Tools That Serve You: AI, Tech, and Autonomy in Pediatric DPC with Dr. Michael Hobbs

This month on the My DPC Story podcast we are talking about the tools that serve us, and Dr. Michael Hobbs is a voice you do not want to miss.

Dr. Hobbs is a pediatrician and founder of Lakes Pediatrics, the first pediatric Direct Primary Care practice in the Minneapolis area, serving families across Edina, Wayzata, and the western suburbs. He brings over twenty years in Twin Cities pediatrics, more than a decade as an adjunct professor at the University of Minnesota Medical School, Top Doctor recognition from Mpls.St.Paul Magazine and Minnesota Monthly, subspecialty training in infectious diseases and Group A Strep, and a Reach Institute mini-fellowship in pediatric mental health care.

What makes this episode essential listening is Dr. Hobbs himself. A self-described knowledgeable hacker who grew up alongside the technology, from a Commodore 64 to writing early web pages, he has watched the entire arc of medical documentation: index cards, paper charts, dictation, the EHR, templates, and now AI scribes. He knows what gets better and what gets worse when tech enters the exam room.

In this conversation, Dr. Hobbs covers:

• The one question to ask before adopting any tool, EHR, phone system, or AI
• Why building your own tools is more doable than you think
• Why now is not the time to lock into a long term software contract
• The difference between AI that serves you and AI that turns you into a liability machine
• Patient transparency, shadow AI, BAAs, and using tools safely
• Why LLMs are terrible at math, learned the hard way
• The best first AI investment for a new DPC doctor on a small budget
• AI as a clinical decision support thought partner, not a guideline machine

And because both Dr. Concepcion and Dr. Hobbs are recovering anthropology buffs, they keep returning to the truth underneath the technology: people like people. The tools only matter if they give us more room to be human with the families we serve.

Whether you are deep into building AI workflows or you hear the word AI and want to run, this episode meets you where you are.

New to DPC or ready to go deeper? Visit the Start Here page at mydpcstory.com. Have a question for the show? Leave a voice message on the Contact page. Loved this episode? Leave a five star review on Apple Podcasts and follow @mydpcstory on socials.

Connect with Dr. Hobbs at lakespediatrics.com.

Learn more about VIVID VAULT HEALTH SOLUTIONS TODAY!

Find a My DPC Story Event near you! State Summits in CA, IL, a My DPC Story LIVE event and the DPC Women's Summit are all coming! Learn more at mydpcstory.com/upcoming-events!

The DPC Directory: If you're a DPC doctor, you’ll find resources to grow your practice! If you serve the DPC world, grab a FREE listing today and get discovered by doctors who need your services. 👉 Visit thedpcdirectory.com and become part of the movement shaping the future of healthcare!

Earn money WHILE running your DPC! Join SERMO for FREE today!

Transcript

0:03

Direct primary care is an innovative alternative path to insurance-driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the My DPC Story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Maryal Concepcion, family physician, DPC owner, and former fee-for-service doctor. I hope you enjoy today's episode and come away feeling inspired about the future of patient care, direct primary care. The fact that I get to be autonomous and to choose the tools I wanna use and use them how I wanna use them is the biggest plus and especially in a DPC model. 'Cause there's just so many different layers of approvals you have to get in so many different systems. And so being able to think for myself, identify the problems that I wanna fix, decide what solution works best for me, implement it, change it if it doesn't work, is the biggest advantage of using technology in DPC. Hi, I'm Dr. Michael Hobbs, and this is my DPC story. Dr. Michael Hobbs is a pediatrician and the founder of Lakes Pediatrics, the first pediatric direct primary care practice in the Minneapolis area. He has spent over twenty years caring for kids in the Twin Cities. He taught at the University of Minnesota Medical School for more than a decade. He has been named a top doctor by both Minneapolis Saint Paul Magazine and Minnesota Monthly. He has subspecialty training in infectious diseases, including real work on the strep that we treat every single day, and he is a father of six. But here is the part you need to hear. Dr. Hobbs grew up alongside the technology itself. A Commodore 64 as a kid, the first Macs in college, writing web pages when the internet was brand new. He stood at the fork in the road where he had to choose between medicine and tech, and he refused to pick just one. That means he has watched the entire arc of how we care for patients. From his childhood doctor's four-by-six index cards, to paper charts, to dictation, to the EHR, to AI scribes. He has seen what gets better. He has seen what gets worse, and he is not afraid to tell you the difference. So this month, when we are talking about the tools that serve us, this is a voice I am glad you get to hear from. Welcome to the podcast, Dr. Hobbs. Thanks for having me. This is fun. Yes, it is fun indeed. It's been a while since I've seen you in person, but man, when I had a last-minute cancellation for this month, I was like, "Oh, who is number one on my I wish that they were talking on the podcast this month?" It was definitely you. So I'm super excited to have our conversation today. And, other thing that I didn't know until I was researching for this interview was that you are also somebody who was in the field of anthropology like myself back in college. Yeah. So- That's right I think that's a, it's a fun fact. Anthro is more than, digging out things from the dirt- in archeology. yeah, Yeah. I did my senior paper on the biology of aging, actually. So I think that's awesome because you are a pediatrician by training, and so you're dealing with the root foundations of how the aging process can be affected. And so I think that's super fascinating. How did you go then from your journey that even took you into the study of aging and anthropology to becoming a pediatrician focusing on, again, those early ages of a kid before they start to become an older geriatric patient? Yeah, I think a lot of people probably can relate to this story because when I was in, a little guy growing up in Nebraska, and med school seemed so far away, right? And I was like, yeah, it's hard. Everyone talks about how hard it is starting a DPC practice. Everyone's like, "Oh, it's so hard. It takes all of this effort." And uh, in college, I was like, "I kind of would love to go to med school," but then I was gonna be an anthropology professor. That was like, that was... I wanted to be Indiana Jones, basically. That was my dream. And I decided to do my own version of a post-bacc where I did all my pre-med stuff uh, in a fifth year at my college. And I was like, "Hey, this is doable," right? This isn't completely crazy. And for me, I wanted to bring that humanity about sort of interacting with people, knowing people, caring for people to my also love of science, which It's a great... Medicine's this great blending of the cultural piece, the social piece, the science piece. And you can really go deep on any of those topics, and there's lots of ways to experience how people exist in their lives. Listening from the ears of a fellow, in anthropology, I was a, that was my main major actually in college, just because it was way more fun to take those classes than being with the gunners in, you know, neurochem- Yeah and all the science classes. It really resonates for me in terms of the things that are so- pertinent to one's culture, and that doesn't have to be- from ethnic culture. The things that are so pertinent to a person's culture really impact their health. I absolutely love that, you made those connections without necessarily someone pointing that out to you. You can see the impact of a person on their health, and a person's health on the person themselves. So, um I wonder here in terms of when you were growing up in Nebraska, what was your access to healthcare like? Did you have somebody who impacted your definition of what it is to be a doctor for a kid? And so I grew up in a classic small town model. We had a family doctor who everybody saw. He did house calls once in a while. And it was funny because is the beginning of my medical journey, but also my interest in technology too, 'cause his record-keeping system was four by six index cards, and his wife was his, office manager and assistant, and she had her little box of everybody's card. And you would go in and see him, and he would give you a shot of penicillin for about everything that was wrong with you. But he took care of everybody, and he knew everybody, and I really liked that small town medicine, and I was originally gonna do family medicine, and then I had lots of interactions with adults and kids, and "Hey, kids are better." For me, going out to rural Nebraska and seeing what family doctors did, I was like, "I cannot deal with parents all day." I can deal with the kids- but I couldn't deal with the parents all day, and so I was like, "I need to have bigger kids who can also express their, maladies in addition to the little ones who can't yet talk." So I love that there's different paths for all of us, and we all- make a difference no matter what path we're on. Now, when it comes to the four by six card, I also am just thinking about you know, this is Nebraska in 2000, oh gosh, I think 2008, maybe 2009. But we would have dictaphones, and then we would- Mm have the people who were transcribing print out our notes on sticker paper, and then we would- put the sticker paper in front- Yeah of the charts. And so I'm like, "That is so high tech compared to a four-by-six card." Yeah. And then we think about, you know, in 2026, we have a completely different ballgame of tech tools. If you can run us through the things that you have used as a person who is in medicine. Because yes, you saw your family doctor have these four-by-six cards- Mm-hmm but there's been so much change- even in the past year. For those people who have graduated 10-plus years ago, those people who are yet to graduate medical school- walk us through your, timeline of things that you've used to document patients' health. Because that, I think that would be a kick for people to hear, almost like when I listen to '90s podcasts and I'm like- Yeah "Oh my God, yes, I remember that." It's funny because, Gen X, which is the generation I am, is the, you know, started analog, switched to digital, and that has been my same experience with medicine. And so I went from that four-by-six card to paper charts where, you're doing paper orders, you wrote your H&P down on paper. Then went through the dictation phase, then EHR phase, template phases. Now we're in AI scribe phases. So I've seen the whole arc, and it's interesting to see where the similarities show up and where the differences show up, and how you see a generation that trained after you, they... Like the template generation who was like, "Oh, you only document with a template." And I was like no, you can write a shorter note than that." And again, I just go back to the anthropology- tie in that when you are taking a step back and looking at things over time, I think for me- that's also why I'm, like, a huge history podcast listener, but I think that it makes you think about, especially when you've been exposed to different ways of doing things, I think it makes you especially able to have a, an even more on-point, autonomous position because then you can say- "this is the goal that I needed to do no matter what tech I used." "And this is a way that I know how to do it as a backup if this tech doesn't work," like- Yeah if the cloud is down. So I'm just wondering here, have a technical background in addition to being a doctor and in, in addition to being- somebody who was in anthropology. So tell us about how you went from being interested in tech to really getting your feet wet in tech and really diving into- the tech space. So little Michael Hobbs was a big fan of all the tech that was coming up, and I paralleled all of the evolution of computers and the internet. And so I had a Commodore 64 when I was a kid, and when I was in college, the first little Macs were coming out that people were buying. The first computer I had in college didn't have a hard drive. 'Cause you just had disks that you swapped around. And then when I was in med school that's when the internet was first coming online, and so I was like, that was my path, was am I gonna stay in med school or am I gonna go into this? Because I just saw a lot of potential for that. And so I was writing web pages, and I was doing some coding, and I've always been sort of, you know, prosumer or, knowledgeable hacker on the edge who never took a lot of formal training. And that's where I ended up now with AI because One of the reasons I did DPC was I needed a different, healthier, more sane way to take care of patients and for patients to receive care, and I also wanted to be able to put some time toward making sure this next wave of technology didn't go the way of like the HR did. And I think that, you know, just thinking about what we're doing in direct primary care, we're taking back the narrative of the patient-physician- Mm-hmm relationship, and absolutely when it comes to protecting the way that we're doing medicine and the way that we need to be accessible, I do think that having input from someone who's actually doing independent medicine completely matters at the table. And every time I hear of another hospital system going to the big E- EHR that- we are celebrating leaving when we choose DPC. Mm-hmm. I think about, that idea of being at the table, and I'm wondering, can you talk to us about how you have seen the technology evolution and how you have participated or tried to participate- before you went private? Because I think that also matters, especially for those listeners who are like, "I'm still trying to make a difference at my facility- at my clinic." What things might be relatable from your experience? I think the most important thing, and I wanna say it to try to empower everybody, is when they're implementing technology, whether it's an EHR in a fee-for-service clinic or an automated phone system, is how is this helping me? How is this helping my patients? Because implementing technology should be a net positive for the practice that what you're doing, not just creating more work. And that's been sort of the tricky part is that people have gone to like, "Hey, I'm implementing this so I can capture more revenue," and then you end up like, "Who am I taking care of? Am I taking care of the insurance company? Am I taking care of my, accounting books? Am I taking care of myself or am I taking care of my patients?" And so when EHR companies come to you and say, "Hey, we can do X, Y, and Z," you can say, "Okay, good. How does this help me do the best that I can being a primary care physician? How does this help my patients receive the best care I can give them?" And I think that is applicable in an organizational system at the hospital level, at the small clinic level, or at an individual level. And I think that it's so in alignment with why we have the direct primary care model because this model is literally built for that patient-physician relationship. And when there's fewer barriers, like the middleman and that middleman experience can come from tech or like- the failure of tech to work for the patient's care for what you need it to do that's so pertinent. When it comes to you opening your practice and you going, into the space of, you know, you're in the western suburbs of Minneapolis- you're the first pediatric DPC in the area. how did you develop your user experience for parents? Because, I would assume that lots of them are used to using cell phones, using apps, but they also are used to the frustrations of big systems where like you have to do this in order to get this, and then if you open your, portal, it has nothing of substance that can actually help you. I think like many DPC docs, I was a little bit of a rebel even in the fee-for-service space. I was eager to use email to help communicate with patients instead of the portal. And I was always trying to think of ways, okay, what technology here is gonna help ease the communication? Because I got frustrated by portals, patients got frustrated by portals. And so the system doesn't always adapt to those changes really quickly. The fax machine is the perfect example, right? People are like, "Oh, it's HIPAA compliant." I'm like, "Okay." And people-- sometimes when you're busy, I understand that it's hard to say, "Hey, I want to introduce a new workflow into my system," because it gives you another surface you have to pay attention to, and that can be really painful and it can create a lot of like, you know, context switching. I'm in the portal, I'm in the chart, I'm in email. And so, I had primed a lot of families already when they started DPC with me as like, "Hey, he likes to have direct communication." I think that it definitely speaks to that word of mouth, like why patients, especially if you've taken care of them before- why patients specifically go to a DPC for the doctor who owns and runs the DPC or who's working at the DPC- Yeah rather than this thing that, Oh, I just found." So I'm, wondering here, though, when you broke away to open your own clinic, when you talk about priming your patients, they knew your culture for sure. But were you able to tell your patients, "Hey I'm opening Lakes Pediatrics, and this is where I'll be"? Not actively. That was part of my exit. But enough families knew how to get ahold of me, and so they'd already had those communication channels open. And I've always tried to cultivate a small-town vibe no matter what model I was doing, and so people knew how to find me. And once they did, their friends found me, and it was, really heartening to see how many people transitioned in the first few months. When you left your practice prior to Lakes Pediatrics- what was your patient panel like? What was the, everyday like that you were going to be excited to be done with? What I wanted to be mostly done with is not focusing on what patients needed. So being able to say yes to more- And also making people happier because when you're busy-- And I was in a completely production-based model, and so you were incentivized to keep your schedule really full. And in that situation, you're gonna be late returning a phone call, you're gonna start running late for patients. And so you start to get this low level of dissatisfaction with people because, you know, you're running late or you didn't get their phone call back or they're waiting to get their prescription filled and you haven't gotten to it yet, and that just doesn't feel great after a while. And so it's nice to be able to attend to people. And I mean, I tell patients still now is like every day someone is surprised at how amazing this model is, and I get to make people happy and say yes to stuff more. And I think that's the biggest change that I love. And being intentional about the type of practice where you're able to have accessibility and timely accessibility, what did you think about opening DPC when it comes to particular, you know, limits in terms of numbers of patients or families- Yeah you would take care of? Because when you're no longer incentivized by how many people- can I see, how many, codes can I collect today? I will say here my, relationship to the Chuck E. Cheese tickets, how many Chuck E. Cheese tickets can I earn today? Did you have a sense of I want to take care of this many patients or families? Mm-hmm. Or did you work up to, oh, this feels actually really comfortable- Yeah and did you make your decision then? I did the math to see, okay, what sort of income would I need to cover what kind of staffing and what kind of overhead, and then kind of work backwards of like, okay, what's my original, pricing gonna be that I feel comfortable with? And is it attractive? I did some A/B testing. I had a soft launch. A lot of pediatricians go with the family medicine data, and I think we're starting to get more data that shows, hey, those numbers don't quite work the same way because of the patient population. And so if I was advising pediatricians who are starting now, I would probably say, "Hey, reach out to the pediatricians and look into the family practice data for sure, but get a bigger sort of data set to work with." I'm wondering here, just focusing on the pediatric DPC experience because, yes, there definitely is a lot more data intentionally because as a community you guys are making that data. You guys are bringing that data to the forefront. I'm wondering for those pediatricians who are, learning about DPC, thinking about it, just exploring the model what are some of the things that you would want pediatricians to know that- Maybe are common myths or things that you hear that are keeping people from choosing DPC. Vaccines is a big one, like vaccine access- Yeah but I'm wondering if you have things that you can speak to, to those pediatricians who are like "Mm, that's cool, but it's not for me quite yet." I think the vaccines make people anxious because there's a lot unknowns. I think pediatricians tend to be a little more risk-averse than other physicians. And so taking the leap and being an entrepreneur and starting your own thing is less their cup of tea than, say, internal medicine docs. And it's a broad stereotype. But I I would encourage them to think through are you getting what you want out of your job right now? And can you imagine being different? And who have you talked to about making that happen? Because, DPC is so altruistic. Everyone's so helpful. People are eager to connect and give information and share resources. And you don't have to do it alone. And everyone feels like they have to go out there and just kinda get going on their own, and you don't. And so that's the thing I would want people to know the most is people are out here and they have your back. For anyone, even if you're in DPC, it's a nice thing to hear that and it is true versus feeling like you are in a place where you're not supported. I know a lot of us can attest to having been through that feeling. So now that we're in the month of the tools that serve you or the support tools that serve you I was thinking, number one on my list, why the heck didn't we reach out to him in the first place? In 2026, you've mentioned some tools already, but when you hear the tools that serve us, what does that mean to you as an independent physician in this era? Because it doesn't necessarily always have to be SAS technology- Yeah it could be other tools. But I'm wondering what does it mean to have tools that serve you as an independent doctor? I think the simplest answer I would say is figuring out what tools you actually need. And I think that's where people kind of get ahead of themselves a little bit. They buy the expensive eye machine or they buy a lot of lab equipment and like, do you need it? Have you used it? Have you wanted to use it? And I think that goes for technology, too. You can overspend on EHRs and you can overspend on fancy network systems and you can also just go to that's fine. Get a little hotspot and go from there. and then you can start saying, "Hey, I'm finding I need this to take better care of my patients," or, "I'm finding this 'cause this'll make my life easier." And if you go deep enough, you can start to say, Hey, in DPC, I don't need a full-time X, Y, or Z," and technology start to be a fractional employee for me in some ways. Um, and I, I, m- you know, Everyone I think knows that I'm weighing deep into AI 'cause I think that has a lot of utility. But, just having a good laptop is really key, so when you do house calls or when you need to document. Because not all the mobile apps are great, and some people will buy like, the big 16-inch laptop, and I'm like, "That's not gonna be super portable." When my mom won a, Chromebook... I, like, do not do Chromebooks, but when she got this Chromebook and it was just sitting there, and I was like- Yeah "That thing is super light, and it has internet access. And I can lasso my internet from my phone." Yeah. Amazing. I totally took that over my 16-inch, MacBook that I use at home. So amen to that. When we're in this era where there's so many people, especially in the AI space, who are developing things for us to use as physician entrepreneurs. And I'm just wondering, when you think about, there's vendors out there. You talk to them. I'm wondering if you have a really quick decision tree as to would you put a tool in a good space or a bad space quote-unquote. Mm. I wouldn't say bad like, malicious, but bad like, this is not gonna serve me or my patients. How do you make that decision when, we're bombarded with different- advertisements, and some things are advertised for, much prettier than the actual product is when you use it? I think the simplest answer I could give you is watch out for the marketing lingo. Because I think most physicians have developed a nose for when someone's just trying to sell you something, and when they hedge or they deflect questions. People who have a product that they believe in know what its strengths are and what its challenges are, and they can tell you what those challenges are. Like This is a perfect example with EHRs. Everyone's like "Well, this one has this feature and this one doesn't." I know, but this one also has this feature and that other one doesn't. And so you have to make your list. You have to say, "Okay, what do I need?" Not, "What is someone trying to sell me?" Because otherwise you'll spend a lot of money on stuff you absolutely do not need, and right now is not a great time to lock into any kind of long-term software contract with anybody. I would underline and caps that statement because things are happening so fast. Again we think about two years ago, did we even have any AI? No. And well, I shouldn't say no, but we didn't have the AI that is accessible for free that we use even of today. When I'm talking to people, I think one of my favorite questions to help me determine should I continue talking or not is the experience that they've had in the direct primary care space working with independent physicians. Because I think there's a lot of people who they're building tools, but the experience of working with, big corporate EHR again, Did you even ask a physician who does independent practice, who doesn't have staff, if this is helpful? 'Cause I'm like, that's totally not helpful. The products I've seen early on in development, I'm just like, man, okay that's not at all useful. And i- in some cases, and that's really critical sounding, but at the same time I hear a lot of, "Oh you should use this, you should use that." But and that's where I will lean into their description of what they're building from the DPC doctor's perspective, and if they even- Yeah understand the DPC doctor. So you'll get a lot of brush off from people who don't wanna sell the small clinics to. And so that signals a lot to me also like, you're not building for me, so, that isn't necessarily a product that I wanna use. And that's one of the tricky things because that's where we get into like well how do we get the tools that we need, and what are the solutions to do that if no one's gonna make it for us? And again, when you talk about, signing big contracts, it's like there's so many tools- or we can make our own tools. And on that note- I would love uh, that was a very loaded lead in, but, when it comes to the way that we've done medicine in terms of- people who can help us do the medicine, call patients back, send messages, et cetera- using AI is a thing absolutely that people are learning about, deploying like crazy. There's a whole spectrum of exposure to AI and how to build and use tools in the clinic. But I'm wondering in terms of how the AI assistant, quote-unquote, could help in- the DPC space compared to a corporate space. what are some ways that you've loved optimizing the autonomy that you have to use and to build an AI assistant within your medical flow? So the most important ones for me that I love the most are the things that get, work out of my way so that I can spend more time with patients. And so we all have this, nuisance tasks that we don't wanna do. Mm-hmm. Like I created a project within Cloud that helps me order labs in radiology because it was such a pain in the butt trying to fill out the form on my computer versus printing it and signing it and then scanning it. And I think you then just have to start imagining, what is it that I need? Because you can build it, it's not as hard as you think. Building and coding sound like skills, right? But interacting with an AI assistant that helps you build these things is really what you're doing. You're communicating to something that can communicate back. You're not saying, "Hey, I have to come up with a plan." You say, "Hey, I want this thing. Help me plan it." And then you can just really have fun and see what you come up with. Then it gets a little addicting because you're like, "I made something. What else can I make?" And here, if there are audience members who are like hear the word AI, that's a bad word, not gonna even- Yeah go there," what would you say to the people who are hesitant about, the unfamiliarity with this tool- the overwhelming presence of this tool- Mm the different ways that, we haven't even learned to use these tools? What would you say to that doctor, especially if they're looking to DPC but they have some hesitancy about AI in particular? I think it's really important because in Fever Service, we all were Subject to people telling us what we had to do and what we were not doing and we couldn't do it that way. So I like to say, "Hey, here's what it can do. Here are what the options are. You don't have to use it if you don't want to. And if you do want to, here's where you could start. And if you wanted to start here instead of here, totally would." The nice thing about it is there are lots of entry points to it. And the nicest thing is you don't have to use it at all if you don't want to. But if you say, "Hey, is there something in this space that could help me do what I'm doing?" I can easily say yes. And then if you say, "Hey, and I want to sort of solve my own problems," this tool can help you. But I absolutely would not say to anybody you have to do anything. I think that is, definitely so pertinent to part of the trauma that we have from employed medicine- Yes is that it's not even just the tools. It's literally "No, you will do this code," or "You will search for this code on the X-ray you ran five years ago because we can still charge for it." So there's a lot of, trauma there. Do you ever have an unsigned note and you're, like stressed about it because someone's gonna get on your case 'cause you have an unsigned note? I still see my list. I'm like, "Oh, I have six unsigned notes." I'm, like, looking around over my shoulder. So I will say that I have always been, like, more of a middle finger to that demand, the 72-hour demand. My husband, on the other hand, he physically gets a, like a different person when his 72 hours had passed in fee-for-service and he hadn't answered them. If anybody has watched Animaniacs and Katie Kaboom- Yeah that was my husband when he did not have notes signed in 72 hours. So 100%, yeah I, know that experience. But I get less stressed about it. It's just I historically got less stressed out about it because I was like, F this, man, for most of my career in fee-for-service. But you also have partners and- Yeah senior managers and it's just, it's funny how those things linger around even after you... I've been out of it three years now and I'm still like And I think that also this is why I love talking with, you know our fellow family DPC physicians because it's and I say family, not family practice, but family. We are our community. Yes. Because I'm like, "That's real, man. Oh my God, yes." It's like when you talk about your high school teacher and you're like, "Oh my God, remember when we had to?" And then it's "Thank God we never have to do that again." And on this note, because you are also somebody that people go to ask for- not only the clinical experience and opinion, but also how to bridge the tech gap into the clinical space in a useful way. When you're sitting at the table, what are some of the things that have shocked you when it comes to like, oh that's a total everyday thing for me- but I didn't realize that wasn't an everyday thing to someone who is coming from the tech side of things. It's an interesting gap because in every space you have people who have great intentions, they're trying to make a good thing that works well, and they just have a blind spot, and so being a clinician it seems obvious to you like, "Hey, this has to do this or doesn't need to do that." And they're like, "Oh, we didn't think about that." I think that's really important too because there are very few people who start their day going, Hey, I wanna do something bad for somebody else." They're, like, trying to do good, and they just need some perspective. They need context. They need a gentle reminder. And I mean, tech people are like that. Physicians are certainly like that. Um, And so that's the thing that's been really interesting working with companies where they say, "Hey, we need clinicians to come in and weigh on these products." And you know, it's like when you teach, right? Sometimes you say something and they're like, "You're so smart." And I'm like, Oh, I mean, that wasn't that important." But okay. Because it's so routine for you, right? You do it every day. You've done it 1,000 times. And so that's been my experience there is kind of helping create that bridge. In the system, in training, in corporate medicine, when we are very much bombarded with the things we have to do and we don't have- as much space to think about, how valuable we are as human beings who've chosen to take care of other people. I'm just wondering what are some things that you would want people to recognize in terms of you may think that you don't know anything about tech, but think about this because you totally have experience in, this or that. 'Cause When I'm asking you this question I think of so many examples of how- the tech experience that is natural for what we do as physicians and have done over time since, the internet has came and, has come and whatnot. But I'm wondering, what would you say to the listeners who might be like, I don't really think I have much experience in tech," but- Dr. Hobbs is gonna prove you wrong. Yeah. So I would say it's important that you know yourself. What are your strengths? What are your challenges? 'Cause some people are, like, very clear. They're not tech people. They don't want to be tech people. They've tried, they've discovered this about themselves, and I'm like, "Great. Who is your friend that can help you?" That's what you need. 'Cause everybody needs friends who have different skills, right? Not everyone's gonna be great at stuff. But physicians, are problem solvers. They're smart human beings. And I think technology is parallel in, to medicine in that there's a lot of lingo, and people who are in it like to use the lingo to create space. Like, Look, it's hard. It's really hard. Look at all these big words I'm gonna throw around. And you're like, well, when people do that in medicine, you know they're not trying to create a bridge of communication. And so if you have that perspective of like, okay, you're smart, you know a lot about tech, but it's something that is learnable, right? Like running a marathon. You, see somebody run a marathon and you're like, "I could never do that." I'm like, "Sure you can. But you have to like, get there." from your perspective, because of you being comfortable with tech and being- very intentional of as to how you use tech and build tech, I'm wondering if you can give us, a workflow example of what happens when a kiddo comes in for a sick visit or- the use case when a kiddo comes in for a physical. I think the best example there is how much you're wanting to use AI scribes to make your visit a little bit more straightforward. Because you can use off-the-shelf ones, you can actually build one if you're that inclined to, and then it can work the way you want it to, and that you can keep then streamlining it. And I think one of the things about technology is-- and specifically about AI, like you can't talk to your laptop and say, "Hey, laptop, diagnose this problem." But that's how you interact with AI, and so if you have experience talking to patients, you have the skills that you need to work with AI. From the patient's perspective again, because we talk about being intentional about use of tools and technology- what does the user experience look like if a patient has come in to see you and then things have to happen because of, what you saw, what you diagnosed in that visit? Can you describe if you have an AI assist helping you with X, Y, or Z- like you talked about labs and and ordering. What happens to... kid comes in, they have concerns for strep throat. You see their- throat, you do an exam, take a history, and then you have things that need to be ordered, you have things that need to be followed up on. It's Friday- you wanna make sure they're doing okay before the weekend. What happens on the back end that is experienced and loved by your patients and their families on the, user experience end? That's a great question because this is where technology helps you versus, I think, can start to take over part of what you're doing. And so when I use technology in that way, it's to help me remember. so I set up a tool, like it can, pen the orders. I can get the orders out so I don't forget to order them. It can pen the script so I can send it out so I don't forget it. It can send me a reminder to check in on them because I forget stuff. We all forget stuff. And so it's like an assistant. It's "Hey, remind me tomorrow to check in on them." And parents love that. families love that. Patients love that. Because I do care, and I do wanna remember to check in on them. I'm just asking something to help me. And I think this is a little bit of a personal belief, 'cause I know people use AI to, like- Great messages and stuff like that. I personally like it. I think it's fine and smart to use AI to do those things. I think patients should know when they're talking to a person and when they're talking to an AI tool, and I think it's really easy to do that gracefully. we've all seen AI-generated text and posts on LinkedIn, and you can tell it, and people can smell it. And in DPC, that's just not ideal. On the other hand, though, giving them an option to say, "Hey, I might have this tool that you can talk to faster than you can talk to me 'cause I'm seeing a patient. You have a choice, right?" I'm fine with that. And I think there's a different buy-in, especially when there's already a relationship with the human being who's associated- with the tech. I think that's a huge thing in terms of patients being willing to try something, being willing to drive into your clinic so that you can help them set up their app. This is the type of stuff that you can't discount the fact that you're still the DPC physician who is using- Right this tech. And so, to the listeners out there who are thinking about "Oh, I've totally created a note and whatnot," great. I have, too. But it's like at the same time they know that we don't pick up our phones at our clinic. goes directly to voicemail. But our patients- know one hundred percent that we're reading the transcript as it's going. They know that we're not like the front office who will never get back to them. And so there's different trust even with similar technology that they might experience at other clinics- Yeah because we're the DPC doctors. And when you talk about an AI assisting you in remembering things, I'm wondering, can you talk to an experience you might have had where you tried something in using AI or using an AI assistant and you're like- Yeah not gonna do that again"? Oh, yeah. I tried to create um, a- an AI bookkeeper, and AI tools are terrible at math. LLMs are terrible at math. And I thought I could solve it and do all this stuff. It was a disaster. Um, But I learned, right? I learned a lot in that process, and so that's what keeps me doing these kind of things because I try not to do anything that's gonna cause any permanent harm to my books or anything else. But you know, failures are learning, too, as long as you fail gracefully. I've mentioned so many of my like, wow have a story to tell you because- Mm-hmm I had this experience that wasn't the best in the moment, but I've learned to not do that again. But there's some things that we learn that are like, oh my gosh, I did not know that this thing actually made my workflow better because I made a change in my workflow. This totally didn't work and now I know for sure that this one really works well. And those are exciting times. On that note, you mentioned how that you'll, talk to your patients, be honest with them, transparent about like- you may be talking to AI in this case or not. How do you especially with new patients, share with them that your practice in particular does use AI for assisting you? They're not the doctor, but they're assisting you so that there's transparency for those people who might not have been, privy to that information at their previous clinic. So mostly I present it to them as "Hey, these are the ways that I help my workflow so that I can be more available, and so I can say yes to more things." And I always say there's always a part of the conversation where it's like, "And if you don't wanna interact with it, we can turn it off." I've got everything set, so if a patient says no, it's off. And I've got a few people who have opted out, and I totally respect it, and they know that I'm gonna respect that too. So like in AI Scribe, I have one family, they don't want me to use AI Scribe. I'm like, "Great, I have a different workflow for that kind of thing," which is totally fine. I mean, it's about communication, right? If you're honest with people and you communicate with them, they like it when you treat them like a human. I will say that with AI notes that I've generated for patient communication at our practice I totally read everything still in terms of- okay, one, that's not how you spell that doctor's name. Two that's not at all what I said 'cause I was talking to the patient, their wife, and their kid in the same room, and like AI decided to make this amazing journey story that's nobody said that, but I'm going to clarify. Yeah. But, for sure, using tools like AI have really helped me in terms of transcription of my notes. It has really helped me remember details that I could have- forgotten if I was listening, looking at the patient, and then afterwards trying to summarize a, 45 to an hour and a half long visit. And so I definitely- Have found help in remembering, but for me, it's remembering what I said, like- yes in addition to what I am supposed to do. I find it's really nice because it surfaces... I've got my scribe set up so it surfaces those little personal things that they say like, you know Lisa loves Bluey, know? And I used to do that in paper charts where I would make little notes to myself, and now I get to do it that way, and I, I really love that feature because it connects me to them differently, and it brings me back to the scene then when I read that note in a different way than just a standard soap note does. Talk to us about that because, again, there's listeners out there who might be very willing, but they're not necessarily sure- Yeah how to train AI. How would you approach, you know, I need this piece of technology that is helping me help me be personable in this way, specifically- by picking up on things like Lisa loves Bluey? What I would tell you if you would call me as my friend and said, "How I do this?" I would say, "That's exactly what you say." And so, um, a, group of our peers that I work with and we do some coding together, we have a phrase, it's just Ask Claude, because what you do is you just say, I would like a scribe that helps me remember these personal things," and it gives you something, and then you say, "You did a great job, but not quite like that, like this." And you actually interact with it in a form of communication to the point where a lot of people have gone from typing into these tools to have like, Whisper flow, these transcription devices, 'cause it's a more natural interaction, and you actually end up getting better results because, when you try to write a note, you're trying to condense it. You're trying to distill something, and you're trying to not write all day. But if you can just hold down your function button and talk, you get more data out, and then that gives the tool more context to work with. And I think that, again, we're still on the verge of what technology- can be doing. And- on that note, it's funny because I... And I don't know if this is because- We're physicians and we talk to patients all day every day Or if it's because, just like yourself, I, grew up when we didn't have the internet, and- I think about that when the first time I ever tried ChatGPT, that's how I naturally talk to it. I talk to it- Mm-hmm like, hey," you're this really smart person and-" can you tell me about this?" But also, when you are using AI, all AIs are not built the same, just like- Yeah every DPC doctor is different and every DPC practice is unique. So I definitely would say try and see what works best for you because I used to say that Chad was my boyfriend, ChatGPT but now I say Claude is my boyfriend, for sure. and the other thing I wanna make sure I toss in that is that um, try all the tools, but also make sure that you're using ones that have the relationship you need to pass patient information into them. Because it's so tempting once you start getting used to like, "Oh, this thing can do a lot. How about if I just drop all of this information in here to summarize it for me?" And it's very doable. You have to get a BAA, and that's something we can go into at a different time. But it's an important distinction, and there's this term called shadow AI, where people are using AI tools that are not suggestive or approved and official tools, and I absolutely understand why they wanna use them, but there are ways to do it safely from a patient standpoint. Because if you were on the other end of that and you knew that your doctor was doing that with your information, you'd probably be like, "No thank you." When we talk about, um, tools that are presented to us in the marketing space, and then there's- tools that are like, This tool is free." I love some of the tools out there that are free that are with, patient protective layers. But- Yeah I also think about and I would love to hear your take on this, like okay, this is free until it's not, and then- we're gonna be locked into this thing- that we can't get out of easily because you're so used to using it. And it's just like when people go through the drama of, Oh my gosh, I've been using this EHR for X, Y- Yeah or Z years and now I have to change." And that's absolutely true. People have gotten to the point where they are so used to interacting with their AI tool, like ChatGPT. So there was a model, GPT-4, that was very popular. It had a personality that people liked, and when it got upgraded, the personality changed, and people were upset. They're like, "You took my friend away from me." And then so when you interact with a tool like that, you can develop this sort of preference for how it's interacting with you. And there is some sycophancy you have to be careful about because you're like, "Hey, Dr. Hobbs, that's a brilliant idea. You're so smart. Way to go." And you're like, "Hey, yeah, where's this positive feedback in the rest of my life?" And just, again, the presence of actual people- Yeah um, is, what these things have been learning off of, information that we've learned, over time that like, the world is not flat and all of these things that, we know as facts now. I'm wondering, you've also gone beyond your patients that you take care of- and you've been helping out with developing care in the virtual model space. And so I'm just wondering how you, separate from the actual building of a tool how clinically we can also use these tools to help us be better clinicians. Because I think- Yeah that is something that I think about as a primary care doctor a lot. There was a lot of things that we learned, but did we learn a lot about menopausal care, nutrition? Nope. We did not learn a lot of that stuff in- medical school. So I'm just wondering, what's your take on how we can continue our education and our knowledge of the world and exploration of the world with these tools? I think it's actually one of the most important use cases for a physician, this clinical decision support. Because if you treat it like a thought partner, it helps fill in your gaps. And I even have my scribe set up, so when it writes a note, it gives me a couple clinical pearls as just like free learning. And some of it's like repetitive. Yes, I know what the bacteria that cause ear infections are. Yes, thank you very much. But it also is like, "Hey, there's this new study that showed Haemophilus influenzae is increasing because of Prevnar vaccinations." And I'm like, "Oh, that's cool. I didn't even..." That just tickles those nerves, right? And so you can start to customize these tools in a way that really speak to how you want to receive information. And that I think can be really powerful because it becomes very personalized, and you can get it short, bulleted, and you can say, "I want citations." You can build in anti-hallucination um, tools so that it doesn't, make stuff up, which I know is a big concern for a lot of people. But I think-- this may sound too dramatic, but I feel like soon we'll all have some sort of clinical decision support tool just helping us through the day because... and what I don't want it to become is it's telling you what to do. Like it's just another guideline machine. "You have to do this differently. You did it wrong." And I'm like, "Okay, that's not what I want these things to be at all." But if it's like, my little helper, then I'm all for it. I'm right along with you. Like, I joke that I don't have addictions to like drugs, alcohol, tobacco, but tech is like, okay, we're That's- -a great playground right there. And I'm wondering to the people who think about, oh, AI is gonna replace us. even in this discussion, I can, pull out the quotes of things that like disprove that we're going to be replaced by AI. But what do you say to that concern about, oh, the corporations are gonna be, turning our models into just AI-driven clinics, you know, things like Forward health tried to do when there's nothing except the pod that magically takes your blood and becomes your- Yeah. -Quote-unquote, doctor. People like talking to people, and I think that's not gonna change. I think that these tools can be very good at augmenting us, and extending our reach. In DPC, for example, one of the biggest criticisms is scale, we're going smaller in practice size. But most patients want information. And so if you have a tool that helps lessen that information asymmetry, and they can ask questions and get information, and that may save you a phone call, it might lighten up your inbox. But when they show up, the AI can hand that information off to you. You've already got a head start on the visit. And so what I wanna make sure doesn't happen is we turn into liability machines, where you're staring at a screen with 15 AI conversations, you're like approve, approve, approve, approve. Th-This is what I wanna prevent, that kind of thing. as you're talking I'm like, "Said Dr. Hobbs to the anthro major, 'People like people.'" 110%. Yeah. Yeah. That's like my go-to response when people are like, "They're gonna replace us." I'm like let's look at how successful Bumble has been from going to swipe whatever direction to we're gonna actually help you organize in-person events. Why did malls become so popular last Christmas? It's because people are people, and people are social beings. So, um, I do not have concerns about us being replaced, to the, extent of like my husband being replaced by a non-physician model. But at the same time I do think absolutely that, again, it is so important for us to put our human sense, our human beings selves into these workflows and into the way that we're using these tools. And here, because, this is the month of tools that help you, I'm wondering if you were going back to day one and you're like, "Oh, I'm totally willing to, invest in something that is helpful- but I have a, smaller starting budget. I'm doing a- Mm-hmm side gig," what would you suggest people look at first when making a this is my first tool in the AI space to use at my DPC clinic? I think one of the best investments you can make is a paid version of ChatGPT or Claude, because you get more usage out of it, it does more for you, and you can start solving problems from day one. And if I had that access then, it would've saved me a few hiccups along the way. And it sounds silly to pay $100 for something like this. You get 10x plus the value out of it, for sure. 'cause you can automate social media, you can do research, you can get lots of information. This tool really becomes a really powerful assistant for $100 a month. That's pretty good deal. Wow, that sounds really affordable, just like a DPC membership. That's pretty awesome. I just, I had to call that out because yesterday I was talking to a, a rep and their mouth kept dropping the more and more I was talking about all of these things for the amazing price of not making a seven-figure salary per year- Mm-hmm people who can afford it. So when it comes to investment though, and the return on investment. I totally agree. Even workflows that I've used because that's all we did from day one, and that's- coming from behavior that we had in fee-for-service. I will totally sit and talk to my Claude and just be like, "This is the workflow. Help me- understand different ways that I could, make- this more efficient," or, "What are the, pros and cons about doing this version of this workflow if I changed it this way- or whatnot?" And so yeah, I mean, I love talking to chat because It's like, oh my gosh, I tot- like, the blind spot, and the sticky things that I'm not necessarily clear on, I love- Mm-hmm being confronted with, "Oh, cool. I didn't think of that option before." And I think verbally processing it helps a ton too. When you're talking, it's like talking to a person and your brain works differently than when you're just sitting there being all introspective. Thank you so much, Dr. Hobbs, for bringing your expertise to the table and sharing it with everybody. I'm so excited to see what you continue to build in the future. So great to see you. It was really nice to chat with you.

Maryal Concepcion 49:10

Thanks for being here for this episode of my DPC story. Whether you stumbled across DPC for the first time today, or you've been in practice for years, these stories are here for you, wherever you are in your DPC journey. And that's exactly, have a start here. page@mydpcstory.com is built now. It meets you where you are new to DPC and learning the fundamentals. There's a path for that already practicing or in the planning stages and looking for practical tools. There's a path for that too. Ready to go deeper. That's covered. Head to the start herePage@mydpcstory.com and find your starting point. If you have a question or challenge you want to hear addressed on the show, go to the contactPage@mydpcstory.com and leave me a voice message. And if this episode moved you, please leave a five star review on Apple Podcasts. It's one of the best ways to help other physicians find these stories when they need them the most. For commercial free episodes and extended conversations, check out our Patreon. There's a free tier and a paid tier, and both help keep the show going. Follow us. On socials at my DPC story and find everything from episodes free resources, the DPC Toolkit Magazine, and more@mydpcstory.com. My DPC story is created and hosted by me Maryal Concepcion A huge thank you to the team that makes this show possible. Chief Growth Officer, Keira Hanselman, head of Marketing and Strategy, Nathalia Highland and Chief Operational Officer Alexander Gobble We are all in your corner. Until next time, this is Maryal Concepcion