The future I want to build

Medicine needs people who refuse to be confined by it

The people most able to fix healthcare are the ones trained hardest to stay inside it. Med school doesn't teach you to build. It teaches you to comply. The most interesting physicians I've met are the ones who decided that wasn't enough.

Most health tech gets built by outsiders who treat clinicians as users to be studied. Some gets built by clinicians who treat technology as a hammer, because it's the only tool they own. What's missing is the person who has actually lived both, and doesn't feel any need to pick a side.

I came to medicine from software, and the first thing I noticed is that the EHR isn't a bad product built by bad people. It's a bad product, built with good intentions, by people who were never asked to understand what they were disrupting. I know this because I worked at Epic. I was one of those people.

Medicine has a complicated relationship with new data. The precautionary principle is real, and it's sometimes right. But the question I keep coming back to is when appropriate caution quietly turns into something else — when it stops being intellectual humility and becomes institutional habit. I don't think the profession has answered that honestly. I think it's the question.

Capital is a tool, not a destination

Money interests me less than what it buys you the freedom to do. I built a 30-year financial model comparing every major medical career path by NPV and optionality — not because I want to be rich, but because I wanted to know which path leaves the most room to act. The answer surprised me, and I haven't stopped thinking about it since.

I don't know yet whether I'll practice as my main work, build companies, or end up on the investment side of the table. I'd rather say that plainly than perform a certainty I don't have. What I do know is that the most interesting seat is the one that lets you speak credibly to all three.

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

On writing

I write because I can't not. I've published a poetry collection. I write a newsletter. The only way I've ever found out what I actually believe is to write it down and see whether it survives contact with anyone who pushes back.

The essays I'm proudest of are the ones where I published something, had to defend it, and the defense changed my own mind. That isn't a side effect of thinking clearly. It is thinking clearly — just done out loud, where people can watch.

If you want to be heard, stop hedging. Say the thing. I gave myself that advice and I'm still trying to take it.

I believe in the reversal

The person society puts in the lower position is often the one holding the real power. The med student who actually understands software. The outsider who actually understands the inside. I've spent years collecting reversals like this, because spotting them might be the most useful habit I have.

Most people never say anything real, because they're optimizing not to look wrong in front of other people. I'm more afraid of staying quiet than of being wrong. That's a small difference on paper. It builds completely different lives.

The weak position, held with enough clarity and nerve, turns into the strong one. I don't think that's optimism. I think it's structural.

Faith is not a footnote

I'm a Shia Muslim. This isn't incidental to how I think. The tradition I come from puts courage above nearly everything — and not the courage of the person who feels no fear. The courage of the person who is afraid, who can see exactly what it's going to cost, and 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 that for myself a year ago. I believe it.

Religion gave the pious beggar a dignity the king couldn't touch. I don't reach for that line lightly.