How I Doctor with Dr. Graham Walker

Offcall
  • 4.9 (21)
  • Medicine
  • Weekly

I built MDCalc 20 years ago because I wanted to save myself and other doctors time and make it easy for them to integrate more evidence into their medical care. Now I’ve launched Offcall to tackle something even bigger: giving doctors back our autonomy — through salary and workload transparency. These ideas shouldn’t be radical…but here we are. I still practice emergency medicine, but I’ve spent my career breaking out of the cookie cutter version of “what a doctor looks like” or “what a doctor’s supposed to do.” That’s why I started How I Doctor: a podcast about the most creative and influential physicians and how they’re rewriting the job description. Medicine wasn’t built for creativity. But I think that’s exactly what it needs. If you’re looking for new role models, different stories, or just proof that fulfillment is still possible in this era of medicine — this show’s for you. Welcome to “How I Doctor,” where we’re bringing joy back to medicine. If you enjoy the show, please hit the follow button! That will help us continue to bring you more great episodes every week. And don’t forget to sign up for Offcall. Join the growing movement! Offcall: https://www.offcall.com/ LI: https://www.linkedin.com/company/joinoffcall TikTok: https://www.tiktok.com/@offcalldotcom IG: https://www.instagram.com/offcalldotcom/

  1. 2d ago

    Meet DR GPT™: Dr. Harvey Castro on Patients, Robots, and Who Will Drive AI in Medicine

    By the time your patient reaches you, you may be their fourth opinion. They have already asked a chatbot, or several, and they arrive with a diagnosis, a drug name, and a level of confidence you did not create. In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Harvey Castro, an emergency physician, MBA, and one of the most visible physician voices on AI in healthcare, known as DR GPT™. Before he became an AI evangelist, Harvey owned and ran freestanding emergency departments in Texas, with a payroll he personally guaranteed. He wrote one of the first medical apps for the iPhone, then wrote a book on ChatGPT in healthcare days after it launched, against the advice of friends. His message to physicians is simple: treat AI output as a draft, not a decision, and keep the clinician accountable for making the call. Harvey and Graham get into what changes when patients show up with an AI first opinion, and why Harvey worries about both bias in the models and patients self-treating. He makes the case that generative AI is mostly a communication tool, from discharge instructions as coloring books to coaching physicians on bedside manner. He describes the personal digital twin he built from his wearables, genetics, labs, and medical record, and why he believes patients, not hospitals or governments, will drive the next wave of AI. Graham pushes back on whether the next generation will really prefer a robot to a human doctor, and the two debate what happens to the role of physicians over the next 50 years. The conversation closes with rapid-fire takes, including whether ambient AI scribes are overhyped, why Harvey calls the human in the loop a scapegoat in the loop, what he thinks is the biggest mistake medicine could make with AI, and the one thing he says AI should never touch. What You’ll Learn Why patients arriving with an AI first opinion creates new risks around bias, self-treatment, and physician liabilityHow generative AI can improve communication across languages, cultures, and ages, and even coach doctors on bedside mannerWhy Harvey believes patients, not hospitals, will drive AI adoption, and what a patient “Bill of Rights” for AI could look likeWhy “human in the loop” can really mean “scapegoat in the loop”Where Harvey draws the line on what AI should never do 📖 Learn more about Dr. Harvey Castro, his apps, books, and speaking at https://HarveyCastroMD.com 🩺 Offcall is more than a platform, it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    Meet DR GPT™: Dr. Harvey Castro on Patients, Robots, and Who Will Drive AI in Medicine

  2. Oct 22

    Primary Care Is the API for Healthcare. So Why Is Nobody Building for It? with Jefferson Health’s Dr. David Nichols

    Primary care doctors spend their days stitching together a system that was never built to connect. Dr. David Nichols thinks they should be the ones to rebuild it. In this episode of How I Doctor, Dr. Michael Hobbs sits in for Dr. Graham Walker to talk with his friend Dr. David Nichols, a family physician who finished residency in 2023 and became a medical director at Jefferson Health a year later. David co-founded a value-based care company at 23, ran its technology side through medical school and part of residency, and now leads AI work inside a large health system. He explains why primary care is the API for healthcare, the connector that fills every gap between specialists, hospitals, and patients’ lives, and why that connector is so poorly built. From there, Michael and David get practical. David shares how clinicians can start building, what makes an AI project stick instead of stalling after phase one, and why hours saved is a risky way to measure AI when saved time can quietly become more patients on the schedule. They also dig into a billing structure that pays doctors only when patient and physician share a room, physical or digital, and never for the thinking and coordination that make care safe. What You’ll LearnWhy David calls primary care the API for healthcare, and why he says it is poorly writtenHow to start building if you’re a frontline clinician, from finding builders in your own network to meetups and online communitiesWhat separates AI projects that stick from pilots that stall, and why Jefferson’s boss prefers the term phase oneWhy AI scribes may not save time but can still improve the quality of a visitWhy doctors are not paid for coordination, asynchronous work, or cognitive thinking, and what David would change 🩺 Offcall is more than a platform — it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    Primary Care Is the API for Healthcare. So Why Is Nobody Building for It? with Jefferson Health’s Dr. David Nichols

  3. Oct 15

    Is Not Asking About ChatGPT the Next Malpractice Risk? With Berkeley Law's Vincent Joralemon

    Your patient asked a chatbot about their medication before they asked you. If something goes wrong, the law may care less about what the chatbot said than about whether you asked. In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Vincent Joralemon, director of the Life Sciences Law and Policy Center at Berkeley Law. Vincent is a former high school biology teacher who went on to law school at Berkeley and Harvard. In his recent paper in npj Digital Medicine, “Who bears liability when AI gives bad prescribing advice?”, co-authored with Julia Etkin, he argues that the learned intermediary doctrine works differently depending on whether AI sits behind the clinician or advises patients directly, and that clinicians may be required to screen patients for AI-sourced prescribing advice. Graham expected the answer to be technology companies, but Vincent’s argument lands back on physicians. Vincent explains the learned intermediary doctrine, the legal principle that already makes physicians the filter between drug manufacturers and patients, and why the same logic is likely to govern AI. He and Graham work through what happens when a physician follows an algorithm, when one overrides it, and how a note explaining your reasoning can be the strongest protection you have. They also get into whether asking “What did ChatGPT tell you?” is on its way to becoming a standard of care question, what de-skilling means in legal terms, and what a physician should do when a hospital mandates an AI tool they know is flawed. The conversation closes with rapid-fire predictions, including a malpractice case that names both a physician and a chatbot company, and Vincent’s answer on the biggest legal mistake a physician can make with AI right now. What You’ll Learn Why the learned intermediary doctrine is the foundation of AI liability for physiciansWhy patients’ tendency to trust chatbots more than traditional sources may change a physician’s duty to ask about themHow to protect yourself when you override an AI recommendation, or follow oneWhat the law may expect of you when your hospital requires a tool you believe is faultyWhy Vincent expects settlements before court decisions, and a physician and chatbot company named in the same suit 📄 Read the paper: Etkin J, Joralemon V. “Who bears liability when AI gives bad prescribing advice?” npj Digital Medicine. 2026;9:448. https://doi.org/10.1038/s41746-026-02854-5 This episode is presented in partnership with eNavvi, a clinician-built digital prescribing platform. ePrescribe anytime anywhere with eNavvi 🩺 Offcall is more than a platform — it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    Is Not Asking About ChatGPT the Next Malpractice Risk? With Berkeley Law's Vincent Joralemon

  4. Oct 8

    If AI Can Prescribe, Who's Liable When It Gets It Wrong? Four Experts Weigh In

    In the first-ever How I Doctor Roundtable, Dr. Graham Walker brings together four people who see prescribing from four different seats: Dr. Simon Chang, an internal medicine physician, AI Task Group lead for NCPDP, and founder of eNavvi; Tanvi Patel, Vice President and General Manager of Amazon Pharmacy; Deepika Srivastava, Chief Operating Officer of The Doctors Company, the nation's largest physician-owned malpractice insurer; and David Simon, Associate Professor of Law at Northeastern University. Together they dig into why prescribing in 2026 still runs on one-way messages and guesswork, why the prescriber is usually the last to learn a patient never got their medication, and how real-time price, stock, and delivery data could change treatment decisions at the point of care. They also take on the harder questions: how AI concentrates liability, why broken handoffs (not bad clinical decisions) drive so much malpractice risk, and what physicians should do to protect themselves while the law and regulation catch up. The common thread: physicians stay in charge of clinical decisions, and everyone else's job is to make that safer and easier. This episode is presented in partnership with eNavvi, a clinician-built digital prescribing platform. ePrescribe anytime anywhere with eNavvi What You'll Learn What really happens after a physician hits send, and why the prescriber is usually the last to know when a prescription fails.How real-time price, stock, and delivery data at the point of prescribing could change treatment plans.Why e-prescribing shifted the burden of choosing a pharmacy from patients to physicians, and how putting the digital script back in patients' hands could restore choice.Why AI prescribing concentrates liability, and what a malpractice carrier and a health law professor say physicians should do right now.Why labeling AI involvement in prescriptions matters for audit trails, accountability, and trust. Where to Find The PanelDr. Simon Chang: https://www.linkedin.com/in/docschang/ Tanvi Patel: https://www.linkedin.com/in/tanvipatel/ Deepika Srivastava: https://www.linkedin.com/in/deepika-srivastava-1041257a/ David Simon: https://davidasimon.us / 🩺 Offcall is more than a platform — it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    If AI Can Prescribe, Who's Liable When It Gets It Wrong? Four Experts Weigh In

  5. Oct 1

    Why Can't Good Medical Advice Go Viral? Dr. Mike Evans on Health Communication in the Influencer Era

    Every physician has met the patient who arrives with a confident claim from a feed, a podcast, or a supplement ad. The careful, evidence-based answer is the one that sounds like the outlier. Good medicine is nuanced, and nuance rarely travels. In this episode of How I Doctor, Dr. John Schumann sits in for Dr. Graham Walker to talk with Dr. Mike Evans, a family physician best known for a whiteboard, a marker, and a question that became a phenomenon: What is the single best thing we can do for our health? Mike practiced inner city family medicine for 15 years, taught at the University of Toronto, and later brought his approach to health innovation at Apple. His whiteboard videos have been watched tens of millions of times. Mike and John dig into the gap between knowing and doing. Mike shares what he learned about behavior change building health programs at Apple scale, including a 900-person asthma trial published in JAMA that cut emergency room visits by 42% among Medicaid patients. They also take on the influencer economy, from the halo effect to paid promotions, and Mike makes his case that the basics of movement, connection, sleep, diet, and agency still deliver the highest return in health. The conversation closes with Mike's research on retirement, his read on where wearables and AI are headed over the next year, and the Evans Health Lab Substack he is building as a counterweight to bad influencers. What You'll Learn Why the most evidence-based health advice struggles to go viral, and why Mike believes audiences will still reward authenticityHow the halo effect and undisclosed paid promotion shape what patients believe about healthWhy behavior change depends more on environment, peers, and personalization than on willpowerWhat an Apple asthma trial showed about who benefits most from digital health toolsWhy the basics still have the best returns in medicine, and what the evidence says about retirement, social connection, and the brain 🩺 Offcall is more than a platform — it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    Why Can't Good Medical Advice Go Viral? Dr. Mike Evans on Health Communication in the Influencer Era

  6. Sep 24

    How Dr. Keith Matheny Turned His Practice's Biggest Headaches Into Businesses, While Still Seeing Patients

    Most physicians finish training without a single business class, then spend their careers inside practices run the same way. Dr. Keith Matheny decided to fix that, starting with his own. In this episode of How I Doctor, guest host Dr. Basil Kahwash sits down with Dr. Keith Matheny, an ENT in the Dallas area who holds patents on bioabsorbable drug delivery implants, has co-founded device and remote monitoring companies, serves as team otolaryngologist for the Dallas Cowboys, and still keeps a full clinic schedule. Keith explains how, before he was even a partner, he took over operations at a practice with paper charts, no website, a leaky revenue cycle, and ancillary services that were losing money, and turned it into one with new locations, new referral streams, and service lines that supported the rest of the practice. That turnaround became a consulting business and then US ENT, a national group purchasing organization. Keith walks through why supply costs have exploded for office-based specialties, why he signed up suppliers before he had a single physician member, and how early suspicion that he was a private equity "Trojan horse" gave way to rapid growth when COVID shutdowns left practices scrambling to make payroll. Today the GPO is free to join and has about 3,500 members. The conversation closes on why Keith refuses to leave the exam room, how staying clinical keeps him credible with colleagues facing the same rising costs he is, and his advice for physicians who want to build something of their own: get involved, protect your ideas, and just start. What You'll Learn What Keith found when he took over the business side of his practice, and how he turned money-losing service lines into profit centersWhy community practice gave him more freedom to patent and commercialize his inventions than an academic path would haveWhy Keith recruited suppliers before physicians, and how COVID turned skeptics into membersHow rising payroll, rising supply costs, and flat reimbursement are squeezing independent practices, and why Keith feels it as much as his members doKeith's case for why physicians should shape AI rather than fear it 🩺 Offcall is more than a platform — it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    How Dr. Keith Matheny Turned His Practice's Biggest Headaches Into Businesses, While Still Seeing Patients

  7. Sep 17

    Cut Out the Middleman, Keep the Patients: Dr. Chloe Kindred on Building a Direct Primary Care Practice From Zero

    Most doctors who complain about their employed job never actually leave. Dr. Chloe Kindred did, with no backup plan the first time and a real one the second. In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Chloe Kindred, a family physician who spent three years in a hospital-affiliated system in Central Florida before leaving to launch Kindred Family Medicine, a direct primary care practice opening this October. Chloe walks through exactly how an employed job that started out manageable became untenable: a starter panel that tripled within months after three colleagues left in close succession, unpaid hours that crept from thirty minutes early into full weekend mornings, and a request to simply pause new patients that her health system flatly refused. What follows is a real-time account of building an independent practice from nothing, from pricing a subscription against other DPC practices in the region to picking an EHR and billing platform to the bureaucratic loops of setting up basic infrastructure like prescribing credentials. Along the way, an unscripted Instagram post she made mostly so patients could find her after she left turned into 800,000+ views and a 230-person pre-enrollment waitlist, more than double her original year-one goal. The conversation closes on why Chloe thinks direct primary care specifically, not just independence broadly, is the model that actually removes the risk she couldn't tolerate: a payer able to unilaterally rewrite the terms of her own work. What You'll Learn What happened when Chloe asked her health system to simply pause new patient intake, and why the answer was noThe story of her first resignation: submitted with zero plan, rescinded twelve hours laterWhat actually convinced her to quit for good, and why it wasn't burnout but a single contract emailHow she's pricing, staffing, and sizing Kindred Family Medicine, and what tools she chose to run itWhy an unscripted Instagram post now has 800,000+ views, and how it turned into a 230-person waitlist before she saw a single patientChloe's case for direct primary care 🩺 Offcall is more than a platform — it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    Cut Out the Middleman, Keep the Patients: Dr. Chloe Kindred on Building a Direct Primary Care Practice From Zero

  8. Sep 10 ·  Bonus

    These Physicians Explain Why They'd Never Go Back to Being Employed

    Something kept happening on Offcall that we didn’t plan for. Guest after guest, across totally different specialties, kept circling back to the same decision: walking away from employed medicine and building something of their own instead. This Labor Day, instead of one long conversation, How I Doctor is pulling together the sharpest moments from five of those conversations, physicians in primary care, pediatrics, allergy, and ENT, who each found their own path to independence and never looked back. Featured in This Episode Dr. Farzad Mostashari, Former National Coordinator for Health IT and CEO of Aledade: on the economics behind why independent primary care is making a financial comeback, and why he calls employed physicians "cogs in a machine" built around someone else's goals.Dr. Ari Brown, Pediatrician and founder of 411 Pediatrics: on what it takes to stay independent for over thirty years, and her stark warning that independent pediatric practice is now "on the extinction list."Dr. Paulius Mui, Family medicine physician and founder of XPC Health: on walking away from full-time employed primary care to build a direct primary care practice where patients pay what they can afford.Dr. Basil Kahwash, Allergist/immunologist and co-author of Offcall's Referral Manifesto: on the isolation that comes with independent practice, and his vision for a connected network that fixes it.Dr. Bradley Block, Otolaryngologist and board member at ENT and Allergy Associates: on how a 170-partner, full-equity ownership model became too big and too democratic for private equity to buy. Resources and Where to Find Our Guests Dr. Farzad Mostashari's full episode: The Future of Primary Care Is Independence, And It's More Lucrative Than You ThinkDr. Ari Brown's full episode: What Happened to Trust Between Parents and PediatriciansDr. Paulius Mui's full episode: Reinventing Primary Care to Put Patients FirstDr. Basil Kahwash's full episode: Going Independent Doesn't Mean Going It AloneDr. Bradley Block's full episode: The Physician-Owned Practice That Private Equity Can't BuySubmit a comment on the CMS CY 2027 Physician Fee Schedule (file code CMS-1848-P): regulations.govRead the Referral Manifesto: offcall.com/manifestoLearn about Offcall's referral product and new Lounges feature: offcall.com/referrals 🩺 Offcall is more than a platform — it’s a community. Join today! 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

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I built MDCalc 20 years ago because I wanted to save myself and other doctors time and make it easy for them to integrate more evidence into their medical care. Now I’ve launched Offcall to tackle something even bigger: giving doctors back our autonomy — through salary and workload transparency. These ideas shouldn’t be radical…but here we are. I still practice emergency medicine, but I’ve spent my career breaking out of the cookie cutter version of “what a doctor looks like” or “what a doctor’s supposed to do.” That’s why I started How I Doctor: a podcast about the most creative and influential physicians and how they’re rewriting the job description. Medicine wasn’t built for creativity. But I think that’s exactly what it needs. If you’re looking for new role models, different stories, or just proof that fulfillment is still possible in this era of medicine — this show’s for you. Welcome to “How I Doctor,” where we’re bringing joy back to medicine. If you enjoy the show, please hit the follow button! That will help us continue to bring you more great episodes every week. And don’t forget to sign up for Offcall. Join the growing movement! Offcall: https://www.offcall.com/ LI: https://www.linkedin.com/company/joinoffcall TikTok: https://www.tiktok.com/@offcalldotcom IG: https://www.instagram.com/offcalldotcom/

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