On/Offcall: Why It's Time to Kill the Fax Machine in Healthcare

Welcome back to On/Offcall!

THE FAX MACHINE HAS STREAMLINED PHYSICIAN COMMUNICATION (!)

… said no physician ever.

This week, we welcome Dr. Basil Kahwash to How I Doctor. Basil is an allergist-immunologist who previously worked as an academic physician at Vanderbilt and recently transitioned to independent practice in Columbus. After stepping into independent practice, Basil came face-to-face with how much administrative friction stands between physicians and actual patient care. He joins Dr. Graham Walker to unpack why referrals and physician communication are failing and what it will take to rebuild it. They discuss:

👉 Why independent practice often feels more isolated and fragmented
👉 How fax machines became the “rate-limiting step” of physician communication
👉 Why referrals often arrive with almost no clinical context
👉 How patients end up carrying information between physicians themselves because of broken systems
👉 The vision behind Offcall’s recently announced physician referral network and referral manifesto

🎧 Listen to the full episode out now

Most Talked About On Offcall

Sign Our Open Letter to Kill The Fax Machine
Inspired by Basil and Graham’s podcast: Join hundreds of physicians and sign Offcall’s open letter to kill the fax and bring physician communication into the current decade. 😀

What Worries Me Most About AI After 26 Years As a Practicing Doctor
From Dr. Elizabeth Vainder: After 26 years in medicine, I cannot stay quiet about what is happening in healthcare with AI right now.

See the Slides from This Week’s AI Residency Webinar: Choosing the Right AI Tools
The biggest takeaways from Graham, Dr. Michael Hobbs, and Heidi’s Mehul Akhouri’s AI webinar from this past week.

Physician Spotlight: Meet Dr. Ioannis Koutroulis

Meet the renowned physician and academic leader with over 12 years of experience spanning clinical practice, medical education, and research (nominated by Dr. Joseph Shapiro!)

1. Ioannis, what's one under the radar AI tool that has made the most impact on your practice and why? One under-the-radar AI tool that I have not routinely used but I believe will have a big impact on my workflow is ambient clinical documentation, which is basically AI that listens to patient conversations and generates structured notes automatically. It eliminates one of the biggest drains on time and attention: documentation. Instead of splitting focus between the patient and the screen, I can stay fully engaged in the interaction while the system handles transcription, summarization, and formatting. The result is better patient rapport, less after-hours charting, and more cognitive bandwidth for actual clinical decision-making, which is where human judgment still matters the most.

2. What’s the hardest part about being a physician that you think should be talked about more openly? The hardest part isn’t the hours or the workload, it’s the feeling of being responsible for human lives. You’re constantly making decisions with incomplete information, and sometimes even when you do everything right, the outcome is still bad. That creates a quiet, cumulative weight, moral distress, and the pressure of knowing your choices carry real consequences for people’s lives. It’s not something that shows up in training metrics or gets discussed openly, but it shapes how physicians think, sleep, and carry themselves over time.

3. Forget pizza parties — what’s one way you’ve coped with burnout that’s actually made a difference? What’s actually helped is building exercise and hobbies into my schedule. Regular workouts aren’t just about fitness. They’re one of the fastest ways to reset mentally after a long shift, burn off stress, and regain a sense of control. And having a hobby that’s completely unrelated to medicine, whether it’s cooking, music, or something creative, gives you an identity outside the hospital. It’s not about having tons of free time; it’s about protecting small, consistent pockets of it so you can enjoy your job but also your life.

4. Who do you want to nominate next to get the next Physician Spotlight?? Dr. Dennis Ren, Children's National

Read the full-length version here. Know someone else who should be featured? Reply or tag them and their company in the comments!

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.

Important work, Lisa Rotenstein
Lisa Rotenstein shared new research showing that 1 in 5 physician intend to reduce their clinical hours and 1 in 6 intend to leave medicine. Alongside co-authors Christine Sinsky, Dr. Heather Farley, Roger Brown, and Tait Shanafelt. Read more here.

Thank you for sharing, Sheri Mancini
Dr. Sheri Mancini posted a thoughtful essay questioning why the U.S. spends more than anyone on healthcare yet ranks near the bottom in physicians per capita. Read it here.

Keep leading, Shannon Udovic Constant
Dr. Shannon Udovic Constant is teaching a new leadership workshop to help address the fact that while 57% of medical school applicants are women, only 27% of deans are women. Learn more about this important work here.

Congrats, Anne O'Connor
Dr. Anne O’Connor graduated from the IU Kelley School of Business Physician MBA Program and was promoted to Professor in the University of Wisconsin Department of Medicine. Congratulate her here!

More career highlights to celebrate!
Dr. Katrina J. Stime announced she’ll be starting an MBA at Stanford Graduate School of Business this fall. Dr. Jeffrey Chen has joined Peak Health as Founding Medical Director. Dr. Aaron Reichlin launched YourStory Health. Dr. Alexandra Gonçalves was hired as the VP, Head of Cardiovascular Medical Affairs at Bristol Myers Squibb.

Give it a listen, Stephen Cohen
Dr. Stephen Cohen appeared on The Hidden Load podcast with Dr. Santina Wheat to discuss the system-level changes we actually need to address burnout. Listen here.

Way to go future doctors!
More congratulations this week to all those who will be pursuing their M.D. this fall, Krishna Hariprasad (here), Thomas Li (here), Jade Mehta (here), Niloufar Golchini (here), and Melody Ly (here). If you know someone else we should lift up in this newsletter, tag them in the comments too!

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