Last episode, we sat down with Dr. TR Levin — the gastroenterologist who built one of the most effective colon cancer screening programs in the country — and worked through why screening is so much harder to understand than it looks.

Some tests find things that would never have hurt you. A simple test sent to your home may work better as a screening program than a more invasive procedure, mostly because people actually do it.

And we talked about how knowing more is not always better, and sometimes no test is the best test.

A lot of you came back with the same question: fine, but what am I supposed to actually do?

In this follow-up, we talk about how to think more clearly about screening: what questions to ask, how to think about your own risk, and how to tell the difference between a test that is worth your time and one that is mostly worth someone else’s money.

Screening Strikes Back

Cancer screening saves lives, and it has been thoughtfully constructed to do so. But the version of cancer screening that some of us experience is one where nobody explains the odds, nobody mentions the alternatives, and a positive result sends you into a cascade of procedures that may or may not have been necessary. That version feels stupid.

And there’s another version of screening, where someone in a 60 second video sells you the idea that the medical establishment is playing it safe and you need to take care of your own health by purchasing these additional tests…that just happen to have celebrity endorsements. That can also be stupid—with a price tag.

In this episode, we sit down with Dr. TR Levin [https://www.linkedin.com/in/theodore-levin-06528312], the gastroenterologist who built one of the most effective cancer screening programs in the world. He’s the person who figured out that the best screening test isn’t the most invasive one — it’s the one people will actually do. He helps us understand how screening fits into the world of medical testing, and how we can do it better.

Links:
US Preventive Services Task Force [https://www.uspreventiveservicestaskforce.org/uspstf/]

Should You Get That Cancer Test?

“Will AI replace doctors?” makes for a great headline, a great dinner party argument, and a great way to stress out a podcast co-host. It’s also, unfortunately, the wrong question.

In a follow up to our last episode, we respond to our listeners’ feedback. We put co-host and radiologist Jonathan Mates on the spot and use radiology as our test case — the specialty that’s been at the center of this conversation longer than any other, partly because the job looks simple from the outside. You look at pictures. AI looks at pictures. What’s the problem? It turns out there are a lot of problems.

We get into what radiology actually involves, why AI can be impressive and still not replace humans, and some other factors we need to consider when answering this (wrong) question.

Links:

Geoff Hinton on radiology [https://youtu.be/2HMPRXstSvQ]

Should AI Replace Your Doctor?

One in four ChatGPT users — roughly 200 million people a week — use it for health questions. About a third of them end up changing their medications or requesting referrals based on what it tells them.

Is that brilliant, terrifying, or both?

In this episode, we dig into the question everyone is asking themselves, whether they want to or not: How should my doctor be using AI? And how should I?

We bring in Rachel Lomasky [https://www.linkedin.com/in/rlomasky?utm_source=share_via&utm_content=profile&utm_medium=member_ios] — an AI scientist and expert — to help us give both the patient perspective and a realistic view of what AI is capable of.

Links:

Large Language Model Performance and Clinical Reasoning Tasks [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2847679?utm_source=openevidence&utm_medium=referral]

Are AI Tools Ready to Answer Patients’ Questions About Their Medical Care?  [https://jamanetwork.com/journals/jama/fullarticle/2846269?utm_source=openevidence&utm_medium=referral]

America’s Largest City Hospital System Ready to Start Replacing Radiologists With AI, Its CEO Says [https://futurism.com/artificial-intelligence/hospital-ceo-ai-radiology]

How should you and your doctor use AI?

People are sharing medical results from their online portals, just like they do with college acceptances and baby gender reveals. How did we get to this point? And what are the real effects on how patients understand their medical records and how doctors document them? In this episode, we explore how technology and regulatory changes have shaped our relationship to healthcare from the inside and out.

Links:

Why am I Watching People Get Their Medical Results? [https://www.nytimes.com/2026/04/07/magazine/medical-records-reveal-videos.html]

Why Reading Your Doctor’s Notes Can Be Painful [https://nautil.us/why-reading-your-doctors-notes-can-be-painful-257796]

When Your Results Go Viral

We’ve all had this experience: you go to your doctor or hospital’s web page to do something. Maybe you want to make an appointment. Maybe you want to refill a prescription. Maybe you just want to know when the lab opens. What should be a simple task—something you can easily do on any other website—instead turns into a frustrating ordeal that leaves you yelling: “Why?!” Why is something so simple so hard to do? Why can’t they make this better? Why is this so stupid?

In this episode we dig into that very question, sharing our own experiences working with these technologies from both inside and outside of healthcare, and shedding some light on how we all got here.

Why is Your Doctor's Website so Terrible?

Doctors’ ability to see inside their patients with lab and imaging tests is one of the miracles of modern medicine. Without tests, we’re just guessing!  But the unsaid truth is that doctors overtest patients, and that may be doing more harm than good to patients, doctors, and the entire health care system. In this episode, we sit down with cardiologist Dr. Jeff Sobel to understand the forces behind overtesting and how he is taking on the problem in his system.

Show Notes:

 1. Overuse of diagnostic testing in healthcare: a systematic review  [https://pmc.ncbi.nlm.nih.gov/articles/PMC8685650/#s5]
 2. The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0078962]
 3. Why Doctors Test Too Much [https://nautil.us/why-doctors-test-too-much-1188119/]
 4. Projected Lifetime Cancer Risks from Current Computed Tomography Imaging [https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2832778]
 5. Getting to “No”  [https://pmc.ncbi.nlm.nih.gov/articles/PMC4090224/]

Should you get that test your doctor ordered? 

Nothing says 'quality care' like showing a stranger your throat via a grainy webcam while your cat walks across the keyboard.

Telehealth — or medical care without the doctor and patient being in the same room — has exploded, partly enhanced by the COVID pandemic. Some say that this is the beginning of a new paradigm in medical care. For others, the experience feels more like putting more technology between them and their doctor. When you need to talk to your doctor, should you email them? Schedule a visit? Meet with them on video?

We chat with Dr. Matt Sakumoto, a virtual care veteran, to answer those questions and more, as we uncover both the brilliant and stupid truth of telehealth.

Show Notes:

The Lancet on the Telephone [https://www.cambridge.org/core/journals/medical-history/article/lancet-on-the-telephone-18761975/99F321AB5C89060E4D5B2C868986F118] (1977)

Why Telehealth is Both Brilliant and Stupid

If a Primary Care physician is the quarterback of our healthcare system…OUCH!…they’re getting sacked time and time again by some burly bureaucratic linebackers.

Primary care medicine is meant to be the foundation for a high-functioning health system. Yet why do so many primary care physicians and their patients experience angst and disappointment with that system? In this episode, we sit down with Dr. Eugene Lee, a primary care physician who has practiced in several systems, to understand the gap between the promise and reality of primary care and what doctors and patients can do to make it better.

The Concussed State of the Primary Care Medicine

In this short trailer, pediatrician Rahul Parikh and radiologist Jonathan Mates introduce Healthcare is Stupid.

We’ll explore the absurdities of American healthcare—how we got here, the incentives and structures that quietly shape it, and what practical, incremental improvements might actually move things in a better direction.

If you work in healthcare, depend on it, or simply wonder why so much of it feels unnecessarily complicated, this podcast is for you.

Why "Healthcare is Stupid" Exists

Physicians Rahul Parikh and Jonathan Mates explore the absurdities of modern American healthcare—what it’s like, how we got here, and what practical steps might move it in a better direction.