Medicine Is Headed Toward Semi-Autonomous Care. Are Doctors Ready? With Counsel Health CMO Rishi Khakhkhar
Episode Description
A recent JAMA perspective argued that AI already outperforms physicians in many cases. One emergency physician building an AI health company thinks that argument gets the timeline right and the conclusion wrong.
In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Rishi Khakhkhar, an emergency physician at Mount Sinai and Chief Medical Officer of Counsel Health, an AI-enabled virtual care company. Rishi splits his week between ER shifts and building toward what he calls semi-autonomous care, a deliberate middle stage between fully human and fully automated medicine.
The two start with the patients Rishi sees in the ER who never needed to be there, then work through how AI-assisted, physician-supervised care actually functions in practice: an AI takes a full history first, flags when a physician should join, and leaves the decision to escalate in the patient's hands. From there the conversation turns to the JAMA piece itself, with Rishi agreeing that AI can already outperform physicians on narrow tasks like reading subtle EKGs, while pushing back hard on the idea that human-in-the-loop care is holding medicine back. He compares it to Waymo's years of supervised driving before removing the human behind the wheel, and argues medicine shouldn't rush that same transition.
The conversation closes on what's structurally in the way: a 50-state licensing system built for a pre-internet world, the deskilling risk facing residents who train alongside tools that already outperform them, and what Rishi thinks primary care looks like in 2036, when it may no longer be built around a relationship with one person at all.
What You'll Learn
- How AI-assisted care actually works: what the AI is allowed to decide, and what always escalates to a physician
- Where Rishi agrees and disagrees with the JAMA perspective arguing AI already beats doctors
- Why Rishi resists skipping past human-in-the-loop care
- What Rishi tells residents they still need to learn without AI, and what he thinks doesn't matter as much anymore
- What Rishi thinks primary care looks like by 2036
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