Notes from the
front lines of care
Essays, a podcast, and the day to day, on AI in primary care, digital health equity, and what the technology looks like from inside a community clinic.
Essays from
MedTech & Heart
The 50 Million Questions
Fetal heart tracings, an iPad in 2012, a T-shirt store, and how a serendipitous friendship built the work I do now. Origin Story, Part 4.
Read on Substack → Aug 27, 2026The Documentation Playbook
We are liable either way. Here is the exact playbook I use to protect my license, my patients, and my time when using ambient scribes.
Read on Substack → Aug 25, 2026The Long Way to Family Medicine
Quitting the wrong specialty, finding the music, and how the detour became the training. Origin Story, Part 3.
Read on Substack → Aug 18, 2026The Test I Kept Walking Back Into
The post-bacc years, the interview where I cried, and what the MCAT never measured. Origin Story, Part 2.
Read on Substack → Aug 11, 2026Before the MD, a Dictionary
The iron, the vapor rub, the curanderos, and the Backstreet Boys. How I learned to practice medicine before I learned to speak English.
Read on Substack → Aug 6, 2026You Know My Work. Let Me Reintroduce Myself
One year on Substack, a birthday month, and the three essays I have been too afraid to write. Until now.
Read on Substack → Aug 4, 2026Zero Studies From Clinics Like Mine
There is a moment, somewhere around slide forty of a deck you are building, when the literature stops being a pile of citations and becomes a map.…
Read on Substack → Jul 28, 2026She Said No to the Scribe
There is a moment when you understand that a patient's no is not about the technology.
Read on Substack → Jul 21, 2026We Handed Them a Ferrari and Never Taught Them How to Drive
What 40 future clinicians told us about AI. Co-written with Jhaimy Fernandez, MD, my Alma First co-founder, whose metaphor gave this essay its name.…
Read on Substack → Jul 16, 2026Before I Sign the Note
Seven questions I run on every AI-generated note in the last hour of clinic. The end-of-day vigilance no one trained us to carry.
Read on Substack → Jul 14, 2026The Outage is the Audit
What a system downtime and two California lawsuits tell us about our unexamined dependence on AI.
Read on Substack → Jul 7, 2026How to Scale Chronic Disease Care Without Widening the Digital Divide
We don't have a time problem in primary care. We have an architecture problem.
Read on Substack → Jul 2, 2026What Your AI Scribe Vendor Will Not Test (and the 5-Step Audit That Will)
The accuracy that matters is not the one on the brochure. It is the accuracy on your patients. Here is the small in-clinic audit I would run before…
Read on Substack → Jun 30, 2026What AI Costs Before It Reaches the Exam Room
A conversation on AI, the environment, and the communities that carry the cost. With Dr. Manijeh Berenji and Betty Villantay, MS1.
Read on Substack → Jun 23, 2026Why the Safety Net Should Lead
Care is episodic, illness is continuous. Why safety-net patients get lost between visits, and what FQHCs must build to hold continuity.
Read on Substack → Jun 16, 2026When the Therapist Is a Chatbot
A 24/7 listener for the people human care never reached. And the moment its warmth becomes the danger.
Read on Substack → Jun 9, 2026I Feel Behind on AI Too
What I do when the model releases stop and the panic does not. The small system that keeps me current without drowning.
Read on Substack → Jun 2, 2026Downstream of the Data Center
The child wheezing in my exam room and the data center six states away may be the same story. Why a clinician's voice belongs in this one.
Read on Substack → May 26, 2026What AI Cannot Do in Primary Care
What ambient AI cannot replace in a safety-net primary care clinic: two patient moments, and the invisible navigation behind one of them.
Read on Substack → May 19, 2026Voy a Pausar
What ambient AI changes in language-concordant safety-net visits, and the deliberate move I now make in the exam room.
Read on Substack → May 12, 2026Liable Either Way
The legal double bind of AI documentation and the question every clinician signing a note needs to ask first.
Read on Substack → May 5, 2026Alma First Roundtable: The AI Curriculum That Does Not Exist Yet
Two educators and a future physician on what students are learning about AI on their own, and what happens when nobody checks their work.
Read on Substack → Apr 28, 2026When the Statehouse Catches Up to the Exam Room
I drove to Sacramento to speak about deepfake physicians, algorithmic downcoding, and the distance between policy and the exam room. It was shorter…
Read on Substack →MedTech
and Heart
First episode live
My podcast on medicine, technology, and heart, published as part of the MedTech & Heart newsletter. The first episode is live, with new episodes monthly. It opens on the hidden environmental cost of AI, the water behind a single prompt.
The digital divide
is a care divide
HIT Like a Girl · November 2025
On HIT Like a Girl with Joy Rios, I joined my Alma First co-founder, Dr. Jhaimy Fernandez, to talk about Latino health equity, the digital access barriers, the systemic obstacles, and how mentorship and community-led solutions build a more culturally competent healthcare system.
More guest
appearances
It's not capability, it's design: digital health equity
On designing digital health for the people most often left out of it, recorded around HLTH.
Listen →FQHC innovation, agentic AI, and health law
A conversation on building AI for safety-net clinics and keeping a clinician in the loop. Recorded, releasing in 2026.
Releasing soonBylines and
media features
The crisis of physician burnout and the promise of technology
On why the tools meant to help clinicians have to be built with the people who use them.
Read the piece → SMLMA News Briefs · 2024The critical role of digital health navigators in achieving health equity
How trained navigators connect Spanish-speaking patients to portals and video visits.
Read the piece → Medscape · 2026AI Is Everywhere in Medicine. Why Aren't Students Being Trained to Use It Responsibly?
Quoted on responsible AI use, equity, and patient privacy in medical education.
Read the piece →Practical, printable
tools for clinics and patients
Free to download and share, unchanged and with credit.
The Pre-Flight Checklist for AI Tools
What to confirm in writing before any AI tool touches a visit, for clinics that do not have a compliance department.
Open the checklist → ScriptThe Bilingual AI Consent Script
The exact words in English and Spanish, the teach-back line, and a printable waiting-room notice.
Open the script → TemplateThe One-Page AI Governance Log
One page, kept current. The tool, the owner, the answers, and a short log of what failed and what changed.
Open the log → FrameworkThe Hardest Day Test
If a tool needs you at your best to be safe, it is not safe. A quick clinical safety test for any AI tool.
Open the framework → Patient handoutYour Clinic Is Using AI
A plain-language handout that explains to patients how AI shows up in their care and what their choices are.
Open the handout →New tools land in the newsletter first
Subscribe to MedTech & Heart to get each new resource as it is released.
Releasing soonNotes from
the front lines
Occasional writing on digital health, AI, and equity in primary care. No noise.