctors document them? In this episode, we explore how technology and regulatory changes have shaped our relationship to healthcare from the inside and o...

We’ve all had this experience: you go to your doctor or hospital’s web page to do something. Maybe you want to make an appointment. Maybe you want to refill a prescription. Maybe you just want to know when the lab opens. What should be a simple task—something you can easily do on any other website—instead turns into a frustrating ordeal that leaves you yelling: “Why?!” Why is something so simple s...

Doctors’ ability to see inside their patients with lab and imaging tests is one of the miracles of modern medicine. Without tests, we’re just guessing!  But the unsaid truth is that doctors overtest patients, and that may be doing more harm than good to patients, doctors, and the entire health care system. In this episode, we sit down with cardiologist Dr. Jeff Sobel to understand the forces...

Nothing says 'quality care' like showing a stranger your throat via a grainy webcam while your cat walks across the keyboard. Telehealth — or medical care without the doctor and patient being in the same room — has exploded, partly enhanced by the COVID pandemic. Some say that this is the beginning of a new paradigm in medical care. For others, the experience feels more like putting more technolog...

If a Primary Care physician is the quarterback of our healthcare system…OUCH!…they’re getting sacked time and time again by some burly bureaucratic linebackers. Primary care medicine is meant to be the foundation for a high-functioning health system. Yet why do so many primary care physicians and their patients experience angst and disappointment with that system? In this episode, we sit down with...

In this short trailer, pediatrician Rahul Parikh and radiologist Jonathan Mates introduce Healthcare is Stupid . We’ll explore the absurdities of American healthcare—how we got here, the incentives and structures that quietly shape it, and what practical, incremental improvements might actually move things in a better direction. If you work in healthcare, depend on it, or simply wonder why so much...