Bob Wachter
@bobwachter.bsky.social
Chair, UCSF Dept of Medicine. Career: What happens when a poli sci major becomes an academic physician. Author: "The Digital Doctor" and upcoming "A Giant Leap: How AI is Transforming Healthcare – and What it Means for Our Future." Hubby/Dad/Grandpa/Golfer
On tonight's All Things Considered on NPR, I discuss patients' use of AI for health. While there are risks, many patients benefit.
Overall, I favor tools that guide patients through their symptoms (with iterative Q's & A's) rather than general tools like GPT or Gemini.
www.npr.org/transcripts/...
Overall, I favor tools that guide patients through their symptoms (with iterative Q's & A's) rather than general tools like GPT or Gemini.
www.npr.org/transcripts/...
The benefits of AI in health care outweigh potential hazards, many experts say
ChatGPT Health is OpenAI's foray into medicine, and so far, it gets high marks from both a cancer patient and a leading doctor. But there are worries it could be misused.
www.npr.org
January 20, 2026 at 2:28 AM
On tonight's All Things Considered on NPR, I discuss patients' use of AI for health. While there are risks, many patients benefit.
Overall, I favor tools that guide patients through their symptoms (with iterative Q's & A's) rather than general tools like GPT or Gemini.
www.npr.org/transcripts/...
Overall, I favor tools that guide patients through their symptoms (with iterative Q's & A's) rather than general tools like GPT or Gemini.
www.npr.org/transcripts/...
AI doesn't need to be perfect to outperform our healthcare system's woeful status quo. It just needs to be better.
In many cases, it already is.
In today's New York Times, I explore this idea – a central theme of my upcoming book, A Giant Leap (out Feb 3).
www.nytimes.com/2026/01/19/o...
In many cases, it already is.
In today's New York Times, I explore this idea – a central theme of my upcoming book, A Giant Leap (out Feb 3).
www.nytimes.com/2026/01/19/o...
Opinion | Stop Worrying, and Let A.I. Help Save Your Life
www.nytimes.com
January 19, 2026 at 2:36 PM
AI doesn't need to be perfect to outperform our healthcare system's woeful status quo. It just needs to be better.
In many cases, it already is.
In today's New York Times, I explore this idea – a central theme of my upcoming book, A Giant Leap (out Feb 3).
www.nytimes.com/2026/01/19/o...
In many cases, it already is.
In today's New York Times, I explore this idea – a central theme of my upcoming book, A Giant Leap (out Feb 3).
www.nytimes.com/2026/01/19/o...
My new Substack:
This week's announcements of ChatGPT Health and Utah's new system that permits AI to refill prescriptions are both interesting in their own right. But together, they usher in the "AI Doctor" era. The implications are enormous. open.substack.com/pub/robertwa...
This week's announcements of ChatGPT Health and Utah's new system that permits AI to refill prescriptions are both interesting in their own right. But together, they usher in the "AI Doctor" era. The implications are enormous. open.substack.com/pub/robertwa...
The Week That AI Crossed the Line
Why ChatGPT Health and Utah’s AI Prescribing Law Mark the Beginning of the “AI Doctor” Era
open.substack.com
January 11, 2026 at 6:40 PM
My new Substack:
This week's announcements of ChatGPT Health and Utah's new system that permits AI to refill prescriptions are both interesting in their own right. But together, they usher in the "AI Doctor" era. The implications are enormous. open.substack.com/pub/robertwa...
This week's announcements of ChatGPT Health and Utah's new system that permits AI to refill prescriptions are both interesting in their own right. But together, they usher in the "AI Doctor" era. The implications are enormous. open.substack.com/pub/robertwa...
A nice summary of the implications of ChatGPT Health @TIME – with a focus on whether you should trust @OpenAI with your health data.
Quotes by me, Adam Rodman, Danielle Bitterman, others.
time.com/7344997/chat...
Quotes by me, Adam Rodman, Danielle Bitterman, others.
time.com/7344997/chat...
Is Giving ChatGPT Health Your Medical Records a Good Idea?
We asked experts the potential risks and benefits of turning over your health data to an AI tool.
time.com
January 9, 2026 at 6:26 PM
A nice summary of the implications of ChatGPT Health @TIME – with a focus on whether you should trust @OpenAI with your health data.
Quotes by me, Adam Rodman, Danielle Bitterman, others.
time.com/7344997/chat...
Quotes by me, Adam Rodman, Danielle Bitterman, others.
time.com/7344997/chat...
A very exciting book day in my household – on the same day I received my copy of Zeke Emanuel's new book (which I'm psyched to read), a pre-pub copy of my new book showed up as well. Mine will be publicly available on Feb 3, but available for pre-order now.
January 7, 2026 at 6:04 AM
A very exciting book day in my household – on the same day I received my copy of Zeke Emanuel's new book (which I'm psyched to read), a pre-pub copy of my new book showed up as well. Mine will be publicly available on Feb 3, but available for pre-order now.
Thanks to David Pogue and CBS Sunday Morning for interviewing me for their "Good News You May Have Missed in 2025" story, discussing AI and healthcare and featuring my upcoming book, "A Giant Leap." (Segment begins at 5:10.)
www.cbsnews.com/news/good-ne...
www.cbsnews.com/news/good-ne...
Good news you may have missed in 2025
The bad news from the past year (and there was a lot of it) drowned out much of the GOOD news that made smaller headlines. David Pogue reports on some of 2025's best underreported stories.
www.cbsnews.com
December 28, 2025 at 9:34 PM
Thanks to David Pogue and CBS Sunday Morning for interviewing me for their "Good News You May Have Missed in 2025" story, discussing AI and healthcare and featuring my upcoming book, "A Giant Leap." (Segment begins at 5:10.)
www.cbsnews.com/news/good-ne...
www.cbsnews.com/news/good-ne...
With all the talk about AI and jobs, there has been surprisingly little discussion about healthcare. In my new Substack, I explore whether there will be a healthcare AI Job Apocalypse – a key question since healthcare has been the US's most reliable employment engine. substack.com/inbox/post/1...
Will The AI Jobpocalypse Hit Healthcare?
It Depends on Which Jobs You’re Talking About
substack.com
December 17, 2025 at 11:57 PM
With all the talk about AI and jobs, there has been surprisingly little discussion about healthcare. In my new Substack, I explore whether there will be a healthcare AI Job Apocalypse – a key question since healthcare has been the US's most reliable employment engine. substack.com/inbox/post/1...
Just in: Next review of A GIANT LEAP, from Publishers Weekly (starred): Evenhanded & insightful…clearly & concisely explains the...technology & its possible medical uses & makes a convincing case that AI will usher in 'something of a golden age in healthcare.'
www.publishersweekly.com/9798217044245
www.publishersweekly.com/9798217044245
A Giant Leap: How AI Is Transforming Healthcare and What That Means for Our Future by Robert Wachter
Wachter (The Digital Doctor), chair of the Department of Medicine at the University of California, San Francisco, offers an even...
www.publishersweekly.com
December 9, 2025 at 6:21 PM
Just in: Next review of A GIANT LEAP, from Publishers Weekly (starred): Evenhanded & insightful…clearly & concisely explains the...technology & its possible medical uses & makes a convincing case that AI will usher in 'something of a golden age in healthcare.'
www.publishersweekly.com/9798217044245
www.publishersweekly.com/9798217044245
My latest post on Substack is my effort to answer a trillion-dollar question: "Is healthcare AI in a bubble?"
robertwachter.substack.com/p/is-healthc...
My answer is both yes AND no – depending on whether you're asking about the technology or the startups.
robertwachter.substack.com/p/is-healthc...
My answer is both yes AND no – depending on whether you're asking about the technology or the startups.
Is Healthcare AI in a Bubble?
The Technology is Real. But So Will Be the Shakeout
robertwachter.substack.com
December 2, 2025 at 3:50 PM
My latest post on Substack is my effort to answer a trillion-dollar question: "Is healthcare AI in a bubble?"
robertwachter.substack.com/p/is-healthc...
My answer is both yes AND no – depending on whether you're asking about the technology or the startups.
robertwachter.substack.com/p/is-healthc...
My answer is both yes AND no – depending on whether you're asking about the technology or the startups.
Exciting: The first official review of A GIANT LEAP, my upcoming (Feb 3) book on AI-meets-healthcare, in Kirkus Reviews:
“An accessible, often fascinating primer on AI tools changing clinical practice—for better or worse.... Essential, illuminating reading.”
www.kirkusreviews.com/book-reviews...
“An accessible, often fascinating primer on AI tools changing clinical practice—for better or worse.... Essential, illuminating reading.”
www.kirkusreviews.com/book-reviews...
A GIANT LEAP | Kirkus Reviews
Powerful AI tools for the medical industry are already shaping our digital shadows, diagnosing disease, recommending treatments, and quietly redefining the doctor-patient relationship.
www.kirkusreviews.com
November 22, 2025 at 9:50 PM
Exciting: The first official review of A GIANT LEAP, my upcoming (Feb 3) book on AI-meets-healthcare, in Kirkus Reviews:
“An accessible, often fascinating primer on AI tools changing clinical practice—for better or worse.... Essential, illuminating reading.”
www.kirkusreviews.com/book-reviews...
“An accessible, often fascinating primer on AI tools changing clinical practice—for better or worse.... Essential, illuminating reading.”
www.kirkusreviews.com/book-reviews...
My new post on Substack: Why patient-facing healthcare AI is a good idea, but general-purpose chatbots like GPT are probably not the right tool for the job. robertwachter.substack.com/p/we-need-me...
We Need Medical AI for Patients
But ChatGPT Isn't It
robertwachter.substack.com
November 18, 2025 at 9:59 PM
My new post on Substack: Why patient-facing healthcare AI is a good idea, but general-purpose chatbots like GPT are probably not the right tool for the job. robertwachter.substack.com/p/we-need-me...
What happens when patients use chatbots for medical advice. Great @nytimes story by @teddyrosenbluth.bsky.social & @maggieastor.bsky.social. I'm quoted, along with @adamrodmanmd.bsky.social & @epatientdave.bsky.social
www.nytimes.com/2025/11/16/w...
www.nytimes.com/2025/11/16/w...
Frustrated by the Medical System, Patients Turn to A.I.
www.nytimes.com
November 17, 2025 at 5:40 AM
What happens when patients use chatbots for medical advice. Great @nytimes story by @teddyrosenbluth.bsky.social & @maggieastor.bsky.social. I'm quoted, along with @adamrodmanmd.bsky.social & @epatientdave.bsky.social
www.nytimes.com/2025/11/16/w...
www.nytimes.com/2025/11/16/w...
Precision Medicine – making clinical decisions based on nuanced analyses of patients' personal characteristics, including genetics – has been "just around the corner" for >30 years. In my new Substack, I describe why AI is poised to deliver on the promise.
robertwachter.substack.com/p/can-ai-fin...
robertwachter.substack.com/p/can-ai-fin...
Can AI Finally Deliver on Precision Medicine’s Promise?
Yes, But Only If We Nail Both the Biology and Decision Support
robertwachter.substack.com
November 6, 2025 at 4:27 PM
Precision Medicine – making clinical decisions based on nuanced analyses of patients' personal characteristics, including genetics – has been "just around the corner" for >30 years. In my new Substack, I describe why AI is poised to deliver on the promise.
robertwachter.substack.com/p/can-ai-fin...
robertwachter.substack.com/p/can-ai-fin...
Signing off from another great UCSF Management of the Hospitalized Patient conference. #UCSFMHP2025 Thanks to wonderful speakers and 500 very engaged participants!
See you next year in SF, October 15-17. 2026.
See you next year in SF, October 15-17. 2026.
November 1, 2025 at 7:31 PM
Signing off from another great UCSF Management of the Hospitalized Patient conference. #UCSFMHP2025 Thanks to wonderful speakers and 500 very engaged participants!
See you next year in SF, October 15-17. 2026.
See you next year in SF, October 15-17. 2026.
"Hospital Medicine Updates" #UCSFMHP2025, by "The Brads" (Sharpe/Monash):
1) Pyelo (even w/ bacteremia): 5-7d Rx equal to 10-14
2) Rigors: Good predictor of bacteremia
3) Acute back pain: Muscle relaxants work
4) Low Na: fast correction (~10meq/d) better
5) Pts w/ CHF & low-Fe anemia: IV iron works
1) Pyelo (even w/ bacteremia): 5-7d Rx equal to 10-14
2) Rigors: Good predictor of bacteremia
3) Acute back pain: Muscle relaxants work
4) Low Na: fast correction (~10meq/d) better
5) Pts w/ CHF & low-Fe anemia: IV iron works
November 1, 2025 at 7:20 PM
"Hospital Medicine Updates" #UCSFMHP2025, by "The Brads" (Sharpe/Monash):
1) Pyelo (even w/ bacteremia): 5-7d Rx equal to 10-14
2) Rigors: Good predictor of bacteremia
3) Acute back pain: Muscle relaxants work
4) Low Na: fast correction (~10meq/d) better
5) Pts w/ CHF & low-Fe anemia: IV iron works
1) Pyelo (even w/ bacteremia): 5-7d Rx equal to 10-14
2) Rigors: Good predictor of bacteremia
3) Acute back pain: Muscle relaxants work
4) Low Na: fast correction (~10meq/d) better
5) Pts w/ CHF & low-Fe anemia: IV iron works
#UCSFMHP2025: @gregorymmarcus on hospital arrhythmias. A Fib pearls:
1) New AF in hospital (PNA, post-op, "stress"): generally should still anticoagulate
2) DOAC lowers risk of dementia in AF
3) In AF: exercise good, EtOH bad, coffee is OK
4) Ablation works, but continue DOAC, at least for 1 year
1) New AF in hospital (PNA, post-op, "stress"): generally should still anticoagulate
2) DOAC lowers risk of dementia in AF
3) In AF: exercise good, EtOH bad, coffee is OK
4) Ablation works, but continue DOAC, at least for 1 year
November 1, 2025 at 6:43 PM
#UCSFMHP2025: @gregorymmarcus on hospital arrhythmias. A Fib pearls:
1) New AF in hospital (PNA, post-op, "stress"): generally should still anticoagulate
2) DOAC lowers risk of dementia in AF
3) In AF: exercise good, EtOH bad, coffee is OK
4) Ablation works, but continue DOAC, at least for 1 year
1) New AF in hospital (PNA, post-op, "stress"): generally should still anticoagulate
2) DOAC lowers risk of dementia in AF
3) In AF: exercise good, EtOH bad, coffee is OK
4) Ablation works, but continue DOAC, at least for 1 year
Next #UCSFMHP2025, @LucasZierMD on cardiac ischemia. Points:
1) Serial troponins are more useful to detect ischemia than EKG or single troponin (latter not sensitive enough). See algorithm below
2) Use new terminology (ACS with or without ST Elevation, vs Demand Ischemia (MI Type 2). Graphic below
1) Serial troponins are more useful to detect ischemia than EKG or single troponin (latter not sensitive enough). See algorithm below
2) Use new terminology (ACS with or without ST Elevation, vs Demand Ischemia (MI Type 2). Graphic below
November 1, 2025 at 5:09 PM
Next #UCSFMHP2025, @LucasZierMD on cardiac ischemia. Points:
1) Serial troponins are more useful to detect ischemia than EKG or single troponin (latter not sensitive enough). See algorithm below
2) Use new terminology (ACS with or without ST Elevation, vs Demand Ischemia (MI Type 2). Graphic below
1) Serial troponins are more useful to detect ischemia than EKG or single troponin (latter not sensitive enough). See algorithm below
2) Use new terminology (ACS with or without ST Elevation, vs Demand Ischemia (MI Type 2). Graphic below
Next #UCSFMHP2025: Jen Babik on viral infections in the hospital:
1) Flu: hard to diagnosis, as any older pts don't have temp; vaccine is only 50% effective. So need to test all during flu season. See table for meds.
2) RSV: Rx with ribavirin (oral, not aerosol) for severe PNA
3) Covid: see table
1) Flu: hard to diagnosis, as any older pts don't have temp; vaccine is only 50% effective. So need to test all during flu season. See table for meds.
2) RSV: Rx with ribavirin (oral, not aerosol) for severe PNA
3) Covid: see table
November 1, 2025 at 4:31 PM
Next #UCSFMHP2025: Jen Babik on viral infections in the hospital:
1) Flu: hard to diagnosis, as any older pts don't have temp; vaccine is only 50% effective. So need to test all during flu season. See table for meds.
2) RSV: Rx with ribavirin (oral, not aerosol) for severe PNA
3) Covid: see table
1) Flu: hard to diagnosis, as any older pts don't have temp; vaccine is only 50% effective. So need to test all during flu season. See table for meds.
2) RSV: Rx with ribavirin (oral, not aerosol) for severe PNA
3) Covid: see table
Last day #UCSFMHP2025. Brad Sharpe on electrolytes:
1) K: Clinical risk high only if K<2.5, >6.5. Replete goal: 4.2. "Kayexalate is fine" (& 1/30th cost of Lokelma)
2) Mag: few sxs unless <1.0. "PO Mg is OK" (1/300 cost of IV)
3) HyperCA: Ddx mostly cancer or hyperpara. Don't "adjust for albumin"
1) K: Clinical risk high only if K<2.5, >6.5. Replete goal: 4.2. "Kayexalate is fine" (& 1/30th cost of Lokelma)
2) Mag: few sxs unless <1.0. "PO Mg is OK" (1/300 cost of IV)
3) HyperCA: Ddx mostly cancer or hyperpara. Don't "adjust for albumin"
November 1, 2025 at 4:30 PM
Last day #UCSFMHP2025. Brad Sharpe on electrolytes:
1) K: Clinical risk high only if K<2.5, >6.5. Replete goal: 4.2. "Kayexalate is fine" (& 1/30th cost of Lokelma)
2) Mag: few sxs unless <1.0. "PO Mg is OK" (1/300 cost of IV)
3) HyperCA: Ddx mostly cancer or hyperpara. Don't "adjust for albumin"
1) K: Clinical risk high only if K<2.5, >6.5. Replete goal: 4.2. "Kayexalate is fine" (& 1/30th cost of Lokelma)
2) Mag: few sxs unless <1.0. "PO Mg is OK" (1/300 cost of IV)
3) HyperCA: Ddx mostly cancer or hyperpara. Don't "adjust for albumin"
Some pearls on IBD inpatient management by @SaraLewinMD #UCSFMHP2025:
1) NPO only if the patient can't tolerate po
2) Steroids (40mg IV) for most
3) Consider rescue Rx (usually Infliximab) if not better day 3-5
4) Consider surgery if no better by day 7; but consider JAK1 inhibitor first
1) NPO only if the patient can't tolerate po
2) Steroids (40mg IV) for most
3) Consider rescue Rx (usually Infliximab) if not better day 3-5
4) Consider surgery if no better by day 7; but consider JAK1 inhibitor first
October 31, 2025 at 6:52 PM
Some pearls on IBD inpatient management by @SaraLewinMD #UCSFMHP2025:
1) NPO only if the patient can't tolerate po
2) Steroids (40mg IV) for most
3) Consider rescue Rx (usually Infliximab) if not better day 3-5
4) Consider surgery if no better by day 7; but consider JAK1 inhibitor first
1) NPO only if the patient can't tolerate po
2) Steroids (40mg IV) for most
3) Consider rescue Rx (usually Infliximab) if not better day 3-5
4) Consider surgery if no better by day 7; but consider JAK1 inhibitor first
Palliative care pearls from Steve Pantilat at #UCSFMHP2025:
1) A way to frame palliative care: "To help you live as well as possible for as long as possible"
2) Prognosis: big bands ("weeks to months"). But add: "I hope you do better" and "things can happen suddenly"
3) Empathy improves outcomes
1) A way to frame palliative care: "To help you live as well as possible for as long as possible"
2) Prognosis: big bands ("weeks to months"). But add: "I hope you do better" and "things can happen suddenly"
3) Empathy improves outcomes
October 31, 2025 at 5:58 PM
Palliative care pearls from Steve Pantilat at #UCSFMHP2025:
1) A way to frame palliative care: "To help you live as well as possible for as long as possible"
2) Prognosis: big bands ("weeks to months"). But add: "I hope you do better" and "things can happen suddenly"
3) Empathy improves outcomes
1) A way to frame palliative care: "To help you live as well as possible for as long as possible"
2) Prognosis: big bands ("weeks to months"). But add: "I hope you do better" and "things can happen suddenly"
3) Empathy improves outcomes
A. Josephson's neuro emergencies talk at #UCSFMHP2025:
1) In both Guillain-Barré & myasthenia, do measure lung strength
2) Short peak time to max pain: main way to tell SAH from other headaches
3) Slurred speech: main way to distinguish central vertigo
4) Empiric Rx of meningitis: include steroids
1) In both Guillain-Barré & myasthenia, do measure lung strength
2) Short peak time to max pain: main way to tell SAH from other headaches
3) Slurred speech: main way to distinguish central vertigo
4) Empiric Rx of meningitis: include steroids
October 31, 2025 at 5:49 PM
A. Josephson's neuro emergencies talk at #UCSFMHP2025:
1) In both Guillain-Barré & myasthenia, do measure lung strength
2) Short peak time to max pain: main way to tell SAH from other headaches
3) Slurred speech: main way to distinguish central vertigo
4) Empiric Rx of meningitis: include steroids
1) In both Guillain-Barré & myasthenia, do measure lung strength
2) Short peak time to max pain: main way to tell SAH from other headaches
3) Slurred speech: main way to distinguish central vertigo
4) Empiric Rx of meningitis: include steroids
Last talk #UCSFMHP2025 Day1: Erik Levinsohn, consult psychiatrist @UCSF. Key points:
Delirium most common cause of agitation in the hospital
Deprescribe before new meds: anticholinergic most common culprit
Haldol most useful Rx; its toxicity is overrated
Remove restraints ASAP & push mobilization
Delirium most common cause of agitation in the hospital
Deprescribe before new meds: anticholinergic most common culprit
Haldol most useful Rx; its toxicity is overrated
Remove restraints ASAP & push mobilization
October 30, 2025 at 11:54 PM
Last talk #UCSFMHP2025 Day1: Erik Levinsohn, consult psychiatrist @UCSF. Key points:
Delirium most common cause of agitation in the hospital
Deprescribe before new meds: anticholinergic most common culprit
Haldol most useful Rx; its toxicity is overrated
Remove restraints ASAP & push mobilization
Delirium most common cause of agitation in the hospital
Deprescribe before new meds: anticholinergic most common culprit
Haldol most useful Rx; its toxicity is overrated
Remove restraints ASAP & push mobilization
Andy Josephson on stroke update at #UCSFMHP2025. Key updates:
1) Most hospitals are switching from TPA to TNK (easier-to-use)
2) Endovascular therapy is indicated even after successful thrombolytics
3) Importance of permissive hypertension: don't lower BP after acute stroke
1) Most hospitals are switching from TPA to TNK (easier-to-use)
2) Endovascular therapy is indicated even after successful thrombolytics
3) Importance of permissive hypertension: don't lower BP after acute stroke
October 30, 2025 at 6:47 PM
Andy Josephson on stroke update at #UCSFMHP2025. Key updates:
1) Most hospitals are switching from TPA to TNK (easier-to-use)
2) Endovascular therapy is indicated even after successful thrombolytics
3) Importance of permissive hypertension: don't lower BP after acute stroke
1) Most hospitals are switching from TPA to TNK (easier-to-use)
2) Endovascular therapy is indicated even after successful thrombolytics
3) Importance of permissive hypertension: don't lower BP after acute stroke
Tracy Minichiello on anticoagulation at #UCSFMHP2025. Some take-homes below. Note trends away from dual therapy (ASA+DOAC), and increasing use of reduced-dose DOACs. Also, in many patients (such as post-DVT or AFib), the benefits of anticoag exceed risks even in patients with history of falls.
October 30, 2025 at 6:19 PM
Tracy Minichiello on anticoagulation at #UCSFMHP2025. Some take-homes below. Note trends away from dual therapy (ASA+DOAC), and increasing use of reduced-dose DOACs. Also, in many patients (such as post-DVT or AFib), the benefits of anticoag exceed risks even in patients with history of falls.