How I Doctor with Dr. Graham Walker

Dr. Raj Narula is a vascular neurologist who walked away from a neurointerventional radiology fellowship to build something that could reach thousands of patients instead of one at a time. Dr. Melanie Winningham is a vascular neurologist, medical director of a comprehensive stroke center in Virginia, and VP of Clinical Strategy at Sevaro- someone who has lived the neurology access gap from both sides of it.In this episode of How I Doctor, Dr. Graham Walker sits down with Raj and Melanie to explore one of the most urgent and most invisible crises in American healthcare. What happens when a stroke patient lands in a rural ER at 2 AM and the nearest neurologist is a hundred miles away? For too long, geography has been the single biggest predictor of whether that patient walks out of the hospital. Sevaro was built to change that. This episode gets into what telestroke actually looks like when it's done right. They explain how Sevaro's AI-enabled platform — built by neurologists, for neurologists — puts a board-certified specialist on screen in 45 seconds, eliminates the call center entirely, and follows patients from the acute encounter all the way through rehab and outpatient care.This isn't a pitch for virtual care. It's a clinician's diagnosis of a workforce crisis that isn't getting better and a concrete look at what it takes to build technology that works the way physicians actually practice.If stroke outcomes are going to improve in rural America, it won't be through more neurologists. It will be through smarter infrastructure that makes the ones we have go further.What You'll LearnWhy geography remains the single biggest predictor of stroke outcomes and what it actually takes to close that gap at scale.How Sevaro eliminated the call center entirely and why that single design decision changes everything about the speed and quality of a telestroke consult.What AI is doing inside an acute stroke encounter and where Raj and Melanie draw a hard line between decision support and decision making.Why the neurology workforce crisis is structural and worsening, and how virtual neurology is reshaping who enters the field and why.How keeping patients in their own communities creates a trust loop that improves outcomes over time.Why state licensing requirements are the single regulatory change that would do the most to expand virtual specialty access in rural America.🩺 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 onLinkedIn 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 

Dr. Geeta Nayyar, rheumatologist and former CMO at Salesforce and AT&T, blends clinical care with health tech to tackle medical misinformation. She traces how access gaps and social algorithms handed the mic to confident but wrong voices. Short, actionable talk on why health systems should own the narrative, how clinicians can use social media responsibly, and the double-edged role of AI.

Dr. Byron Crowe, internal medicine physician and Doctronic CMO who taught at Harvard and studies AI in medicine, discusses the nation’s first state-approved autonomous AI prescription renewal program in Utah. He explains AI-native care and Doctronic’s graduated autonomy model. They explore safety checks, regulatory sandboxes, clinician accountability, and how routine work could be reassigned as AI handles refills.

Dr. Ashley Alker, an emergency physician, author, and medical consultant, shares how confronting death shaped her work. She discusses why ER clinicians carry losses more than saves. She explains using storytelling to translate medicine for the public. She reflects on prevention, communicating risks, and diversifying work to combat burnout.

Dr. Vivek Garg, an internist and NCQA President and CEO who led quality work at Humana Centerwell, discusses how quality measures are built and why many miss the full clinical picture. He critiques data gaps, the strain on small practices, and the limits of financial incentives. He also weighs realistic roles for AI and why primary care must be the focus for true system improvement.

Physicians are making more correcting medical misinformation online than delivering babies.In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Fran Haydanek, better known to millions as Paging Dr. Fran, for an unfiltered conversation about medicine in the algorithm era.Fran is a board-certified OB-GYN, residency faculty member, hospital medical director and a physician creator with more than one million followers across TikTok and Instagram. What began as a simple video correcting breastfeeding misinformation during maternity leave has evolved into a full-scale media operation. One that now generates more income than her clinical practice.But this episode isn’t about clicks. It’s about trust.Together, Graham and Fran examine why patients increasingly turn to influencers instead of physicians and why the medical system itself helped create that vacuum. Fran argues that physicians don’t just compete in this digital ecosystem and that they have an obligation to show up in it.This episode isn’t a defense of influencer culture.It’s a reckoning with where patients actually learn about their health and whether physicians are willing to meet them there.What You’ll LearnWhy patients are turning to TikTok for medical advice and how 15-minute visits contribute to the problemWhat it means for medicine when a practicing OB-GYN earns more correcting misinformation than delivering babiesHow religion and politics uniquely fuel misinformation in women’s healthPractical ways any physician can participate in the digital information ecosystemResources & Where to Find Dr. FranWebsite: https://www.pagingdrfran.com/TikTok: https://www.tiktok.com/@pagingdrfranInstagram: https://www.instagram.com/pagingdrfran

Yann LeCun, Turing Award–winning deep learning pioneer, and Alex LeBrun, entrepreneur and CEO building clinical AI tools, discuss world models for healthcare. They explore why next-word LLMs fall short. They debate patient simulation, sensor-rich data over text, reliability needs beyond 80% accuracy, and practical near-term wins like documentation and medical coding.

Primary care sits at the center of medicine and yet no one seems willing to truly own it.In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Lisa Rosenbaum, cardiologist and national correspondent for the New England Journal of Medicine, for a wide-ranging conversation about why primary care remains both indispensable and persistently undervalued.🎧 Before you go any further: If this conversation resonates, make sure you also listen to Lisa’s excellent NEJM podcast, Not Otherwise Specified. It’s one of the most honest, intellectually rigorous explorations of modern medicine and this past season focuses deeply on primary care.Lisa has spent the past year reporting on primary care across the country, and what she uncovers isn’t a story about technology gaps or workforce shortages. It’s a story about culture. About respect. About responsibility. Together, Graham and Lisa explore how modern incentives have quietly shifted medicine away from ownership - of patients, of decisions, and of outcomes - and why primary care has absorbed the consequences more than any other specialty.They dig into uncomfortable but essential questions:Why is the specialty that knows patients best paid and respected the least?How did “referral culture” replace continuity?And what happens to trust between doctors, and between doctors and patients when no one is clearly responsible anymore?Lisa argues that the crisis in primary care is not inevitable, and not intractable but only if medicine is willing to confront its own values.This episode isn’t about nostalgia.It’s about deciding what kind of profession medicine wants to be.What You’ll LearnWhy the crisis in primary care is fundamentally about respect and ownership, not technologyHow modern systems discourage physicians from fully “owning” their patientsThe hidden costs of referral culture and fragmented responsibilityWhy restoring autonomy may be essential to saving primary careWhat gives Lisa hope—and why cultural change is still possible in medicineResources & Where to Find LisaLisa Rosenbaum, MD – National Correspondent, New England Journal of MedicineNot Otherwise Specified (NEJM Podcast)🩺 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 onLinkedIn 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 onLinkedIn https://www.linkedin.com/company/joinoffcall/IG https://www.instagram.com/offcalldotcom/TikTok https://www.tiktok.com/@offcalldotcom

Dr. Robert Wachter, UCSF chair and author on digital health, brings grounded optimism about AI in medicine. He discusses early ward tools, risks of de‑skilling, designing AI that preserves trainee reasoning, trust versus instinct, equity gaps for vulnerable patients, and cautious low‑risk rollouts with local accountability.

Dr. Shikha Jain, a board-certified hematologist-oncologist and founder of Women in Medicine, dives into the systemic issues plaguing female physicians in a male-dominated healthcare environment. She highlights how the current system undervalues essential invisible labor and pushes women into uncompensated roles. Shikha argues that physician burnout stems from systemic failures rather than individual shortcomings. The discussion includes actionable insights for establishing boundaries, recognizing the value of caregiving, and advocating for gender equity to enhance patient outcomes.