S1E18 AI Is Not Just Theory, It's Practice: How Akshat Paliwal Built a Remote Radiology Company from Scratch

S1E20 "I Don't Know" — The Three Words AI Can't Say (But Every Clinician Should)

"I Don't Know" — The Three Words AI Can't Say (But Every Clinician Should) In this solo episode, Dr. Adama Diarra makes the case that saying "I don't know" is one of the most underused and undervalued tools in clinical medicine. Using a real patient encounter from the week of recording — a gastroenteritis case in late spring where the standard viral default turned out to be the wrong seasonal answer — he walks through what happened when he paused, admitted uncertainty out loud, did the research, and came back with a better answer. The data showed a meaningful seasonal shift toward bacterial pathogens like Campylobacter and Salmonella in warmer months, which changed how he counseled the patient and shaped their shared decision to pursue supportive care with a clear plan to escalate if needed. From that clinical story, Dr. Diarra draws out three things "I don't know" actually accomplishes: it preserves a clinician's calibration and credibility, it models intellectual honesty for trainees, and most importantly, it protects patients by creating a disclosure loop that a confident wrong answer never would. The episode then pivots to a May 2026 New England Journal of Medicine perspective piece — Can AI Say "I Don't Know"? by Sikora, Celi, and Abdulnour — which argues that AI tools, as currently deployed, lack the reflex to disclose uncertainty. They generate fluent, confident responses regardless of whether the underlying evidence is solid or absent. Dr. Diarra illustrates the danger with a methotrexate dosing example and maps it back to his own gastroenteritis case: an AI would have given the annual default answer with full confidence, missing the seasonal nuance entirely. He closes with a practical framework: become AI-fluent, not AI-dependent. Use multiple sources the way clinicians always have — PubMed, Cochrane, colleagues, subspecialists. Don't outsource critical thinking. And until the tools learn to say "I don't know," that responsibility stays with the clinician.

S1E19 How to Build a Membership Based Private Practice That Still Takes Insurance with Rene Hermes

The New Healthcare by Adama Diarra, DO, FACP, DipABOM Guest: Rene Hermes Content Type: Interview Primary Goal: Educational Summary Most physicians enter independent practice with clinical confidence and financial blind spots. Rene Hermes entered with both — and built something different. In this episode, Rene shares how a background in corporate finance shaped her approach to running independent primary care practices, why she developed a hybrid insurance-plus-membership model, and what it actually takes to make concierge medicine accessible without sacrificing financial sustainability. Whether you're curious about leaving employed medicine or already making the leap, this conversation offers a grounded, practical roadmap. Key Topics * Why corporate finance principles change how you see practice economics * How a hybrid insurance + membership model works in real primary care * Making concierge medicine accessible — and still viable * The operational infrastructure independent practices often overlook * What physicians consistently underestimate about building independence Sound Bites * "Finance looks at the future, not just the past." * "One emergency visit can pay for the entire year." * "Living independently in medicine is achievable." Chapters * 00:00 — Introduction: Who Is Rene Hermes? * 03:48 — From Corporate Finance to Medical Management * 06:46 — Building a Family Practice from the Ground Up * 10:14 — What Finance Teaches You About Primary Care * 13:53 — The Hybrid Practice Model, Explained * 17:59 — Making Concierge Medicine Accessible * 28:26 — Rethinking Concierge: A New Framework * 32:33 — Operational Realities of Running a Private Practice * 41:36 — Building Your Concierge Model: What to Consider First * 47:56 — The Case for Independence in Medicine Resources * Hermes Health [https://hermeshealth.net] * American Academy of Professional Coders (AAPC) [https://www.aapc.com] * Certified Physician Practice Manager (CPPM) Certification [https://www.aapc.com/certifications/physician-practice-manager/] * Contact Rene: rene@hermeshealth.net [rene@hermeshealth.net]

S1E18 AI Is Not Just Theory, It's Practice: How Akshat Paliwal Built a Remote Radiology Company from Scratch

By Dr. Adama Diarra, DO, FACP, DipABOM | CEO & CMO, Diarra Health. Is AI actually changing radiology — or is it just hype? Akshat Paliwal has a definitive answer. As the founder of FlexRad, a remote radiology company built on AI-enhanced workflows, he's not theorizing about the future of medical imaging. He's living it. In this episode, Akshat walks us through his journey from traditional academic and private radiology practice to building a scalable, AI-driven remote radiology business — including what COVID-19 forced him to rethink, the hard lessons of physician entrepreneurship, and why he believes the radiology workforce is at an inflection point that most practitioners aren't ready for. We dig into the practical realities of integrating AI into radiology workflows — not as a replacement for clinical judgment, but as a force multiplier for efficiency, accuracy, and autonomy. Akshat also shares how FlexRad's hybrid model is redefining what a sustainable radiology practice can look like in the age of remote work and intelligent automation. In this episode: * How FlexRad's hybrid remote radiology model actually works * Where AI is delivering real results in radiology workflows today — and where it isn't * The risk profile every physician entrepreneur needs to understand before making the leap * Why referrals and reputation remain the currency of growth even in a tech-forward practice * What the radiology workforce will look like in 5 years — and how to position yourself now Whether you're a radiologist navigating a changing landscape, a physician considering entrepreneurship, or a healthcare leader thinking about AI integration, this conversation will challenge how you think about the future of your specialty. 🔗 Connect with Akshat: linkedin.com/in/akshatpaliwal 🌐 Learn more about FlexRad: flexrads.com 📧 Reach out directly: akshat@flexrads.com [akshat@flexrads.com]

S1E17 The Clinic of the Future with Dr. Holly Tse: What's Broken, What's Next, and How AI Changes Everything PART 2

Episode Summary — Part 2: Clinics of the Future with Dr. Holly Tse The cliffhanger is over. In Part 1, Dr. Holly Tse laid out everything wrong with primary care today. In Part 2, she builds the thing she believes can replace it. Her framework is called the Clinic of the Future — and it starts with a radical proposition: break the visit. Break the PCP. Maybe even break the note. Replace all of it with a continuous flow of care, supported by a trusted multidisciplinary team, standardized clinical protocols, and AI tools that do the heavy lifting so physicians can do what only physicians can do. Dr. Tse introduces two AI agents at the center of her vision: Charlie, a patient-facing empathetic agent available around the clock to listen, coach, and navigate; and Emily, an in-EMR clinical intelligence agent that synthesizes patient data in real time — surfacing rising risk, flagging missed refills, summarizing entire workup histories before you even ask. Together, they represent a shift from reactive, encounter-based medicine to proactive, panel-level care. The conversation gets honest about what stands in the way: a fee-for-service payment model that still rewards discrete visits, clinicians who are skeptical by training, patients who are increasingly transactional, and real HIPAA and liability questions that nobody has fully answered yet. Dr. Tse's position on all of it is grounded — value-based care is the financial engine that makes the flow of care work, and CMS's stated goal of moving all Medicare patients into VBC arrangements by 2030 means the window is closer than it feels. She and Dr. Diarra also go somewhere most healthcare podcasts don't: the future role of the physician when AI can handle the bread-and-butter cases. Dr. Tse's honest read is that physicians who don't evolve toward higher-complexity cognitive work risk being compensated like advanced practice providers — and she thinks that conversation is already happening, just not loudly enough. The episode closes with practical advice for independent and small practice physicians on where to start with AI today: website chatbots for FAQ and scheduling, productivity tools like Claude's Cowork for synthesizing presentations and documents, and a simple guiding question — what keeps you up at night, and can a tool help with that first? If Part 1 was the diagnosis, Part 2 is the treatment plan — specific, ambitious, and delivered by someone who has lived at every level of the healthcare system and still believes it can be redesigned for good.

S1E16 The Clinic of the Future with Dr. Holly Tse: What's Broken, What's Next, and How AI Changes Everything Part 1

What does it feel like when the system weaponizes your own compassion against you? Dr. Holly Tse has a phrase for it — and it stopped a colleague in his tracks: my compassion has been hijacked. In this episode of The New Healthcare, Dr. Tse — dual board-certified internist, former hospital CMO, and founder of Novella Insights — makes the case that primary care isn't just strained. It's past the breaking point. And the only way through isn't another workflow patch. It's a complete redesign. Dr. Tse brings a rare combination to the conversation: 20+ years of frontline clinical experience, a humanities background that shaped how she listens and leads, and a systems lens built from running a 25-clinic medical home program and serving as CMO of an underserved community hospital. She sees the whole elevator — from the individual patient crying in the exam room to the structural forces that put her there in 20 minutes with a quality metric hanging over both of them. In this conversation, she and Dr. Diarra dig into: * Why the clinic of 2026 is still running on a chassis built for 1995 — and why that matters * How physician burnout is a design failure, not a resilience failure * The "Clinic of the Future" framework — using AI and team-based care to protect the human moments that only physicians can deliver * Shared medical decision making as both a clinical skill and a leadership philosophy * What it actually looks like to leave a CMO role to have more influence on the future of medicine — not less If you're a physician wrestling with what sustainable, meaningful practice looks like in the AI era, this episode is for you.