#32: The Part of Care No Algorithm Can Replace

A patient walked into a visit last month with three years of direct-to-consumer laboratory testing (DTCT) panels stored in a Google Drive folder. Some came from a subscription testing service. Some came from a clinic that tests everything and interprets nothing. Her Oura had flagged forty-seven recovery concerns this quarter alone, ChatGPT had become her most frequent conversation partner about her own body, and she had been paying out of pocket for all of it. She still didn't know what was wrong.

This has become a common new-patient intake in 2026. Gallup now puts it at one in four U.S. adults using an AI tool for health information in any given month, with 59% using it to research before a doctor visit and 56% after one.

The frustrating part is not that patients do it.

The frustrating part is that we understand exactly why they do.

She wanted to feel better. She was paying attention to the signals. The instinct to pull on every thread she could find led her to a wearable, an Instagram quiz that turned into a customized supplement regimen, a DTCT hormone panel in her feed at 11:47 PM, and a chatbot for the 2 AM questions. What she had Frankensteined together was a care plan. What she was missing was a healthcare provider.

AI has become an extraordinary thought partner for the data part of the job. The synthesis, the cross-referencing, the pattern-finding, and the correlation across data streams no human can hold in their head at once: AI handles all of it faster and better than any of us can. That is real, and it is not nothing.

But AI has also multiplied the signals. Your patient now has ChatGPT's read of her lab, her wearable's AI-driven insight, the supplement company's AI-generated protocol, and the clinic's AI-drafted summary, all speaking with authority, none of them calibrated to where she is trying to go. What was once a signal-to-noise problem has become a signal-against-signal problem. That is where you come back in. Not to interpret the labs; the AI already did that. You are there to decide which of those AI-generated interpretations is relevant to this patient's goals, and which are insightful detours. 

She was, whether she knew it or not, on a journey towards health. She had been on one for three years. The problem was that no clinician was in it with her.

For the last decade, healthcare has been billed in visits. Always visits. A single encounter, a CPT code, a line on the invoice. Add a video call here, a follow-up there, and it was still visits all the way down. The operational stack (the EHR, the schedule, the billing codes, the way your malpractice carrier thinks about your work) was built around that atomic unit, and for a long time, it was the only unit anyone was selling.

Patients have been living in a different unit for years. What a patient actually wants is a journey: a structured path through their concern that begins with a question, moves through assessment, lands on a protocol, runs an implementation phase, and keeps going through iterative refinements that flow with the patient’s life. They have been buying that shape of care from whoever could make it most accessible, whoever could offer answers that reassure them a solution exists and a clear plan for getting there. Until recently, it was not their physician.

The DTCT health boom is what happens when patients build their own journey because no one in the traditional system will provide it to them as a coherent package. They piece together labs from one place, a protocol from another, a wearable from a third, a chatbot for the 2 AM questions. They call it self-advocacy. In the clinic, it looks like a folder with hours’ worth of documents to review, and a patient who is relying on you to make sense of it all.

Several forces are converging at once. Longevity and functional medicine practitioners have been delivering journey-shaped care for years, which is a meaningful part of why they have grown as fast as they have. And a new generation of tools is making it possible to offer those journeys outside the framework of a traditional billable visit, at price points that compete with the DTCT subscriptions patients were going to buy anyway, without burning the clinician out, and providing patients with the precision care they are seeking.

Fullscript Journeys is now available for healthcare practitioners. One proof point, and a concrete one. The 125,000 providers already on Fullscript can now offer health experiences directly to patients: lab testing, AI-drafted interpretations queued for provider review, phased supplement and lifestyle protocols, and follow-through, all inside their own practice. The press release put it plainly: To care is human. That framing is only possible because enough practitioners have already figured out that a visit is no longer the unit their patients are shopping for, it’s their ability to connect with their provider. 

This is bigger than one product launch. The patient journey experience with a provider is redefining the unit of modern practice with the help of AI. Though it seems ironic that technology would be our answer to strengthening the human connection that makes up the therapeutic alliance between providers and patients, the reality is that thoughtful integration of AI frees clinicians from administrative burdens, allowing them to dedicate more focused, meaningful attention to the patient relationship itself.

Here is the conversation we kept having at A4M Longevity Spring Fest this weekend.

If AI handles intake synthesis, draft lab interpretations, protocol generation, follow-up messaging, charting, coding, and most of the coordination between visits, what is left for humans to do?

The answer is almost the whole point of the job. But it takes naming it to see it.

I recently sat down with Dr. Dan Lukaczer, whose work incorporates both educating functional medicine providers and providing functional medicine care in group visits and shared medical appointments, placing him at the leading edge of re-establishing human connection in healthcare. He has run them for years, and what he described was not a scheduling efficiency. It was a delivery mechanism for the part of care that nothing else in the system produces, and what struck us most was how much of it would be invisible on any chart.

A group visit builds community. Patients meet others following the same protocol and no longer feel like the only ones struggling. It turns into a discussion forum on its own. Someone says, "I tried the collagen in the morning instead of the evening, and my sleep got worse," and six people lean forward in their chairs, phones down, suddenly recognizing the exact moment they have been trying to name for themselves. It creates a kind of accountability that no push notification has ever managed to generate. "I told everyone last week I was cutting out the nightly wine. I know we're meeting again on Thursday." That is social pressure with a human face, and the evidence on group visits aligns with what every clinician running them already knows: better adherence, better patient-reported outcomes, and better clinical outcomes in chronic disease.

None of that can be produced by a consumer app, a wearable, or a chatbot yet. Human connection inside a space a practitioner built is still the part of care only humans can deliver, and the research we are about to get to has been pointing at exactly that for a decade and a half.

Solo visits sit in the same category. When AI takes the cognitive overhead off the clinician, what opens up inside the visit is the part we have spent a decade apologizing for compressing into fifteen minutes. You can sit with the patient. You can listen long enough for the second question to come out, which is almost always the real one. You can be the honest second opinion on the lab from the longevity clinic they went to first, and the one adult in their health life who remembers the whole arc of the story.

None of this is soft. The Holt-Lunstad meta-analysis of 148 studies and 308,849 people found that people with stronger social relationships had a 50% greater likelihood of survival (OR 1.50, 95% CI 1.42–1.59), an effect size comparable to smoking cessation and larger than obesity or physical inactivity. A trusted, ongoing relationship with a clinician who knows your health over time is exactly the kind of social connection that finding measures. We have never had the infrastructure to deliver that part of care at scale. That is what is changing now. A well-designed patient journey, with AI handling the mechanical work and the clinician holding the relationship, is what the delivery looks like.

This week's exercise has two halves. Do both.

Pick the workup you run most: perimenopause, metabolic, gut, cardiometabolic, whichever one hits your schedule every week. Think through every step between the test result landing in your inbox and the patient walking out of the follow-up visit: the ordering, the reviewing, the uploading, the first-draft interpretation, the action plan, the scheduling. All of it mechanical. All of it is still on your plate today.

Now go to Fullscript Journeys (or your EHR's care plan template, or whatever platform runs your protocols) and build that entire journey once, end-to-end. If you are not sure what that should look like, activate one of the preset Journeys and run it on yourself or on a willing patient so you can see the whole loop automated before you start customizing it.

When the first draft of the action plan for that patient lands in your inbox, only edit where you need to. Is this patient already on vitamin D, and has the draft just added more? Fix that. Do you want to speak to her more directly about the alcohol than the draft's default tone? Fix that. Everything else, approve and move on. The whole point of automating mechanical work is that you stop editing things that didn't need editing in the first place and start spending your effort on the parts only you can see.

Pay attention to how much time this actually saves. On your schedule. On your cognitive flow. On the friction running through your practice. On the decision energy, you usually have nothing left by 3 PM. Then decide what the time is for.

This is the half that matters most.

Maybe you realize you explain vitamin D food sources to every third patient, and you now have twenty minutes to record the evergreen explainer you have been meaning to make for a year. That asset becomes a cog in the rest of your journey, and you stop re-explaining it from scratch every week.

Maybe you realize this patient actually needs the fifteen minutes of face-to-face that you have been compressing out of every visit for three years, and you finally have it to give her.

Maybe what you need most this week is the walk outside you keep recommending to your patients and never take yourself. Or the hour to try the thing you just wrote into someone else's protocol. Or the nap.

That choice is the exercise. The AI is what makes the time. You decide what the time is for.

Be a modern clinician with the help of Ultralight, the AI-powered EHR built specifically for personalized medicine.

Fullscript Journeys is live. Wednesday's launch hands 125,000 providers a provider-led answer to the consumer lab and wellness subscription stack. Consumer-grade health experiences with human-centered care now lies within Fullscript dashboards, with FS Assist (built on 13,600 hours of validated clinical logic) drafting lab interpretations and queuing them for provider review before anything reaches a patient's inbox. If you have been watching patients piece their own care together, this is worth your time this week.

Vibrant Practice is now Ultralight. The rebrand landed with a $9.3M seed round led by The General Partnership, with participation from Wisdom Ventures, Anthemis Group, Emerson Collective, GSBackers, and angels including Jonathan Swerdlin and former Surgeon General Vivek Murthy. Ultralight unifies EHR, practice management, and patient engagement into a single AI-native stack, built specifically for functional, integrative, and longevity practices. Live in 75 clinics and used by hundreds of physicians. A clinical advisory board that includes Jordan Shlain, MD; Brian Hollett, MD, MBA; Alexis Gonzales, ND; and George Papanicolaou, DO. Axios covered the raise on Monday, and there is more in Sunita's note on what comes next.

Protocole emerges from stealth with $6M. Protocole, co-founded by Delphine Le Grand and Cindy Yan, launched this month as a clinical-grade peptide platform. Patients complete an intake, receive a personalized peptide protocol matched to their health goals, and get ongoing access to licensed clinicians, with products fulfilled by regulated pharmacy partners. The model explicitly distinguishes multi-peptide protocols with clinician oversight from the self-directed DTCT peptide world, a category you have almost certainly seen patients wander into this year, and one worth having a clinician-led answer for when they ask.

May 8, Fullscript Forward · Virtual  · Half-day summit with the Fullscript practitioner community. Low lift to attend, high signal on where whole-person care is heading. Dr. Lexi Gonzales is speaking on "Hallmarks of Health: An evidence-driven look at today's leading longevity ingredients."

May 27–30, IFM Annual International Conference · San Diego, CA  · The largest gathering of functional medicine clinicians in the world. The clinical programming is worth the trip; the hallway conversations are worth twice that. Reply if you want to connect onsite.

Jun 9–11, Longevity Docs Cannes 2026 · Cannes, France · Invite-leaning room for clinicians at the frontier of longevity medicine. Worth it if you are designing the next iteration of your own practice.

Jun 24–26, Longevity Summit Dublin · Trinity College Dublin, Ireland  · Three days deep on the biology of aging with the translational researchers and biotech founders most clinicians only meet through papers. For anyone who wants their longevity practice grounded in the actual science.

Sep 24–26, Vibrant Longevity Summit · Austin, TX  · A clinical room of practitioners running lab-driven, longitudinal care. For anyone building a practice around diagnostics and biomarkers who wants peers who work the same way.

Oct 8–10, A4M Women's Health Summit · San Antonio, TX ·  The best clinical education on hormone, metabolic, and midlife women's health you will see this year. The room to be in if you are growing the perimenopause and menopause side of your practice.

Oct 21–24, NAMS Annual Meeting · San Diego, CA  · The single most practice-changing meeting of the year for midlife women's health. Your protocols will look different after this one.

Nov 5–8, Eudēmonia Summit · West Palm Beach, FL ·  One of the most talked-about longevity gatherings in the U.S. Experientials, hands-on demos, and the best place to try the emerging frameworks your patients will ask you about next year.

Dec 11–13, A4M Longevity Fest · Las Vegas, NV  · The biggest longevity event in the U.S. The room spans clinicians, industry, founders, and the people building next year's platforms, and the connections from this one tend to compound through the rest of your year.

Know of an event we should add? Reply and tell us.

We started writing this newsletter because we missed the conversation. The one that used to happen at a conference, at a dinner, in a text thread at midnight, on a call with a colleague who was navigating the exact same clinical conundrum you are facing — between clinicians who still believed the practice of medicine was worth saving and were willing to do something about it. That tribe is not small, but it is scattered, and every one of us has felt at some point over the years like we were the only ones still thinking this way.

You are not. The week we just spent at A4M was a reminder of that, and your replies to this newsletter are another one. The practitioners reading this are running functional, integrative, and longevity-focused practices on every flavor of EHR, with every mix of cash-pay, concierge, and insurance you can imagine, and we are all reaching for the same thing — a way of practicing medicine that helps patients reach their health goals and want to continue on a trajectory towards health.

We are on this journey with you. The AI tools, the journey-shaped care, and the group visits are not the end of the story. They are the infrastructure that finally makes the story possible. The story is still the relationship you build with the patient in front of you, and the fact that you keep showing up to build it when almost everything about the system is pushing against you doing so.

We hope this newsletter is planting a small seed of human connection with every reader on the other end of it. And we hope to meet you in person sooner than later.

Until then, see you next week.

—Sunita and Dr. G

The Modern Clinician is written for functional, integrative, and longevity-focused physicians who want to scale their impact and deliver cutting-edge care.

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