Where clinical depth meets AI product thinking. Written by Yoram Friedman, MD, physician and enterprise product leader.
The word "prompt" was not invented for AI. It was on the screen in 1993, the C colon and the blinking line, waiting for you to learn the machine's language. We are teaching doctors DOS again. The interface will absorb the commands, the way it always does. What it cannot absorb is judgment.
People keep asking how I found time to write four books in a year while doing my day job. The answer is not a tool and not discipline. It is a layered setup where every piece of work is tagged, linked, and ready for the next one. The tools are rented. The brain underneath is the asset.
The operator did not vanish when the agent arrived. She split. What she knew became the agent's context and bounds. What she checked before committing became the supervisory surface. The only casualty was the dashboard, and most agents are being built to generate it.
A new paper rebuilds the DIKW pyramid for medicine and shows where AI actually breaks. Strong on the arrows nobody worried about, weak on the one the structure depends on. The pyramid always assumed you could tell which layer you were standing on. That assumption is gone.
A Cybercab was filmed with no steering wheel. Removing it was the honest part. The rungs below it, hands on the wheel, eyes on the road, ready to take over, were never supervision. They were accountability. Most enterprise AI is still on rung three.
Engineering changed its unit of work to intent, policy, and boundaries. Product and design mostly still ship user stories and screens. So the policy gets written by the last person to touch the ticket, in a prompt, at midnight. The control plane has inputs, and nobody upstream owns them.
The Claude Code team ships most of its code through an agent that acts on its own. The six lessons everyone is copying are real. But in a regulated enterprise, earning your way out of the loop only counts when the receipt is an audit trail, not one person's memory.
Anthropic mapped product work into five archetypes: Prototyper, Builder, Sweeper, Grower, Maintainer. All five stop the moment the thing ships. But an agent keeps deciding after you let go of it, and there is a sixth archetype no one drew: the one who watches it decide.
Six people sent me their skills this week. The feed is full of them. But everyone is treating a skill like a macro, a way to go faster. It isn't. A skill is a template, and templates were never about speed. They were about everyone doing the work the same way. That changes who should build them.
Two things are both called "building with AI." One makes small teams faster at familiar products. The other ships products that act on their own, and that one needs a bigger, more senior supervisory layer, not a leaner pod. The ICU knew this before software did.
Every PM team I know is busy automating the wrong things. Skills, MCP servers, vibe coding prototypes. The demos are impressive. But if AI is handling your roadmap research, your status updates, and your PRD drafts, what are you doing with the time you got back?
A Nature Medicine paper just benchmarked frontier LLMs against the best clinical AI tools on the market. The frontier models won, and it wasn't close. But the real story isn't the benchmark. It's what the result tells us about who controls clinical AI in five years.