Nobody Will Quarterback Your Health Like You (and AI)

Fun fact: there is no doctor in a white coat, staying up late at night, figuring out how your symptoms might tie into a bigger picture.

I don’t mean this in a ‘the system is broken’ way (although, also, that), I mean it literally. There is no person in a white coat somewhere holding your whole chart in their head and wondering, over lunch, whether your bloodwork from March has anything to do with the fatigue and hair loss you mentioned in a prior appointment.

I kept assuming there was, or there would be. Maybe I just hadn’t found the right provider yet, but I kept doing the same thing expecting different results and in psychologist language: this is the definition of insanity.

In the wild, a mother octopus guards her eggs for months without eating, and once they hatch she drifts out of view and dies, which until fairly recently was also the general plan for women over 45.

We are not doing that anymore. American life expectancy hit a record 79 in 2024, and for women it’s 81.4, so a lot of us are headed for our 80s and 90s whether or not anyone has thought about what that half of the film is supposed to look like… (I realize that getting to be foggy and bored at 80 is a privilege. I am grateful. I would also like to be able to find my words while I do it).

We already know we have to be our kids’ best advocates. Nobody mentioned that we would have to be our own.

Anyway. Here is what happened to me.

I started noticing that I wasn’t as sharp as I used to be, which matters quite a lot when your job is being sharp about other people (some days I could not recall the training I’d had, and some days I could not recall the words, either, which is an inconvenient thing to happen to someone who is essentially paid by the word… I’m not, technically, but it felt like it).

I knew I didn’t have ADHD. I diagnose it in people most days of the week. But an embarrassing amount of what I was experiencing was walking around in an ADHD “skin,” as the kids say, so I mentioned it to my prescriber, who more or less shrugged and said yeah, you’re getting older, you’re going to have a little cognitive fog, you know what I do? I just take a stimulant.

Okay.

So I tried it. Ten milligrams of Focalin, and lo and behold, it worked wonders. Does that mean I have ADHD? No. Does it mean I’m now lying awake wondering how many other women in their mid-40s and 50s are having this exact conversation, in this exact exam room, with this exact shrug? Yes.

Quite a few, it turns out. Federal researchers reported in JAMA Psychiatry last year that the number of women aged 35 to 64 with stimulant prescriptions went from 1.2 million in early 2019 to 1.7 million by the end of 2022, and one of the study’s own authors admitted he couldn’t fully explain a jump that size.

I have a guess.

More than 60 percent of women report trouble with memory, attention, processing speed or executive function in these years, according to the neurologist who runs Stanford’s Midlife Brain clinic, and estrogen (which is busy packing its bags), helps regulate dopamine, which happens to be the same brain chemical those stimulants work on. At this year’s Menopause Society meeting, researchers reported that two ADHD drugs made women’s brain fog feel better while barely moving their actual scores on memory and attention tests, which is science for ‘we don’t really know yet’.

Nobody has run the randomized trial on whether hormone therapy clears the fog, either (one of the field’s longtime researchers says it shouldn’t be prescribed for that reason, and the Alzheimer’s Drug Discovery Foundation, which went through the trials this spring, landed in roughly the same place: started within ten years of menopause, estrogen neither sharpens thinking nor dulls it, and started much later it may raise dementia risk…) It took the FDA until November 2025 just to take the 22-year-old black box warning off estrogen.

The one thing the menopause clinics do agree on is that the fog usually lifts. It peaks in late perimenopause and eases once the hormones settle down, which is lovely, unless you happen to have a career to run in the meantime.

So, no, I am not telling you to go and get a stimulant. I am telling you that the official answer to a symptom hitting most of us is, for now, a shrug.

A shrug is not a workup.

Meanwhile (and this is the part where I’d like you to picture the jersey), I was crunching ice like I was in training for a set of dentures. I was cold all the time. My hair was coming out in the shower. I couldn’t think, and I was exhausted all day and then wide awake all night, which is a combination I would not recommend to anyone.

Craving ice has a name (pica), and it is one of the classic signs of anemia, which my bloodwork said I had, severely. My PCP said to eat more meat and try a cast iron skillet.

I did all the things. The skillet did not work. (It’s a very nice skillet. I still have it. It makes a lovely frittata, which is not what I asked it for. I have also yet to meet a man who was handed cookware for a blood count. I’m sure he exists. I would like to see his chart.)

I was also bleeding, a lot, and for a while I assumed (and so did my friends, and so did my doctors), that this was the grand finale of menses, the end of the fireworks show, every period of the past coming out at once in one big jubilee of you’re done now, exit stage left so that no one has to look at you.

It was not the finale.

By then I had started feeding my labs and my symptoms into an AI and asking it to think alongside me (instructions further down, I promise, I’m getting there), and it pointed out, quite calmly, that bleeding like mine has a list of possible causes (endometriosis, adenomyosis, a polyp), and that a standard pap smear is not looking for any of them. ChatGPT suggested I ask for a sonogram. So, like any person should be able to, I asked.

The sonogram found a polyp the size of a golf ball. Non-cancerous, luckily. It was contributing to the bleeding, which was contributing to the anemia, which was contributing to the psychologist who couldn’t find her words.

None of this is exotic medicine. The gynecology literature lists polyps, adenomyosis and fibroids as common structural causes of abnormal bleeding in perimenopause, and says ultrasound is the best way to find them. Doctors don’t routinely screen for iron deficiency either, even though a 2023 JAMA study found nearly 40 percent of American girls and young women are low, and a University of Oklahoma study last year tied lower iron to worse cognitive performance in perimenopausal women who weren’t even anemic yet.

The information exists. It is just that nobody is paid to put it together for you.

(I have a whole separate rant about why nobody is paid to put it together for you, involving the phrases ‘managed care’ and ‘fifteen-minute slot’, which I will write another time. Probably.)

Then came the catch-22, and I do love a catch-22 when it is happening to someone else. My doctor did not want to operate until my anemia was under control, and my anemia could not get under control until my doctor operated. So I took my health into my own hands again, drove down to Hydration Room, and paid out of pocket for four iron infusions.

And isn’t that sad, in this day and age? I could afford it. Most people can’t. Even if you are very, very good at advocating for yourself, it turns out you also need a shit ton of money to stay well, and those of us who live somewhere with a Hydration Room on the corner should probably say that part out loud.

Cut to nearly a year later. My anemia is, I think, getting out of hand again (the ice is back. The ice is always the first to know). This time I know what to do. I’ll go back in for iron. I’ll sleep. My hair will grow back and my skin will look better and I will stop staring at a screen at 4pm wondering what, precisely, I did with my day.

I’m proud of that, actually. A younger me would have accepted the skillet.

So here’s the bad news, if you haven’t already worked it out. Nobody is quarterbacking your health. Your care is spread across four or five people who have never met each other, nobody working inside managed care has time to read your records, and so you have to.

Congratulations. You got the job. (The jersey is optional. The eye black, I’m told, is a lot.)

The good news is that the technology to do the job already exists, you are probably already paying for it, and you can set it up this weekend for yourself and everyone in your house.

How to build your own AI health quarterback

A word about comfort, first. I err very heavily on the side of ‘I will give you all of my data if you can help me’. Some people have real and reasonable concerns about where their data goes, and this is not the article for them (sorry. I do see you).

If you’re still here, it goes roughly like this:

a) Give it a home. Open a project in ChatGPT, Claude or whichever one you already use, and name it for one person. One per family member, so your teenager’s labs don’t end up in your chart.

b) Upload everything. Quest and LabCorp results, imaging reports, notes from doctor’s visits, your medication list, your Oura Ring or Apple Watch data, and a plain list of your symptoms and concerns with rough dates. Rough is fine. It is better at dates than you are right now.

c) Paste in the master prompt below.

d) Tell it where to read. JAMA, the New England Journal of Medicine, the American College of Obstetricians and Gynecologists, The Menopause Society. Not CatLady2002 on Reddit (no offense to CatLady2002, who I suspect is also anemic).

e) Loosen the guardrails. Left alone it will say ‘I’m not a doctor, you’ll have to ask your doctor’ on a loop until you cry. So say it first: I know you’re not a doctor, obviously, I have doctors, what I need is someone to hold all of this together and help me do the research.

f) Ask for theories, like an old-school doctor would. What do these symptoms have in common? What else fits? What test would confirm it or rule it out?

g) Take the questions to your actual doctor. It will be wrong sometimes, which is precisely why its job is to hand you better questions and your doctor’s job is to order the test. That is exactly how I got my sonogram.

h) Keep feeding it. Every new lab, every visit, every ‘huh, that’s new’.

You do not need to be good at technology, and you do not need to assemble your entire medical history tonight. Start with one recent lab report, your current medication list, and a few sentences about what has been bothering you. You can add the rest later.

The master prompt

You are my personal health quarterback. I know you are not a doctor. I have doctors. What I do not have is anyone holding my whole picture together, and that is your job.

I will upload my lab results, imaging reports, visit notes, medications, wearable data and a running list of symptoms. Please:

1. Build and maintain one timeline of my health: labs, symptoms, medications, procedures, with dates.
2. Flag anything out of range, anything trending the wrong way, and anything nobody seems to have followed up on.
3. Look for patterns across specialties. My doctors each see one piece. Work from the information I provide, and tell me what is missing.
4. When I describe symptoms, give me a ranked list of possible explanations. For each one, tell me what fits, what doesn’t, and what evaluation might help distinguish the possibilities.
5. Use peer-reviewed and professional sources only (JAMA, NEJM, ACOG, The Menopause Society, USPSTF, major academic medical centers) and use current guidance and relevant research, including older evidence when appropriate. Link what you cite. Tell me when the evidence is thin or experts disagree.
6. Before every appointment, write me a one-page brief: what has changed, my top three questions, and the specific tests I should ask about and why.
7. Do not answer with “ask your doctor” and stop there. Tell me what to ask my doctor, in plain language.
8. If anything I describe sounds urgent, say so first and plainly.
9. Tell me when you are unsure, and never guess at a number that is not in my records.

Start by reading everything I have uploaded and giving me the timeline, the three things you would want looked at first, and the questions you have for me.

That’s the setup. A folder, a prompt, and a second job coordinating the people you hired to help you feel well enough to do your first one. The chatbot didn’t need to practice medicine. It needed to remember that the woman discussing her bleeding and the woman discussing her anemia were the same woman.

I’m glad I can do it. I’m glad I have the training, the skill set, and the technology.

But I’m reluctant to call this empowerment, in much the same way I’m reluctant to celebrate being the sole person responsible for loading the dishwasher because my husband insists, “You always do it better than me.”

Weaponized incompetence aside, the calculation is remarkably similar. Sometimes it’s easier to do the chore yourself than to spend twice as much time making sure someone else does it.

The difference is that at home, the dishes can wait.

Sources: CDC/AP, US life expectancy 2024 · JAMA Psychiatry via NBC News, stimulant prescriptions in women 35 to 64 · Stanford CME, Brain Fog in Midlife · Medical News Today, ADHD medications and menopausal brain fog, Menopause Society 2026 · National Geographic, menopause and hormone therapy for cognition · Alzheimer’s Drug Discovery Foundation, estrogen rating · Harvard Health, FDA removes hormone therapy black box warnings · JAMA 2023, iron deficiency in US females 12 to 21 · Contemporary OB/GYN, iron levels and perimenopausal cognition · Contemporary OB/GYN, perimenopausal abnormal uterine bleeding