Category: Personal

Stuff about just me

Sylvia Plath’s “human” quote for the modern age (NYTimes)

In the scramble for humans to keep up with the modern age, particularly the AI accelerations (every week good and bad news), I love this quote from Sylvia Plath, via Melissa Kirsch, of the Good List from NYTimes.

https://www.nytimes.com/2026/03/18/briefing/the-good-list-wordle-tulips.html

From Melissa:

There’s a quotation attributed to the poet Sylvia Plath that’s been popping up on my social media: “In March I’ll be rested, caught up and human.” It’s good, right? A prophecy for renewal.

I repeated it to myself during this frigid February, and then went to find the quotation in Plath’s papers. The words come from a 1953 letter: “Dearest mother,” she wrote. “Well, the event has come and gone, and I feel amazingly eager to plunge into the next five weeks of work so that when I take the pilgrimage to Yale in March I’ll be rested, caught up and human.”

My take: as a physician informaticist, technologist and aging human, our ongoing technology acceleration is both wondrous and deeply troubling.

Recently I read a book by Heather Haying, A Hunter-Gatherer’s Guide to the 21st Century, and her quote struck me as well:

When it rains in the mountains, stay out of the river.” — from a local farmer in South America

Yes, it was difficult for her to understand what the farmer was talking about: the mountains were many miles away! And yet a few minutes later the river swelled and became instantly dangerous. Sometimes, unless you’re a local, you don’t understand the dangers and the warning signs.

And she goes on to talk about Hyper-Change: change that is too fast for human brains to accommodate. We are living in the age of Hyper-change. It is exhausting. The FOMO (fear of missing out) is constantly in our ears.

When I look back over my writings and readings over the past 20 years, I have always thought “wow, things are moving so fast now, we can’t keep up.” I have been writing and thinking this for 30 years.

  • 1995: Oh no! Our dictated and typed notes take too long to get in the chart!
  • 1998: Oh no! CT wants us to look at test results on a PC!
  • 1999: Oh no! PC’s are to costly to install in EVERY clinic!
  • 2001: Oh no! Patients want to see test results immediately!
  • 2003: Oh no! We have to switch EHR vendors!
  • 2005: Oh no! We can’t install Allscripts quickly enough!
  • 2009: Oh no! Paying for paper chart records is costly on top of an EHR!
  • 2011: Oh no! We have to switch to Epic. We don’t have time to learn this!
  • 2013: Oh no! Handwriting, scanning, typing, dictation. Writing notes sucks! 
  • 2014: Oh no! Speech recognition is better, but still sucks!
  • 2016: Oh no! CT is forcing us to show all our progress notes to patients!
  • 2020: Oh no! Pandemic and learning to do telehealth!
  • 2021: Oh no! The Feds say we have to show patients results immediately!
  • 2023: Oh no! These EHR quarterly upgrades keep breaking my workflow!
  • 2026: Oh no! Everyone is using AI well except me!

And things keep accelerating, and then I look back fondly on 2 years ago and think “how quaint and peaceful that used to be.”

I don’t have a point, except, I certainly feel unsettled by generative AI, and the social media posts on “Look what I figured out! You’re an idiot if YOU haven’t done the same!”

Enough.

Thank you, Sylvia Plath for your words.
And to Melissa for resurfacing them for us.

March I’ll be rested, caught up and human.

Are you agentic enough? (wired.com)

“I think it’s cringy to refer to yourself or someone else as agentic. But that doesn’t mean those are not, in fact, good qualities to look for and cultivate,” said Rechtman. “It sort of reveals a worldview that you genuinely, unironically believe there are two kinds of people in the world: the NPCs and the main characters, and you’re one of the main characters.” –Yoni Rechtman

https://www.wired.com/story/silicon-valley-agentic-individuals-future-of-work/

Wired asks us “are you agentic enough”? This is yet another form of FOMO. OMG! Am I not keeping up with the Jones? With the smarties at the end of the hall, or in the other building who are “playing” with their new AI BFFs?

Well, I am not. At least, only a little. I don’t have an agent, nor have I built one (my sister has), but I am asking questions of Claude, and finding out what Claude can and cannot do, and checking the work.

Claude is certainly confident, and month over month, seems to make fewer mistakes. To wit:

  • Claude has taken a handful of PDF’s and summarized them for me, and abstracted numbers from specific fields and put them in a spreadsheet correctly.
  • Claude has taken several hours of transcripts and summarized them into a couple of pages, taking conversations and turning them into a curated family history
  • Claude has let me explore informatics writings and consider different viewpoints as I ask questions and get prompted with complementary ideas

I have resisted using Claude for writing blog posts. I believe I still have some responsibility for being a human here.

What about you? How are you dipping your toe into AI?

“Harvard Learning” preserving learning in the age of AI shortcuts (harvard.edu)

This is a sobering reflection. How do we learn when grasping information is so easy?

Preserving learning in the age of AI shortcuts

https://news.harvard.edu/gazette/story/2026/02/preserving-learning-in-the-age-of-ai-shortcuts/

Easy AI answers all the time?

How will we balance human learning against the constant temptation of “easy AI answers all the time”? Of 7000 high school students surveyed, about 40% indicated that they had failed to resist the temptation of over-using AI on their schoolwork.

Self-Regulation will be a crucial skill in our coming age of AI. OR at least, designing environments that support human self-regulation, because we are temptation-succumbing agents. At least, I am.

This is a great podcast, and you can listen, or read the transcript.

WiFi Blocking?

I like our best human thinkers as they grapple with the necessary productive cognitive friction that is needed for human brains to encode hard-earned knowledge. It is not good enough to have a super-search algorithm finding answers for you. There is something ineffable about being able to take a difficult problem, and reason through it as a human.

At the same time, we know that younglings have access to all the AI models out there. No amount of “adult protection” or “wifi blocking” or other pretend gatekeeping will keep smart kids from figuring out how to get to forbidden fruit.

So it remains, how would informaticists, physician teachers, all teachers, coaches, mentors, suggest we move forward when EVERYTHING is changing, and this new AI entity or entities are everywhere?

Idea 1: Invite our learners into the problem.

We recently struggled whether to grant our medical students access to Abridge, the ambient note solution offered at University of Colorado and UCHealth. Shouldn’t we prohibit students from using ambient notes? Don’t all of us teaching professors remember struggling to write comprehensible notes in our learning years, and now can quickly and incisively think through hard problems by writing notes that get to the root of the patient’s pathophysiology? Who hasn’t worked on writing a note, and in the process, discover an angle on the patient’s medical problem that was not obvious before starting the writing?

Now, if ambient notes are done at the end of the visit, where does that cognitive friction go? Removing this friction is perhaps a slight problem (and a big benefit) for experienced clinicians. However, removing this friction for students and residents might impair their learning just as it is most needed to form neural pathways, knowledge and … wisdom and judgement.

This year our graduate medical education leaders decided to give all students access. And then allow them to choose: how WILL you use it, knowing that it might impair your learning and there are as yet NO GUIDELINES? We must write these guidelines together. As a result, most students have chosen NOT to use ambient notes because of exactly that concern: they are in medical school for the training, NOT to simplify their work. This is a gratifying outcome.

Idea 2: Construct problems unsolvable by AI.

In this podcast, college professors describe writing problems specifically so that AI at present, cannot solve them. This is difficult work, and perhaps unsustainable if AI continues to improve at dramatic rates. It is an interim solution. Better yet…

Idea 3: Learners explore the human/AI interface.

Assume that everyone has access to AI, and then ask questions that could not be asked before. Specifically, have our learners ask questions that could not be asked before. And in answering them using AI, and critiquing each other, learning the field in a way not possible before.

In this podcast, college professors are now adjusting their curricula, instead of giving take-home exams that GPT can easily answer, they have in-class work where students design and ask mathematics problems that the AI cannot answer, and then have to figure out an answers the long-hand way. As a result, professors are seeing levels of learning and sophisticated understand that comes from exploring the space WITH an AI and all the extra reading needed to figure out what the edges of what an AI can do, and what the modern questions are in mathematics, and how to approach them. This also, is a winning approach.

This man is sad. But is he?

This man appears sad, but is he?

We have a new entity in every conversation

How might we keep human learning, human judgement, human embodied cognition front and center, when our old teaching methods no longer work? It is both terrifying and amazing to think what comes next.

The Cholera Pump and the Oldest Operating Theater in London

Ever asked ChatGPT for tourism advice for medical professionals? I did. Its not what you think.

The Oldest Operating Theatre in London.

  • Totally worth a visit. My favorite story: a surgeon asked to be buried in his clothing when he died. The authorities did not respect his wishes, and when undressed for the casket, they found he was a woman. Served an entire career as a surgeon, in an age when women were not allowed to be physicians or surgeons. 
  • The theatre, here, lit only by skylight, with a steeply graded theater so all could see down into the body of the patient undergoing surgery. Survival rates were typically 30%, death usually from exsanguination or more likely infection, in the days before germ theory. 
  • Too many other stories and artifacts to recount. See if you can. 

 

The Cholera pump!

  • A reproduction of the original pump in London that ended up being the source of a major cholera epidemic. This is the spot of the birth of epidemiology, with the key insight by Dr. John Snow. 
  • At the time, cholera was a deadly disease, but unknown what caused it and how it was transmitted. Many thought it was due to bad smells called “miasma.”
  • The book “The Ghost Map” if you haven’t read it, is a riveting account. 
  • It all happened here, and John Snow plotted the graph and realized all the deaths centered geographically on this one pump.
  • Perhaps cholera was not airborne, but carried in the water from the pump!
  • He came, removed the pump handle AND THE PANDEMIC STOPPED. 

 

I guess I’m just a fan-boy of medical history. 

Kpop Demon Hunters, yes, I’m a fanatic. Interview with EJAE (wired.com)

I am a huge fan of Kpop, and of Kpop Demon Hunters specifically. Read the interview with EJAE. I very much align with her Asian-American vibe and insights. So cool for a colleague’s success and for the American melting-pot. And the song and movie: excellent as well.

https://www.wired.com/story/how-k-pop-demon-hunters-star-ejae-topped-the-charts/

Do pictures change patient behaviors (James Stein substack)

I don’t often cite other blogs, but this is a worthwhile quick read about changing patient behaviors. Wonderful story about a physicians failure with a patient and the lessons he draws from using a calcium score to try to get a patient to change. Did not go well. And I will change how I think about this as a result.

https://jamesstein18.substack.com/p/do-pictures-change-patient-behaviors

Epic UGM 2025 FOMO generator. #15. CMIO friends

Oh the people you’ll meet at UGM…

I’m a fanboy of so many.

David Butler and a colleague from UTHouston (sorry tell me who you are again)

Jen Simpson copresenter extraordinaire.

Kelley Aurand CMIO at Legacy

PIGlets at UCHealth

Amy Hassell and Britt Cyriacks amazing nurses who make our virtual health center world class.

Another UGM in the books for me. Thanks Epic friends for another thought-generating meeting and reunion with new and old friends.

Epic UGM 2025 FOMO generator #12. The dinner spaceship cruise.

At the end of the day. Brain is full. Epic big tent does fun. Spaceship cruise. Join us!

Amanda Brill, Laura Macke, Rachel Rodriguez, Adam Ward, Frances D’Arcy, this blogger.

The author and Kelley Aurand, CMIO extraordinaire at Legacy Health who taught me about ambient.
Is this what AI really thinks I look like?
AI printers.

End of day introvert face. Thanks to Esther Park Christina Jung and David Bar-Shain for my PACmentor lapel badge for 2025-26. Go PACmentors!

Thanks Epic colleagues for another amazing day of learning.

Another day tomorrow. Anyone coming to my book club talk at 230pm? UGM255. Book Club for piglets. Mystery in the Midwest. Ukulele song. Fair warning.

Cycling in Korea with CT, a 9-minute video escape

Recently, my son and I made the trek to South Korea and rode the famed 4 Rivers Bike Trail. 400 miles in 6 days. I made a video!

https://vimeo.com/1107152224

Brief facts:

  • We rented bikes in Seoul, one-way, our luggage forwarded to destination
  • A sister bike shop in Busan shipped them back to Seoul
  • We rented gravel bikes. Road bikes would have been fine too
  • The roads: incredibly well maintained. 400 miles, we did it in 6 days
  • Online booking for hotels and bike motels, many options, distances
  • It is helpful to have a son who can speak Korean, translation apps also help
  • Dedicated bike path 90% of the way: , 10% on roads with great bike lanes
  • Convenience stores every few miles with gourmet instant ramen for lunch
  • Also convenience stores for gimbap: wrapped rice rolls for breakfast
  • Every stop, we checked into hotel, then wandered town for dinner
  • Bring a plastic baggie with spoonfuls of detergent for sink-washing laundry
  • My trick: roll your wet clothes into a bath towel, stand on it, then hang-dry
  • 27 stamp stations along the way: collect all of them!
  • If you collect them all (echoes of Pokemon), you get a certificate!
  • Achievement-oriented people know what I’m talking about
  • Thanks to my wife for logistics, traveling with us, meeting us along the way
  • I am grateful for this beautiful country, this ride, cycling with my son
  • If you are a cyclist, the 4 Rivers Bike Trail, Korea is a bucket list candidate!

Peer relationships, trust, and a foundation of joy

Things are stable, in an unstable way.

Liz Fosslein speaks for us so perfectly.

In our line of work (optimizing the electronic health record to serve patients, and to reduce the burden for physician/APP colleagues), we serve many purposes.

Many internal forces buffet us, we have to manage them carefully:

  • How much time goes to direct patient care, vs protected for informatics?
  • How much overtime should I spend at work vs with family/friends?
  • Which of 17 priorities should I work on?
  • What skills do I need to grow in order to improve my effectiveness?
  • What relationships do I need to improve? Which ones need repair?

These are difficult enough. Worse yet, we are buffeted by external forces:

  • What is does my boss want from me this week?
  • Which of many crises among my clinical colleagues do I help with?
  • Which strategic priority am I not paying enough attention to?
  • What state or federal regulation do I need to translate into EHR-speak?
  • With leaders leaving and arriving in my organization, where do I stand?

Here is CTL pouting about something having changed.

The core of our work is about change. Change to adopt new technology, to adapt to new circumstances, to accommodate new teammates.

As the agents of change related to the EHR, we cause anxiety among colleagues. We are careful to mitigate the anxiety of change among our colleagues by carefully designing workflows, making them as obvious, and as useful as possible.

AND YET: As for informaticists ourselves, we crave stability in our work and our teams, so why are we ourselves dismayed by change?

In a down moment, one of my colleagues said this recently to me:

Things are stable, in an unstable way.

—anonymous hardworking informatics colleague

This hit me pretty hard. I feel it in my body. In a superficial, and also very deep way.

To combat this instability, I remember my gratitude. I am grateful for my thousands of informatics colleagues, locally and globally, using our technical and relationship skills unselfishly, to make things better for all around us.

Colleagues at University of Pennsylvania, teaching our team about CUPID

Colleagues from UCHealth, presenting at Epic XGM

Colleagues inhaling knowledge from other Epic-using organizations

CMIO’s take?

Within our hardworking IT and informatics teams, we engender trust in our relationships. By doing so, we can lay a foundation of joy in our work. Teams achieve so much more than lone wolves.

We will always have setbacks. And yet, we will always have each other.

Rock on, Garth. Rock on, Wayne.