Everything I Have Done Has Been on Purpose

I have run over ten marathons. My personal best is 2:52 at New York, which is not a time you stumble into. New York will punish you on the Queensboro Bridge at mile 16 when your legs are already asking questions, and again on the hills in Central Park when the finish feels close but your body is doing the math. The only way through is to have already decided, long before race day, exactly what you are going to do and why.

That is what intention means to me. Not motivation, not ambition, not a vision board. A decision made in advance about where you are going, followed by every subsequent action either serving that goal or not. In a marathon you feel the cost of each choice in real time. A pace that is ten seconds too fast in the first half will find you at mile 22. There is nowhere to hide.

I have tried to live this way since I was six years old, when I stepped off an elevator at the Cleveland Clinic and found myself alone in one of the largest hospitals in the world.

Lost in Cleveland

It started when I was six years old. My father was a pulmonary fellow at the Cleveland Clinic, and I had tagged along on one of those days when you are a small child and the adult world simply carries you wherever it is going. Somewhere between floors, I stepped off the elevator without him noticing. The doors closed. And suddenly I was alone in one of the largest medical institutions in the world, at six years old, with no idea where I was.

What I remember is not fear, though I am sure some of that was there. What I remember is the people. Adults moving through those halls with a kind of focused energy I had never seen before. They were busy in a way that felt different from ordinary busy. They were busy because someone needed them. I did not have words for it at six, but I understood it. These people had dedicated themselves to something that mattered.

That image never left me. A boy lost in a hospital, watching adults who had found their purpose.

The Goal That Has Never Changed

By high school I knew medicine was where I was headed. I did everything required to make that happen: became an EMT, volunteered, kept my grades up, checked every box. Not because someone handed me a checklist, but because I understood what each step was for.

In medical school I assumed I would follow my father into pulmonary critical care. Three years in, I changed my mind. Eighty hour weeks in the hospital was not the life I wanted, and more importantly, it was not the way I was going to reach the most people. I tried hospital medicine first. Fifteen patients kept me busy but felt like a ceiling. Clinic work pushed that to twenty or thirty patients a day, which turned out to be unsustainable in a different way. Neither model felt like the answer.

Then I found telemedicine. Patients could complete intakes before we ever spoke, and I could move from video call to video call without the friction that slows everything else down in medicine. For the first time, the math started to work. Reaching more people with real clinical care was no longer a theory. It was a workflow.

What Intention Actually Requires

Living with intention is not the same as having a plan. Plans change. As Mike Tyson once said, "Everybody has a plan until they get punched in the mouth". What intention gives you is a filter. When a decision is in front of you, you only need to ask one question: does this get me closer to where I am trying to go, or does it take me somewhere else? If it does not serve the goal, the answer is no, even when no is hard.

This is why I want to push back on the idea that mission is something you discover. For most people I have talked to who are doing work they find meaningful, the mission was there early, often as a feeling before it was a thought. What they did was choose to follow it consistently, and say no to everything that pulled them away from it.

If you are still looking for yours, I would start by asking what gap in the world has always bothered you. Not a general problem, but something specific that you have witnessed or experienced that felt wrong in a way you could not let go of. That feeling is usually pointing at something real.

The Current Chapter

Healthcare AI is moving fast. Faster than most people in medicine are comfortable with. Companies are deploying AI systems that interact directly with patients, and influence diagnoses. Many of these systems are being deployed after signoff by small internal teams of doctors after engineers have tested them on benchmarks that measure whether an AI can recall medical facts. They score in the 90th percentile and call it validated.

But a physician does not practice medicine by recalling facts. A physician practices by exercising judgment in uncertain, high-stakes situations where the wrong call can harm someone. Those two things are not the same, and no benchmark currently tests the difference.

This is the gap I am trying to close now. It is the same gap I have been working on since I was a boy watching purposeful people move through the Cleveland Clinic. The question has always been the same: how do we make sure that the people who need excellent care actually get it? Today, that question is running towards AI safety.

Every step that led here was intentional. The boy who got lost in an elevator at the Cleveland Clinic has been walking toward this work his entire life. He just did not know yet what form it would take.

If you are a physician who cares about where healthcare AI is headed, I would like you to be part of this. We are currently accepting applications to our rapidly growing faculty community. If you would like to learn more please apply and schedule a time to talk to us at Automate Clinic.

Find your gap. Follow it with intention. The rest has a way of building itself.