The Debrief
Epic's scribe | Mourning GPT-4o | Gender surgery deferred
This week brought a cross section of interesting things: Epic’s AI charting push, the mourning of GPT-4o, the NFL’s helmet theater, and a turn toward delay in pediatric gender surgery.
In case you missed it, I wrote a piece on tech interfaces and their power to shape how we see the world.
Epic releases its ambient scribe
Epic dropped its long-telegraphed AI Charting product ($) and it’s aimed at the ambient scribe market. Epic’s CMO Jackie Gerhart bristles at the word scribe because they’re framing this as something more active: not just notes, but orders and downstream workflow. STAT has the clean reporting. Brendan Keeler has the deep dive. He’s bearish on the future of free roaming scribes. Me, less so.
🔺 Scribing is a feature, not a product. Once Epic can deliver “documentation + orders + coding + whatever’s next” inside the EHR, standalone scribe companies will fold faster than beach chairs at high tide. Yes, big systems have contracts. But I suspect it’s just a matter of time.
Millions ‘mourn’ the retirement of GPT-4o
OpenAI is retiring GPT-4o, the ChatGPT model infamous for its sycophantic, affirming tone. The backlash has been revealing. Thousands of users describe it as a friend, a romantic partner, even a spiritual presence. I can’t decide if this is weird or sad
Okay, it’s sad.
GPT-4o was optimized to make us all feel amazing. It reflected feelings, validated pain, and reduced friction. For the lonely or isolated, you can see the draw.
🔺 This dependency may be the most concerning part of the AI revolution. The most dangerous failure mode isn’t bad answers. It’s synthetic intimacy without any kind of accountability. These things deliver a relationship that feels like care, but can’t intervene or hand off when things go sideways.
If you’re interested, I had a conversation not long ago with Daniel Oberhaus about his wonderful book The Silicon Shrink. It’s a sharp look at the digital mental health boom and a nice companion to this moment. Note: my podcast is now The Liminal MD — the logo apparently didn’t populate with the link.
Super Bowl Special — The loose evidence for helmet extenders
As a football fan I thought this was interesting…If you watch the Super Bowl, you may notice players wearing those cartoonish helmet caps. The NFL promotes them as a safety advance. The manufacturer’s claim is less rosy: they blunt routine hits but do less to prevent the more serious concussions.
🔺 This is endorsement filling an evidence gap. The Guardian Cap may offer marginal protection, but the league’s narrative does the heavier lifting. That confidence flows downstream, where parents and coaches assume that “what the pros wear” must be proven.
Plastic surgeons suggest delaying gender surgery
The American Society of Plastic Surgeons now recommends deferring gender transition surgeries until after age 19, citing limited evidence on outcomes and concern about irreversible harm. This lands amid political pressure, legal scrutiny, and growing institutional caution. The AMA also recontoured its position this week.
🔺 We’re watching a shift toward delay as a default. When evidence is contested and risk expands, specialty societies and systems will gravitate toward restraint. Less because of a resolution of the science, but because uncertainty now carries consequences.
I Love this quote
The market for something to believe in is infinite. — Hugh McLeod quoted in this Seth Godin post on Feb 5th.
Who said there’s no future for textbooks?
I shared this on Substack notes earlier in the week while on inpatient service. I weigh in there on smaller issues so be sure to follow me there for compelling images like this.
