Most people spend their entire lives trying not to think about death. Emergency physicians don't have that option.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Ashely Alker an emergency physician, founder of Meaningful Media, and author of 99 Ways to Die and How to Avoid Them.

This episode goes somewhere most medical conversations don't. And that's the point.

Because death isn't an abstract concept in the emergency department. It's the patient who never documented their wishes and ended up on a ventilator they never wanted. It's the 19-year-old with undiagnosed Marfan syndrome you catch while suturing a hand. It's the lost patients you carry with you forever.

Ashely has been thinking about death since her twenties, when she lost her mother and became the de facto medical translator for a family with no one else to turn to. That personal history, combined with years on the front lines of emergency medicine, is what eventually became a book she wrote for the patients who need it most.

This episode is an honest conversation about what emergency medicine teaches you about dying and how that changes the way you live.

What You'll Learn

1. Why ER physicians remember their lost patients more vividly than their greatest saves — and what that means for how we process the emotional weight of the work
2. How Ashlely thinks about the gap between helping people live longer versus helping them live better, and why the ER is the hardest place to close it
3. Why storytelling is a clinical skill, and how physicians who don't engage with public communication cede the conversation to people with no training
4. What writing a book about death taught Ashely about being a better doctor and a more intentional human being

Resources & Where to Find Ashely

99 Ways to Die and How to Avoid Them — available at Amazon, Barnes & Noble, and independent bookstores everywhere

Ashely's Website

Instagram

LinkedIn

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Every quality metric shaping your career, your bonus, and your reputation traces back to one nonprofit most physicians have never thought twice about.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Vivek Garg, the new President and CEO of NCQA - the National Committee for Quality Assurance - and only the second leader in the organization's 36-year history.

This episode is unabashedly nerdy. And that's the point.

Because the measures you're chasing, the scores you're being judged on, and the bonuses tied to your performance don't come from nowhere. They come from a deliberate two-year long process of evidence review, statistical validation, and independent clinical committee sign-off. It’s a process most physicians have never seen and don't know they can influence.

Vivek doesn't come to this conversation to defend the status quo. He's blunt that the current system produces incomplete data, punishes independent practices for lacking the infrastructure of large health systems, and has overused financial incentives as a lever for change. He calls value-based care underappreciated and AI overhyped, and then spends the rest of the conversation explaining exactly where both could actually move the needle.

This episode is an honest reckoning with whether we're measuring what actually matters and what it would take to build a system that clinicians trust and patients actually feel.

What You'll Learn

1. Where your HEDIS scores actually come from and the two-year pipeline behind every measure that lands in your workflow
2. Why the data feeding your quality scores is often incomplete, lagged, and missing critical parts of your patient's clinical picture
3. How Goodhart's Law plays out in real clinical practice — and why even well-designed measures can distort the behavior they're trying to assess
4. Why independent and small practices carry the same reporting burden as large health systems with entire quality departments

Physicians are making more correcting medical misinformation online than delivering babies.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Fran Haydanek, better known to millions as Paging Dr. Fran, for an unfiltered conversation about medicine in the algorithm era.

Fran is a board-certified OB-GYN, residency faculty member, hospital medical director and a physician creator with more than one million followers across TikTok and Instagram. What began as a simple video correcting breastfeeding misinformation during maternity leave has evolved into a full-scale media operation. One that now generates more income than her clinical practice.

But this episode isn’t about clicks. It’s about trust.

Together, Graham and Fran examine why patients increasingly turn to influencers instead of physicians and why the medical system itself helped create that vacuum. Fran argues that physicians don’t just compete in this digital ecosystem and that they have an obligation to show up in it.

This episode isn’t a defense of influencer culture.

It’s a reckoning with where patients actually learn about their health and whether physicians are willing to meet them there.

1. Why patients are turning to TikTok for medical advice and how 15-minute visits contribute to the problem
2. 
   
3. What it means for medicine when a practicing OB-GYN earns more correcting misinformation than delivering babies
4. 
   
5. How religion and politics uniquely fuel misinformation in women’s health
6. 
   
7. Practical ways any physician can participate in the digital information ecosystem
8. 
   

Website: https://www.pagingdrfran.com/

TikTok: https://www.tiktok.com/@pagingdrfran

Instagram: https://www.instagram.com/pagingdrfran

Yann LeCun is one of the most influential figures in artificial intelligence. Alex LeBrun is the founder of Nabla and newly announced CEO of AMI Labs, a new AI research company he and Yann are building around a bold idea: large language models aren’t enough for medicine.

In this special episode of How I Doctor, Dr. Graham Walker sits down in-person with Alex and Yann to explore the next frontier of AI in healthcare - world models. While today’s AI systems excel at predicting the next word, Yann argues that real clinical intelligence requires something deeper: models that can imagine, simulate, and plan.

From the limitations of LLMs in high-stakes environments to the concept of building a “patient model” that can predict the consequences of treatment decisions, this episode dives into what it would actually take to build AI that reasons more like a physician. They discuss why documentation was the first breakthrough use case, how 80% accuracy fails in clinical settings, and why reliability, and not hype, will determine who wins in healthcare AI.

This isn’t about replacing doctors. It’s about amplifying them.

If AI is going to meaningfully change medicine, it won’t be through better chatbots. It will be through systems that understand the world.

🎥 Watch the full video conversation now — exclusively on https://www.offcall.com/learn/podcast/ai-world-models-medicine-yann-lecun-alex-lebrun

🔊 Or stream the audio version on your favorite podcast platform.

1. How predicting the next word isn’t the same as clinical reasoning and where LLMs fall short in medicine.
2. What “world models” are and how they differ fundamentally from today’s large language models.
3. Why 80% accuracy isn’t acceptable in healthcare and what reliability really means in clinical AI.
4. Why medical coding may be one of the next frontiers for AI in clinical workflows.
5. How AI assistants could amplify doctors the way a research lab amplifies a professor, by making clinicians smarter, not obsolete.

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Primary care sits at the center of medicine and yet no one seems willing to truly own it.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Lisa Rosenbaum, cardiologist and national correspondent for the New England Journal of Medicine, for a wide-ranging conversation about why primary care remains both indispensable and persistently undervalued.

🎧 Before you go any further: If this conversation resonates, make sure you also listen to Lisa’s excellent NEJM podcast, Not Otherwise Specified. It’s one of the most honest, intellectually rigorous explorations of modern medicine and this past season focuses deeply on primary care.

Lisa has spent the past year reporting on primary care across the country, and what she uncovers isn’t a story about technology gaps or workforce shortages. It’s a story about culture. About respect. About responsibility. Together, Graham and Lisa explore how modern incentives have quietly shifted medicine away from ownership - of patients, of decisions, and of outcomes - and why primary care has absorbed the consequences more than any other specialty.

They dig into uncomfortable but essential questions:

1. Why is the specialty that knows patients best paid and respected the least?
2. How did “referral culture” replace continuity?
3. And what happens to trust between doctors, and between doctors and patients when no one is clearly responsible anymore?

Lisa argues that the crisis in primary care is not inevitable, and not intractable but only if medicine is willing to confront its own values.

This episode isn’t about nostalgia.

It’s about deciding what kind of profession medicine wants to be.

1. Why the crisis in primary care is fundamentally about respect and ownership, not technology
2. How modern systems discourage physicians from fully “owning” their patients
3. The hidden costs of referral culture and fragmented responsibility
4. Why restoring autonomy may be essential to saving primary care
5. What gives Lisa hope—and why cultural change is still possible in medicine

1. Lisa Rosenbaum, MD – National Correspondent, New England Journal of Medicine
2. Not Otherwise Specified (NEJM Podcast)

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AI has arrived in medicine faster than anyone expected, but speed doesn’t guarantee wisdom.

In this episode of How I Doctor, Dr. Graham Walker sits down with Dr. Robert Wachter, chair of medicine at UCSF and one of healthcare’s most trusted voices on technology, to unpack what physicians are getting wrong about AI.

Drawing from his new book A Giant Leap, Bob offers a rare, grounded perspective: neither hype nor fear, but informed optimism. Graham and Bob explore de-skilling, trust, medical education, workflow realities, regulation, and the very human question of what happens when clinicians start relying on machines that may eventually outperform them.

This is a conversation for doctors who are already using AI, and those who are uneasy about what comes next. Not a manifesto, but a clear-eyed guide to thinking better about AI before it reshapes medicine for us.

1. Why AI can both improve clinical judgment and quietly erode core physician skills at the same time.
2. What AI means for medical education, training, and the future of clinical reasoning.
3. Why trust in AI systems may arrive sooner than we expect, and why that’s both rational and risky.
4. How health systems should think about regulation, guardrails, and local accountability.

1. A Giant Leap: How AI Is Transforming Healthcare and What It Means for Our Future
2. Robert Wachter on Substack
3. Robert Wachter, MD – UCSF Faculty Page
4. Previous Book: The Digital Doctor

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Medicine is full of people doing the right thing inside systems that reward the wrong work.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Shikha Jain, a hematologist-oncologist, professor, and founder of Women in Medicine, to discuss why some of the most essential work in medicine happens after hours, off the clock, and without recognition - especially for women physicians.

Shikha makes a clear case for why physician distress isn’t a resilience problem, a time-management issue, or a pipeline failure. It’s a systems problem. From RVU-based compensation models that ignore invisible labor, to unpaid committee work that never counts toward promotion, to insurance barriers that put doctors in the crosshairs while profits flow elsewhere, she explains how modern healthcare quietly extracts more from physicians while valuing them less.

Together, Graham and Shikha explore how gender expectations shape leadership, why women physicians are “voluntold” into uncompensated work, and how stereotypes around empathy and agreeableness create double standards that follow doctors from the clinic to the boardroom.

The conversation closes with practical guidance for change: how physicians can set boundaries without guilt, how institutions can measure the work that actually matters, and how male allies can show up in ways that help rather than harm.

This episode isn’t about blaming individuals. It’s about fixing the system so doctors can keep doing the work that brought them to medicine in the first place.

1. Why physician burnout is a structural failure, not a personal one
2. How RVU-based compensation undervalues real clinical and cognitive work
3. The hidden, uncompensated labor disproportionately carried by women physicians
4. Practical ways physicians and allies can drive meaningful change

1. Dr. Shikha Jain: https://shikhajainmd.com
2. Women in Medicine: https://www.wimedicine.org
3. Women in Medicine Summit September 24-26, 2026: https://www.wimedicine.org/summit
4. Oncology Overdrive Podcast: https://oncologyoverdrive.com

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Tim Peck has spent his career practicing medicine where the system is most fragile. A Harvard-trained emergency physician, healthcare entrepreneur, and frontline clinician in rural America, Tim has worked inside nursing homes, healthcare deserts, and communities shaped by the opioid crisis—places where delays, payment failures, and policy decisions have immediate consequences.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Tim to explore what emergency medicine teaches about leadership, systems failure, and responsibility beyond the bedside. Tim shares why ER doctors are uniquely trained to lead in chaos, how seeing patients too late distorts outcomes, and what he learned by embedding himself in the environments that generate avoidable hospitalizations.

The conversation moves beyond ideology into the mechanics of why U.S. healthcare breaks down—from fee-for-service incentives and uninsured rural populations to ambulance shortages and hospital closures that happen quietly, then all at once.

This is not a political debate or a campaign pitch. It’s a clinician’s diagnosis of a system under strain—and a candid discussion of what it would take to fix it.

1. Why emergency medicine is one of the most effective forms of leadership training
2. What changes when doctors see patients earlier instead of downstream in crisis
3. How rural healthcare deserts form—and what they look like in real time
4. Why nursing homes and opioid care expose the deepest system failures
5. How payment models shape clinical behavior more than most physicians realize

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Eve Cunningham has spent her career navigating the hard edges of modern medicine from delivering babies and performing gynecologic surgery to leading large health system initiatives and now serving as Chief Medical Officer at Cadence. Along the way, she’s seen firsthand why chronic disease care continues to fail patients despite more data, more technology, and more dashboards than ever before.

In this episode of How I Doctor, Graham Walker sits down with Eve to unpack why clinic-based, episodic care is fundamentally mismatched to conditions like heart failure, diabetes, and hypertension. She explains why early efforts at remote patient monitoring fell flat, how change management and not technology has always been the real barrier, and why most health systems struggle to turn insight into action.

The conversation moves from the realities of governance-heavy decision-making and physician burnout to what it actually takes to manage patients upstream before they land back in the ICU. Eve also shares the deeply personal connection that drives her work, including how her father’s experience with chronic illness shaped her view of what patients truly need.

This is not a tech demo or a sales pitch. It’s a candid discussion about redesigning chronic disease care in a way that works for patients, clinicians, and the realities of modern medicine.

1. Why episodic, visit-based medicine is structurally incapable of managing chronic disease
2. What early remote patient monitoring efforts got wrong and what has finally made them work
3. How change management and incentives matter more than technology alone
4. Why health systems struggle to act on data, even when the answers are obvious
5. What proactive, upstream care looks like when someone is actually accountable

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David Rhew has spent his career at the intersection of frontline medicine and cutting-edge technology. An infectious disease physician by training and now Global Chief Medical Officer at Microsoft, David brings a rare perspective shaped by decades of clinical work, health system leadership, and early research on AI in healthcare.

In this episode of How I Doctor, Graham Walker sits down with David to unpack where AI in medicine is actually headed and why so many clinicians feel frustrated despite using these tools every day. David explains why physicians aren’t afraid of AI itself, but of poorly designed systems that remove judgment, overload workflows, and fail to reflect how medicine really works.

From agentic AI and ambient documentation to population screening, risk stratification, and resource allocation, the conversation moves beyond buzzwords into the real mechanics of how AI can support better care.

David makes the case that AI’s true promise is helping clinicians practice at the top of their license, identify disease earlier, and redesign care around human decision-making rather than administrative burden.

This is not a futurist thought experiment or a vendor pitch. It’s a grounded, systems-level look at how AI could meaningfully improve medicine.

Explore the Data

📊 Want to see how your peers are actually using AI today? Download Offcall’s 2025 Physicians AI Report, featuring insights from over 1,000 physicians on daily AI use, adoption gaps, and what doctors really want from these tools:

👉 https://2025-physicians-ai-report.offcall.com/

1. Why the biggest failure of healthcare AI isn’t the technology itself, but how it’s measured, implemented, and governed
2. How agentic AI with multiple models working together on discrete tasks can outperform single “super models” in complex clinical problems
3. Why ambient documentation succeeded by addressing burnout and patient experience, not productivity metrics
4. How AI-enabled screening and risk stratification can identify high-risk patients long before symptoms appear
5. What skills physicians will need in the next decade to apply AI responsibly without losing clinical judgment

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