The Clinical Realist

The Clinical Realist

By Dr. Sarah MattBusinessMedicineHealth & FitnessManagement
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The Clinical Realist episodes

  • AI Is a Power Shift, Not Just a Tool: Dr. Robert Pearl on What Generative AI Actually Changes for Physicians and Health Systems
    Two years ago, every health system was running an AI pilot. Today, most are still running AI pilots. The technology improved dramatically. The deployment gap between what a board approves and what happens in an exam room stayed the same.
    In this episode of The Clinical Realist, Dr. Sarah Matt talks with Dr. Robert Pearl about what that gap looks like from inside a system that actually closed it. Pearl was CEO of The Permanente Medical Group and Co-CEO of Kaiser Permanente for 18 years, running 22,000 physicians and 103,000 staff while practicing facial plastic surgery. He is now a clinical professor at Stanford GSB and the School of Medicine, and the author of ChatGPT, MD: How AI-Empowered Patients and Doctors Can Take Back Control of American Medicine.
    The conversation covers the part that does not fit on a conference slide: the honest before-and-after between narrow AI and generative AI, why patients gaining information parity with physicians is a power shift and not just a convenience, the diagnostic error comparison that almost no one in medicine will make publicly, and what it actually takes to close the boardroom-to-care-floor seam before the tools scale past the governance.
    What you will take away:
    - The honest clinical difference between the first wave of narrow AI and generative AI in practice (not in press releases)
    - Why physician resistance to AI second-opinions is about power structure, not just liability or hallucinations
    - The diagnostic error comparison between AI and physicians, and why the data is not being discussed publicly
    - What health system boards are being told about AI ROI versus what is actually happening in exam rooms
    - Where the governance needs to be before the tools scale
    Book a Discovery and Clarity Session: https://calendly.com/sarahmattmd
    Subscribe to The Sarah Matt Briefing: https://drsarahmatt.com/newsletter-signup

    —

    Resources & Links:

    📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

    💼 Work with Dr. Matt:
    Looking for a keynote speaker or strategic advisor?
    Visit: drsarahmatt.com

    🔗 Connect on Social:
    LinkedIn: https://www.linkedin.com/in/sarahmattmd/
    YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

    📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
     
    —
    Disclaimer:
    The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

    36 min
  • Why Health Systems Keep Getting Patient Experience Wrong | Amanda Brummitt, FACHE
    Patient experience gets treated as a soft metric. Amanda Brummitt, FACHE, has spent 25+ years in health system operations proving it is a margin lever, a retention lever, and the first thing most AI rollouts ignore.\n\nIn this episode of The Clinical Realist, Dr. Sarah Matt sits down with Amanda Brummitt, Principal of Brummitt Group, to unpack why patient experience is strategy, not sentiment, and what health system leaders get wrong when they bolt AI onto a broken experience.\n\nGuest: Amanda Brummitt, FACHE, Principal, Brummitt Group\nHost: Dr. Sarah Matt, MD, MBA, surgery-trained physician-executive\n\ndrsarahmatt.com | https://calendly.com/sarahmattmd

    —

    Resources & Links:

    📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

    💼 Work with Dr. Matt:
    Looking for a keynote speaker or strategic advisor?
    Visit: drsarahmatt.com

    🔗 Connect on Social:
    LinkedIn: https://www.linkedin.com/in/sarahmattmd/
    YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

    📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
     
    —
    Disclaimer:
    The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

    27 min
  • The Other Side of the Table: What Academic Health Systems Actually Need From Health Tech
    Dr. Marschall Runge, MD, PhD, Dean of the University of Michigan Medical School and CEO of Michigan Medicine, sits across the table from health tech founders every day. In this episode, he shares the institutional reality that most health tech companies never see: what it actually takes for an academic medical center to say yes. Not the demo. Not the pilot. The governance questions, the budget structures, the clinical workflow realities, and the leadership calculus that decides whether a tool survives past the first quarter. If you build for health systems, or you are trying to scale inside one, this is the conversation that explains why the buyer behaves the way they do.

    —

    Resources & Links:

    📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

    💼 Work with Dr. Matt:
    Looking for a keynote speaker or strategic advisor?
    Visit: drsarahmatt.com

    🔗 Connect on Social:
    LinkedIn: https://www.linkedin.com/in/sarahmattmd/
    YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

    📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
     
    —
    Disclaimer:
    The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

    42 min
  • When the Algorithm Is a Device: AI, the FDA, and the Question Almost Nobody Is Asking
    The AI tool you bought last quarter, the one bundled into your EHR upgrade, the one your hospital piloted on your unit. Was it cleared by the FDA as a medical device? Most physicians do not know the answer. In this episode of The Clinical Realist, Dr. Sarah Matt walks listeners through three questions: when is an AI tool a medical device, what do the three FDA approval pathways (510(k), De Novo, PMA) actually mean about the evidence behind a product, and what does professional liability look like when the algorithm is the one making the call. Book a Discovery and Clarity Session: calendly.com/sarahmattmd

    —

    Resources & Links:

    📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

    💼 Work with Dr. Matt:
    Looking for a keynote speaker or strategic advisor?
    Visit: drsarahmatt.com

    🔗 Connect on Social:
    LinkedIn: https://www.linkedin.com/in/sarahmattmd/
    YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

    📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
     
    —
    Disclaimer:
    The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

    16 min
  • When the Algorithm Is a Device: AI, the FDA, and the Question Almost Nobody Is Asking
    The AI tool you bought last quarter, the one bundled into your EHR upgrade, the one your hospital piloted on your unit. Was it cleared by the FDA as a medical device? Most physicians do not know the answer. The vendor's pitch deck almost certainly did not lead with it. And the answer matters, because once an algorithm crosses into FDA medical device territory, the rules that govern what it can claim, how it has to perform, who is liable when it fails, and what evidence the manufacturer had to produce before it reached your practice change categorically.
    In this episode of The Clinical Realist, Dr. Sarah Matt walks listeners through three questions: when is an AI tool a medical device, what do the three FDA approval pathways actually mean about the evidence behind a product, and what does professional liability look like when the algorithm is the one making the call.
    What you will take away:
    - When a clinical AI tool crosses the line into FDA-regulated medical device territory
    - What 510(k), De Novo, and PMA clearance pathways actually say about the evidence behind a product
    - Why the word cleared is doing enormous amounts of work in this industry
    - What changes for physicians, procurement teams, and health system leaders when the algorithm is making the call
    Book a Discovery and Clarity Session: https://calendly.com/sarahmattmd
    Subscribe to The Sarah Matt Briefing: https://drsarahmatt.com/newsletter-signup

    —

    Resources & Links:

    📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

    💼 Work with Dr. Matt:
    Looking for a keynote speaker or strategic advisor?
    Visit: drsarahmatt.com

    🔗 Connect on Social:
    LinkedIn: https://www.linkedin.com/in/sarahmattmd/
    YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

    📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
     
    —
    Disclaimer:
    The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

    16 min
  • The Economics Nobody Taught You in Medical School
    Medical school teaches you pathophysiology, pharmacology, and clinical reasoning. It does not teach you how the money actually works.
    In this episode, Dr. Sarah Matt breaks down the economic structures that govern every clinical decision, every technology purchase, and every AI pilot that dies in a committee room: who pays, who decides, who uses, and why those three people are almost never the same person.
    What you will take away:
    - The user / decider / payer split and why it explains nearly every failed health-tech deal
    - How the RVU system shapes physician behavior and silently resists AI adoption
    - Why value-based care is harder to execute than the architects planned for
    - The practical questions buyers, vendors, and physicians should be asking before any AI deployment
    If you want to understand why healthcare moves so slowly, start here.
    Book a Discovery and Clarity Session: https://calendly.com/sarahmattmd
    Subscribe to The Sarah Matt Briefing: https://drsarahmatt.com/newsletter-signup

    —

    Resources & Links:

    📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

    💼 Work with Dr. Matt:
    Looking for a keynote speaker or strategic advisor?
    Visit: drsarahmatt.com

    🔗 Connect on Social:
    LinkedIn: https://www.linkedin.com/in/sarahmattmd/
    YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

    📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
     
    —
    Disclaimer:
    The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

    12 min
  • The Patient We Never Designed For (Live from Cornell Ithaca, Extended Cut)

    Recorded live at Cornell Ithaca. This is the extended cut of Dr. Sarah Matt's keynote on the central design flaw in modern healthcare: a system optimized for an "average" patient who does not exist.


    When you build clinical workflows, EHR defaults, drug dosing tables, and AI training sets around a statistical mean, every patient outside that mean pays the cost in workarounds, missed diagnoses, and unsafe care. And most patients are outside the mean.


    In this talk, Dr. Matt walks through:


    - Where the "average patient" assumption shows up in clinical AI, and why it compounds bias instead of correcting it

    - The design debt baked into EHRs, order sets, and risk calculators

    - What health systems and physician leaders can do now to design for variance instead of pretending it away

    - Why the patient we never designed for is the patient most likely to be harmed by the tools we are deploying next


    Recorded live at Cornell. Audience Q&A included.


    —


    Resources & Links:


    Get the book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.


    Work with Dr. Matt: Looking for a keynote speaker or strategic advisor? Visit drsarahmatt.com


    Connect on social:

    LinkedIn: https://www.linkedin.com/in/sarahmattmd/

    YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist


    Subscribe to The Briefing: drsarahmatt.com/newsletter-signup


    —


    Disclaimer: The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

    —

    Resources & Links:

    📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

    💼 Work with Dr. Matt:
    Looking for a keynote speaker or strategic advisor?
    Visit: drsarahmatt.com

    🔗 Connect on Social:
    LinkedIn: https://www.linkedin.com/in/sarahmattmd/
    YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

    📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
     
    —
    Disclaimer:
    The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

    57 min
  • Sunk Cost, Vendor Lock, and the AI Tools Health Systems Can't Let Go Of
    Most clinical AI governance frameworks tell you how to evaluate tools before you deploy them. Nobody talks about how to exit a tool that is not working.
    In this episode, Dr. Sarah Matt walks through the anatomy of sunk cost bias in health system AI: how it starts (month four or five, mixed performance data, a vendor who keeps resetting the clock), how experienced vendor account teams use it to extend bad contracts, and how to build exit criteria into your governance framework before you ever go live.
    What you will take away from this episode:
    - Why sunk cost bias in vendor relationships is a governance failure, not a behavioral one
    - How vendors use remediation roadmaps to reset your evaluation clock
    - What a real clinical AI exit criterion looks like: specific, measurable, time-bound, established before go-live
    - How to execute a clean exit without losing six months to organizational politics
    - Why the cost of staying with a bad tool grows geometrically

    —

    Resources & Links:

    📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

    💼 Work with Dr. Matt:
    Looking for a keynote speaker or strategic advisor?
    Visit: drsarahmatt.com

    🔗 Connect on Social:
    LinkedIn: https://www.linkedin.com/in/sarahmattmd/
    YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

    📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
     
    —
    Disclaimer:
    The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

    9 min
  • The Q2 Governance Problem: When AI Goes Live Without a Safety Net
    Most health systems that deployed clinical AI in Q1 are now six to eight weeks post-launch and starting to see the governance gap. Dr. Sarah Matt explains what the gap looks like in production, why retrofitting governance is more expensive than building it before go-live, and the four-step rapid governance build for organizations that are already live and need to catch up.

    —

    Resources & Links:

    📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

    💼 Work with Dr. Matt:
    Looking for a keynote speaker or strategic advisor?
    Visit: drsarahmatt.com

    🔗 Connect on Social:
    LinkedIn: https://www.linkedin.com/in/sarahmattmd/
    YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

    📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
     
    —
    Disclaimer:
    The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

    10 min
  • The Pilot Trap: What Health Systems Get Wrong About Implementation
    Your pilot worked. You got approval to scale. Six weeks into full implementation, something is wrong: not catastrophically wrong, just wrong enough to make you wonder whether "it worked in the pilot" meant anything at all.
    In this episode, Dr. Sarah Matt breaks down the pilot trap: the gap between proving a tool works under controlled conditions and proving an organization is ready to run it under normal operating conditions. Pilots and implementations are not on the same continuum. They measure fundamentally different things. The health systems that scale successfully treat the pilot as a learning vehicle, not a prediction. The ones that get stuck assumed pilot success equaled implementation readiness.
    What you will take away from this episode:
    - Why pilot success measures tool performance, not organizational readiness
    - The three gaps that trap most health systems: motivation, workflow integration, governance
    - Why resistance to clinical AI is usually not irrational, and how to diagnose the source
    - How the physician champion role shifts from pilot advocate to implementation steward
    - Why building governance before implementation begins is the single variable most predictive of scale-up success
    Website: https://drsarahmatt.com | Book a Discovery and Clarity Session: https://calendly.com/sarahmattmd | LinkedIn: https://www.linkedin.com/in/sarahmattmd/

    —

    Resources & Links:

    📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

    💼 Work with Dr. Matt:
    Looking for a keynote speaker or strategic advisor?
    Visit: drsarahmatt.com

    🔗 Connect on Social:
    LinkedIn: https://www.linkedin.com/in/sarahmattmd/
    YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

    📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
     
    —
    Disclaimer:
    The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

    11 min

About The Clinical Realist

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Healthcare innovation is broken. We have billion-dollar AI running on 1990s infrastructure. We have startups dying in "Pilotitis." And we have leaders frozen by analysis paralysis.

Dr.…