Before the Claim

Essays about how decisions get made in healthcare.

Most healthcare writing starts with the evidence, the product, or the recommendation. I am usually more interested in what happens before that.

Why one physician earns a patient's trust before the appointment. Why some technologies become indispensable while others quietly add work. Why changing a health warning changes demand. Why the same product promise means one thing to the person buying it and another to the person living with it.

Some pieces draw on published research. Others build on surveys and interviews I have run with independent physicians. When I use my own data, I say so. When I rely on someone else's, I tell you whose, and whether they funded it.

New essays are published through the Before the Claim newsletter on LinkedIn.

Featured

The AI Scribe Promise Has Two Audiences

Health systems buy relief from documentation burden. Patients are promised a better conversation. The evidence is much stronger for the first claim.

8 min readRead

Independent Practices Need Technology They Can Afford to Get Wrong

Technology is becoming harder for independent practices to avoid and harder for them to choose badly.

8 min readRead

When a Health Warning Changes, Demand Changes Too

The estradiol patch access problem shows why risk communication cannot be separated from the system expected to respond.

6 min readRead

All essays

The AI Scribe Promise Has Two Audiences 8 min Independent Practices Need Technology They Can Afford to Get Wrong 8 min When a Health Warning Changes, Demand Changes Too 6 min AI Is Adding a Second Algorithm Between Physicians and Patients 4 min When the Blood Test Changes the Treatment Conversation Before the Scan 7 min The Human Relationship Cannot Become Healthcare’s Premium Tier 6 min The Best New Feature Might Be One Less Vendor 9 min The Technology Was Visible. The Doctor's Expertise Wasn't. 7 min Subscription Medicine Changes More Than How Patients Pay. It Changes How They Choose. 7 min Empathy Is Not a Soft Skill. It Is How Patients Choose. 4 min The Meet-and-Greet Is Not a Closing Call. 4 min Who Was I to Do This? 5 min They Loved the Meet-and-Greet. They Still Did Not Sign Up. 4 min The Cheap Bottle of Wine on the Menu 4 min The Best Insurance Money Can Buy Still Can’t Get You a Doctor 6 min Referrals Do Not Just Bring You More Patients. They Bring You Better Fit. 3 min Direct Primary Care Has a Data Problem. Not the One You Think. 7 min

Why Before the Claim

In healthcare a claim can mean several things. A scientific claim. A marketing claim. An insurance claim. They have something in common: by the time the claim arrives, someone has usually already decided what to believe.

That is where these essays begin. The longer version of the argument is Prescribing Trust.