On/Offcall: Top Endocrinologist Shares Everything You Need to Know About Peptides
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His first whiteboard video had 250 views…then hit millions… and now he’s this week’s How I Doctor guest! Welcome to the show Dr. Michael Evans, with this week’s guest host Dr. John Schumann. 👏
Mike is a family physician who practiced inner-city medicine at St. Michael's Hospital and taught at the University of Toronto. His whiteboard videos starting with "What is the single best thing we can do for our health?" have been watched tens of millions of times.
The question behind his work has always been bigger: How do we get good evidence to change what people actually do, not just what they know? At Apple, he got to test that at scale. In a 900-person randomized trial published in JAMA, high-risk adults with asthma received daily check-ins, air-quality alerts, early warnings of respiratory infections, and whiteboard education videos. Among participants on Medicaid, ER visits dropped by 42%.
Meanwhile, doctors are losing the attention war. In one study of health influencers promoting medical tests, 70% were being paid. The number who disclosed it to their audience was zero. On this week's episode, John talks with Mike about why good medical advice is so bad at going viral, and what physicians can do about it.
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See the Slides From This Week’s AI 202 Webinar
🎉 Thank you to everyone who joined live and brought such sharp questions. Featuring: Dr. Michael Hobbs, Dr. Graham Walker, and Dr. Kai Romero. 🙌
How Dr. Keith Matheny Turned His Practice's Biggest Headaches Into Businesses
All while still seeing patients! Featuring Dr. Keith Matheny and How I Doctor guest host Dr. Basil Kahwash.
Download to join the waitlistMedicine 
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Physician Spotlight: Meet Rosy Thachil
Dr. Rosy Thachil was recently promoted to Associate Professor of Medicine at Icahn School of Medicine at Mount Sinai. Celebrate her here!
1. Are you worried about deskilling — that the next generation won’t develop the intuition you did because the model handled it? It’s nuanced. Clinical intuition is really pattern recognition built through thousands of repetitions: seeing the patient who looks fine until they suddenly aren’t, realizing the numbers don’t quite fit the clinical picture, or recognizing that something just feels off before you can fully articulate why.
If AI removes too many of those repetitions before trainees have had the opportunity to build their own mental models, we could create physicians who are excellent at interrogating an algorithm but less comfortable reasoning independently when the algorithm isn’t there—or when it gets something wrong.
But I also don’t think the answer is to preserve inefficient work simply for the sake of training. We have to move with the times. Medical education has to evolve alongside the technology, just as medicine has evolved with every major advance before it. The goal shouldn’t be to train physicians who can compete with AI at information retrieval; that’s perhaps a losing—and unnecessary—battle. The goal should be to train physicians who know when to trust AI, when to challenge it, and, perhaps most importantly, what to do when the data or the model doesn’t give you a clean answer.
Medicine is more than information. The art of medicine is being able to sit with a frightened patient or family, understand the medical, social, and cultural context behind the numbers, recognize uncertainty, communicate difficult information, and exercise judgment when the evidence doesn’t fit neatly into a box. Those are deeply human skills, and I don’t think they’re going away. In fact, as AI becomes better at the technical and informational parts of our work, our ability to bring context, judgment, empathy, and humanity to the bedside may become more important than ever.
The goal is to train physicians who know medicine deeply enough to use AI as an extraordinarily powerful tool without ever surrendering their own judgment to it.
2. Will AI solve the physician shortage or quietly make it worse? I think the answer will depend largely on how we implement it. AI has the potential to give physicians back meaningful capacity. If it can reduce documentation, inbox work, administrative friction, and some of the cognitive overhead that consumes our days, physicians can spend more of their time doing the things that genuinely require a physician—clinical reasoning, complex decision-making, communication, and caring for patients.
But there’s an important question about what we do with that recovered capacity. We have to be thoughtful about ensuring that efficiency gains translate into better care and a more sustainable practice of medicine, rather than simply creating expectations for continually increasing productivity.
If we get that balance right, AI could help address both access and burnout by allowing physicians to spend less time on the friction surrounding medicine and more time practicing it.
3. If you could redesign residency from scratch, what’s the first thing you’d change? I would broaden what we consider essential physician training. Residency and medical training does an extraordinary job of teaching physicians how to care for sick patients, manage complex disease, interpret diagnostic studies, and make decisions under pressure. Those clinical skills are—and should remain—the foundation of medical training. But practicing medicine today requires another set of skills that we often expect physicians to somehow pick up along the way: communication, team dynamics, leadership, technology, operations, healthcare economics, and understanding how the systems around us actually work. I would build more of those skills into training rather than leaving physicians to figure them out on their own once they’re in practice.
Medicine is ultimately a team sport practiced within a remarkably complex system. You can be an outstanding clinician and still struggle if you don’t understand how to lead a team, resolve conflict, communicate across disciplines, use technology effectively, or recognize the incentives shaping the care around you.
I imagine it’s a little like training a pilot to fly the plane beautifully without teaching them how the airport, air traffic control, or the broader aviation system works. Flying the plane is still the most important part—but understanding the system around you undoubtedly makes you a better pilot.
4. If you had a magic wand for one thing in medicine, what would you fix tomorrow? I would fix the amount of human talent we waste on friction. Healthcare is full of extraordinarily bright, highly trained people spending enormous portions of their day fighting systems: hunting for information, duplicating documentation, navigating prior authorizations, tracking down records, clicking through suboptimally designed software, and solving operational problems that should never have reached them in the first place.
As someone who works in a busy cardiac ICU, I know that some complexity is unavoidable. Sick patients are complicated. Medicine is complicated. There are difficult decisions that require time, judgment, multidisciplinary collaboration, and careful attention to detail. This is necessary complexity.
But we’ve somehow allowed a tremendous amount of unnecessary complexity to become part of the definition of practicing medicine. We’ve built layers of processes and systems around patient care that can sometimes consume the very resource healthcare has the hardest time replacing: the time and attention of highly trained people.
A healthcare worker spending two hours figuring out how to get a medication approved is two hours they aren’t spending thinking about a patient. A healthcare worker tracking down information across multiple systems is time that could otherwise be spent at the bedside.
And I think the same is true for patients. They spend enormous amounts of time navigating portals, phone trees, authorizations, referrals, forms, and fragmented systems simply to get the care they have already been told they need.
If I had a magic wand, and at the risk of sounding reductionist, I’d remove the unnecessary complexity so we could devote more of our time and attention to the necessary complexity.
5. What's something physicians are quietly worried about that the public doesn't know about yet? Rules and regulations getting in the way of physicians' ability to use their actual clinical judgment. One example in addiction medicine is a mandatory minimum number of urine drug screens every year for patients on certain controlled medications, in certain settings or jurisdictions. This is sometimes regardless of how long they’ve been stable in recovery. It’s costly and paternalistic, and it’s another hoop that both doctors and patients have to jump through.
Other rules and regs may not impact clinical judgment, but they take up a ton of our time unnecessarily. For instance, we spend countless hours sitting through redundant corporate compliance modules (workplace safety, cultural difference, sexual harassment, how to use a fire extinguisher, etc). Similarly, there are burdensome state-specific CME requirements in many states that are required to maintain your licenses. They are often on very specific topics like HIV care or bioterrorism. Sometimes the topics have very little relevance to many doctors’ actual daily scope of practice. This stuff is time-consuming and frustrating. It's less time we're able to spend helping patients.
Read the full-length version here. Know someone else who should be featured? Reply or tag them and their company in the comments!
Emergency Physicians, Headed to ACEP 2026? Let Us Know!
If you’re headed to ACEP 2026 this year in Chicago, let us know! Offcall is proud to be sponsoring a happy hour on Tuesday, October 6th in the Innovation Hub alongside ShiftChange, Kevin Spencer from Ring Rescue, and led by Dr. Patrick O’Malley. Learn more here. Reply and we’ll add you to the event.
We also set up a private networking group for all the emergency physicians who will be there – let us know if you’d like to be added!
Highlights From Our Community
Each week, we celebrate career milestones, launches, & other goings-on in the physician community. Have something to promote? Reply and we’ll feature you.
Great interviews, Sahar Hashmi
Dr. Sahar Hashmi was interviewed on WBUR's Morning Edition about doctors now being able to use ChatGPT to search health records. She also recently published an article in Becker's Hospital Review, "Who Monitors the Guardrails? Healthcare Needs an Independent AI Safety Board." Check out both here and here.
Give it a listen, Basil Kahwash and Ben Phillips
Dr. Basil Kahwash appeared on the HealthCare Uncut podcast with Ben Phillips to discuss why physicians — regardless of specialty — can help shape the future of medicine far beyond the hospital or exam room, and how Offcall fits into that vision (!!). Listen here.
Read the article, Ge Bai
Dr. Ge Bai published a new study in JGIM Journal of General Internal Medicine entitled “Commercial Prices for Primary Care Physician Office Visits” alongside Yang Wang, PhD, Mark Meiselbach, and others. Read it here.
Thanks for your advocacy, Sally Primus
Dr. Sally Primus posted about why she remains in private practice despite the very real structural challenges: “We can't keep saying we value independent physicians while designing a system that makes independence harder every year.” Read more here.
Thanks for speaking out, Dr. Tiffany Martinez
Dr. Tiffany Martinez posted about the structural disadvantages of being a woman doctor in America: “A woman doctor in this country is the most credentialed exhausted woman alive — and the world still asks her to smile more.” Watch her commentary here.
Also read the article, Ishani Ganguli
Also on the topic of primary care, Dr. Ishani Ganguli was published in the Washington Post on the subject of: “When emailing your doctor comes with a price tag, what is the true cost? Read it here.
Well done, Gihan de Mel
Australian physician and Swiftio Founder and CEO Dr. Gihan de Mel used Heidi to pick up his patients in Swiftio, get them an Uber, and let the nurses know the ETA. Check out the demo here!
Way to go, Tania Elliott!
Dr. Tania Elliott recently became a CBS News Medical Contributor! Congratulate her and see her on television here.
Check out their panel this weekend at AAP
This weekend, social media star doctors Dr. Ari Brown, Dr. Paul Tran, Dr. Tommy Martin, Dr. Mike Varshavski, and Dr. Leah Rappaport will all appear on a panel together at the AAP conference entitled “Conversation That Takes Questions Out of the Comment Section and Straight to the Pediatrician.” See more here.
Congrats on the career news!
Dr. Manuel Tapia, MD has been appointed the Stephen and Faith Brown Professor of Family and Community Medicine. Congratulate him here. Dr. Pradeep Natarajan received the 2026 Population Research Prize from the American Heart Association. Learn more here.
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