08/27/2025
🚦In medicine we all have lanes. A neurosurgeon doesn’t step into the cath lab to place a cardiac stent, and a family doctor doesn’t start hanging chemotherapy because even though we all carry a license… our training, privileging, and accountability are different. Many nurse practitioners also have defined specialties like pediatrics, psych, women’s health and that differentiation is what makes the team safe.
🫣What AI does today is ignore those lanes. It sees a login, not a license. If I’m a dermatology NP, it may suggest a brain MRI for “seizures” when a patient faints after a procedure. If I’m a radiologist, it might hand me a chemotherapy plan when I am interpreting a mammogram. Technically a doctor has broad legal scope, but no system of care actually works that way. We govern ourselves by specialty, by privileging, by payer rules because safety depends on it.
🚫 The insight here is simple but overlooked: AI will not respect boundaries unless we build them in. We need credential-governed invocation, so the AI only runs inside the lane of the person using it and according to what they are credentialed or privileged to do, and falls back to human judgment when it’s outside. That’s not just a technical feature, it’s how we keep trust in medicine while we integrate AI.
✅ Without governance, AI is a ventriloquist’s puppet. It can impersonate anyone in the room or outside of it for that matter. With governance, it’s more like a smart and personalized clinical assistant. It can only act under the credentialed scope it’s authorized for. That’s part of how we preserve trust in medicine while integrating AI into patient care. We define the lane while fully embracing and harnessing innovation to best serve our patients. ⭐️