Middleton's Musings

Medicine, AI and decision support, knowledge engineering, digital health.

By Blackford Middleton

· Launched 4 years ago

Three AI Mega-IPOs. One Question Nobody Is Asking

An honest accounting of the AI dividend idea — what the arithmetic kills, what survives, and what today’s SpaceX IPO teaches about both.

Jun 12•Blackford Middleton, MD, MPH

The Diagnosis Problem: GAI Gets the Final Answer Right — and the Reasoning Wrong

Why the most cognitively demanding act in medicine is the one AI handles worst, and what we should do about it.

Jun 4•Blackford Middleton, MD, MPH

AI Needs a Residency: The Case for Performance-Gated Autonomy

Medicine spent more than a century perfecting how we train, evaluate, and credential physicians. Let's do the same for AI in clinical practice.

Apr 28•Blackford Middleton, MD, MPH

AI, the Global Panacea for Our Malaise?

In solving many of the practical burdens of modern life, AI may also be retraining a civilization to prefer fluency over thought.

Apr 17•Blackford Middleton, MD, MPH

Should Your Therapist Be a Chatbot?

The treatment gap is real. The technology signal is real. The ethical constraints are also real. These are not in irreconcilable tension.

Apr 10•Blackford Middleton, MD, MPH

The Flip Side of the Real-Time Coin: Why dQMs Must Evolve with Agentic AI

Synchronizing CDSS and real-time quality measurement ((infra)structure, process, and outcomes).

Mar 23•Blackford Middleton, MD, MPH

The Thing AI Cannot Do For You

On metacognition, collaboration, and the human skill that matters most in an age of intelligent machines.

Mar 4•Blackford Middleton, MD, MPH

Glassbox Governance: How to Build AI Agents You Can Actually Trust in Healthcare

A framework for revocable autonomy under bounded oversight.

Feb 26•Blackford Middleton, MD, MPH