The future I want to build

Medicine needs people who refuse to be confined by it

The people most qualified to fix healthcare are systematically trained to stay inside it. Medical school doesn't teach you to build, it teaches you to comply. The most interesting physicians I've encountered are the ones who found that insufficient.

Most health tech is built by outsiders who treat clinicians as users to be understood. Some is built by clinicians who treat technology as a hammer because it's the only tool they recognize. What's missing is someone who has genuinely lived both — and doesn't feel the need to choose a side.

I came to medicine with a software engineering background, and what I noticed immediately is that the EHR isn't a bad product with good intentions built by malicious people. It's a bad product with good intentions built by people who were never asked to understand what they were actually disrupting. I was one of those people at Epic. That's worth sitting with.

Medicine has a complicated relationship with new data. The precautionary principle is real, important, and sometimes right. But the question I keep returning to is: when does appropriate caution become something else? When does it become institutional habit rather than intellectual humility? I don't think the profession has fully answered that, and I think it's one of the most important questions in health technology right now.

Capital is a tool, not a destination

Money interests me less than what it makes possible. I've built a 30-year financial model comparing every major medical career path by NPV and optionality. I did it not because I care about being wealthy but because I wanted to understand which path leaves the most room to do things. The answer surprised me and I keep returning to it.

I don't know yet whether I will practice medicine as my primary work, build healthcare companies, or eventually sit on the investment side of the table. I think it's important to say that honestly rather than perform certainty I don't have. What I do know is that the most interesting position is the one that lets you speak credibly to all three.

There is enormous arbitrage between people who understand the biology and people who understand the capital. I want to be someone who can sit at that table and be taken seriously on both sides. Building toward that is part of what I'm doing right now.

On writing

I write because I can't not. I published a poetry collection. I write a newsletter. The only way I've ever arrived at what I actually believe is by writing it and watching whether it holds up under scrutiny.

The essays I'm most proud of are the ones where I published something, had to defend it, and the defense changed my mind. That process is not incidental to thinking clearly, it is thinking clearly, done in public.

If you want to be heard, don't hedge your statements. Say something. This is advice I gave myself and try to follow.

I believe in the reversal

The people society places in the lower position often hold the real power. The medical student who actually understands software. The outsider who actually understands the inside. I have spent years cataloguing reversals because I think identifying them is one of the most important skills a person can have.

Most people won't say anything real because they're optimizing not to be wrong in front of others. I am more afraid of not saying anything than of being wrong. These are different orientations toward truth and they produce very different lives.

The weak position, held with enough clarity and discipline, becomes the strong one. I don't think this is optimism. I think it's structural.

Faith is not a footnote

I am a Shia Muslim. This is not incidental to how I think. The tradition I come from places courage above almost everything else. Not the courage of the person who isn't afraid, but the courage of the person who is afraid, who can see exactly what it will cost them, and who does it anyway because it's right.

“Allow God to work through your hands so that He can help you do in the world that which He knows only you can do.”

I wrote this for myself a year ago. I believe it.

Religion gave the pious beggar a dignity the king couldn't touch. That is not a metaphor I use lightly.