The Opening
This is the first one. There will be fifty-one more like it this year, one every Sunday, without fail.
If you're reading this, you work in medicine, or you're on your way into it, or you love someone who does. You already know the job is hard. You don't need another email reminding you of that. This one won't.
What we'll do instead, every week, is five minutes of the things worth paying attention to. The research, the tools, the people, and the stories from our colleagues across the field. Pre-hospital to nursing to physicians to the folks keeping the lights on. Medicine is still one of the most extraordinary things a person can spend their life on. We're going to write like we believe that.
- Troy, Ray, and Ibrahim
Agentic AI is moving from pilot to production.
Source: Deloitte Center for Health Solutions, 2026
The phrase to learn this year is agentic AI. Not predictive models. Not ambient scribes. These are AI agents that operate inside your EHR, prep patient summaries before you walk into the room, and chase down the missing potassium holding up a discharge. They observe, decide, and execute. You keep the clinical reins.
Why it matters: Deloitte's 2026 outlook found 61% of healthcare executives are already building or have funded agentic AI initiatives. 98% expect at least 10% cost savings within three years. Mayo Clinic and Mount Sinai are deploying agents for prior auth and back-office work. Stanford is using them at the point of care. The UK's NHS just launched a national framework for responsible deployment.
The catch: A March 2026 npj Digital Medicine review found early agentic systems showed strong accuracy in diagnosis and workflow optimization, but only one of the studies reviewed involved actual patients. Most are exploratory. Fragmented EHRs and unclear governance are the bottleneck, not the model.
Bottom line: The question isn't whether agentic AI is coming to your workflow. It's whether you'll have a seat at the table when your hospital decides what these agents can do without asking you first. The chart above shows what one year of ambient AI scribes already delivered at Kaiser. Multiply that by autonomous decision-making.
How comfortable are you with AI agents acting autonomously in your workflow?
On what the job is.
Dr. Troy Akers · Chief of Emergency Medicine
I met my wife when we were seventeen years old. She has watched me become every version of a doctor a person can become. The exhausted medical student. The Army flight surgeon hanging off a helicopter. The terrified resident. The attending who sometimes forgets what month it is. The chief trying to keep a department running while the hospital reinvents itself around him. She has held the whole life together while I held other people's.
Our daughters have grown up with a father who missed birthdays. Who fell asleep at the dinner table. Who sometimes came home from shift quiet in a way they learned not to ask about. None of us signed up for that life knowing what it would cost. All of us stayed anyway.
I say that because I want you to know who is writing this. Here is what almost twenty years inside medicine has taught me. Smart gets you in the door. Everyone here is smart. That is how you got here. That is how the resident next to you got here. That is how the nurse running the code got here. That is how the paramedic who brought them in got here, and the consultant you called at 2 a.m., and the pharmacist catching the dose you almost missed. What makes someone good at this job, year after year, is not intelligence. It is care.
Care does something to a person. The people who do this work well get bigger on the inside until the job is just a shape they have grown around.
Right now there is a loud argument happening about whether AI is going to replace us. I have thoughts about that argument. We will get to them. The short version for today is this. AI is going to do a lot of what I do. It is going to read the scan faster than me. It is going to catch the drug interaction I miss. It is going to draft my note while I am walking to the next room. Good. My patients deserve that.
What it is not going to do is sit on the edge of a ninety-six-year-old man's bed and let him tell me about his wife. That is still our job. It might be the only job left that really is ours. And I think it is a beautiful one.
This newsletter exists because I believe we deserve five minutes on a Sunday morning that reminds us of that. Every one of us. Every role. Every shift. Not a rah-rah five minutes. An honest one. Welcome. I'm glad you're here.
— Troy
These views are my own and do not represent the views of any government agency or employer.
Have a story from your corner of medicine?
We want it. EMS, nursing, pharmacy, techs, registration, administration, all of it. You choose how you are named. Full name, role only, or fully anonymous. We protect patients in every story we run. That is not negotiable and it never will be.
If we run your story, we will send you a Consult mug as a thank you.
Maria Ansari, MD, FACC Co-CEO, The Permanente Federation
A cardiologist running medicine's largest ambient AI deployment. Under her leadership, TPMG rolled the tech out to 7,200+ physicians across 17 medical centers.
Year one results:
2.5M patient encounters
15,791 hours of documentation time returned
84% of physicians reported better patient connection
82% reported greater job satisfaction
In 2025, all three medical groups she oversees earned the AMA's Joy in Medicine recognition, with TPMG taking Gold for burnout reduction.
Why she matters: Most AI deployment stories are written by tech vendors. Ansari's is being written by the 7,200+ physicians who used it across 2.5 million real encounters.
First personalized CRISPR therapy turns one.
Baby KJ at CHOP, treated for a rare urea cycle disorder with a CRISPR therapy designed for his exact mutation, is walking and talking a year later. The FDA's new "plausible mechanism" framework now allows results in as few as 5 to 10 patients to support platform approval.
GLP-1s and Alzheimer's: the contradiction deepens.
A new Anglia Ruskin review found GLP-1s reduced beta-amyloid and tau in preclinical tissue. Meanwhile, Novo Nordisk's two Phase 3 EVOKE trials of semaglutide failed to slow cognitive decline across 3,000+ patients. The class effect debate is wide open.
The Pitt’s not acting
Why the most realistic medical drama on TV feels uncomfortably close to your last shift.
If you've watched The Pitt, here's something you didn't know: before filming season one, the entire main cast spent two weeks training with three real ER physicians. Suturing. Intubation. Bedside ultrasound. CPR. Even the background extras got medical training.
It explains why every ER doc you talk to about the show says some version of "I can't watch it after a shift." Season two leans hard into the conflict playing out in your hospital right now: Dr. Robby's old-school skepticism vs. Dr. Al-Hashimi's enthusiasm for AI charting. The writers are mining the same fault line you're walking every Monday.
That EMR-goes-down storyline? Real ER docs told People it happens routinely. 20 minutes to 3 hours. Sometimes scheduled maintenance.
Until next Sunday,
For the people keeping medicine human.
