Josh Briscoe
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jbriscoe.bsky.social
Josh Briscoe
@jbriscoe.bsky.social
440 followers 310 following 650 posts
Hospice and Palliative Care Physician
#MedPsych #MedSky #HAPC #Bioethics
Writing @ Notes from a Family Meeting: https://familymeetingnotes.substack.com
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jbriscoe.bsky.social
familymeetingnotes.substack.com/p/a-machine-... Some thoughts on using #AI for surrogate decision-making.
The PPP is grounded on the presumption that a patient with the capacity to make a decision is given information and they yield a response. It treats the patient as a machine, which is why we believe a machine could so easily replace them.2 But that’s not how decision-making works. It’s laden with emotion and values. It’s fraught with negotiation. Most people aren’t sitting at home pondering their...
October 22, 2025 at 9:30 AM
jbriscoe.bsky.social
I’m amazed anyone could believe that once an AI scribe saves a clinician time, administrators will leave the reclaimed time untouched. If a clinician could see 14-16 patients in a day without an AI scribe (already a number too high for primary care and most sub-specialties), surely they could see 20-25 patients with an AI scribe. The encounters become shorter because what is expected isn’t human connection but a technical service rendered ever more efficiently by other tools in the AI suite. That reclaimed, unbillable time shouldn’t be given back to those 14-16 patients because presumably those encounters are already optimized. It should be given to 6-9 other patients who can be seen today instead of next week. This isn’t good for the clinicians but the encounter isn’t about them. They are parts in the machine, and may soon be expunged by AI anyway. Ironically, neither is it good for the patient who finds themselves treated as a bureaucratic client, a machine, or an animal, depending on the flavor of dehumanization their condition warrants.
October 3, 2025 at 9:24 AM
jbriscoe.bsky.social
...where I worry it's headed: familymeetingnotes.substack.com/p/where-the-... #medsky #ai
Dr. Paisley’s brow furrowed. “I will say, it looks like you’re spending about an average of three minutes per encounter on non-clinical chatter. Hmm. The weather, patient vacations. Of course, of course we want our patients to feel welcome, but…” A pie chart grew on the wall. “If you reduce that to just one minute, you’ll be able to see seven more patients in a day! Goodness, look at that. Three minutes of non-clinical puts you in the bottom 10th percentile. Friendly, but inefficient!” An item popped up on Winston’s to do list at the bottom right hand corner of the wall: Complete efficiency module #151.
October 3, 2025 at 9:19 AM
jbriscoe.bsky.social
We should avoid misleading language in clinical communication, but it's harder than we might think. familymeetingnotes.substack.com/p/getting-be... #medsky #hapc
This woman upon admission to the intensive care unit had a health status of 5. Today, as the resident gives updates to the patient’s husband, the woman’s health status is a 6, because all else is unchanged apart from the kidney function. In no way should the conversation highlight that things are “better.”
July 20, 2025 at 9:36 AM
jbriscoe.bsky.social
familymeetingnotes.substack.com/p/crafting-h...
Our work flows from our beliefs, however inchoate, about the good life. Our work also shapes what we take to be the good life. It shapes our life anyway. We might not see it right away, but that’s why Crawford invites us into a closer reading of our lives and work
July 7, 2025 at 9:46 AM
jbriscoe.bsky.social
familymeetingnotes.substack.com/p/where-the-...
I’m not sure anyone predicted the EMR would be so quickly and completely co-opted for non-clinical interests, chiefly to be used for billing and coding. After that there are medicolegal uses of documentation. Trailing, frail and almost forgotten, are the actual clinical uses of documentation. The EMR is already used as a form of surveillance, though it is a blunt instrument as it depends on the clinicians’ honesty and thoroughness in being their own clerk. “If you don’t document it, it didn’t happen.” Understood in a certain way, that’s just not true: the patient really did receive a thoracentesis whether it was documented or not. You really did palpate their abdomen whether it was documented or not. But in another way, in the way that administrators, lawyers, and billers care about, it absolutely did not happen if it wasn’t documented. The note doesn’t just reflect reality. It is reality. When EMRs were first being broadly deployed in the United States, clinicians were encouraged to adopt them and demonstrate “meaningful use” - e.g., writing electronic orders. There were some incentives that went along with this. Now, as far as I know, there aren’t any more carrots. There are only sticks, ranging from polite reminders to addend or update documentation to accord with coding rules all the way to temporary banishment from the EMR if you’re delinquent on certain forms of documentation.
June 23, 2025 at 9:58 AM
jbriscoe.bsky.social
familymeetingnotes.substack.com/p/where-the-...
June 16, 2025 at 8:13 PM
jbriscoe.bsky.social
Looking forward to digging in to this issue of @plough.bsky.social
June 14, 2025 at 8:46 PM
jbriscoe.bsky.social
familymeetingnotes.substack.com/p/better-hab... #medsky #meded
June 11, 2025 at 12:09 AM
jbriscoe.bsky.social
As an aside: familymeetingnotes.substack.com/p/coping-mor...
June 8, 2025 at 9:56 AM
jbriscoe.bsky.social
Clinicians find solace in the belief that because their patient chose something, it's okay. But the choice was constructed by them, often without acknowledging vulnerability. familymeetingnotes.substack.com/p/helping-pe... #medsky #hapc
We shouldn’t hide behind the belief that a patient’s mere choosing means they “accept the risks.” Patients are vulnerable. Trade-offs are necessary. Choosing isn’t a means of defying or defending one’s vulnerability, but should be recognized as a fragile act carried out in the context of that vulnerability. Trade-offs come with the territory.
May 23, 2025 at 9:25 AM
jbriscoe.bsky.social
familymeetingnotes.substack.com/p/where-the-...
Dr. Paisley’s brow furrowed. “I will say, it looks like you’re spending about an average of three minutes per encounter on non-clinical chatter. Hmm. The weather, patient vacations. Of course, of course we want our patients to feel welcome, but…” A pie chart grew on the wall. “If you reduce that to just one minute, you’ll be able to see seven more patients in a day! Goodness, look at that. Three minutes of non-clinical puts you in the bottom 10th percentile. Friendly, but inefficient!” An item popped up on Winston’s to do list at the bottom right hand corner of the wall: Complete efficiency module #151.
May 22, 2025 at 10:56 AM
jbriscoe.bsky.social
familymeetingnotes.substack.com/p/helping-pe... #medsky
illness is the abnormality that reveals what is normal
May 22, 2025 at 9:34 AM
jbriscoe.bsky.social
From @nejm.org www.nejm.org/doi/10.1056/... I'm often pessimistic that a "rebalancing of power" will happen in favor of a more humane medicine because the shift away from it started before the EMR and has continued apace with each innovation. #medsky
Given the time pressures on clinicians, AI documentation is an unstoppable tsunami, a wave that will wash over our work lives, with no way of turning it back. Perhaps there will be technical “fixes” to help the virtual AI creature in my exam room better sort the wheat from the chaff, or learn my charting preferences. What is less likely is that primary care physicians will be able to regain control over our relationships and the means of production of our notes without a fundamental shift in the balance of power — a concerted move away from a corporate-controlled, transactional, assembly-line model toward a more patient- and clinician-centered redesign of primary care.
May 22, 2025 at 1:06 AM
jbriscoe.bsky.social
March 29, 2025 at 10:19 AM
jbriscoe.bsky.social
Me while editing what I’ve written. IYKYK. #amwriting
March 15, 2025 at 2:54 PM
jbriscoe.bsky.social
I reflect on that here: familymeetingnotes.substack.com/p/still-huma... #medsky #hapc #meded
All experts were at one time novices; all masters were once newbies. Every one who wants to learn the craft will grapple with inexperience. The technical mindset, on the other hand, is probably held with ambivalence.2 Sure, it’s good to be efficient, maybe it’s sometimes necessary to be reductionistic, and perhaps we can trick ourselves into believing we’re amoral, and all this might require trading off warmth and compassion. Some clinicians might willingly make that trade, but many do without knowing it. A virtue-based frame of moral development could respond to both challenges. For the inexperienced, it could help orient education not toward knowledge acquisition for its own sake, which is not the purpose of the clinical encounter, but toward restoring and sustaining health. For those captured by the technical mindset, this frame helps enliven and humanize their practice of medicine by orienting it toward something more meaningful than efficiency for its own sake. A virtue-based frame can help clinicians attend to the moral landscape of the clinical encounter, sustain presence amidst distraction, and care well for their patients, colleagues, and themselves. It also acknowledges that the clinicians themselves, not just their tools, are part of the healing process of the clinical encounter.
February 23, 2025 at 10:29 AM
jbriscoe.bsky.social
So many of our ethical debates are grounded in profound disagreements about anthropology. Carter Snead helpfully digs to the root and offers a helpful way forward. Even if you don’t agree, maybe our disagreements can be made more productive as a result. #medsky #bioethics
February 21, 2025 at 1:14 PM
jbriscoe.bsky.social
From @shannonvallor.bsky.social - relevant as we consider the use of #AI in medicine #medsky bookshop.org/p/books/the-...
Today’s AI mirrors tell us what it is to be human, what we our- selves care about, what we find good, or beautiful, or worth our attention. It is these machines that now tell us the story of our own past, and project our collective futures. They do so without living even one day of that history, or knowing a single moment of the human condition. What happens to a person, or an intel- ligent species, when they stop telling their own story? What do we lose when self-knowledge and self-determination yields to the predictive power of an opaque algorithm?
February 7, 2025 at 10:57 AM
jbriscoe.bsky.social
What happens if you give a clinician a blood pressure measuring machine? #medsky familymeetingnotes.substack.com/p/if-you-giv...
The cover of the children's book "If You Give a Mouse a Cookie," featuring a mouse holding a cookie.
January 31, 2025 at 7:39 PM
jbriscoe.bsky.social
familymeetingnotes.substack.com/p/the-priest... #medsky
January 14, 2025 at 10:42 AM
jbriscoe.bsky.social
What the fable about the fox and the grapes can teach clinicians in geriatric oncology. #hapc #medsky #oncsky linkinghub.elsevier.com/retrieve/pii...
The fox's struggle to reach the grapes mirrors our ongoing efforts to include older adults in clinical trials. Much like the fox's fruitless leaps, our attempts to create meaningful, inclusive research in geriatric oncology often fall short of their goal. Even when older adults are included in trials, the outcomes measured frequently do not align with what matters most to them.
January 12, 2025 at 10:24 AM
jbriscoe.bsky.social
open.substack.com/pub/familyme... #medsky #medtech
The lesson for those who would seek their healing from machines (or the Machine) is to behold how easily technology slips between humans, promising to enhance their relationships. Instead, it modifies them. It sets the tone. It frames the questions. It shapes the vision. For health and medicine, does that matter? Only to the extent that we believe people are more than machines themselves.
January 11, 2025 at 12:01 PM
jbriscoe.bsky.social
Scott Alexander has tens of thousands of readers. Not every blogger is going to have such a readership, but I wish more clinicians wrote their perspective essays outside of academic journals. The dialogue would be much richer. #writing #medsky #psychsky www.astralcodexten.com/p/on-priesth...
Consider how impressive a boundary this is - someone can have literally tens of thousands of fans for doing popular writing in a field, and the amount of extra status it gives them in the field is within a rounding error of zero. Only your reputation within the priesthood matters.
January 9, 2025 at 10:12 AM
jbriscoe.bsky.social
Diving into this by @warrenkinghorn.bsky.social. I’ve been looking forward to it! #psychsky #medsky
January 5, 2025 at 1:52 PM