How AI Could Strengthen the Doctor-Patient Relationship: Dr. Ashwin Vasan, Senior Fellow in Health Policy and Global Affairs at Yale School of Public Health

Lindsey Smith

Hi, I’m Lindsey Smith, welcoming you to Raise the Line with Elsevier, an ongoing exploration about how to improve health and healthcare.  

According to the American Medical Association, one of the top concerns physicians have about the use of artificial intelligence is that it will harm the patient-provider relationship. But today’s guest believes there’s more to the story, and that physicians should play a central role in shaping how AI is designed and implemented in healthcare. 

Dr. Ashwin Vasan has more than two decades of experience as a physician, epidemiologist, and health policy leader across public, nonprofit, multilateral, and academic sectors in the U.S. and globally. As the 44th New York City Health Commissioner, he led public health strategy for more than 8 million New Yorkers, navigating successive COVID-19 variants, the mpox outbreak, and a deepening mental health crisis. 

Under his leadership, New York City became a national model for responsible health innovation, launching first-of-its-kind programs, including NYC Teenspace and other technology-driven initiatives addressing chronic disease prevention, maternal health outcomes, and crisis response systems. 

He currently teaches at Yale as a Senior Fellow in Health Policy and Global Affairs, and serves on the boards of the Child Mind Institute, OneMind, the Mental Health Coalition, Inseparable, and the Milken Institute. He’s also an Operating Partner at Commonweal Ventures, where he works to bridge the gap between government and technology to better serve communities.  

I’m looking forward to exploring his perspective that AI could allow physicians to focus on the human side of care if it is governed thoughtfully and implemented strategically.  

Dr. Vasan, thank you so much for joining us today.

Dr. Ashwin Vasan

It's great to be here.

Lindsey

So to kick things off, and before we get into AI, I'd love to hear a little bit more about your personal journey and what sparked your interest in medicine.

Dr. Vasan

I had a really strong family influence. My hero – and I think it was recently International Women's Day -- my hero in medicine is very much my mother. She was a physician, a neonatologist, took care of premature babies and some of my earliest memories are tagging along with her around the hospital. I just saw so deeply the kind of reverence with which she was held, but also the really strong commitment to service and to impact that she had.

That lasted throughout my life because I saw these babies and their families kind of grow along with my mother and every year they would kind of keep in touch. So that really was inspiration that she was making an impact today, but also that would last the lifetimes of these families.

My father was an engineer and in many ways fostered kind of a broader systems thinking that I can also trace back to why I'm interested in things like policy and larger scale problem solving. So it's really that combination of the bedside kind of service, patient-oriented culture that my mother showed me and then this broader systems view that my father constantly exposed me to. I feel very lucky to have had those role models in my life.

Lindsey

That's awesome. As you mentioned, your connection to medicine started early following your mother's path. You saw firsthand how transformative that compassionate care can be. It sounds like both the experience from your mother and father really kind of laid that foundation for everything you've gone on to do since then.

Dr. Vasan

Yeah, they were such great role models and a lot of what I do is just to make them proud but also to carry on their mission and the way that they live their lives and the impact that they wanted to make in the world.

Lindsey

I think that foundation makes your early career even more interesting because you decided not to stay close to home. You stepped directly into some of the most challenging public health environments in the world when you worked on HIV and AIDS and broader public health initiatives across several African countries. Can you talk about what pulled you to do that work and how did those experiences shape the way that you lead today?

Dr. Vasan

Yeah, just tracing it back to my origin story, I think really understanding where I came from and the fact that I had family members living in conditions in India that were so different to the ones I grew up in here in the US and kind of this notion of two worlds and deep disparities. It also shaped my focus on kind of working back against those disparities and also focusing on prevention and some of those broader systems that impact health.

I was really taken by economics and public health early in my career. At the time, we were really facing this huge challenge of HIV, the last real pandemic that we faced when I started studying public health at Harvard in the early 2000s.

The global health field was gaining massive momentum with the launch of things like the “3 by 5” initiative, which I would go on to work at in at the UN and at the WHO; the launch of the global fund to fight AIDS, TB and malaria; and the growing global commitments for things like the Millennium Development Goals. It felt like a real moment of inspiration and collective energy and action. It felt like the world was coming together to tackle big health challenges.

I remember being both a student and then early in my career, feeling like, wow, I want to be a part of something much bigger than myself. I want to marry that with my interests in health, in society, in science, in policy. There was no more important issue than HIV at the time.

The last thing I'll say is just knowing that I wanted to go directly to where the problem was. At the time, the problem was how do we get these life-saving AIDS drugs from the global north into the global south where the vast majority of cases were. That meant not only working at places like the UN and the WHO, but also going into countries like Uganda, Rwanda, Lesotho, Haiti, India, -- places that were facing this disproportionate burden --  and where we felt like we could make a difference with this global momentum and collective priority that was really built in global health.

Lindsey

I can imagine those years had a profound impact on you. Something you mentioned just a minute ago was you were running towards the problem and trying to solve that problem. We're going to talk about another pandemic that you had a very important role in. You stepped into leading New York City's health department during and after COVID. Looking back, what are a few lessons that stayed with you from that experience?

Dr. Vasan

It was a really challenging time for all of us. I remember not only those early days, but the listeners will recall that New York City was very much the epicenter of the COVID pandemic in the United States and one of the epicenters in the world. We faced, particularly early on in 2020 before I became health commissioner, enormous tragedy and enormous loss and enormous trauma.

I was both running a nonprofit at the time, as well as being a clinician. I remember just a lot of fear and a lot of pain during that time. In the following months and years, as I took over the health department and as health commissioner, I think I learned one major takeaway, which was how essential public trust is to public health.

You can have the best science, the best tools, the best interventions, the best policies, but if communities don't trust you, don't trust the institutions that you represent -- government in my case -- it's much harder to protect health at any sort of scale, particularly against an emergency. Ultimately, public health is the marriage of science and society. It doesn't matter how good the science is if you don't have the trust and the skills to bring society along with you. 

It also reinforced that we did some remarkable things with the vaccination effort, with scaling up testing and treatment. We were the first city to do mobile treatment where we would deliver treatment into your home if you couldn't make it out.

It also reinforced that public health is so interconnected with social conditions, things like economic stability and housing and healthcare access and affordability and mental health. COVID really exposed these long-standing disparities. It reminded us that improving health at a population level demands that we fight those systemic factors as much as any vaccine or any pill and that we must come together to do those things. Our fates are intertwined, your health is linked to my health, and the solutions are often grounded in the things that we can do together as much as any individual steps we take.

I learned both that public health infrastructure is something that needs tending and needs investment and that we weren't as a nation or even as a world quite resilient enough in our public health infrastructure. Whether it's data systems or community health workers and partnerships, it requires ongoing investment and upkeep, whether we're responding to a crisis or managing ongoing health challenges.

Part of what we need to do is not only invest in what works, but also embrace innovation and move innovation faster, whether that's embracing technology use in strategic ways or modernizing our system and our workforce. Public institutions need to evolve and to grow and to keep a pace with how society is innovating all around us. The pandemic exposed that we still have some work to do to make that true.

Lindsey

Sure. I remember this was a very turbulent time. I actually have a personal story to share. I remember sitting in the hospital after having my son on March 2nd, 2020, watching the news from the hospital bed about New York City, the epicenter, when everything was just starting to unfold. We didn't know a lot at that point. It was a very surreal moment for me personally.

Dr. Vasan

It was so surreal. I was running a nonprofit called Fountain House at the time, and we had to shut down all of our congregate programs. We actually did so about a week before the city did, which turned out to be quite life-saving for these really vulnerable people, people dealing with mental health conditions and homelessness and a whole lot of social instability.

I was also called back to do clinical work, both in-person and telehealth. I just remember how afraid everyone was. I myself and my own family was deeply afraid. Yet so many of us swallowed that fear and metabolized that fear and pushed on, especially first responders, especially essential workers, especially doctors, my colleagues and nurses, and everyone managing the health response.

That really has an impact over time if you don't deal with it. One of the things that makes me a little sad about the aftermath of the pandemic is that collectively as a society, it doesn't seem like we want to deal with that. It doesn't seem like we want to talk about it. It seems like we just want to pretend it never happened.

I don't think you move on as a people unless you reckon with the past and reconcile it inside yourself, let alone with each other. We all did the best we could, but we can't move through it unless we talk about it.

Thank you for sharing your story. There are so many stories like that I've heard of moments of joy juxtaposed with moments of pain and real tragedy and loss, alongside moments of personal fear and insecurity. We all went through a lot, especially in New York City. I'm glad we're out of it now.

Lindsey

Absolutely. There were so many healthcare heroes that shined during that time. We've heard from other guests about some of the mental health challenges that came along with that time and hopefully we'll be able to get to that here in a little bit.

I want to shift our attention to innovation, particularly AI and medicine. When you think about the patient provider relationship, where do you see the biggest opportunities for AI to strengthen that connection?

Dr. Vasan

Yeah, that's a great question because I think often we talk about technology and AI specifically with a lot of fear and a lot of worry and rightfully so because there's a lot of change happening all around us.

I'm not a technology optimist, nor am I a pessimist. I am in many ways what I would call an “inevitabilist.” That means it's happening. So, I think it behooves us, it behooves your listeners and everyone to engage with this technology, to learn it and to not simply fear it or promote it, but rather help steer it in the directions that we want as a society and especially physicians and trainees to really think how is this going to impact my work.

If I am being optimistic for a moment, I'm hopeful that AI will help clinicians get back to the very basic reasons why we went to medicine in the first place, which is to help people. None of us went to med school or spent all those years training or went into practice in order to sit in front of a computer and fill out electronic health records and stay on the phone with insurance companies and fight billing and make appointments and referrals.

There's a promise of AI to reduce that burden, whether it's administrative tasks, documentation, data entry, patient navigation. There are lots of ways in which AI is already starting to reduce that burden. There are ambient listening scribes, automated reads of radiology or laboratory results. There are many ways in which AI can hopefully free up more of our time as clinicians to actually do the things we love most, which is spend time with people and be their counselor and be their shepherd through a complicated system and through difficult moments in their lives.

I hope that AI can help responsibly reduce that load and increase time and presence and give us back the chance to do meaningful communication. So often I've been in a position as a primary care provider where I felt stretched. In many places, it drives people out of care because nobody wants to sit with patients for 15 minutes where most of their attention is drawn towards the computer. Abraham Verghese talks about the “iPatient,” these terminals we sit at in order to interact with an actual human being. I hope that AI frees up clinicians' time.

Another area is helping clinicians synthesize large amounts of data and information quickly, which can support better decision-making, faster decision-making, and more tailored care. Over time it may reduce medical errors and make care safer, better quality, and more reliable. Only about 50 percent of patients in America get evidence-based care, and that can't be the case. If we can de-burden clinicians by helping them master knowledge, that could help.

It doesn't take humans out of the loop. It augments their work. While keeping the human relationship at the center of care, there is a lot of potential. Ultimately, AI needs to be a tool that doesn't break down trust or empathy or clinical judgment, but rather helps enhance those things.

Lindsey

That's an encouraging way to look at it. I think a lot of people in our audience will appreciate that framing. Building on that, you've emphasized that AI's impact really depends on how thoughtfully it's implemented. In practice, what does that look like in the clinical setting?

Dr. Vasan

Yeah, look, a lot of what I'm saying is my hopes and I'm speculating to the degree that this is the future of AI in medicine that I want. Is it going to be the future that we get? That remains to be seen. That's largely not because of the technology itself. The technology is fairly agnostic. It depends on how we as humans, as leaders, as care systems, insurers, pharma -- all the key players in healthcare -- implement those tools. Do we implement them to make care better, increase trust, and free up time? Or do we implement them simply to maximize revenue and increase costs? These are central questions.

We need thoughtful leaders to step up and say let us help steer this technology towards the healthcare system we always wanted, where everyone has access to care, where care is affordable and accessible, where care is high quality, and where care is delivered equitably and fairly. Everyone deserves a fair shot at a healthy life. We need to deploy AI in ways that enhance fairness, not just efficiency for its own sake.

Where is AI already working? Much of it is in parts of medicine that clinicians don't see. On the provider side, things like billing and claims submission, account management, and patient billing. On the payer side, claims adjudication, payment processing, and prior authorizations. These are parts of the system that are already being automated behind the scenes.

On the provider side, there are exciting developments. Medical imaging and diagnostics, radiology, pathology, cancer screening, where AI is performing at a high level and augmenting clinical judgment. There is also clinical decision-making. Companies are helping providers synthesize vast amounts of medical literature to support good decision-making.

There are tools supporting nurses, nurse practitioners, and physician assistants to practice at the top of their license, particularly in settings where they take leading roles in care. There are clinical tools like ambient listening scribes that capture key elements of a patient visit while allowing clinicians to focus on the patient.

On the public health side, AI can analyze and forecast large amounts of data to predict trends and outbreaks and help target prevention efforts. We are also seeing patient-facing tools delivering medical advice directly to people, which is powerful and exciting but also potentially dangerous. These are all areas that clinicians need to understand.

Lindsey

That's a really great context. AI is definitely advancing at a rapid pace. Everyone is trying to stay informed and ready. As AI becomes more integrated into healthcare, there is also the question of cost. Some people worry that new technologies can drive healthcare costs up. From your perspective, what should clinicians and all of us be thinking about when it comes to AI and the cost of care?

Dr. Vasan

This is such an important question, especially at a moment where affordability is central to politics, to the public conversation, and to what people are experiencing every day. When I was health commissioner, we wiped out two billion dollars of medical debt in the city by purchasing secondary debt. That raises the question of why that debt exists in the first place. 

Costs in American healthcare are out of control. We spend close to five trillion dollars every year on healthcare. Only about three percent goes to public health and prevention. The rest goes to the healthcare system, and that number continues to grow.

We need to ask how AI tools can make care more affordable at both the individual and societal level and help bend the cost curve. There are many ways that could happen. The role of insurance companies, how care is delivered, how technology can enable more preventive care and reduce the need for office visits.

There are opportunities to speed up the time it takes to move research into clinical practice. On average, it takes about seventeen years to move from the bench to the bedside. That is far too long. There are also administrative efficiencies. About a third of healthcare spending is administration, and it is the fastest growing segment of healthcare. Why does that need to be the case?

These are areas where AI could help, but there are trade-offs and labor implications that we need to discuss openly. We must ensure that affordability is central as we design AI implementation. Otherwise, we risk using AI to extract more revenue and increase costs.

We have a real opportunity over the next couple of years to shape this. The question is whether we will take that opportunity and who is willing to have that conversation.

Lindsey

Such important points. Affordability and accessibility are always part of the conversation in healthcare, and AI is no exception.

I want to pivot to Osmosis. We are a teaching company and we love to fill knowledge gaps. Is there a topic you think Osmosis should make a video about that deserves more attention?

Dr. Vasan

Too many clinicians do not understand how the US healthcare system is set up, why it is set up that way, and who pays for what. Across these transactions, who wins and who loses. It is essential that clinicians learn the basics of health policy and healthcare administration to understand the friction points and why things are the way they are. There is always a reason. You can follow the money, follow the policy, and follow the history.

A primer would be useful, including the origins of health insurance, Medicare, Medicaid, and the Affordable Care Act. That foundation would help clinicians understand where technology can address pain points.

Another important topic is communication. With the rise of technology, clinicians do not spend enough time developing communication skills. When I practiced primary care, I used to say the purpose of the first visit is to get a second visit. Trainees often try to do too much in one visit instead of building trust and creating continuity. Communication, shared decision-making, and rapport are critical, especially in a world where more interaction happens online.

Lindsey

Those are great suggestions. To play that back, focusing on health policy, administration, and communication. Most of our listeners are students or early career professionals. What advice would you give them about navigating this moment and building a meaningful career in medicine?

Dr. Vasan

I would bring it back to motivation. Why did you get into this field in the first place? It is important to stay connected to those core reasons. They help you remember who you are, structure your values, and guide you in a rapidly changing world with many external pressures. For me, moving from public service into technology and venture capital was about recognizing a societal shift and wanting people focused on public impact to be at the table. If you are not at the table, you are on the menu. 

I worry that the public interest could be lost in the rush to implement AI. We need people who care about fairness and opportunity helping to steer these decisions. Right now, the conversation is often framed as acceleration versus safety, gas versus brakes. Few people are talking about steering, about who is in the driver’s seat. To engage meaningfully in this moment, you have to stay grounded in your purpose, to help people.

At the end of every number, every curve, every dataset, there are human beings, often at their most difficult moments. Whether I am working in government, policy, or at the bedside, I try to keep that in mind. At the end of the day, it is about people and relationships.

Lindsey

Absolutely. I know our audience will appreciate that perspective. Before we wrap up, is there anything we did not cover that we should have?

Dr. Vasan

We could have talked for much longer. I think we are at a moment where the instinct is to focus on what we do not like about the healthcare system and try to fix it with technology.

That is one set of applications, but we also need to step back and ask why we are doing this. We need to get back to a world where technology serves clinicians in spending time with people, being good stewards, translators, and sense makers for patients, especially the most vulnerable.

When technology does not do that, we need to question why it exists and who benefits from it. Clinicians should be asking whether a technology makes their work better and improves patient care or serves another purpose such as financial or administrative gain.

These questions need to be part of the public conversation.

We may not have another moment like this for a while. Over the next several years, we will see major changes in how medicine is practiced. It is important for clinicians to be at the table, to have a voice, and to keep patients at the center of this work.

Lindsey

I'm glad you brought that up. It is a great note to end on. Technology needs to help providers do what they do best, which is help people. Thank you so much for being with us today.

Dr. Vasan

That's right. Big pleasure. Thank you for having me.

Lindsey

As we close, I'm struck by Dr. Vasan's blend of optimism and pragmatism. While many clinicians worry that AI could weaken the human connection in medicine, he offers a compelling alternative. With thoughtful governance and smart implementation, AI could actually strengthen that connection by freeing physicians to focus on what only they can do.

His decades of leadership across public, mental, and global health, and his experience guiding New York City through the COVID-19 crisis underscore that technology's impact ultimately depends on the people and values shaping it.

If AI is going to enhance rather than erode the patient-provider relationship, it will require exactly the clarity and purpose Dr. Vasan brings to the conversation.

I'm Lindsey Smith. Thanks for checking out today's show. Remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.