Advertise on podcast: Knock Knock, Hi! with the Glaucomfleckens

Halloween is around the corner, so here is a little housekeeping. I open with the saga of my HOA fining me for window units during a 117°F Portland heat wave, including the time I taped a photo of Brad Pitt to one to make it “more beautiful.” Then our family’s Star Wars Halloween plan: I was going to hide inside an inflatable Jabba the Hutt until Kristin called me on it, so I’m compromising with a Jawa. After the break, the real news. The FDA just approved Brightly (Alcon’s apraclonidine 0.125%), the newest over-the-counter redness reliever. I walk through why Visine is the worst thing ever invented, why Lumify is still my go-to recommendation if you absolutely must use one, and why I’m cautious about Brightly, especially around kids. And a reminder: if your eye redness comes with any other symptom, don’t mask it. Go see an eye doctor. Takeaways: Visine’s tetrahydrozoline is a potent vasoconstrictor that causes rebound redness and chronic irritation, and ingesting it can cause life-threatening cardiovascular effects. Lumify (brimonidine 0.025%) has been the preferred over-the-counter option since 2017, but overuse can trigger allergic reactions that force patients to stop. Brightly (apraclonidine 0.125%), approved October 16, 2026, is Alcon’s new low-dose alpha agonist redness reliever indicated for ages 12 and up. Will remains cautious about Brightly for pediatric exposure risks, since full-dose apraclonidine can cause CNS depression in children. Age-related eye redness without associated symptoms generally doesn’t need treatment, but redness with burning, discharge, blurry vision, or light sensitivity should be evaluated by an eye doctor. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠⁠ -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Rachel Zoffness is a pain psychologist and assistant clinical professor at UCSF and Stanford, and she came on to do something I desperately needed, explain what I actually did not learn in medical school about pain, which turns out to be most of it. The thing I absorbed is apparently what 96% of medical schools teach as their entire compulsory pain curriculum, and it's missing about two-thirds of the actual story because pain is not made in your skin, it's constructed by your brain, which means it is always biopsychosocial: biological inputs, psychological inputs, and social inputs, and you cannot treat chronic pain by ignoring any of them.  We go through the tale of two nails, why Usain Bolt's S-curved spine and unequal leg length are a really compelling argument against doing back surgery before you've exhausted every other option, how loneliness chemically amplifies pain the way social connection suppresses it, what central sensitization actually is and why chronic pain patients are not imagining anything, and how "pain as the fifth vital sign" was literally a big pharma campaign to sell OxyContin that caused enormous damage to how medicine prescribes opioids. Kristin also gets a professional consult on being a Highly Sensitive Person, which Rachel frames as being a more accurate seismograph than other people. Takeaways: A nociceptor is not a pain receptor The "tale of two nails" proves that hurt and harm are not the same thing Chronic pain is a disease of the central nervous system Loneliness is a direct pain amplifier  "Pain is the fifth vital sign" was a big pharma invention  — Want more Dr. Rachel Zoffness? Instagram @therealdoczoff Facebook @ Dr. Rachel Zoffness LinkedIn Rachel Zoffness Bluesky @drzoffness  Twitter @drzoffness  The Zoffness Team Pain Science and Education Tell Me Where It Hurts zoffness.com We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠ -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

This week I get into the No Surprises Act, starting with my own $20,000 out-of-network bill after my cardiac arrest and the nine-month fight to resolve it. The law was supposed to prevent exactly that, and from the patient side it works. But the arbitration system behind it is now processing millions of claims per year (not the 22,000 the feds expected), doctors are winning about 85% of the time, and insurance companies are lobbying hard to rewrite the rules.  Then the drama at the American Diabetes Association. The ADA published an editorial in Diabetes Care criticizing proposed NIH cuts, then invited NIH head Jay Bhattacharya to keynote their June meeting. Twelve members handed out reprints of that same editorial outside the keynote, five got escorted out by Louisiana State Police, and Dr. Khan was denied re-entry to his own panel. A CEO apology video, blocked editorials, and a growing boycott later, we’re watching a case study in physician collective advocacy. Takeaways: Will’s own $20,000 surprise bill after his cardiac arrest came from out-of-network physicians inside an in-network hospital, and took nine months of fighting to resolve. The No Surprises Act’s arbitration system was projected to handle 22,000 claims per year but now handles millions, with physicians winning roughly 85% of disputes. Insurance companies are lobbying for amendments to the arbitration system and routinely delay payment of settled claims by six to nine months to continue floating the money. The American Diabetes Association had five members escorted out by Louisiana State Police in June for handing out reprints of an editorial published in the ADA’s own journal criticizing NIH funding cuts. A growing boycott of the ADA journal Diabetes Care illustrates the increasing willingness of physicians and researchers to use collective action against their own professional organizations. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠⁠ Go to ⁠⁠cozyearth.com⁠⁠, and use code KnockKnock, for up to 20% off home and sleepwear. And when they ask where you heard about them at checkout, let them know you heard about them right here on Knock Knock, Hi! -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Lindsey Fitzharris is back and she brought her best book yet. Sleuth Hound: The Case of the Real Sherlock Holmes, out October 20th, which tells the story of Joseph Bell, the Edinburgh surgeon who was the actual inspiration for Sherlock Holmes. We cover optography (the Victorian belief that eyeballs record the last thing a person sees before death, which murderers took seriously enough to destroy their victims' eyeballs), Bell's diagnostic party tricks (dipping his middle finger in a flask and tasting his index finger while students drank whatever was in it), how the Chantereau poisoning case connects to Robert Louis Stevenson and Dr. Jekyll and Mr. Hyde, why much of 19th century forensics was built on the brutalized bodies of women killed by their husbands, and the extraordinary case where Bell and Conan Doyle defended a man they personally believed was guilty because the body had been embalmed before autopsy and the physical evidence was compromised, which Lindsey correctly identifies as the "if the glove doesn't fit" moment of the 1890s. Takeaways: Joseph Bell worked as an actual consulting detective  Victorian forensics advanced largely on the bodies of women killed by their husbands Optography was a real and widely believed forensic theory  Bell and Conan Doyle once defended a man they believed was guilty The death of the physical exam has a 150-year precedent — Want more Dr. Lindsey Fitzharris? https://www.facebook.com/DrLindseyFitzharris/ IG: @drlindseyfitzharris X: @drlindseyfitz Bluesky: @drlindseyfitz To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠ Go to ⁠cozyearth.com⁠, and use code KnockKnock, for up to 20% off home and sleepwear. And when they ask where you heard about them at checkout, let them know you heard about them right here on Knock Knock, Hi! -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

The weight of the healthcare system has been sitting heavy. Our practice officially dropped UnitedHealthcare after they offered a 0.8% rate increase, and I’m feeling genuine empathy fatigue for the first time since I came back to clinic after my cardiac arrest. I talk about what that feeling actually is, how to spot it, and what finally helped me through it last time. Also, Dr. Oz is pushing to eliminate modifier 25, which would effectively end same-day procedures in private practice.Then some actual good news: the 2026 Nobel Prize in Physiology or Medicine went to Peter Hegemann, George Nagel, and Karl Deisseroth for optogenetics. I walk through the 2021 Nature Medicine case of a man with 40 years of retinitis pigmentosa who regained the ability to locate and touch objects after an AAV-delivered opsin was injected into his retinal ganglion cells. It’s mutation-agnostic, it’s low-resolution, and it’s one of the most exciting developments in vision science in a long time. Takeaways: After years of negotiation, Will’s practice has fully dropped UnitedHealthcare over a 0.8% rate increase offer against a 3% request. Empathy fatigue is real, often follows personal medical trauma, and requires time off, honest conversations, and self-awareness to work through. Dr. Oz and CMS are pushing to eliminate modifier 25, which would effectively end same-day E&M visits combined with procedures and devastate private practice. The 2026 Nobel Prize in Physiology or Medicine went to the discoverers and developers of optogenetics, which has already shown promise restoring partial vision in retinitis pigmentosa. Optogenetics is mutation-agnostic because it installs light sensitivity in surviving ganglion and bipolar cells rather than repairing dead photoreceptors. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠ -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

We did back-to-school night for our ninth grader and I came away wanting to re-enroll myself. The CS teacher (28 years in the classroom) convinced me that what computer programming really teaches is attention to detail, one misplaced space breaks the whole thing, and the Spanish teacher, who grew up under Franco with his left hand literally tied to his chair for writing right-handed, had a philosophy so good I almost asked if I could come on Monday. After the break, I get into the AI mathematics controversy. OpenAI announced their agents solved the Navier-Stokes equations using 10,000 agents over 88 hours on a problem humans have worked on for 60 years, but an NYU mathematician and an Anthropic researcher claim OpenAI trained on their ongoing unpublished work without attribution, which is a more acute version of the IP argument that's followed AI from the start, and it bugs me in a way I don't have a clean answer for. Takeaways: Computer programming teaches attention to detail above almost everything else  OpenAI's Navier-Stokes announcement is a sharper version of AI's ongoing IP problem The AI regulation debate keeps hitting the same wall Franco's Spain was still enforcing Catholic baptism within 72 hours of birth and banning left-handedness well into the 1970s High school is wasted on teenagers — We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠⁠http://aka.ms/knockknockhi ⁠⁠ -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

The Blue Cross Blue Shield Association put out a truly hilarious study complaining that AI tools drove nearly $1 billion in extra costs for their insurers over two years, blaming hospitals and doctors for using AI to code more accurately. This from the industry that pioneered using AI to deny claims. It's an arms race now, and the only people who actually lose are patients, premiums keep going up regardless of who wins. Then two big eyeball wins. The AMA House of Delegates finally reclassified myopia as a disease, which should push pediatric progression treatments like Stellest lenses, ortho-K, and atropine drops onto medical insurance instead of cash pay. And Dr. Morgan Micheletti's team sent 135 intraocular lenses to the International Space Station for six months to see if cataract surgery could survive deep space travel, most held up remarkably well. Takeaways: Blue Cross Blue Shield Association is complaining that AI tools have driven ~$1 billion in extra insurer costs, ignoring that insurance companies pioneered using AI to deny and downcode claims. The healthcare AI arms race is a battle for a fixed pot of money, and patients always end up paying via higher premiums. The AMA House of Delegates has adopted a resolution formally classifying myopia as a disease, opening the door for medical insurance coverage of progression treatments. Stellest lenses, orthokeratology, and atropine eye drops are the current options for slowing pediatric myopia progression, with Stellest showing about 70% reduction over two years. Dr. Morgan Micheletti's ISS study found that most acrylic intraocular lenses survived six months exposed to space, suggesting cataract surgery in space may eventually be feasible. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠⁠⁠http://aka.ms/knockknockhi ⁠⁠⁠ Cozy Earth almost never does 30% off, and they're doing it right now through the 11th. Go to ⁠cozyearth.com⁠, use code KnockKnock, and get 30% off home and sleepwear. Cozyearth.com, code KnockKnock -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

This week Kristin and I sat down with Dr. Sasha Hamdani, a board-certified psychiatrist, ADHD expert, and author of the new book Too Sensitive: Rejection, Resilience, and the Science of Feeling Deeply. Sasha breaks down the actual neuroscience behind why some of us feel emotions so intensely, and gave us some genuinely useful tools for dealing with it. We also got a proper medical explanation for hangxiety, which, as someone who has experienced it, I found extremely validating. Sasha also walked us through rejection sensitive dysphoria, its connection to ADHD, and her own long and slightly chaotic road to getting diagnosed at 40. And look, I'll admit that by the end of this conversation I may have lost an ongoing argument with Kristin about whether or not I have anxiety. Takeaways: Emotional sensitivity has a neurological basis involving a hyper-responsive amygdala and an under-responsive prefrontal cortex. Cyclic sighing, a specific breathing technique, can help calm the nervous system and re-engage logical thinking during moments of panic. Rejection sensitive dysphoria is closely linked to ADHD and can be one of the most limiting aspects of the condition for many people. "Hangxiety" occurs because alcohol interacts with GABA receptors similarly to anti-anxiety medications, leading to a rebound anxiety effect the next morning. Delaying your response to conflict or bad news allows alarm chemicals to subside, leading to a calmer, more rational reaction. — Want more Sasha Hamdani, MD? @thepsychdoctormd To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠⁠http://aka.ms/knockknockhi ⁠⁠ Cozy Earth almost never does 30% off, and they're doing it right now through the 11th. Go to cozyearth.com, use code KnockKnock, and get 30% off home and sleepwear. Cozyearth.com, code KnockKnock -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

I'm back in the corporate practice of medicine content cycle, this time on the Stop Corporate Takeovers of Physicians Act, a new federal bill modeled on Oregon's landmark CPOM law. It closes the MSO / PC ""friendly physician"" loophole that corporations like Apollo MD use to get around existing laws in 34 states, and it kills non-competes and non-disparagement clauses so hospital-employed doctors can finally speak out. It's not perfect, nonprofit hospitals are exempt, but I support it. My answer to declining reimbursement isn't to sell to private equity, it's to work together: merge practices, form IPAs, unionize where employed. Physicians are terrible at group projects, and it's costing us.After the break, an update on GLP-1s and NAION now that the lawsuits are hitting mainstream media. The correlation is real, the causation isn't proven, and the comorbidities overlap heavily. Don't stop your GLP-1 based on a news story, talk to your doctor about your specific risk factors. But if you have sudden painless vision loss on the medication, see an eye doctor immediately. Takeaways: The Stop Corporate Takeovers of Physicians Act closes the MSO / PC "friendly physician" loophole that corporations use to circumvent existing corporate practice of medicine laws in 34 states. The bill also eliminates non-competes and non-disparagement clauses, freeing hospital-employed physicians to speak out about harmful practices without fear of retribution. The critique that killing private equity gives nonprofit hospitals free rein misses the point,  hospitals and PE are aligned on profit motives, not competitors. Will's answer to declining reimbursement isn't selling to PE, it's merging practices, forming independent physician associations, and unionizing where employed. On GLP-1s and NAION, the current signal is correlation, not causation, don't stop the medication based on news coverage, but seek immediate care for sudden painless vision loss. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠⁠http://aka.ms/knockknockhi ⁠⁠ -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

This episode kicks off with a listener email from someone facing a conundrum: she finds out about getting tenure within a few weeks of turning 40, all while wondering if she should ditch academia and go to medical school instead. Kristin and I dig into what it would actually take to start med school at 40: the family logistics, the physical toll of taking overnight call as you get older, the financial reality of avoiding debt at that age, and whether it's even possible to "test drive" medicine before committing. From there, we get into an update on the health systems behaving badly that I've been calling out, including why I keep getting cease and desist letters from hospital systems but never from insurance companies, and what's really going on when hospitals fire independent doctors and replace them with more expensive locums. We wrap up with a couple extra questions: whether it's weird for a doctor to use their iPhone flashlight during an exam, and a genuinely tough one about whether you'd want to get tested for a fatal genetic disease like Huntington's if it ran in your family. Takeaways: A listener asked whether it's worth pursuing medical school at 40 instead of pursuing tenure, prompting a discussion of the financial, physical, and family challenges of a late-career switch to medicine. Independent medical practices are increasingly being pushed out by hospital systems in favor of contracts with private equity-backed groups, sometimes at a higher cost. Corporate Practice of Medicine (CPOM) laws, like Oregon's, are gaining momentum in more states as a way to limit corporate control over medical practices. Will has received cease and desist letters from hospital systems for his content but has never received one from a health insurance company. Will and Kristin discuss whether they'd want to get genetic testing for a fatal disease like Huntington's if it ran in their family. — We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠http://aka.ms/knockknockhi ⁠ -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Head to http://www.cozyearth.com and use my code KNOCKKNOCK for an exclusive 20% off. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Coming to you from a hotel patio in Lebanon, New Hampshire, this week I dig into the ACGME's newly released revisions to resident work-hour restrictions. We walk through what's actually being proposed: eliminating the mandatory 8-hour rest period between ordinary shifts, cutting required rest after a 24-hour call from 14 hours down to 12, and loosening call frequency from every third night to every second night. Despite some pushback that current restrictions have made residents "soft," I think these changes go too far and put both patients and physicians at risk. Then it's back to more familiar territory: eyeballs. After getting my own eyes irritated in the indoor hotel pool, I break down the actual science behind why your eyes turn red around chlorine. Spoiler: it's not (directly) pee, it's a gas called chloramine that forms when chlorine reacts with body oils, sweat, and other impurities, stripping the protective oil layer off your tear film.  Takeaways: The ACGME has proposed eliminating the 8-hour rest period between ordinary scheduled shifts for residents, with a public comment period open until October 22nd. The proposal would also reduce required rest after a 24-hour in-house call from 14 hours to 12, and change call frequency from every third night to every second night. I oppose the proposed changes, arguing that sleep-deprived residents make more medical errors and that the current 80-hour work restrictions strike a reasonable balance. Red, irritated eyes after swimming aren't caused by direct contact with urine, but by chloramine gas, formed when chlorine reacts with sweat, body oils, and other impurities in the water. Chloramine gas strips the protective oil layer off the eye's tear film, causing redness, burning, and dryness. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠http://aka.ms/knockknockhi ⁠ -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

This week Kristin and I are talking business; specifically, how doctors go from having a great idea to actually building a company around it. We're joined by Dr. David Lortscher, a board-certified dermatologist, co-founder of Curology, and author of Why Doctors Win: The Doctor's Guide to Creating or Joining a High-Impact Startup. David breaks down why so many of the most successful healthcare companies of the last few decades, including Intuitive Surgical, Gilead, Regeneron, UpToDate, were founded or co-founded by physicians. He makes the case for why more doctors, nurses, PAs, and other clinicians should be in the room when healthcare companies get built, instead of leaving it entirely to people with zero patient care experience. We get into the real differences between venture capital and private equity, what VCs actually look for before funding a startup, and the story behind how David built Curology, including the surprisingly counterintuitive pay structure that helped it scale to treating millions of patients. Kristin and I also talk about our own version of this, how she basically became CEO of Glaucomflecken so I could keep doing what I actually want to do, which is make dumb videos and still practice ophthalmology four days a week. Takeaways: Over half of the top 100 most successful healthcare startups founded in the last four decades had a physician founder or co-founder. Venture capital funds early-stage companies with high growth potential, while private equity typically buys existing businesses and tries to make them more efficient, often through cost-cutting. A successful startup needs both a transformational product and a clear path to winning the market, not just a clever idea. Physicians don't need to quit clinical practice to start a company if they have a good support system and trusted co-founders. The two things every successful startup needs are a truly transformational product and a clear path to winning over the market. — Want more Dr. David Lortscher? LinkedIn: https://linkedin.com/in/DavidLortscherMD X (Twitter): @DavidLortscher To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠http://aka.ms/knockknockhi ⁠ -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. To get your Henson Razor go to ⁠hensonshaving.com/knockknockhi⁠ and use code knockknockhi to receive 100 blades for free with the purchase of a razor. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

This week I'm tackling two things that have been on my mind. First, I saw a piece of content from another physician creator explaining why they left private practice, and the framing bothered me: the idea that private practice is inherently about squeezing as much money out of patients as possible. I get where that creator is coming from, but I think that's simply a culture problem at that practice, and I don't want med students or residents seeing that content and writing off private practice entirely. I talk through why financial pressure and reimbursement cuts are real, how to spot when a doctor is actually upselling you, and what to look for in a practice that shares income and actually operates like a partnership. Then I get into something a little heavier: an angry, anonymous email I got accusing me of tanking a hospital's reputation and making it harder for them to recruit, just for reporting on the neonatologists who were fired there. I break down why I make these videos, how seriously I take sharing information on my platform, and why I think doctors get blamed for administrators' decisions. Takeaways: Financial pressure in private practice can be real, largely driven by declining reimbursement, but it doesn't have to dictate individual clinical decisions. A key sign of a healthy private practice is one that shares a significant percentage of income among partners rather than paying doctors only for what they individually bring in. Patients who feel like they're being upsold on elective procedures should trust that instinct and seek a second opinion. I stand by my hospital accountability videos, arguing that I'm amplifying stories from healthcare workers who can't speak publicly themselves due to non-disparagement agreements. I explicitly condemn any threats or violence directed at hospital administrators or CEOs. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: ⁠http://aka.ms/knockknockhi ⁠ -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

This week I'm sitting down with Dr. Fran Heydanek, OBGYN, mom, and one of the biggest medical content creators out there fighting misinformation. We start with the wildly common experience of getting scammed by fake podcast invites (yes, it's happened to both of us), then get into her actual path to medicine: integrated arts classes, a rejected dentistry detour, a brief love affair with pathology, and a med school that apparently banned water in the lecture halls. From there we go deep on the business of being a doctor who also makes social media content: how she films, edits, and posts everything herself, how she decides which brand deals are worth it (spoiler: no liver detoxes), how she balances a full clinical schedule with content creation, and more. Takeaways: Podcast scam emails targeting content creators are common; both Will and Dr. Fran have nearly fallen for fake booking requests. While Dr. Fran shoots, edits, and posts nearly all of her own content herself, it can be challenging to balance with a full clinical schedule. She still works as a full-time OBGYN and has no plans to leave clinical practice, even as her content career has grown, not only because she loves her job but also because it is important for credibility. Not all brand deals should be accepted. Dr. Fran turns down brand deals for products she wouldn't personally use, and I agree that most offers aren't worth the credibility hit.  Dr. Fran's early career included a fashion blog that helped fund her wedding and car payments before medical school and before she started posting medical content. — Want more Dr. Fran Heydanek? @pagingdrfran - Instagram, TikTok, Facebook, YouTube To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs To learn more about Microsoft Dragon Copilot, visit: http://aka.ms/knockknockhi -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome back to Knock Knock Eye, my one-stop shop for all things eyeball related. This week I'm taking a quick break from corporate practice of medicine talk (just this once, I promise) to dig into a mailbag question from a listener named Gina, who fainted during a routine gonioscopy exam. We get into what a vasovagal reaction is, why the eye seems to be such a common trigger for fainting, and what you can actually do in the moment to keep your blood pressure from tanking. From there I go into the oculocardiac reflex, which is a genuinely wild phenomenon where manipulating the muscles around your eye can drop your heart rate enough to cause cardiac arrest, plus how it shows up clinically when someone has a trapped eye muscle from an orbital fracture.  As always, send me your hospital horror stories, and also your hospital success stories, at [email protected]. Takeaways: Passing out during an eye exam is usually a vasovagal reaction, not a sign anything went wrong. Clenching your muscles while breathing slowly and calmly can help prevent a fainting spell if you know you're prone to one. The oculocardiac reflex is a real drop in heart rate triggered by pulling on the eye muscles, and in rare cases it can lead to cardiac arrest. A sudden heart rate drop when a patient looks up can signal a trapped eye muscle from an orbital fracture. Persistent dry, itchy eyes could actually be Demodex blepharitis rather than simple dryness. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! [email protected] Can’t get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 As a proud FIGS Ambassador, visit https://WearFIGS.com and use code DrGFIRSTFIGS to shop, stay updated on new launches, and learn more about FIGS advocacy projects. Check out FIGS on social platforms: @wearfigs -- A friendly reminder from the G’s and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices