Notes in the Margin - 24 May 2025
Notes from a Family Meeting is a newsletter where I hope to join the curious conversations that hang about the intersections of health and the human condition. Poems and medical journals alike will join us in our explorations. If you want to come along with me, subscribe and every new edition of the newsletter goes directly to your inbox.
Every so often, I’ll share things I’ve been reading with a few words of mine scribbled in the margins. If you have something to share, please do! The comment section is open.
I’ve heard this is Isaac Asimov’s own favorite of the short stories he wrote. It can be read in about 20 minutes, which is saying something for a story that spans about a trillion years. Humans, no matter where they’re situated in the history of the story, turn to the machine to assuage their deepest anxiety and answer their most pressing question. Hope springs eternal. But the end offers an ironic (albeit fictional) concession from one of literary history’s most staunch atheists.
Private equity in health care puts patients’ lives in danger, studies show
Here’s a conundrum: health care is necessary but it also costs money - how do we pay for it? One of the most potent incentives in the modern era is satisfying the capitalist metrics through mechanisms like private equity. One would think that by using private equity to address the problems of access and quality across different areas of health care, it would be a win-win. Instead, once the vampire of private equity is invited into a space, it kills its host, sell its, and moves on to the next victim.
People are losing loved ones to AI-fueled spiritual fantasies
Black Mirror meets That Hideous Strength meets The Screwtape Letters. We’re going to trust this tool in health care? In psychotherapy?
A call to end daylight saving time - implications for public health
As I’ve grown older, I’ve become less a fan of DST. For a couple weeks this past year, I drug myself through the mornings and late afternoons after the switch. Even now feels rougher than late winter. Reading the evidence against it makes sense of my experience. How wonderful it would be if we adopted permanent standard time, but alas, we live in an era where it seems unlikely any legislative body can muster the political will to do anything productive or helpful.
What makes me mad about AI in education
From
: “What I care about very much is a situation where education is so corrupted that it can no longer serve its true function, the one that isn’t reducible to diplomas or grades or career-oriented learning outcomes: giving young people the tools to survive whatever the world will throw at them. I care about an educational system that has given up on fostering in young people the imagination, resilience, and tolerance for boredom and failure that are necessary to build a world better than the one we have now.”Building the AI-enabled medical school of the future
An attempt to sound cautious but with a strong undertone of giddiness. "Curricula should incorporate a deep focus on data systems literacy to enable physicians to thoughtfully implement and oversee these powerful tools." We struggle to use our current tools wisely and well. Why would we be better at managing more powerful tools? "Although medical education will continually integrate the latest technologies, such as AI, it will serve the foundation of elite clinical care only if it can excel in instilling principles in the future physician: rigor in reasoning, empathy, and moral judgment." Medical education struggles to inculcate these things, and the EMR (the last major technological revolution in medicine) atrophies all these things. I don’t see AI would help.
NEJM AI podcast: Rewriting the clinical playbook
"We need automation in a way that we didn’t before. We need to augment clinicians somehow by hook or by crook." An off-handed comment reveals the path AI will take will be the familiar path of the EMR. The government and corporations induced physicians to adopt the EMR through “meaningful use” incentives. Now there are no incentives, only punishments. What is adopted with glee today will be mandated for surveillance tomorrow. There is no discussion in this podcast about how to help clinicians become the people they need to be for their work. It’s all technique - with some allusions to how much money there is to be made in this market. I'm not anti-tech, but the relentless focus on technique and technology overlooks that we need traditions, institutions, and processes to help clinicians become to the kinds of people we need them to be. We can't automate that away.
From the Archives
Here's something, only a little dusty, that new readers may not have seen.
It’s such a tempting rallying cry: let’s care for the whole person! But in the ways we “care” for patients today, what does that actually mean?
Shouldn’t We Care for the Whole Person?
Geraldine Jackson was used to a life with diabetes. She was more familiar than most with doctor’s appointments, waiting rooms, blood work, and lines at the pharmacy. While she didn’t structure her day around insulin, it did have its unique place in her routine. But then she was diagnosed with breast cancer. More appointments, more waiting rooms, more bl…
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