Bookwild - Medicine, Machines, and Meaning: Justin C. Key's The Hospital at the End of the World

Episode Date: April 7, 2026

In this episode, I talk with Justin C. Key about his speculative novel The Hospital at the End of the World.  Justin shares how his medical training and fascination with AI, consciousness, and ethics informed the novel’s evolution from a short story into a full-length work. We dive into the tension between technological advancement and human connection, particularly in medicine, emphasizing the irreplaceable value of empathy and lived experience. Justin also discusses worldbuilding choices, balancing speculative ideas with grounded realism, and both the promise and risks of AI in healthcare and learning. Listen to hear about: How Justin’s writing journey evolved naturally from a deep love of reading into a disciplined, intuitive creative practice   How his “pantser” approach prioritizes discovery, with structure and outlines often emerging during the editing phase   How The Hospital at the End of the World began as a short story and expanded over years alongside his medical education   The way the novel explores AI in healthcare, balancing its powerful analytical potential with the risks of over-reliance and loss of human judgment   How the novel explores the irreplaceable role of human connection, arguing that empathy and presence are just as critical as data in medicine Follow Justin C. Key here and grab a copy of The Hospital at the End of the World here Check Out Author Social Media PackagesCheck out the Bookwild Community on PatreonCheck Out My Stories Are My Religion SubstackGet Bookwild MerchFollow @imbookwild on InstagramOther Co-hosts On Instagram:Gare Billings @gareindeedreadsSteph Lauer @books.in.badgerlandHalley Sutton @halleysutton25Brian Watson @readingwithbrianMacKenzie Green @missusa2mba 

This week I got to talk with Justin C. Key about his first novel, The Hospital at the End of the World. I was obsessed with this. If you enjoyed artificial wisdom, if you enjoyed Barrier Gays by Chuck Tingle, I think you will really, really, really enjoy this book. In a time not so far from our own, society is run by a global AI system controlled by an all-powerful corporation. The Shepard Organization oversees every medical school in the country, save one in New Orleans, which still insists on human-led medicine. It is the last choice school for an ambitious young New Yorker named Pock. But after his father, himself a physician, dies under mysterious circumstances that seem connected to the Shepherds and their megalomaniacal young CEO, Pock finds himself on a quest for answers

that leads right to Hippocrates. Once enrolled, he stumbles upon a further mystery. A strange illness is plaguing newcomers to New Orleans who grew up under the Shepard rule. What is causing this fatal anomaly and how does it relate to the mystery? mystery of Pock's father's death and his own mysterious past. If you enjoy speculative fiction, you will very much enjoy this one, like hands down, but also I coincidentally happened to start watching the pit at the same time that I was listening to this book, and it really hits on a lot of the same themes that season two of the pit are exploring. So also, if you're really enjoying the pit, there's a huge likelihood that you will enjoy the hospital at the end of the

the world as well. That being said, let's hear from Justin. So I am super excited to talk about hostile at the end of the world, but I do always want to get to know a little bit about you first. So did you always know that you wanted to write? Did you just have an idea one time? Like, how did that all come together for you? Yeah, you know, for as long as I can remember as a kid, I wanted to write. I know that I loved reading. My mom worked at the library at Congress. and I used to viral books, you know, started with goosebumps and then went up to animarks and then progressed Stephen King and Michael Crichton. I can't remember exactly when it turned into such a burning want to write. I do know that, you know, when I was in third grade, I think I wrote this little book called The Butterfly Chronicles and I illustrated it.

And it was about reincarnations. This guy that went back in time and he kept being reincarnated as like these different animals. I did write some short stories in high school. And when I went to college, I was thinking pre-med, because I also wanted to be a doctor as a kid from very early on. And so that took up a lot of my time because there's specific things you have to do for the pre-medical requirements. But my second half of college was really focusing almost like 100% on writing,

you know, finishing school and writing. And I think I got really serious about it. in 2007. So that was like halfway through college for me. I read Stephen King's own writing and, you know, he says, he reads every day, he writes every day, the first million words of practice. And that's when I sat down to start a novel. Before I know it, I had 100 pages and then I was like, well, I can't stop now. So yeah, so there was not a, you know, a light bulb moment for me. Yeah. I progressed over from a love of reading that just gradually went over. over to like, oh, I want to create these things that I love.

Yeah, that makes sense. Do you, how did your, like, writing process develop? Which I'm kind of asking to, are you like a plotter or a pants or like, how do you start once you have an idea? Yeah, so Panser and that a lot of Stephen King's process imprinted on me at this early age. I was like maybe like 20 when I read on writing. so for better and for worse but you know

I sat down and just started writing and seeing where the words went and that's how I usually do you know across the board like the first drafts I'll sit down with my idea and I'll go and go

and go into the end and I also allow myself to jump around you know I mean as I'm right let's say if I'm starting to write a story and I'm like maybe like a third of the way through I might have an idea for a scene

that's later that's kind of burdened of mind I want to kind of flesh it out So I may jump towards that or if there is a scene that's hard and I feel like it's impeding like the day-to-day writing process, I'll put in brackets. You know, I'll put like insert so-and-so you know. I'm going back over a draft right now and I'll see and I'll see. And I'll see. I was like, oh, yes, I forgot to go back and go to this. I've got to do that. That's a hard thing.

Right. And sometimes I'll do it almost like a puzzle. Like I'll keep writing around that scene and then and then as when I come to actually, sit down to write and I'll find that I field in a lot of elements around it. So yeah, so that's that's my first draft and then editing. I will like make outlines when it comes to like afterwards reading through write an outline or synopsis of it and then maybe look at that and think about what I may want to change there.

To be honest, it's very fluid like my process. You know, I'll do a lot of different things in terms of how I feel in the time. I do across the board usually do longhand edits. So I'll print out the pages and then I'll go and I'll sit down or lay down or whatever and go through and cross out, move around. And, you know, it does, it feels like there's a different aspect of my writing or my prose ability that I'm able to unlock doing like the long hand. So even though it's like twice as long, like sometimes after I'll sit down and like, you know, hand edit like 100 pages or so. I'd be like, now I've got to incorporate all of these. Yeah.

And it could take just as long because then I'm editing again as I'm incorporating it. Right. It's like a bird's eye view of my process. It's like what works for you creatively, though. Yeah. Yeah, yeah, yeah. And then I do like just the feel in Longhand. There's a story recently, a few short stories that I've written over the past year,

I've wrote entirely longhand. Oh, wow. And the second novel I ever wrote, like one of the truck novels that maybe on my shelf here, I wrote completely like longhand, like, you know, two to 300 pages and just in back, and back then I remember I tried to use the early days of like those speech to text. It was horrible. Yeah. It was it was enunciating every single thing and then every fifth word is wrong.

Yeah. So it was a process. Yeah. They're a little better now, I think. But yeah, I remember being like, oh, this is mostly is still just creating work for me. Yeah. Yeah. What about like your characters?

Do you do anything to get to know them before you start or is that kind of a panting process too? It's mostly a pants and process. You know, I've heard a lot of writers who will write like backstories for characters or put them into other stories. I've always been hard and I always thought like oh that would be great action. I think that with my writing process I usually will explore those anyway even if they get cut. I guess I'm writing I'll find myself going on some tangent with this character or doing like some backstory or you know bringing in some memory and then later that might be cut but it kind of informs the character. So yeah so a lot of times as I'm going I might realize as I'm writing about oh this character

you know, has this characteristic or, oh, this is what I want to say about this character. Or I need to change this around with them and then I have to go through and, you know, sometimes heavily, sometimes like slowly, like change that. I think a story I'm working on right now, I'm making a fairly big change in the character, in the relationship dynamics of the supporting character. It's like the end result is the same. but what the arc, what they probably did there. Yeah, what they

transition from. Going through and being like, okay, yeah, she wouldn't think that about that, that other character at this point. Or they would, you know, they would talk to each other differently in this point. That's more later when they would talk to each other like that. So yeah, so it's very much still a pants and process. It's, you know, one thing that's recently I've done like with the novel, I've written two stories, short stories in the last few months set in that world.

And one of them explores is like a younger Philando. So it's like 12,000 words of him, you know, having an 18-month-old pod and navigating like, you know, AI starting to take over the hospital as his son is hospitalized. So it's really cool actually to go back and, you know, be with him like in that world. And it's funny. I kind of did it backwards, right? You're doing your prequel. Yeah, like the book is already done and stuff like that.

So, you know, it's kind of interesting because I had to go back and then look and make sure that it's online, the stuff that's already, you know, cemented on the page. Right. So it's been cool. I definitely love to go back and sit with the characters that I've already made. Yeah, I'm intrigued because he's definitely a pretty intriguing character that I don't want to give spoilers away. but I definitely could I definitely could spend some more time with them basically. So with this one, hospital at the end of the world, what was your initial idea that got you going? And it sounds like maybe like your interest in medical stuff might have been a part of it, but how did that get going in your mind?

Yeah. So I entered medical school in 2013 and I went to medical school in New York. And I have written maybe close to mine, maybe like a half a million or a quarter million words like leading up in terms of like different novels and short stories. And I started to, and ultimately like learning experiences, but I started to take a step back from the longer projects and focus more short stories, especially since I was entering medical school. And excuse me, there was a call for submissions to this online magazine cross genres. and they had themed submissions. And I remember the theme was school. And I was like, well, I'm in school.

You know, and so I knew that it was going to be like a school story. And it's speculative fiction. And I had been writing horror and deviling and science fiction. So the idea came of, you know, like an AI versus medicine story. I had, you know, back then, AI was still very speculative, you know, in terms of what it's going to manifest as. And I was very interested in it from intellectual perspective and kind of a what-if perspective because I was also very interested in consciousness and it being this thing of like the final frontier and what makes up consciousness.

So I had always thought that AI is being like, you know, the general intelligence, the, the singularity, like having like an emergent property where, you know, like sky net or what have you, whether they're good or bad. So that was when I was going into this and then thinking, okay, what would the future look like if robots were in control of medicine and what are the implications of that? So it started off as a short story. I mean, at the time, I was a first year medical student. So all I had under my belt was anatomy lab and, you know, organic chemistry and more of the intellectual side of treating patients because the first two years of medical school is mainly lectures, you know. And then the second two years is more of the, is more of like a, when you're in the hospital, you have to be there at 5 a.m. And you're working under more senior doctors and residents or what have you.

So you're learning. So this story grew with me over time. It started a story, became like a novella. And then I became a novel. And yeah, I've been working on it on and off, you know, since then, to be honest. Wow. that's cool. It is really fascinating reading it because I think I feel like in 2025 and now of course going into 26 AI is an even bigger deal. You're hearing about it across the board and coincidentally I saw that

your book came out. I started listening to it and I was loving it and then my friend was like Kate you have to watch the pit and I was like really and he's like yeah you just have to do it and I just hadn't had time when it came out like the first season. So it was like I was listening, I was probably like 50% through your book. I started watching the pit and I was like, what is happening to me medically right now? But it was making it all more interesting too, just like all the hierarchies that you're kind of mentioning with in it and how like doctors do have to have the opportunity to learn as student doctors. But then the second season is focusing very heavily on AI and where it's ethical to use it medically. And I was like, Justin was talking about that

already. Yeah. Yeah. You saw it. Yeah. And I love the pit. Oh, yeah. And it's so interesting from, because when I first started watching it, I was like, how does everybody else understand this? I was like, I feel like I needed to go to medical school to understand. And it's so interesting because I think that it, It, you know, I imagine from someone who has it is not in the medical field, like 25% of it. It's like, what are they talking about? Right. And they don't slow down to explain it. It's almost for immersion, but it's still cabbating and still winning all these awards.

So it's interesting. Like, you know, I would wonder if I was screaming it myself, if I would be like, oh, I don't know if this needs to be made more digestible for the public or having me, but I think it's really well done. And yeah, and I think that those, that ask. of AI and not to spoil anything with the pit. One thing that I recognize is creating more work. I think it's one thing to go through, for example,

my own notations or what have you and find my own mistakes or have that Swiss cheese model, which they have in the hospital, where it's like maybe I put in the wrong dosage for order, and the nurse is like, this usually isn't the right order or this isn't what it was like before. Let me check if it gets past them, then the pharmacy is also like, hey, this doesn't, let me call it. This doesn't seem like this.

So there's like a Swiss cheese model that's supposed to, you know, somebody's supposed to catch it. And with that, I think having the mistakes that it, the differences that it made, I think it'd just be that much more harder if it's not in your, in your generated from your mind, I think. And I think that there's already, doctors already fatigued or what have you. So, you know, I would be even more nervous.

I feel going through and checking through that. Yeah, for example, like the self-driving cars, I feel like I'm the most nervous when I have that, when I'm trying like that beta or something, you know, yeah, you know, I'm much more aware. Like when I'm in an Uber for a human driver, I might fall asleep, but, you know, if I'm, someone's driving itself, I'm, you know, I'm looking,

just make sure it's not making like a mistake, or I'm thinking of like this scenario. Like, oh, is it going to know how to, to handle that. I don't know how I would handle that. So yeah, and I think that the pit touched on that pretty well. Yeah, it is a very difficult conversation right now to talk about it at all, just since everyone is really emotional about it.

And I think there are some really practical uses for like the language learning model part of it. Like you can kind of do some more research. You want to check your research after, of course. But there's like some of that or some of the summarizing for some. stuff is useful. But actually tying back into your book, what I thought was kind of cool is there is AI kind of completely proliferated hospitals, except for one. And you bring in this element that the essence of a human being is just as important when being someone's doctor. And I thought that was really brilliant the way you kind of handled it. So can you kind of talk about like

wanting to keep or make that a big part of the story. Yeah, you know, one of the, I think, cool things that it, that exists that allowed me to kind of run with that a little bit is the idea of like dark matter. And I think I saw just a headline this morning. I didn't click on it, but it was saying something about, you know, anti-matter able to be transported. So I don't know if it's clickbait. I haven't looked at it. But, you know, the idea of dark matter is, and I'm not an expert on this, but it's like something

that we know exists and we know affects the universe, but we can't show it to you. You know, it's so, and then if you think about, like, physics and the further you go into physics, it's very straightforward in the beginning, but then it becomes, you know, like almost speculative fiction itself. I still have my head around, like, you know, relativity and light travel. So, thinking of that, knowing that, like, going into medicine and knowing that, like, my thoughts of the innate value of human and human connection. You know, I wanted to ground it in science just so it doesn't seem hand-wavy. And it's one of those things that I imagine could completely be true.

Just like, you know, 200 years ago, if you're talking about dark matter, it's like, oh, that's just speculation. But now you can like point, well, we can't point to it. But you know what I mean? So that's where that idea came from, it being like some innate part of the universe, where they're even like the same exact molecule if it's synthetically made is different in some way. To, you know, the placebo effect thinking like thinking deeper with it, there's something about being seen by human, you know, similar to like the Schrodinger's cat or that quantum thing of like observing a particle changes it, you know. So that was like where I tried to not get too deep but to root it into like, okay, this could.

be possible. And then that made it easier to incorporate into the medical school. Because one thing I didn't want to do was have it, early drafts of this actually did do this a long time ago in the short story was like it was almost like a medical school that was seemed to be operating devoid of the hard science. It was just like it was based in. more in my thoughts of like what, you know, ideal human medicine may be and, you know, what it looks like outside of technology. So I wanted to not have it be seen as it's like more like

backwards or its harm. It's rooted in the science. And so the essence allowed me to do that. And then once that's incorporated, then like the downstream effect is like, okay, you have a bunch of overachievers that, you know, are going to, you know, make sure that they know the latest studies and do evidence-based medicine. And this isn't something that's just like, ah, you know, I don't know if that's important, like, you know, the connection with the patient. It's something that they're supposed to learn. It's part of, you know, their armamentarium for lack of better term.

Yeah. Like that human connection. And it, yeah, it was almost reminding me, too, of just like the empathy that you're never going to get to experience with like a computer or, a robot. And it's like when something's really wrong with your body, I would think I would prefer being able to still talk to someone, even if AI can be incorporated in useful ways, which I think is always important to remember with any technology that like it's also only as good as how people are using it. And some people aren't great and some people are. But you can always find

uses for it. It just doesn't need to be the only thing. I think is like one of the important. parts as well. I also thought the world building was kind of fun. Like with your the, so the, there are two newspapers or like newsletters that go out, like the daily hippo and the second opinion. I love when a book is like really related to a certain like realm and then like commits to like coming up with cool things that like fit the theme. So did you just, I see, I'm assuming.

as a Pancer, you were probably kind of discovering that as you wrote. But what was it like building out the world? Yeah. So interesting in the, it was almost emerged, like I went far and then I came back. And what I say with that is that originally, like, you know, back in 2013, and for a while, this was set like far in the future, you know, where, you know, the world was almost not recognizable. It's almost kind of, almost like fantasy in that sense that, you know, there's geographical lines were broken down because, you know, and you might have a city that's, that has territories on one, on both sides of the world and things are broken down more by, you know, like time zones are different, you know, since everything's virtual and there's

like hyper, hyper speed travel. So all of this. And then at that point, really like, really, like the AI was fully taken over or what have you. And then so technology had gone far in the future. And in contrast, the medical school in the city was far in the past. They didn't have electricity at all. So I remember for a while I was studying, you know, how like, you know, medieval cities worked.

I think I took one of those, I forget what it's called, but those online courses, I think it's the great courses or something like that. Okay, yeah. You know, about how like old cities worked. And then the, let's say the last several years, I decided to bring it a step into the future, which actually allowed me to then not reinvent the wheel. And then I could focus on, like, things that I'm familiar with. Like, for example, I did medical school in New York City, and I spent

five years there. And I can imagine in 20 years in the future, the trains will probably look largely the same. You're still going to have broken elevators. You're still going to have air conditioners hanging out because that's what we saw like still 20 years ago. And then I could focus really on like the technology. And then it also allowed me with the city, Hippocrates, okay, maybe, you know, they're not completely off the grid, right? Like they, I don't have to take them back to medieval times. You know, things are more, their resources are more ration. You know, they're more like tempered in terms of like what technology they're adopting. And then a lot of the elements though of that far future

where there, like a lot of the naming conventions because, you know, if it's like 200 years in the future, everything has like a new name, right? Like I changed their speech, etc. I had to keep some of the things that were fun, you know, like calling the cafeteria of the white doors, you know, or, you know, thinking.

Like, so that far future, I was actually, those two newspapers because it's like we don't have online anymore. So what would paper like, what would paper news look like again? And then I, you know, I like those elements. So I decided like, how do I keep it?

How do I bring that back, you know, back to the present or the future? Yeah. I also thought it was really fascinating because you also kind of explore what these students would be thinking. So like most hospitals are running on AI, but POC is in one that is not, it's not run by AI. And so the training that they get is so vastly different to work in a to work in a really AI hospital. And so they're even kind of working more theoretically. And I don't think it's a spoiler, but there's like one point where someone is like, well, I was fine with blood when I was just like doing it in an AI model. And now that I'm having to like actually touch a person and help them and see blood, I can't handle it.

which is like even if Aal was really popular or not popular really working well in these other hospitals it would still be pretty practical that we would need like people who had had like the real life experience with it too um so were you trying to kind of just like think of all the different ways that it would change medicine yeah you know trying to think of the ways like positive and negative um i think that um you know i think it can be a very powerful tool and I'm I'm mainly thinking, you know, because when I, when I first started the idea of this, it was before, I'm sure large language models was someone knew the term, but it was before like the general public knew the term. I was thinking more of, you know, the ability to analyze like large, large datasets and to be able to take them like insights. And I think that can be very powerful for medicine, especially from prevention, you know, I can imagine that like if, some powerful system had like all the data, what have you and looked through it. It might show that the change in rate that a person blinks per day could be an indicator

that they might are going to develop like depression or psychosis or cancer, right? Like something that we might never even think of where it'll just link those two, maybe not even be able to tell you physiologically why it's linked, but then it's like, with all that data, things that we may not even be able to be aware of, like how much further out could we you know prevent certain things um when it came to the hospital you know thinking about those positives people having buy-in from those positives and then you know bringing in the whole uh just all of the implications with it right because you know so i had to think about you know how would society might change right and when what big thing may happen where

you know, they went over the favor of people, right? But they give something like a pandemic. And if people are very frustrated with like how humans have run things and then there's this company that comes in and says like, hey, you know, we fix it fairly fast, then they might be like, you know, take all of my, you know, take all of my doctor. Yeah. So then I'm able to think about, okay, what's the positive? What's the negative?

And it's interesting. I think that there's a line to, to walk. because for example like you know Pock is a medical student or medical school hopeful like how it could be used as a study aid right you know and thinking about being in med school myself and constantly trying to figure out like what's the best way do I do flash cards is it like more immersion is it like what is it like there were some people who would like wouldn't go to the lectures but they would they would look at the slides and they were like I look at the I go through the slides like three times a day. And, you know, everyone has like these different things. So I did think of like it would be something powerful that could analyze how you're doing and over time being like, hey, this is how you study. Yeah. Even if you take it too far, are you blunting your ability to kind of learn yourself? Yeah. Yeah. Make decisions. Yeah. Yeah. That's, we don't want to lose that ability. Yeah. Where people think they have to ask an AI.

about literally everything. The other thing I thought was really interesting, too, is for the, so Pock's dad, Philando, he is kind of practicing this more personal one-on-one medicine with people that they live near at the beginning. And he has honey that he uses for a lot of stuff. And I know historically, honey has been used for really, like, healing process. So is that kind of what made you choose honey for the more like natural practisers still? Yes.

I think that it was, if I remember, I think there was like an interest in using it. And then I looked it up and I was like, oh, okay, I can keep this as missing. You know, one of the things, I remember for entering med school, I had done a lot of research on bees. Like there's some books on here about like bees. And I was doing research for an idea for a book. I actually hope to actually 13 years later, actually start writing on later this year. But I was studying the biology of bees, et cetera, et cetera.

So I think I already had in my brain like kind of a fascination with them. And just thinking about, you know, when this was like further in the future and they didn't have, like we couldn't, didn't have access to producing medicines. Like, you know, what would people use? And I think that I did, I do have an integrative medicine somewhere in this her book somewhere on this bookshelf.

Yeah. I remember just it made sense in that, in that setting. I do remember somebody reading like an early draft, one of my writing friends, and was like, oh, this feels like a placeholder. And I was like, I like it. So I'm going to flesh it out. So it feels legit. Yeah. So sometimes I take feedback like that.

Like I'll like that as a defensive thing, but like, oh, I really like this element, but it's not working for someone else how it'll be cool if I could make this this seemingly off element shine you know sometimes it's kind of a challenge in winter revisions yeah I think it's um like getting feedback on something you've worked on sometimes especially what I'm trying to say is especially if you can shift your mindset into I'm like really close to this project and like my brain can never see it as fresh ever again. I feel like that's like where it's really important to have other people who have it who are now going to be like consumers of it or whatever, be able to give you feedback because you can't get you like can't get out of your own head in that way. There's like

nothing you can do to see it for the first time basically. Yeah. So it is good. You can take the feedback. Yeah. Getting you know, getting feedback has been a big part early on of my writing process. Yeah. And you know, And I hope to never lose that need. Like even right now, like, I'm finished up this draft of this novel to get to three of my friends. We critique each other's novels. We're all writers. And even though as early, there's some things that I feel like aren't fleshed out, I, you know, getting other people's eyes and, you know,

and seeing like what resonates, what doesn't, what doesn't, et cetera, you know, am I just completely off the mark? Or is there something that's, like, offensive? Or if I'm, you know, using some trope that. I didn't even know about. That's been pivotal, I think, for me, every step away from short stories and novels. Yeah, I like that. I don't think it's a spoiler, but you can tell me if it is.

It's also dealing with what does it mean for a like mega corporation to be the one with all of this data on all of the people and the implications of that, basically? And were you kind of drawn to it? exploring like we don't want a monopoly in medicine essentially is kind of what I was taking away from it. So is that something you wanted to explore? Did it just kind of come up as you were writing it? Yeah, definitely. I think it probably came up and then I was like, oh yeah, you know, I do think this about it. Yeah. Because it's interesting. I think one of the one of the interesting things to

see play out with AI and just technology in general is where it's going to take advantage of the flaws of the current system like a feeling again and i think that right now there's some things a lot of things about medicine that's too disconnected you know like i you know i'm a practice psychiatrist and i see patients and you know it's all the the medical records aren't connected you know um like the patient could have all of this history that i have no quick access to right right and that's for better or for worse, right? I think that there's, like, if you think of it, I think that there's a secure system, you know, all protected on the HIPAA, but where a physician, you know, who's trusted to, to begin care is able to see that like quickly. I think that that would be great, right? So then I could see

someone taking advantage of that thought and being like, hey, we have this company where everything top down is just involved. But then I wouldn't want a system where or a company that, you know, employees the doctors, owns the hospital, owns the insurance, owns the pharmacy. Because then, especially when you're thinking about AI or algorithms, if it's like in the system, are they considering all of the interests, right? Like, you know, is bottom line being included in this algorithm? Is it becoming like bigger than just, you know, the physician and the patient? I mean, you know, not to get into any conspiracy theories, and I don't know the actual details of it, but you hear grumblings about like when there's like a plane crash and there was like some safety issue,

some that there might have been like a bottom line somewhere that says that it's actually like, you know, it's cheaper for us to deal with a crash than to fix this issue. Again, I don't want to get, you know, but those are, I think that those are, even if it's not happening actively, I think that when you're giving it, you're feeding it into the system like these cold AI. And we still don't know exactly how they come to their decisions. You definitely see, like, you know, without them even trying to be nefarious, those starting to be part of the calculations. And then another aspect is, too, is because being a doctor, all doctors spend a lot on malpractice.

Right. And if I have a system that's going to suggest something to me, and then it's automatically the fact that it's suggested means that it's like written and it's documented, even if I disagree with it, I'm going to feel like I'm going to feel a push towards following it because bad things can happen even if you do the perfect things. But if something bad comes up and then if a lawyer is like, yeah, but the ad told you to do that. this, you know, then you're, you're liable, right? So how much is it going to affect like people's practice, you know, even if it's like suggestions that they, you know, might inherently know, like this isn't the best interest of the patient? How are they going to go away to need to follow it? Yeah. I thought it was interesting too where you, because you talk about like, there's like that, like the patient level. And then there's like, like the macro level of data where it's like, uh, like

there was something about like raw data doesn't lie but selective data can lie. I thought that was a really great like there's a whole paragraph or a couple paragraphs breaking down like what that means. But I thought that was such a great way to show like sometimes we think like oh it's data so it is factual and that means it's 100% true what they're saying. But like you actually can craft some narratives with data, especially if you're in control of like, what is like making the data essentially. So I was just like, yeah, this is this is not where we want to be headed. Yeah, yeah.

And I, something that comes to mind, like early on, I remember in college, I was taking like this eco-biology course or something like that. It was actually like abroad in Australia. And one of we did research projects and one of my group, what we had to do was like look at this big tree. And then we would. put data points on how different sections of the tree, how many birds were there over time, right? And then try to bring some insight from it. And I remember actually looking at the numbers,

it seemed random. It seemed like it didn't make sense, you know. But by, you know, trying to find something there by shifting around was able to make this full narrative that sounded plausible just in terms of like, oh, you know, when, when there's a bunch of, when there's a lot, either a lot of birds or few birds in one area. They spend less time foraging and more time, like, focusing on each other because, you know, either there's a lot of competition or they're wary that things are scarce. And then you see, like, them focusing much more on the food in the middle. And I think it was completely random made up, but the numbers, I made it so that the numbers

actually supported that. So very early on, I was, you know, I've had the thought of, you know, like, you know, going in, having this data set of numbers, knowing that our brains as humans are designed to make narratives out of it. And then if you give it to AI that are kind of like descendants of us and we still may happen that, you know, you see with these large language models, they're designed to make it feel like a coherent story going forward. So I think it's already baked in there for them to bring out meaning where meaning may not be there. Yeah. Yeah, and that gets really tricky. What was the other thing that that was just making me think of?

Oh, you have this other really cool sentence at some point that talks about how healing is art meets meeting science. Yeah. And I kind of love that because I think it actually, it almost thematically sums up the core story, like that it's not just science and that there is an art involved to it as well. can you kind of talk about like what what you meant like specifically with that? Yeah. And early on also in my medical school, we had a class. I think it was called the art and science of medicine. Maybe it's the art of medicine, one of those.

But thankfully, I think my medical school was very, was progressive about this. And actually, I think half of their students came from humanities background. I think they had a program where like half of the students actually didn't. finish the pre-mail requirements. I was actually, it was funny, I was like a humanities person, but I did do the pre-mayor requirement, so I actually didn't count. The author in a group didn't count towards that. So even more of my classmates came from these, I think, diverse education backgrounds. And the idea from very early on is that, yes, we have, we have this science, we have this data, but know that like in 10 years, 50% of what you learn, it's going to be

like obsolete or we're going to know something different. So, you know, those are going to change, what we want to focus on early on is how do you sit with a patient? How do you, you know, how do you, you know, notice sick versus not sick, but, you know, have intuition, but also be able to challenge it. How do you deal with, you know, difficult emotions? How do with the physical exam, like what are different techniques that you can do, like, in addition to or supplemental to, like, your instruments? We have scans, we have stethoscopes, we have ultrasounds, right?

But also learning, like, they showed us this thing where you put the two fingers on the body and you percuss. And then you can learn to listen. I was never good at this, but learn to listen of like, you know, hollow versus, you know, different sounds. And then you'd be like, oh, this is how big the liver is before I even do like an ultrasound. So, you know, being able to not just rely on the technology. And you see, for example, in the pit when they walk into the room with the patient, they look at the patient. They're not walking in and immediately looking at the scans or et cetera. You know, I think it does, even think of it now, it does it really well.

Like laying eyes on the patient is very powerful because it, there's from experience over time. you know, there are things that we can learn to like recognize or intuitions or what have you in addition to, you know, the technology. Because there's also aspects where somebody looks fine. And then you're making something and the technology helps with that. But then there's also an aspect where the technology could say that everything's fine, but it's like, but this patient isn't fine. Like let me ask more.

Yeah. Yeah, it's got to be both for sure. There's also a chapter that kind of gets into. the fact that to your point, that AI is our descendants as humanity in the sense that it is like it's learning from what we know. And then with the speed of computing and lack of emotions, it can do different things with data. But you do have a chapter where it's like even AI ends up having biases against minorities or in general non-white patients. I think that's, I'm assuming you were kind of even coming from that from, we're already like that.

I just interviewed someone who wrote a book called The Cost of Healing in Silence, and it's about how there should be racially, racially inclusive healthcare conversations. So, yeah, can you kind of talk about, like, how even with AI, there's even some of those discriminations that could still happen. Yeah, I definitely think that some of the things that we're still working through and getting better at can be baked in to these models because of, you know, the way that they learn. You know, if you even think about like the large language models. Yeah. The idea is that really even, I say if you ask it to create like a new story, you know, it's pretending to be new, but it's derivative in a way.

And it's, let's say if all humans like stopped writing right now, you know, and it was just good. Like it would be, it would kind of be frozen in time in terms of like, you know, not progressing. Right. Like human arts may progress and ideas may change, what have you. It's really just stuck on like what it is that we gave it. So I think that in the same way. Like if we give over the reins to medicine and then, I'm sorry, of medicine. to AI and then we look to it for our kind of like advancements.

Yeah. Even if it feels like it's progressing us, is it still like holding us back in some ingrained in ways? And then are there things that are going to be baked in that then it becomes like a self-fulfilling prophecy where it's like generations from now we have these disparities because it started from like childhood based on like the, you know, the decision that making um because right now you know to be honest not to get too much into it but you can see it now in the political discourse where it's like oh you know we're removed from you know it's been 200 years

you know since slavery for example so you know everybody's on the same footing now like those but if you go back and you look and you know um my mom already tells me about like certain grants i think for home ownership that she wasn't eligible for right and And then those things trickle down, like me being a doctor and a physician now, you know, my life and what I can do, et cetera, it looks different from some of my colleagues who, you know, may not be as first generation as I am. You know, I recognize that my kids are going to be like maybe like a generation or two behind of some of the colleagues that I have.

So the reason that I say that is that even if you seemingly seem removed, if you just look like top down, it's like everybody has the same opportunities, everything, the same, you know, it, then it may cover up what some of the disparities are. And I can see that happening, like, generations away from AI. It's like, when we look at it, it's like, okay, it doesn't have any bias towards this, but it's so kind of baked into the system that it's hard to notice unless you, like, go back. Yes. That's what you were just saying. So I'm reading Chain of Ideas by Ibramax-Kindy right now. And he has a whole, there's a whole chapter where he talks about racial inequality data and how actually we should be just considering it

inequality in data in general is like part of the beginning of the chapter but he would he talks about some different countries that like post holocaust were like oh the thing we should do is not collect any racial related data like we shouldn't do that because maybe that's what like led to the Holocaust, but actually it's still always going to be really important to have that data. Like we do need to have that data to be able to see what you're saying if there's, if there's different treatment happening for people and it's just maybe because of the color of their skin. And so it's also important for those things, whereas it's not even always that maybe

it's bias is malicious in general with AI, but it may not be able to take into contact. a lot of what you're saying there, like, even, even like from a trauma perspective, like you said, like, yes, slavery was 200 years ago, but segregation only ended like 61 C years ago. So like there's a lot that is still worth knowing. And it's almost like saying you're colorblind when like that's not what you need to do. You just need to not like judge people based off of like their ethnicity and all of that. You still want to see it. and you still need to like know all of those things so it was wild like i listened to your book and

then i've been listening to his and i was like i'm just here for the data i guess right now yeah yeah and how it can look different yeah and real quick and you know historical context i think is is very important um and i think of it in medicine um i believe i read medical apart i think it's by harriet waston i'm harbord somewhere on this book show um it's like research a while and it just, you know, detailed a lot of the different, you know, basically experimentation on marginalized communities. You know, we know about like Tuskegee, but it's like, you know, juvenile hall system, you know, Marion Sims, like the father of OBGYN did, like, you know, progressed a lot of the surgeries on, you know, so, um, I, so what, what, I think having that knowledge,

going into medical school, I think is important because I could see a lot of the tension between communities that look like me, black and the hospital system. I think without that context, it doesn't, knowing that context doesn't make it less stressful for the doctor, it doesn't make it at times like emotion is going to come up. But I think knowing that context, I'm able to better understand it, whereas someone, let's say one of my colleagues who comes to him with all the best intentions is, you know, they, without that context, they may just think that like, oh, this, this person doesn't, you know, trust me as a doctor. They're not appreciative, et cetera. They don't know where all this is coming. And then it just leads to, I think, more mutual resentment. I feel like

I've seen it happen in real time, you know, and just being able to say, like, you know, it makes sense that, you know, that you're wary of the system. So it can be very, very interesting, I think, having that context and just seeing it like throughout my career. Yeah. And recognizing what people may not have that context. And then it just makes both sides worse. It just then reinforces to, you know, the patient that like, oh, you know, this, this, this doctor isn't here for me.

They don't care about me, et cetera, et cetera. Yeah. You know, so it could be very tough. Yeah. We need, we also like need a little more awareness in general about some of these. That's what I was interviewing. she's a psychotherapist as well. And so like her book is about why you need to have understandings of other cultures if you're

going to be treating other cultures. And then she's black. So it's mostly about that culture. But she talks about other ones. But when we were talking, she was even mentioning. And somehow I didn't even end up being aware of this during COVID. I didn't realize that the like the pulse occipitors weren't working on non-white skin. as well. And it's like if you were, if you experienced that during COVID, you're always going to be

defensive or like defensive when you're going to the doctor. You're like, you didn't even know that this couldn't actually help me. So it is. It's like I just, yeah, I can't imagine having to kind of like advocate and then to be advocating against AI essentially. Yeah. Yeah. It would be real. And you know, it's a tough line to because like so for example, even of COVID and I'm talking about, you know, as a health care provider, I was. was a very early adopter. I was one of the first people to get the vaccine. And I'm fine, right?

Yeah. Same. But it's interesting because then it's like you, and I think this is simplifying it, but I saw two different, two different camps of like anti-vaccines. I saw like people that I, you know, that I can understand like why, you know, people that look like me that's like, you know, we have this history of being done wrong by, et cetera, why should I trust this? And, you know, actually I would, you know, jokingly say to them.

them. I was like, hey, but look who's getting in line first for these vaccines. That's a good point. It is interesting because I think I even heard that they had set up, because I live in Los Angeles, they had set up like places to get the vaccine and more like marginalized communities. But people who had access more to technology, like using like apps to find, like the lines were actually more fluid people, you know. And then, you know, and then you have the camp that are more, you know, science than denies. I feel like maybe that should know better, but have less, for me, have less of a kind of a understandable reason. So then it's tough because it's like, how do you tow that line?

And it ended up having like some tough conversations too, you know, where it's like, all right, well, you know, we should make sure that we're understanding where people are coming from so that we kind of criticize it in the right way or inform in the right way. You know, so for example, me tell me telling family members like, like, hey, look who's lined up. Like that's, that's going to more so align with them and maybe like, yeah, you're right. Versus if I say that to the other group, they're going to be like, yeah, I'm not following the elites or something like that. Yeah. Like the people who thought there was going to be a chip implanted. Yeah.

Yeah. Be swayed by like, hey, look who's getting it first. Yeah. Yeah. It was such a weird time. And I have asthma. So it was the same thing where like I was able to get it. the vaccine pretty early. And I was like, I mean, I can't get super sick with something respiratory

right now. So it was very intense, which to your point, though, that's kind of for your story, kind of like having that much uncertainty would make a population of people want to be like, oh, this one company figured out all these AI reasons and it's going to make hospitals better. like you are more likely to try something that could be like morally compromised or like in a gray area if you felt desperate for a really long time. Yeah. And if there's like, you know, distrust of people, I think that it. Yeah.

It appeals to that. You know, this, this AI can't hurt me in the same way. And even if it does hurt me, it's not going to feel it's personal. That's true. Yeah. Yeah. So I think that's a complicated thing to kind of to navigate to, especially when you hear about, you know, people use them chat bots for like their

therapists or what have you. That is alarming. Like I understand getting maybe some advice if you're giving some really specific parameters. And I also understand the argument that not many people can pay for therapy right now. But I don't, I would not want to. be doing like deep. I did therapy for like 20 to 28. So I did a lot of it and I would not want to do that with something that's kind of geared to tell me like, yeah, you're right. Yeah. Sometimes I'm not right. Yeah. Same. Yeah. And I do a lot of therapy as a psychiatrist.

It's one of the things that drew me to it. And again, it's tough because, you know, if you tell somebody like hey you shouldn't use it they might be like well I haven't been able to find like actual therapist my shirt I don't know recovery etc etc so that's where I think that it's unfortunately it's going to be ripe to come in and fill in like these gaps that we should be fixing in other ways you know so I know I feel like our government could be um more geared towards social services which is typically what your goal is with a government when you start it um like I have a friend in Bain when we were talking about in our book club, like, I don't know, like, I don't know if I can go to the doctor for that. I don't know how expensive. She's like, you guys get doctor bills? And we're like,

yeah, yeah, we do. And it was like such a reminder to me again where I'm like, we're so heavily embedded into capitalism at this point. But it's like, it's not helping people maybe get to actually see a therapist. And then the fact that the loop then goes to them getting AI therapy is not going to make anything better. So I don't know. I hope we can change some things in health care, but I know that's always a slow thing to do, especially at the government level. Yeah, what scares me is if insurance is going to, like I can definitely see insurance being like, hey, you need to use this, this $20 a year for us chat by therapists first, you know, because they're already set up to do that in a way. Like I'll prescribe like a medication to a patient

I think it's the best medication for them. And then they'll deny it. And be like, you need to use this medication that cost us less first. And it's like, well, I would have chosen that medication if I thought of the best one. But yeah, I run into that with asthma. Oddly. Like there are so many different inhalers. And it's like, like powder inhalers.

I still am not on. I still don't have insurance that makes it less than like $300, which is crazy. Yeah, it's frustrating. And then no one wants to sit on the phone with. insurance customer service. That's never fun. So yeah, hopefully I don't know. I don't know who will, but hopefully we can get some changes there. I think that obviously privatizing insurance was a dangerous move. And then I feel like your book is almost kind of like privatizing healthcare. We don't want to do that at a large level either. Yeah. Yeah. It's so frustrated to work with like

insurance knowing that they're that they have probably whole in whole apartments departments to deny claims because they didn't make more money it's like you know i don't think i've ever gotten the claim approved and it's screwed me over a few times as i'm sure it has for multiple people um well obviously i loved your book and i think there's lots to talk about with it i think there's lot if it if you're a book club that kind of leans towards speculative fiction i think you would be a really good book club book too because of all these topics that you and I are even talking about so everybody needs to go read it or listen to it um because I just I really loved it but I do also always ask at the end if there's anything you've read recently that you really loved or if there's just a

book you love that you like always recommend to people yeah see so um what have I recently I've read some good stuff. He was going to go. So from horror, um, incidents around the house scared the, you know, yes. I said that was really well done. It takes some getting used to, but I thought formatory was great. I loved that one. I'm current, I forget, I'm currently reading butter. Oh yeah. I just seen it. Yeah, from my book club. It's a fascinating character setting. Okay. Okay. Curse of Hester Gardens by Tamika Thompson that's coming out soon that I was able to read an early copy of. And that was great.

And I feel like there's something in my mind that I'm like, oh, yeah, later, I'm like, oh, I didn't talk about that. But those are some of the things I've read recently. Those are good ones. Yeah. Yeah. That's awesome. Well, where can people find you to stay up today with everything? Yeah.

So, um, Justin C.key.com. C is important because there's another Justin Key who's African American who has a beer in Los Angeles who's in entertainment and he just got a PhD Oh my gosh Another doctor Justin Key

And his middle initial is D So that's what I have to see So Justin C2 And you find on Instagram Don't judge me if you go on TikTok I'm trying to find my footing there Yeah And yeah

I'm a scroller On TikTok talk. Yeah, so definitely you can find me. Awesome. I'll put those links in the show notes for everybody. And otherwise, thank you so much for talking with me about it. Yeah.

Thanks for having me. This is a great conversation. And, you know, natural fluid conversation. It's nice to talk about this stuff.