At the center of this transformation lies a deceptively simple question: what does it mean to be a good doctor in the twenty-first century? Traditionally, competency was understood primarily in terms of medical knowledge and technical skill — the ability to diagnose accurately, prescribe appropriately, and perform procedures safely. Those qualities remain essential. But they are no longer sufficient. Today’s physician must also function as a manager of complex information ecosystems, a coach who motivates patients toward healthier choices, and a critical interpreter of algorithmic outputs that no previous generation of clinicians was trained to evaluate. The role has expanded dramatically, even as the time available for each patient encounter has, in many settings, grown shorter.

This matters enormously for Americans seeking care. The United States spends more on healthcare per capita than any other nation, yet its outcomes — measured in life expectancy, preventable mortality, and the burden of chronic disease — frequently lag behind peer nations. The gap between what medicine knows and what medicine actually delivers to patients remains startlingly wide. Evidence-based guidelines for managing hypertension, preventing cardiovascular disease, and detecting cancers early exist in abundance. Yet research consistently shows that these guidelines are applied inconsistently, risk factors go unaddressed, and patients are too often left without the information and support they need to make truly informed decisions about their own health. Closing that gap is not simply a matter of spending more money or building more hospitals. It requires physicians who possess the knowledge, the skills, and — perhaps most critically — the attitude to harness every available tool in service of their patients’ well-being.

Digital health information technology, and the artificial intelligence systems now embedded within it, represents the most powerful set of tools medicine has ever had at its disposal. Electronic health records can surface hidden risk factors. Predictive analytics can identify patients most likely to benefit from early intervention. Remote monitoring can transform chronic disease management from a series of episodic encounters into a continuous, responsive partnership between patient and clinician. Large language models and clinical decision support systems can place vast bodies of evidence at a physician’s fingertips in real time, helping to reduce diagnostic error and standardize care in ways that were simply impossible a decade ago.

But technology does not heal people. Physicians do. And the physician who lacks the digital literacy to critically evaluate an AI-generated recommendation, or the communication skills to translate complex probabilistic data into meaningful guidance for a patient, or the managerial awareness to coordinate care across a fragmented system, will find these powerful tools of limited use — or worse, a source of new errors. Conversely, the physician who embraces these capabilities thoughtfully, who sees the patient not as a recipient of care but as a partner in it, and who commits to continuous learning in a landscape that will not stop changing, stands at the threshold of a genuinely transformative era in medicine.

The stakes could not be higher. A healthcare system that promotes genuine well-being and achieves optimal outcomes for all Americans — not just the affluent, the well-insured, or the geographically fortunate — depends on a profession that is prepared for this moment.

What follows is an exploration of what that preparation looks like in practice: the specific competencies physicians need, the ways digital technology can extend and enhance those competencies, the barriers that stand in the way, and the path toward a healthcare system worthy of the patients it serves. The conversation begins here.

And yet we keep having the same argument. Is healthcare a right or a service? Single payer or free market? We’ve staged that debate for decades, and it has gone nowhere. The shouting gets louder; the system gets sicker.

Moonshot Press in collaboration with the Institute for Salutogenesis The Healthcare Initiative — begins from a different premise. The problem isn’t that we lack ideas. It’s that we lack a way to reason through them together. So we borrowed a method from the one field that confronts overwhelming complexity every single day and still manages to act: medicine.

A good doctor doesn’t lead with the cure. When a patient arrives in distress, the doctor takes a history, examines, runs the tests, and names the problem — before reaching for the prescription. Diagnosis comes first. Treatment follows. And then, crucially, the patient is monitored and the plan adjusted over time.

What if we treated the healthcare system the same way? Not as a battle to be won by one side, but as a patient to be understood. That is the idea behind Civic Grand Rounds.

In medicine, grand rounds is a disciplined public forum where a difficult case is presented, the evidence examined, competing explanations debated, and a plan proposed and followed up. Civic Grand Rounds brings that discipline into public life. The premise is simple and a little radical: the patient is the system — not a party, not a CEO, not “the other side” — and the public is part of the clinical team. Your experience as a patient, a parent, a caregiver, or a clinician isn’t an anecdote to be managed. It’s evidence.

Each session unfolds like a case. We present the problem and trace, briefly and without blame, how we got here. We examine the data calmly — what’s actually true, and what we don’t yet know. Citizens testify from lived experience: the denied claim, the delayed referral, the postpartum care that never came. Experts clarify. Insurers, hospitals, and agencies answer for their part of the story. Then we build a problem list, a treatment plan, and — most important — a scorecard that tracks whether anything actually improves before the next round.

Sessions are held in public and livestreamed on Zoom, Facebook, and YouTube, so that a neighbor in the room and a parent watching from a kitchen table can take part on equal footing. Artificial intelligence helps us organize hundreds of testimonies and summarize the evidence — but under one unbreakable rule: AI recommends; humans decide. Always. No person is reduced to a data point. No community is synthesized into invisibility.

Two commitments anchor everything. The first is a floor: can everyone get the care they need across a job loss, a move, a disability, the years of aging? The second is an aim: does the system actually create health — through prevention, mental health, and the first years of life — rather than only billing fastest after harm is done? Universal coverage is the floor. A salutogenic system, one that produces flourishing, is the aim. We hold both.

This is not a town hall built for performance, or a debate built for winners. It is a public diagnostic process with a record and a plan. Behind it stands a wager as old as the republic itself: that ordinary citizens, given real information and real tools, can be trusted to reason through hard problems — and that an engaged, informed, respectful public is not a luxury in a crisis like this one. It is the treatment.

The case is open. The treatment plan is unfinished. And the question it turns on belongs to all of us: How do we build a system where everyone can get the care they need to live healthy, flourishing lives?

The Case Presentation is Being Developed. The rounds are open soon.

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