Between Heartbeats and Algorithms: One CMO’s Call to Reclaim the Human Side of Medicine

In this episode of SoundPractice, host Mike Sacopulos speaks with Devjit Roy, MD, CPE, a rural CMO, hospitalist, and palliative care physician whose book Between Heartbeats and Algorithms: Reclaiming What Matters in Healthcare grew from journals kept during COVID-19 surge duty. Dr. Roy examines how clinical algorithms, electronic health records, and artificial intelligence are transforming — and at times diminishing — the art of medicine. Drawing on 15 patient stories, he makes a passionate case for physician leadership, clinical humility, and the irreplaceable value of human judgment. He also addresses physician burnout, the self-selection effects of medical technology on the physician workforce, and why he remains hopeful that AI, designed with physician input from the ground up, can restore rather than replace the doctor–patient relationship.

This transcript of the discussion has been edited for clarity and length.

Mike Sacopulos: Before we get to the book, I’d like to hear more about your path as a physician leader. Can you tell me?

Devjit Roy, MD, CPE: I’m currently the CMO, CMIO, and VPMA at Nathan Littauer Hospital. So I wear a lot of hats. We’re a rural nonprofit — as rural as can be — and I’m also the medical director at the nursing home here. We’re a hospital, nursing home, and 11 primary care practices speckled across the Adirondacks. I also serve as a board member for Mountain Valley Hospice and as co-president of a joint venture between our hospital and another hospital about an hour away, focused on preserving specialty practices in the region.

In rural medicine, you always have to wear multiple hats. I still practice as a hospitalist and as a palliative care physician, and I work in the nursing home as well. My path to this role ran through a lot of different settings. I was Medical Director for Hospital Medicine with SCP, a hospitalist group. Before that, I was trying to grow a palliative care program at another hospital during COVID. And prior to that, I was deeply involved in informatics — I was a wellness director out in Wyoming, seeing patients with addiction and lifestyle medicine needs, while also helping with a Cerner EHR rollout. So I’ve always worn both an IT hat and a clinical hat. I stepped into this CMO role in 2023, and it’s been remarkable.

The Journal That Became a Book

Sacopulos: Your book opens with the lines, “I didn’t set out to write a book. I was just trying to make sense of it all.” Can you tell me about that?

Roy: When I started writing, it was during COVID. I was one of the hospitalists at a COVID surge hospital — ground zero, really. The first case was a couple of blocks from my apartment. We didn’t know the disease course. We were discharging patients home on room air, and then they’d come back two days later near death. We were figuring out the blood clots in real-time. There was enormous uncertainty. At points I was sleeping in my car because I didn’t know how exposure might affect my wife.

I started writing down lessons I had learned from patients — just journaling to cope with the trauma. Years later, after several moves, I was cleaning out my office and found that journal. It held 10 or 15 patient stories I had never done anything with. And by then, so much in healthcare had changed. Medicine was becoming algorithmic — sepsis protocols, blood transfusion criteria, insurance criteria for inpatient versus observation status. All of these algorithms had quietly been inserted into our clinical lives and were changing the way we practiced. Nobody teaches you that in medical school or residency. You learn the medicine, but not the algorithmic scaffolding that increasingly surrounds it.

So I took the passion behind those journals and made it contemporary: How do we maintain the humanity in clinical care as medicine becomes more algorithmic? My conclusion was that we need physicians much more involved in leadership. That’s the angle the book takes — it’s a call to physicians.

The Art of Medicine Under Pressure

Sacopulos: Your book speaks largely to the art of medicine. Do you believe that art is being neglected?

Roy: The quick answer is yes. But with that said, when you’re learning something new — when you’re in medical school or residency — you do need a roadmap. You need a textbook and a checklist. The art comes with experience. After you’ve seen patient after patient and worked through difficult cases, you start compiling a person’s story and getting to the root causes in a way that experience enables but algorithms cannot fully replicate.

Some things can be put into an algorithm, but you also have to know when to color outside the lines. The problem is that you can’t always code that capacity. You can’t structure it. And I think that is what’s starting to disappear. People are messy. You can’t put every patient in a bucket. You have to be able to think outside that box — and that’s the art.

Technology and the Self-Selection of Physicians

Sacopulos: As medical technology becomes ever more involved in the practice of medicine, do you believe it alters the composition of medical school classes? Are we self-selecting for different types of individuals to become physicians based on technological advancement?

Roy: Absolutely — and it’s a fascinating concept. In a rural setting, our recruiting pool is already limited. We won’t have the newest robotic surgery system; we won’t have any robot, for that matter. If a surgical resident has trained exclusively on robotic systems and can’t perform an open procedure, they simply can’t practice here. The same logic applies to AI. If medical students are being trained through AI-enabled workflows and our systems don’t have that infrastructure, they’ll burn out quickly when they encounter our clunky, manual workflows.

I’ve noticed that at least one medical school I’m aware of is being very deliberate about not allowing AI use, because they believe it stunts clinical reasoning development. I think about it the way I experienced it as an engineer. Before we were allowed to use a calculator, we had to write the code for one in Fortran. Miles and miles of code. Only once you truly understood what the calculator was doing were you permitted to use it. I think something similar needs to happen with AI in medical training. Students need to first learn to think like clinicians before they’re given the tool to lean on.

A Patient Story: Humility, Curiosity, and Grit

Sacopulos: In your book you write about 15 patients who have influenced how you practice medicine. Can you tell me about one of them?

Roy: This is one that’s close to the heart. It was during COVID. A patient had been intubated and then transitioned to a long-term ventilator — and ultimately was on it for around 60 days. They simply weren’t waking up. A loved one of the patient worked at our hospital. I was involved as both a hospitalist and a palliative care provider.

Each time I saw this patient, I was reminded of a patient with Parkinson’s disease — locked in, unable to mobilize. And I thought: if you give a Parkinson’s patient Sinemet, they’ll start to unlock. Sleep–wake cycles were also disrupted. So we trialed two medications — modafinil and Sinemet. Within two days, after roughly 60 days of near-comatose existence, the patient woke up. They started eating. About two weeks later, they were discharged to acute rehabilitation.

Most of the medical staff had already quietly concluded that this patient would be heading toward hospice. What I took from that case was the importance of staying humble — we still don’t know so much in medicine. Be curious: when something isn’t adding up, keep asking questions. And have grit: the discipline to stay with it. Those three things — curiosity, humility, and grit — are what I try to carry with me every day, whether I’m working as a clinician or as an administrator.

Why Dr. Peter Angood Wrote the Foreword

Sacopulos: The foreword to your book was written by Peter Angood, CEO and president of the American Association for Physician Leadership. Why did you choose Dr. Angood for that role?

Roy: I was just so grateful he could do it. He has tremendous experience — he was an ICU physician who successfully transitioned into leadership and has since mobilized an entire community of clinicians to do the same. I love that. I’ve heard him speak and he is polished, compelling, and authentic. He’s read broadly and done so much. When that opportunity came up, I said absolutely, without hesitation — because he gets it. Honestly, he’s what I aspire to be.

Today’s Patients: Accountability and Communication

Sacopulos: Over your career, the practice of medicine has changed, but so have patients. How are patients different today?

Roy: In a rural setting, patients are generally just grateful to have someone in their corner — and that’s genuinely refreshing. But I’ll say this: I used to struggle with “Dr. Google.” Now I’ve come around to appreciating it. Patients are taking more accountability for their own care, and that’s a good thing. When a patient comes in having researched their symptoms on Gemini or Doximity or any other platform, my job is to help them unpack all of that information and connect it to their individual clinical story.

What I’ve realized is that when a patient is pushing back on my diagnosis or bringing in outside information, that’s also a mirror on my own communication. Did I take too paternalistic an approach? Did I explain things in a way that actually landed? If a patient didn’t take their medication, was it because they weren’t convinced — and did I give them enough reason to be? It keeps me accountable. It shows me my gaps.

Who Should Read This Book

Sacopulos: Now that you’ve written the book, describe who you hope reads it.

Roy: It started as lessons I wanted medical students and residents to have — things like: listen to your nurse. Be humble enough to listen to the patient who has scattered records across 10 different specialists. Take the time to unpack that complexity, because you’ll do them more justice. Then it expanded into physician burnout. I write about a friend of mine who died by suicide — it’s in the book — and about how we build resilience, how we cope with the daily weight of clinical practice while maintaining the relationships that matter in our lives.

What’s been interesting is that nurses have embraced it enthusiastically. So while it began as a book for medical students and new physicians, it has become something for anyone in healthcare — anyone dealing with leadership, with burnout, with the implementation of new technology. It touches all of it.

Hopeful About the Future

Sacopulos: The subtitle of your book is “Reclaiming What Matters in Healthcare.” Are you hopeful?

Roy: Definitely hopeful. And we should be. One of the biggest sources of burnout in my career has been the EHR. We became documentation specialists. I didn’t go to medical school to be a record keeper. And why did EHRs cause such suffering? Because physicians weren’t part of the build. How many doctors were involved in the coding teams that created Epic or Meditech or Cerner? The workflows of a physician are messy and complex, and EHRs were inserted into those workflows rather than built around them. We ended up creating workarounds to compensate.

What gives me hope is that AI companies are now doing something different — they’re actually bringing physicians in to help design the workflow from the ground up. The questions being asked are: How do we let a doctor be a doctor? How do we let AI handle documentation, billing, and coding so the physician can focus on the patient? How do we return the conversation to where it belongs — between the doctor and the patient? That’s where my hope lives. But only if we get enough physicians at the table for these conversations.

What’s Next

Sacopulos: As our time together draws to a close, what’s next for you?

Roy: My three main goals are: making care delivery easier, maintaining access for all patients, and “unhijacking” lives that have been hijacked by illness. When someone gets a cancer diagnosis or a heart failure diagnosis, their life gets derailed. How do we unhijack that life and get them back to what matters to them? That’s what drives me in my current role — and it’s what I want to scale to the population level. We need more physicians engaged in that kind of work.

Listen to this episode of SoundPractice .